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Three virtual roundtable convenings of national arts and public health leaders, including practitioners, researchers, agency leads, and policymakers from the arts and public health sectors, were held to identify priority research questions and outcomes for the project analyses. Attendees were asked to identify and prioritize socio-demographics that should be considered as variables, as well as arts activities and health outcomes that should be studied in relation to key public health issues. The final report outlines the findings of a thematic analysis of the roundtable transcripts, a pre-survey, and notes from small groups discussions within the roundtable.

View the report here. 

There is a social gradient in attending arts events such as music, theater, or dance performances and art exhibits, which is not as pronounced in participatory arts activities, creative groups, or interest in arts events in the US. 

Key Design Elements:

• The study used repeated cross-sectional data from the General Social Survey (GSS) to examine which demographic, socioeconomic, residential, and health-related factors were associated with attendance at arts events, participation in arts activities, membership of creative groups, and being interested in (but not attending) arts events in a nationally representative sample of adults in the US.
• Data was analyzed using logistic regression.

Key Findings:

• Socioeconomic factors such as higher income, higher social class, better general health, and living in urban areas were associated with higher odds of attending an arts event, but not participating in arts activities or creative groups.
• In comparison to White participants, Black participants had 34% lower odds (95% CI = 0.55–0.78) of attendance at arts events such as music, theatre, or dance performances as well as art exhibits.
• This  racial disparity in art event attendance, with an over-representation of White individuals compared to those of racial/ethnic minorities, increased from 1993 to 2016.
• Several factors, namely higher education, higher parental education, and being female, were associated with increased levels of all types of arts engagement.
  • Females were between 1.24 and 1.71 times more likely to report each type of arts engagement than males. 
  • The odds of creative group membership — such as hobby or garden clubs and literary, art, discussion, or study groups — were 1.15 times higher with each additional year of more education (OR = 1.15, 95% CI = 1.10–1.20) and 1.04 times higher with each additional year of parental education (OR = 1.04, 95% CI = 1.01–1.08).
• For each additional year of education, adults in the US were 1.19 times more likely to attend arts events, 1.15 times more likely to be a member of a creative group, 1.08 times more likely to participate in arts activities, and 1.11 times more likely to be interested in (but not attend) arts events.
• For adults in the US, each additional year of education obtained by their parents was associated with 1.05 times higher odds of both attending arts events and participating in arts activities, and 1.04 times higher odds of being a member of a creative group.

Citation: Bone, J. K., Bu, F., Fluharty, M. E., Paul, E., Sonke, J. K., & Fancourt, D. (2021). Who engages in the arts in the United States? A comparison of several types of engagement using data from The General Social Survey. BMC Public Health, 21(1), 1-13. https://doi.org/10.1186/s12889-021-11263-0 

There are socioeconomic inequalities in arts and cultural engagement that may increase with age in older adults in the US, although participatory arts activities are generally more accessible than cultural events. 

In adults aged 50 and above in the US, those who are older, female, wealthier, more satisfied with how they are aging, more interested in the arts, and have higher educational attainment and fewer difficulties with instrumental activities of daily living are more likely to participate in arts activities.

In contrast to the accessibility of arts activities, there appears to be socioeconomic inequalities in cultural engagement that may increase in older age due to additional financial barriers and transportation barriers

Key Design Elements:

• Data from the Health and Retirement Study (2014) were used to identify sociodemographic, life satisfaction, social, and arts appreciation predictors of (1) frequency of participatory arts engagement, (2) cultural event attendance, (3) difficulty participating in the arts, and (4) being interested in but not attending cultural events. 
• Logistic regression models were stratified by age groups [50–59, 60–69, ≥70] for the frequency of arts participation outcome and [50–69 vs ≥70] all other outcomes.

Key Findings:

• Older adults of all ages who reported less appreciation for the arts were less likely to participate in the arts.
• Educational attainment became a stronger predictor of arts engagement with age, as it was only associated with engagement in the oldest age groups. For adults aged 70 and above, those with at least a college education had 6.04 times higher odds of participating in the arts, 5.35 times higher odds of attending cultural events, and 3.40 times higher odds of being interested in (but not attending) cultural events compared to those who did not complete high school.
• Across all age groups, older adults who were of Black/African American race/ethnicity and those with poorer neighborhood safety were less likely to report difficulties participating in the arts.

Citation:  Fluharty, M., Paul, E., Bone, J., Bu, F., Sonke, J., & Fancourt, D. (2021). Difference in predictors and barriers to arts and cultural engagement with age in the United States: A cross-sectional analysis using the Health and Retirement Study. PLoS ONE, 16(12), e0261532. https://doi.org/10.1371/journal.pone.0261532

For older adults in the US, engaging in creative leisure activities such as hobbies and projects, clubs, and baking or cooking every week is associated with reduced odds of depression concurrently and two years later.

Key Design Elements:

• This study used longitudinal data from 19,134 participants aged over 50 in the Health and Retirement Study, with engagement in leisure activities was measured every four years and depression every two years, between 2008 and 2016.
• The study fitted population-averaged panel data models using generalized estimating equations with a logit link.

Key Findings:

• Compared to older adults who did not spend time on a hobby or project, those doing hobbies or projects monthly or weekly had 19% to 20% lower odds of depression concurrently. Those who did hobbies or projects weekly also 19% lower odds of depression two years later. 
• Attending sport, social, or other clubs monthly or weekly, which are likely to include creative or artistic groups, was associated with 15% to 22% lower odds of depression concurrently and 18% lower odds of depression two years later compared to people who were not part of these groups.
• Longitudinally, the odds of depression two years later were reduced amongst people engaging in weekly baking or cooking, hobbies or projects, and clubs.
• Baking or cooking something special weekly, compared to never, was associated with 30% lower odds of depression two years later in adults aged 50-59, but there was no evidence for a benefit of baking or cooking in older age groups. It is possible that adults aged 50–59 were more likely to bake or cook for friends or family, and thus more frequent engagement in this activity was an indicator of increased social interactions in this age group, which were then associated with reduced odds of subsequent depression. 

Citation: Bone, J. K., Bu, F., Fluharty, M. E., Paul, E., Sonke, J. K., & Fancourt, D. (2022). Engagement in leisure activities and depression in older adults in the United States: Longitudinal evidence from the Health and Retirement Study. Social Science & Medicine, 294, 114703.  https://doi.org/10.1016/j.socscimed.2022.114703

Arts and cultural engagement may provide opportunities for adolescents in the US to realize positive developmental outcomes, reducing their risk of reportedly antisocial or criminalized behaviors, improving attitudes towards these behaviors, and enhancing self-control.

In the future, researchers must a) recognize the need for changes in terminology around “delinquency”; b) acknowledge the fact that behaviors are often labeled and interpreted by others; and c) undertake more research into the effects of social and structural determinants of health on adolescent behaviors and health outcomes.

Key Design Elements:

• Data was drawn from the National Longitudinal Study of Adolescent to Adult Health (n=10,610) and the National Education Longitudinal Study of 1988 (n=15,214).
• For the analysis the study utilized structural equation modelling (SEM) across three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and the National Education Longitudinal Study of 1988 (NELS:88).

Key Findings:

• In two large longitudinal studies of adolescents in the US, engaging in a wider range of arts and cultural activities in mid-adolescence was associated with fewer reportedly antisocial or criminalized behaviors up to seven years later.
• More arts and cultural engagement was associated with better self-control scores one to two years later, and there was some evidence that this then led to fewer subsequent reportedly antisocial or criminalized behaviors. Self-control is the ability to regulate one’s emotions, thoughts, and behaviors and enhancing it has previously been associated with improved social functioning, emotion regulation, wellbeing, and other health behaviors.
• More arts and cultural engagement altered adolescents’ attitudes towards reportedly antisocial or criminalized behaviors one year later, leading to fewer positive perceptions of these behaviors. These attitudes are an important intermediate outcome in and of themselves and have previously been associated with the amount of time spent with peers with similar attitudes, wellbeing, and academic achievement.
• The benefits of arts and cultural engagement on reportedly antisocial or criminalized behaviors were similar across males and females and were also replicated when including only violent behaviors, such as using a weapon, fighting, and seriously injuring someone, demonstrating the critical policy relevance of promoting arts and cultural engagement in adolescence.

Citation: Bone, J. K., Bu, F., Fluharty, M. E., Paul, E., Sonke, J. K., & Fancourt, D. (2022). Arts and Cultural Engagement, Reportedly Antisocial or Criminalized Behaviors, and Potential Mediators in Two Longitudinal Cohorts of Adolescents. Journal of Youth and Adolescence, 51, 1463–1482. https://doi.org/10.1007/s10964-022-01591-8

After matching older adults in the US who did and did not participate in community arts groups on a range of demographic, socioeconomic, and health-related factors, these arts groups enhanced the positive aspects of wellbeing such as positive affect, life satisfaction, purpose in life, and perceived control over life.

Key Design Elements:

• The study utilized data from 12,111 older adults in the Health and Retirement Study (2014-2016) to test whether participation in community arts groups was associated with concurrent and subsequent wellbeing.
• For the analysis, the study used propensity score matching to remove confounding by a range of demographic, socioeconomic, and health-related factors.

Key Findings:

• Participating in arts groups was associated with higher positive affect (average treatment effect on the treated (ATT)=0.19, 95% CI=0.13-0.24), life satisfaction (ATT=0.10, 95% CI=0.05-0.16), purpose in life (ATT=0.08, 95% CI=0.02-0.14), and mastery (ATT=0.08, 95% CI=0.02-0.13) than not participating. 
• For older adults who participated in community arts groups, this participation was associated with a positive affect score that was 0.19 standard deviations higher, a 0.10 standard deviation higher life satisfaction score, and purpose in life and perceived mastery scores that were 0.08 standard deviations higher than if they had not participated in community arts groups. These are all small but significant causal estimates.
• All of these associations were maintained longitudinally, meaning participating in community arts groups was associated with enhanced positive affect, life satisfaction, purpose in life, and perceived mastery

Citation: Bone, J. K., Fancourt, D., Fluharty, M. E., Paul, E., Sonke, J. K., & Bu, F. (2022). Associations between participation in community arts groups and aspects of wellbeing in older adults in the United States: A propensity score matching analysis. Aging & Mental Health. https://doi.org/10.1080/13607863.2022.2068129

Arts engagement may enhance the three domains of flourishing (emotional, psychological, and social wellbeing) in young adults. Emerging adults undergo a different “social ecology” of psychological experience than adults. Thus, separate longitudinal evidence is necessary.   

Key Design Elements:  

• This study used data from 3,333 young adults aged 18 to 28 years from the Transition into Adulthood Supplement (TAS) of the Panel Study of Income Dynamics (PSID) to test whether arts engagement was associated with concurrent and subsequent flourishing across a range of demographic, socioeconomic, and health-related factors.  
• For the analysis, fixed effects regression and Arellano-Bond models were utilized to account for within-individual variation and directionality in flourishing.  
• Given the sensitivity of Arellano-Bond models to specification decisions, this study tested whether results from the Arellano-Bond models were robust to two alternate model specifications. Namely, the difference GMM estimator was used instead of the system GMM estimator, and all specifications of the original Arellano-Bond model were retained while the number of included lags used for the outcome, exposure, and time-varying confounder instruments was limited to two per participant. 

Key Findings:

• Increasing time spent doing organized activities related to art, music, or the theater was associated with enhanced flourishing
• This was a dose-response relationship, as engaging in the arts daily was associated with larger increases in flourishing than engaging weekly, which was associated with larger increases than engaging monthly
• The association was driven primarily by increases in social wellbeing (feeling like an integral part of a positive community), accompanied by smaller increases in psychological wellbeing (feelings of autonomy, mastery, and personal growth)
• Looking at the direction of these relationships, increases in arts engagement predicted subsequent increases in flourishing, and this was also driven by increases in social wellbeing.

Citation: Bone, J. K., Bu, F., Sonke, J. K., & Fancourt, D. (2023). Longitudinal associations between arts engagement and flourishing in young adults: A fixed effects analysis of the Panel Study of Income Dynamics. Affective Science, 4, 131–142. https://doi.org/10.1007/s42761-022-00133-6

The COVID-19 pandemic established newfound barriers or opportunities to engage in the arts depending on varying indicators including the most strongly associated factors of social support, social network size, age, race/ethnicity, keyworker status, and experiencing physical or psychological abuse during the pandemic. However, some of these predictors of engagement remained consistent with findings before the pandemic and may need to be evaluated for long-term changes post-pandemic. The diverse consumers of the arts brought forth by the pandemic offer new insights into the intersection of art engagement and population health 

Key Design Elements:  

• The study used a heterogenous sample of 4,731 participants from the United Kingdom COVID-19 Social Study run by University College London, where engagement in arts was measured with questions asked between April 6 and July 23, 2020. 
• Logistic regression was used to analyze associations between predictors of engagement to the type of arts activity. 

Key Findings 

• We explored the factors associated with home-based arts engagement, specifically reading for pleasure, arts or crafts activities, and digital arts activities, in 4,731 adults who participated in the United States COVID-19 Social Study between April and July 2020
• The factors most strongly associated with increased odds of arts engagement were higher social support, more social network size, older age, non-White race/ethnicity, not being a keyworker, and having experienced physical or psychological abuse during the pandemic
• In contrast to findings from before the pandemic, most socioeconomic and health-related factors were not associated with arts engagement, including household income and mental and physical health problems
• Overall, our findings indicate that the social gradient in arts engagement was reduced in the first 4 months of the COVID-19 pandemic in the United States
• Given the health benefits of arts engagement, the potential diversification of arts audiences during the pandemic is promising for both population-level health and wellbeing and the future of the arts and cultural sector

Citation: Bone, J. K., Mak, H. W., Sonke, J. K., Fluharty, M. E., Lee, J. B., Kolenic, A. J., Radunovich, H., Cohen, R., & Fancourt, D. (2022). Who engaged in home-based arts activities during the COVID-19 pandemic? A cross-sectional analysis of data from 4,731 adults in the United States. Health Promotion Practice. https://doi.org/10.1177/15248399221119806 

For adolescents in the US, participating in extracurricular arts activities is associated with increased odds of reporting good social support, independent of participation in other extracurricular activities and previous levels of social support. This may be because arts activities they provide opportunities for social engagement, developing friendships, and building a sense of community.

Key Design Elements:

• The study included a nationally representative sample of 11,780 adolescents aged 11-21 years from the National Longitudinal Study of Adolescent to Adult Health.
• Logistic regression was used to test whether school-based extracurricular arts engagement was associated with loneliness and social support, measured concurrently and one year later.

Key Findings:

• Doing one or more school-based arts activities (e.g. band, book club, chorus/choir, cheerleading/dance, drama club, newspaper, orchestra) was associated with 28% higher odds of reporting high social support one year later (adjusted OR [AOR]=1.28, 95% CI=1.03-1.59), compared to not engaging. This association was independent of a range of demographic, socioeconomic, and health-related factors and previous social support.
• Doing arts activities was associated with 59% higher odds of high social support concurrently (odds ratio [OR]=1.59, 95% CI=1.32-1.91), although this cross-sectional association was attenuated after adjusting for demographic, socioeconomic, and health-related factors (AOR=1.16, 95% CI=0.95-1.42).
• Doing non-arts extracurricular activities (compared to not) was associated with 24% lower odds of concurrent loneliness (AOR=0.76, 95% CI=0.66-0.88) and 39% higher odds of high social support concurrently (AOR=1.39, 95% CI=1.14-1.71). Longitudinally, doing non-arts extracurricular activities was associated with 14% lower odds of subsequent loneliness (AOR=0.86, 95% CI=0.74-0.99) and 27% higher odds of high social support (AOR=1.27, 95% CI=1.06-1.53) one year later. These associations were all independent of a range of demographic, socioeconomic, and health-related factors and engagement in arts activities.

Citation: Bone, J. K., Fancourt, D., Fluharty, M. E., Paul, E., Sonke, J. K., & Bu, F. (2022) Cross-sectional and longitudinal associations between arts engagement, loneliness, and social support in adolescence. Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-022-02379-8 

For Americans living through the COVID-19 pandemic, time spent gardening was associated with reductions in depressive and anxiety symptoms and enhanced life satisfaction. Spending more time doing woodwork/DIY and arts/crafts were also associated with enhanced life satisfaction. However, more time watching TV, films, or other similar media (not for information on COVID-19) was associated with increased depressive symptoms. Other creative activities were not associated with mental health or wellbeing.

Key Design Elements:

• A heterogeneous sample was recruited using a snowballing approach with a focus on reaching diverse populations. 3,725 adults were included from the COVID-19 Social Study in the United States, a panel study collecting data weekly during the COVID-19 pandemic. We measured engagement in eight types of creative leisure activities on the previous weekday between April and September 2020. 
• Fixed effects models tested the longitudinal associations of engagement in creative leisure activities with mental health and wellbeing.

Key Findings:

• The largest reduction in depressive symptoms was for participants who increased their time spent gardening from none to less than 30 mins per day. In contrast, increasing time spent watching TV from none to more than 30 mins per day was associated with increases in depressive symptoms. Increasing time spent gardening to less than 30 mins per day was associated with lower anxiety symptoms.
• Increases in time spent doing arts/crafts, gardening, and doing woodwork/DIY were associated with higher life satisfaction.
• Total time spent on creative hobbies was not associated with depressive or anxiety symptoms or life satisfaction.

Citation: Bone, J. K., Fancourt, D., Sonke, J. K., Fluharty, M. E., Cohen, R., Lee, J. B., Kolenic, A. J., Radunovich, H., & Bu, F. (2023) Creative leisure activities, mental health, and wellbeing during five months of the COVID-19 pandemic: A fixed effects analysis of data from 3,725 US adults. Journal of Epidemiology & Community Health. http://doi.org/10.1136/jech-2022-219653

Higher levels of social, cultural, and community engagement (SCCE) in older adults was associated with more dental and outpatient care utilization and reduced inpatient and community health care utilization. SCCE may have a protective role in shaping beneficial early and preventive health care–seeking behavior, facilitating health care decentralization and alleviating financial burden by optimizing health care utilization.

Key Design Elements:  

• This population-based cohort study used data from 2008-2016 rounds of the Health and Retirement study (HRS), which used a sample that was nationally representative of citizens aged 50 and older in the US population. Eligibility was granted to participants who claimed involvement in SCCE and healthcare utilization. 
• Participants’ mean levels of social engagement were calculated using the values recorded by a Social Engagement Scale. This scale was comprised of 4 subscales that each related to aspects of community engagement: community activities, cognitive activities, home-based creative activities, and physical activities. Changes in these averages were observed and measured over waves of time throughout the study.  

Key Findings 

• More frequent SCCE was associated with lower inpatient and community health care utilization but more interaction with outpatient and dental care in 2 years of follow-up
• Longitudinally, compared with consistent engagement, individuals with decreased SCCE were more likely to use inpatient care but had fewer outpatient and dental care visits at 6 years of follow-up.

Citation: Gao, Q., Bone, J. K., Bu, F., Paul, E., Sonke, J. K., & Fancourt, D., (2023) Social and cultural engagement and health care utilization in the Health and Retirement Survey. JAMA Network Open. http://doi.org/10.1001/jamanetworkopen.2023.6636

Engaging in a greater number of extracurricular arts activities (such as dance lessons, music lessons, art classes or lessons, organized performing art programs) in early adolescence is associated with fewer externalizing behaviors (such as conduct problems, hyperactivity, and inattention) in mid-adolescence.

Key Design Elements:

• A nationally representative sample of 8,586 adolescents from the Early Childhood Longitudinal Study was included, with the study baseline taken at 5th grade (age 10-11 years) and outcomes measured at 8th grade (13-14 years).
• Ordinary least squares regression was used to examine the individual-level associations between extracurricular and school-based arts engagement (number of arts classes and adequacy of arts facilities) and subsequent externalizing behaviors. 
• Poisson regression was used to examine the associations between school-level arts classes and facilities and the subsequent rates of externalizing behaviors reported at the school-level (such as class cutting, vandalism, and bullying). 

Key Findings:

• At the individual level, each additional extracurricular arts activity engaged in (from dance lessons, music lessons, art classes or lessons, and organized performing art programs) at age 10-11 was associated with a 0.22 point reduction in the externalizing behaviors score three years later (which measured levels of conduct problems, hyperactivity, and inattention). This association was independent of a range of demographic and socioeconomic factors.
• Individual levels of engagement in extracurricular arts activities were more important for subsequent externalizing behaviors than the number of arts classes or the adequacy of arts facilities available in each adolescent’s school. This may suggest that it is the level of engagement a child has with the arts (i.e., actively creating or skill development) that may be driving the associations with externalizing behaviors (as opposed to exposure to the arts).
• Before accounting for sociodemographic factors (such as school type, percentage of students from ethnic minority groups, overcrowding, and location), each additional arts class offered to 5th graders was associated with 0.51 fewer externalizing behaviors in the school at 8th grade. However, this association was no longer present after accounting for these sociodemographic factors, which likely influenced both the number of arts classes on offer and the rates of externalizing behaviors. 

Citation:Fluharty ME, Bone JK, Bu F, Sonke JK, Fancourt D, Paul E. Associations between extracurricular arts activities, school-based arts engagement, and subsequent externalising behaviours in the Early Childhood Longitudinal Study. Scientific Reports. 2023 Aug 24;13(1):13840. https://doi.org/10.1038/s41598-023-39925-6

For older adults, engaging in participatory or receptive arts for up to one hour per week (but not more frequently) was associated with better subsequent executive function/language. Similarly, engaging in receptive arts activities for up to three hours per week (but not more frequently) was associated with better subsequent episodic/working memory. These effects were of similar sizes to doing vigorous physical activity for up to one hour per week.

Key Design Elements:

• For older adults, doing 1-3 hours of arts activities per week helps to prevent cognitive decline, with similar benefits to exercising for 1 hour per week. 
• Participants were drawn from the Wisconsin Longitudinal Study (WLS), which has followed a random sample of one third of the students graduating from Wisconsin high schools in 1957. The sample was limited to respondents were eligible for cognition measures in 2004 (considered baseline for this study) and 2011 (considered follow-up for this study) with no missing data on arts engagement, covariates, and each cognition measure at baseline and follow-up. This resulted in a final analytical sample of 3,245 participants for memory and 2,926 for executive function/language. Participants were aged 63 to 67 years at baseline and 70 to 74 at follow-up.
• To address the issue that there are a range of structural determinants of arts engagement, we used inverse probability of treatment weighting (IPTW). This approach, also referred to as propensity score weighting, creates a pseudo-population in which the treatment (arts engagement) no longer depends on the covariates, and the outcome (cognition) is conditionally independent of the treatment. Confounding by all observed covariates is thus removed. In this way, IPTW simulates a trial with the measured covariates randomized between groups.

Key Findings:

• For older adults in the Wisconsin Longitudinal Study (WLS), receptive arts engagement (eg. lecture, concert, play, museum, or movies) was associated with better memory. However, there was no evidence that engagement in participatory arts engagement (eg. painting, drawing, playing a musical instrument, arts, crafts, or hobbies) was associated with subsequent memory. 
• There was some evidence that low levels of engagement in both participatory and receptive arts was associated with subsequent executive function/language.

Citation: Bone, J.K., Fancourt, D., Sonke, J. K., & Bu, F. (2023) Participatory and Receptive Arts Engagement in Older Adults: Associations with Cognition Over a Seven-Year Period. Creativity Research Journal. https://doi.org/10.1080/10400419.2023.2247241

The lack of consistent associations between receptive and participatory arts engagement and healthy aging was unexpected given previous evidence for links between arts engagement and each of the four domains of healthy aging. Our findings highlight key methodological issues that should be explored in further research with larger nationally representative samples, longer follow-ups, and more detailed measures of arts engagement.

Key Design Elements:  

• A nationally representative sample from the 2014 Arts and Culture Supplement of Health and Retirement Study (HRS) was included. From the study 1269 adults over the age of 50 who were alive during 2016-2018 and had complete and consistent data on arts engagement were included as participants. Participants from the HRS were originally interviewed in 1992 and were followed-up every two years.  
• The study defined health aging as a binary outcome (yes or no), where they used a multidimensional definition of healthy aging. During each wave of the study, participants must have passed four criteria within physical, mental, and biological characteristics to be defined as healthy.  
• Demographic and socioeconomic covariates were included as the baseline of the samples.  

Key Findings:  

• Before adjusting for confounders, doing receptive arts once a month or more was associated with 80% higher odds of healthy aging four years later compared to never engaging. However, after adjusting for demographic and socioeconomic factors, there was no longer evidence for this association.
• In sensitivity analyses, there was some evidence that receptive engagement was associated specifically with higher odds of good physical functioning four years later.
• There was no consistent evidence for an association between participatory arts engagement and healthy aging.

Citation: Rena, M., Fancourt, D., Bu, F., Paul, E., Sonke, J.K., & Bone, J.K (2023) Receptive and participatory arts engagement and subsequent healthy aging: Evidence from the Health and Retirement Study. Social Science and Medicine, 334, 116198. https://doi.org/10.1016/j.socscimed.2023.116198

Having a hobby is linked to fewer depressive symptoms and higher levels of happiness, self-reported health and life satisfaction among people aged 65 and over, and this holds true across 16 countries on three continents, according to a new study led by UCL researchers.

Key design elements

• We included a total of 93,263 older adults across 16 countries, including the US
• We used similar measures of hobby engagement and mental wellbeing (depressive symptoms, self-reported health, happiness, life satisfaction) across countries
• Fixed effects models investigated whether changes in hobby engagement were associated with changes in the 4 different domains of wellbeing
• Meta-analyses pooled results and explored differences across countries

Key findings

• Rates of hobby engagement varied substantially across countries, from 51% of Spanish respondents to 96% of Danish respondents
• Independent of confounders, having a hobby was associated with fewer depressive symptoms, and higher levels of self-reported health, happiness and life satisfaction
• Effect sizes were relatively small but consistent across countries
• The strength of these associations, and rates of hobby engagement, were correlated with country characteristics such as life expectancy and national happiness levels but, overall, these country-level factors did not contribute much to the findings

Citation: Mak, H.W., Noguchi, T., Bone, J.K. et al (2023) Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries. Nature Medicine. https://doi.org/10.1038/s41591-023-02506-1

Our findings provide empirical support for potential benefits of leisure engagement on positive self-perceptions of aging, regardless of the type of activities. As the overall association appears to be stronger between leisure engagement and subsequent self-perceptions of aging, interventions designed to increase leisure engagement may be effective for improving older adults' health.

Key Design Elements:  

• The study included a total of 32,703 observations collected over three waves between 2008/2010 and 2016/2018 of 17,753 adults aged 50 and above living in the United States from the Health and Retirement Study.  
• The data was analyzed using the structural equation modeling (SEM) approach with latent variables being perceptions of aging and leisure engagement modeled by confirmatory factor analysis (CFA). A controlled test of the lagged and concurrent effects of leisure engagement on self-perceptions of aging to identify potential reciprocal correlations. 

Key Findings 

• We included 17,753 adults aged 50 or above living in the United States, who participated in the Health and Retirement Study over three waves between 2008 and 2018.
• We used structural equation modelling to explore the direction of the associations between leisure engagement (community, cognitive, creative, and physical activities) and older adults' self-perceptions of aging (their attitudes towards and satisfaction with aging).
• We found consistent evidence that more leisure engagement predicted better subsequent self-perceptions of aging.
• There was weaker evidence for a reciprocal relationship, specifically in the domains of creative and physical activities, whereby levels of engagement in these two activity types were also predicted by older adults’ self-perceptions of aging.
• Our findings provide empirical support for potential benefits of leisure engagement on positive self-perceptions of aging, regardless of whether leisure engagement consists of community, cognitive, creative, or physical activities

Citation: Bu, F., Mak, H.W., Bone, J.K., Gao, Q., Sonke, J.K., Fancourt, D. (2023) Leisure engagement and self-perceptions of aging: Longitudinal analysis of concurrent and lagged relationships. Journal of Gerontology: Psychological Sciences, gbad182. https://doi.org/10.1093/geronb/gbad182

Physical and creative activities may influence important aging metrics, reducing age-related decline and keeping older adults functionally independent for longer, potentially limiting increasing healthcare costs.

Key Findings 

• We included 8,893 older adults (mean age=63.18) from the Health and Retirement Study, a nationally representative study of individuals over the age of 50 in the US
• We used an outcome-wide approach with 23 outcomes across seven domains (daily functioning, physical fitness, long-term physical health problems, heart health, weight, sleep, subjective perceptions of health) measured concurrently and eight years later. This outcome-wide approach has been recommended over traditional studies of single exposure-outcome relationships as it allows us to compare effects, has broader implications for policy, and is less subject to bias.
• Comparing four domains of leisure engagement (physical, creative, cognitive, and community activities), physical activity was most consistently associated with experiences of aging. It was related to more positive experiences in all domains concurrently and all but heart health eight years later. 
•  Creative engagement was positively related to experiences of aging in most domains concurrently, and daily functioning, physical fitness, sleep, and subjective perceptions of health longitudinally.
• Associations were independent of other domains of leisure engagement, demographic and socioeconomic factors, and previous experiences of aging
• Cognitive and community engagement were less consistently related to aging experiences.

Citation: Bone, J.K., Bu, F., Sonke, J. K., & Fancourt, D. (2024). Leisure engagement in older age is related to objective and subjective experiences of aging. Nature Communications, 14, 1499. https://doi.org/10.1038/s41467-024-45877-w

Key Findings:

• This mapping review identified, described, and synthesized the broad array of social prescribing outcomes, and maps the outcomes that have been most commonly studied in 13 countries cited in the World Health Organization’s Social Prescribing Toolkit
• Critical to precision and quality in social prescribing research, this work lays a foundation for the development of key common outcomes and a Core Outcomes Set.
• Social prescribing has relevance to over 300 health and health system outcomes.
• 347 unique outcomes were identified, including 278 unique patient outcomes and 69 unique system outcomes.
• The mental health category encompasses 61 unique outcomes and was the largest category of outcomes.
• Categories of unique patient-level outcomes included Mental health, Lifestyle and behavior, Patient/user experience, Relationships and social connection, Physical health, Community engagement and belonging, Wellbeing, and Social determinants of health.
• System-level outcome categories included Healthcare and service utilization, Financial/ economic, Workforce, Medication use/ prescribing, and General system outcomes.
• Contributes to the advancement of evidence synthesis for social prescribing globally by quantifying and offering insight into the outcomes that have been studied to date.
• Compared to parallel work, this review identified a wider range of outcomes that represent a wider geographic area of programming as well as a more recent period of time in which more programming has been implemented and more research and evaluation undertaken.
• Emerging research priorities include loneliness and social isolation, non-communicable diseases and health equity.

Citation: Sonke, J., Manhas, N., Belden, C., Morgan-Daniel, J., Akram, S., Marjani, S., Oduntan, O., Hammond, G. P., Martinez, G., Carroll, G., Rodriguez, A., Burch, S., Colverson, A., Pesata, V., & Fancourt, D. (2023). Social prescribing outcomes: a mapping review of the evidence from 13 countries to identify key common outcomes. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1266429

Key Findings:

• We included 15,066 older adults from the US and 10,290 older adults from England
• We measured their levels of C-reactive protein (CRP), a biomarker of inflammation that has been linked to increased risks of heart disease, depression, disability, and even increased mortality
• We tested whether social engagement (a combined index of hobbies/community activities/social or sports activities/educational or training courses/charity work/volunteering) was associated with lower subsequent inflammation, and whether loneliness and social isolation were associated with higher subsequent inflammation
• We also tested the reverse relationships - whether inflammation influenced subsequent social factors
• In both countries, there was a negative feedback loop between loneliness and inflammation, with higher loneliness predicting higher subsequent inflammation, and higher inflammation predicting higher subsequent loneliness
• In England, there was also a positive feedback loop, whereby higher social engagement was associated with lower subsequent inflammation, and lower inflammation was associated with higher subsequent social engagement. There was no evidence for this in the US.
• This loop was stronger in those with depression or at high genetic risk for major depressive disorder.
• Overall, findings indicate that loneliness may increase chronic inflammation, whereas social engagement may reduce inflammation

Citation: Gao, Q., Bone, J. K., Finn, S., & Fancourt, D. (2024). The reciprocal associations between social deficits, social engagement, and inflammation: Longitudinal evidence comparing venous blood samples and dried blood spots and mapping the modifying role of phenotypic and genotypic depression. Brain, Behavior, and Immunity, 119, 120–128. https://doi.org/10.1016/j.bbi.2024.03.045

Abstract:

• Introduction: Arts engagement is a positive health behavior that could support the wellbeing of aging populations globally. However, there is no evidence on what predicts arts engagement in Japan or how predictors in Japan compare to Western countries such as the US, where a social gradient in engagement is well-established.

• Methods: We harmonized cross-sectional data from the Japan Gerontological Evaluation Study (JAGES) 2016 wave and the US Health and Retirement Study (HRS) 2016/2018 wave, enabling cross-country comparisons. We included adults aged ≥65 from JAGES (n=15,598) and HRS (n=6,644). We tested factors associated with arts engagement (participation in artistic hobbies and groups) in logistic and mixed effects logistic regression models.

• Results: Similar factors were associated with engagement across countries. In both Japan and the US, participants who were female and had higher education, more total assets, more frequent social contact, and fewer difficulties with instrumental activities of daily living had higher odds of arts engagement. However, further factors were associated with engagement in Japan, but not the US, including employment status and neighborhood social cohesion.

• Conclusion: The social gradient in arts engagement in Western countries such as the US is also present in Japan, despite the differing cultural and social context, but there may be additional barriers to participation in Japan. Given the potential benefits of arts engagement for older adults, our findings indicate the importance of further international research and policies to increase access to the arts, reducing inequalities in engagement for older adults globally.

Citation: Bone, J. K., Noguchi, T., Mak, H. W., Fancourt, D., Kondo, K., & Saito, T. (2023, August 25). Predictors of arts engagement in older adults in Japan: novel findings from a national study and cross-cultural comparisons with the United States.  https://doi.org/10.31234/osf.io/yv85k 

Engaging in hobbies appeared to be associated with lower odds of substance use early in adolescence, but this association reversed with age, meaning more frequent engagement in hobbies was associated with higher odds of substance use in young adults. This change in the association could be a result of differing social contexts, changes in peer influence, or an indication that creative hobbies are particularly beneficial. Our findings could explain why previous evidence has been inconsistent and also show the importance of considering age-related differences when investigating engagement in hobbies. 

Key design elements: 

• We included 7,454 young people from the US, initially aged 11-20 years, and followed up over 22 years 
• We split this sample into three age groups, according to their age at baseline; early adolescents (aged 11-14 years), mid adolescents (aged 15-16), and late adolescents (aged 17-20)  
• We measured the changes in young people’s binge drinking, marijuana use, and tobacco use over the study 
• We then tested whether engaging in hobbies (e.g. playing instruments, arts and crafts, collecting cards) was associated with lower substance use at baseline, one year later, and six years later in each age group 

Key findings: 

• Doing hobbies more frequently was associated with lower odds of binge drinking and marijuana and tobacco use in early adolescence 

• Although there was initially a similar protective association in mid and late adolescence, this had reversed six years later for binge drinking and marijuana use; by early adulthood, those who did hobbies most frequently had the highest odds of binge drinking and marijuana use 

Citation: Bone, J.K., Fancourt, D., Sonke, J.K. et al. The Changing Relationship Between Hobby Engagement and Substance Use in Young People: Latent Growth Modelling of the Add Health Cohort. J. Youth Adolescence (2024). https://doi.org/10.1007/s10964-024-02047-x