Center for Arts in Medicine

EpiArts Lab

EpiArts Lab Publications

EpiArts Lab Roundtable Report

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 above 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

Who engages in the arts in the United States? A comparison of several types of engagement using data from The General Social Survey

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 Health21(1), 1-13. https://doi.org/10.1186/s12889-021-11263-0

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

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

Engagement in leisure activities and depression in older adults in the United States: Longitudinal evidence from the Health and Retirement Study

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, Reportedly Antisocial or Criminalized Behaviors, and Potential Mediators in Two Longitudinal Cohorts of Adolescents

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, 1-20. https://doi.org/10.1007/s10964-022-01591-8  

Associations between participation in community arts groups and aspects of wellbeing in older adults in the United States: A propensity score matching analysis

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, 0(0), 1–10. https://doi.org/10.1080/13607863.2022.2068129

Cross-sectional and longitudinal associations between arts engagement, loneliness, and social support in adolescence (preprint & under review)

For adolescents in the US, participating in more extracurricular arts activities is associated with higher social support, independent of participation in other extracurricular activities. 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 used a nationally representative sample of 11,060 adolescents aged 11-21 years from the National Longitudinal Study of Adolescent to Adult Health.

  • Logistic and linear regression were both used to test whether school-based extracurricular arts engagement was associated with loneliness and social support, measured concurrently and one year later.

Key Findings:

  • Each additional extracurricular arts activity engaged in (from band, book club, chorus/choir, cheerleading/dance, drama club, newspaper, orchestra) was associated with an increase of 0.20 points in social support, both concurrently (coef=0.20, 95% CI=0.02-0.38, p=0.03) and one year later (coef=0.20, 95% CI=0.02-0.38, p=0.03), independent of a range of sociodemographic and health-related confounders.

  • Although extracurricular arts engagement was no longer associated with social support one year later after accounting for previous levels of social support, this is likely to be because adolescents reported relatively stable levels of social support across this year. 

  • For adolescents in the US, each additional non-arts extracurricular activity engaged in was associated with 24% lower odds of concurrent loneliness and 17% lower odds of subsequent loneliness, alongside a 0.69 point higher social support score concurrently and a 0.37 point higher social support score one year later.

Bone, J. K., Fancourt, D. Fluharty, M. E., Paul, E., Sonke, J. K., & Bu, F., (preprint & under review). Cross-sectional and longitudinal associations between arts engagement, loneliness, and social support in adolescence. https://psyarxiv.com/64d7c/

Associations between extracurricular arts activities, school-based arts engagement, and subsequent externalising behaviours: Findings from the Early Childhood Longitudinal Study (preprint & under review)

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 0.17 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. 

Fluharty, M., Bone, J., Bu, F., Sonke, J., Fancourt, D. & Paul, E., (preprint & under review) Associations between extracurricular arts activities, school-based arts engagement, and subsequent externalising behaviours: Findings from the Early Childhood Longitudinal Study. https://psyarxiv.com/gdk3t/

Associations of arts and cultural engagement with substance use trajectories in adolescence and early adulthood: a latent growth curve analysis of the Add Health cohort (preprint & under review)

For adolescents in the US, engaging in both extracurricular arts activities and creative hobbies is associated with lower rates of substance use, namely alcohol intoxication, tobacco use, and marijuana, both concurrently and over the subsequent 14 years, although the protective effects did attenuate over time.

Key Design Elements:

  • A nationally representative sample of 6,965 adolescents and young people aged 12 to 32 years were included from the first four waves (1994-2008) of the National Longitudinal Study of Adolescent to Adult Health.

  • Latent growth curve modelling was used to examine associations between arts and cultural engagement, as indicated by the number of extracurricular arts activities participated in (from book club, drama club, band, cheerleading/dance, chorus/choir, orchestra, and newspaper) and frequency of participation in creative hobbies (such as playing a musical instrument, reading, or doing arts and crafts), at wave 1 and trajectories of past month alcohol intoxication, marijuana use, and tobacco use over waves 1 to 4.

Key Findings:

  • For adolescents aged 12 to 19 years, engaging in one or more extracurricular arts activities was associated with lower odds of alcohol intoxication and tobacco use concurrently, compared to not engaging in any of these activities. Engaging in more of these activities was also associated a less steep increase in alcohol intoxication and tobacco use over the subsequent 14 years.

  • For adolescents aged 12 to 19 years, doing creative hobbies three or more times a week was associated with lower odds of alcohol intoxication, marijuana use, and tobacco use concurrently, compared to not engaging in any of these activities. Doing creative hobbies more often was also associated with a less steep increase in alcohol intoxication, marijuana use, and tobacco use over the subsequent 14 years.

  • These associations were present two years later but had started to attenuate by seven years later. 

  • Participating in more arts and cultural groups was associated with lower concurrent likelihood of being intoxicated by alcohol and using tobacco. 

  • Adolescents who participated in more weekly hobbies were less likely to have used any marijuana, tobacco, or alcohol concurrently. 

Fluharty, M., Bu, F., Bone, J., Sonke, J., Fancourt, D. & Paul, E., (preprint & under review) Associations of arts and cultural engagement with substance use trajectories in adolescence and early adulthood: a latent growth curve analysis of the Add Health cohort. https://psyarxiv.com/nz7ps/

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