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

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Background Engaging in the arts is a health-related behavior that may be influenced by social inequalities. While it is generally accepted that there is a social gradient in traditional arts and cultural activities, such as attending classical music performances and museums, previous studies of arts engagement in the US have not adequately investigated whether similar demographic and socioeconomic factors are related to other forms of arts engagement. Methods Using cross-sectional data from the General Social Survey (GSS) in the US, we examined which demographic, socioeconomic, residential, and health 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. We combined data from 1993 to 2016 in four analytical samples with a sample size of 8684 for arts events, 4372 for arts activities, 4268 for creative groups, and 2061 for interested non-attendees. Data were analysed using logistic regression. Results More education was associated with increased levels of all types of arts engagement. Parental education demonstrated a similar association. Being female, compared to male, was also consistently associated with higher levels of engagement. Attendance at arts events was lower in participants with lower income and social class, poorer health, and those living in less urban areas. However, these factors were not associated with participation in arts activities or creative groups or being an interested non-attendee. Conclusions Overall, we found evidence for a social gradient in attendance at arts events, which was not as pronounced in participation in arts activities or creative groups or interest in arts events. Given the many benefits of engagement in the arts for education, health, and wider welfare, our findings demonstrate the importance of identifying factors to reduce barriers to participation in the arts across all groups in society.
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R E S E A R C H Open Access
Who engages in the arts in the United
States? A comparison of several types of
engagement using data from The General
Social Survey
Jessica K. Bone
1*
, Feifei Bu
1
, Meg E. Fluharty
1
, Elise Paul
1
, Jill K. Sonke
2
and Daisy Fancourt
1
Abstract
Background: Engaging in the arts is a health-related behavior that may be influenced by social inequalities. While
it is generally accepted that there is a social gradient in traditional arts and cultural activities, such as attending
classical music performances and museums, previous studies of arts engagement in the US have not adequately
investigated whether similar demographic and socioeconomic factors are related to other forms of arts
engagement.
Methods: Using cross-sectional data from the General Social Survey (GSS) in the US, we examined which
demographic, socioeconomic, residential, and health 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. We combined data from 1993 to 2016 in four analytical samples with a sample size of 8684 for arts events,
4372 for arts activities, 4268 for creative groups, and 2061 for interested non-attendees. Data were analysed using
logistic regression.
Results: More education was associated with increased levels of all types of arts engagement. Parental education
demonstrated a similar association. Being female, compared to male, was also consistently associated with higher
levels of engagement. Attendance at arts events was lower in participants with lower income and social class,
poorer health, and those living in less urban areas. However, these factors were not associated with participation in
arts activities or creative groups or being an interested non-attendee.
Conclusions: Overall, we found evidence for a social gradient in attendance at arts events, which was not as
pronounced in participation in arts activities or creative groups or interest in arts events. Given the many benefits of
engagement in the arts for education, health, and wider welfare, our findings demonstrate the importance of
identifying factors to reduce barriers to participation in the arts across all groups in society.
Keywords: Arts, Culture, Social gradient, Wellbeing, Health, United States
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* Correspondence: jessica.bone@ucl.ac.uk
1
Research Department of Behavioural Science and Health, Institute of
Epidemiology & Health, University College London, London, UK
Full list of author information is available at the end of the article
Bone et al. BMC Public Health (2021) 21:1349
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Background
There are many known social inequalities in health, in-
cluding differences in healthy life expectancy and mor-
tality [1,2]. These disparities may be partially explained
by a social gradient in a variety of health behaviors, in-
cluding diet, obesity, physical activity, alcohol consump-
tion, and smoking [35]. Health behavior norms may be
learnt within the socioeconomic context, with social de-
terminants influencing behavior throughout the life
course [6]. Engaging in the arts is an example of a
health-related behavior that demonstrates social inequal-
ities [7,8].
Arts engagement typically refers to different types of
creative activity, from actively participating in the arts
(e.g. dancing, singing, acting, painting, reading) to more
receptive cultural engagement (e.g. going to museums,
galleries, exhibits, performances and the theater [9]). It
can also encompass broader creative activities that,
whilst not always labelled as arts, share similar proper-
ties of creative skill and imagination (e.g. gardening,
cooking, and hobby or book groups [10]). In 2019, the
World Health Organization identified more than 3000
studies showing the beneficial impact of arts engagement
on mental and physical health and social determinants
of health, from education to social cohesion and welfare
[9]. Despite growing awareness of the benefits of en-
gaging with the arts, there is a social gradient in arts par-
ticipation. Previous surveys have found that arts
engagement in the United States (US) may differ accord-
ing to socioeconomic status, education, and income
[1113]. Similar factors are associated with inequalities
in access to health care and health and social outcomes
[1417]. Varying engagement in the arts may therefore
further contribute to health and social inequalities [8].
However, the literature on this topic is limited by a
number of factors.
First, many previous studies have focused on certain
demographic or socioeconomic predictors of arts en-
gagement without always taking into account the broad
range of factors that may be related to one another.
From these studies, the most consistent predictors of in-
creased arts engagement are higher levels of education
and income [12,13,1824]. There have been extensive
efforts to differentiate the effects of education and in-
come on arts engagement, and it appears that both inde-
pendently contribute to engagement levels [21,25].
However, education may be more strongly associated
with attending highbrow cultural events, whereas in-
come is more strongly associated with other forms of
arts engagement [25]. Further, self-identified social class
may be another important factor which should be stud-
ied alongside income and education [23]. There is also
evidence for lower rates of engagement in Black than
White racial/ethnic groups [12,18,22,26,27]. Still, it
remains unclear whether race/ethnicity has a strong as-
sociation with engagement after other factors, particu-
larly education and income (as interconnected systems
that contribute to structural racism), have been taken
into account [18,21,22,27,28].
Additionally, there are other factors that could be as-
sociated with arts engagement that have not been inves-
tigated in the US to date. In the UK, there are
geographical differences in participation independent of
individual demographic and socio-economic back-
grounds [29]. Further, living alone is associated with
fewer perceived opportunities to engage in the arts and
those with poorer physical and mental health may ex-
perience more barriers to engaging [30]. As many previ-
ous studies of arts engagement in the US are based on
the Survey of Public Participation in the Arts (SPPA; Na-
tional Endowment for the Arts), which does not collect
data on physical and mental health, these factors have
not been investigated.
Moreover, in the US, most research on predictors of
arts engagement has measured engagement with bench-
markarts activities, as defined in the SPPA. These activ-
ities include attending jazz, classical music, opera,
musical or non-musical plays, ballet performances, and
art museums or art galleries. Although these activities
are not intended to be comprehensive [31], they have re-
peatedly been used as a metric of engagement in the
arts. This has led to the perception that arts participa-
tion is declining in the US [11,22,32]. However, when
defined more broadly, including other types of arts activ-
ities and going beyond the non-profit sector to recognize
the many diverse commercial forms of cultural expres-
sion, participation is not declining and the way in which
people participate may instead be changing [13,33,34].
There may be a growing gap between arts participation
metrics and the ways in which people participate, and
this could be affecting our understanding of the predic-
tors of engagement [35].
Therefore, in this study, we used a large nationally
representative sample of adults in the US (the General
Social Survey; GSS) to investigate predictors of different
types of arts engagement. Specifically, we were interested
in whether there are social inequalities in engagement in
the arts, as found in other health-related behaviors. To
do this, we tested which demographic, socioeconomic,
residential, and health factors were associated with at-
tendance at arts events, participation in arts activities,
and membership of creative groups. Further, in order to
differentiate between non-attendance due to a lack of
interest versus non-attendance due to barriers or a lack
of opportunities, we investigated whether similar factors
were associated with being interested in, but not attend-
ing, arts events. Finally, we examined whether engage-
ment changed across time, from 1993 to 2016, and
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whether associations between demographic and socio-
economic factors and engagement changed over these
two decades.
Methods
Sample
Participants were drawn from the General Social Survey
(GSS); a repeated cross-sectional and rotating panel
study of adults aged 18 and over in the US [36]. Each
survey year was an independently drawn sample of
English-speaking individuals living in non-institutional
arrangements. From 2006 onwards, Spanish-speakers
were added to the target population. Full probability
sampling was employed, and surveys sub-sampled non-
respondents from 2004 onwards.
We used data from GSS waves at which arts outcomes
were measured between 1993 and 2016. Each wave in-
cluded a unique sample of individuals so we were able
to combine data across waves. We used four indicators
of arts engagement (arts events, arts activities, creative
groups, and interested non-attendees), each measured in
different waves of the GSS. Arts events were measured
in 1993, 1998, 2002, 2012 and 2016, arts activities were
measured in 1993, 1998, and 2002, creative groups were
measured in 1993, 1994, 2004, and 2010, and interested
non-attendees were measured in 2012 and 2016. We
therefore identified four samples, one for each outcome.
When combining samples across all relevant years, the
total number of participants was 14,890, 7203, 12,311,
and 7687 for arts events, activities, creative groups, and
interested non-attendees respectively. We then restricted
the sample just to participants with complete data on
arts variables, which produced a final sample size of
8684 for arts events, 4372 for arts activities, 4268 for
creative groups, and 2061 for interested non-attendees
(see Supplementary Table 1for further details).
All participants gave informed consent and this study
has Institutional Review Board approval from the Uni-
versity of Florida (IRB201901792) and ethical approval
from University College London Research Ethics Com-
mittee (project 18839/001).
Arts engagement outcomes
Arts events
Participants were asked whether they had attended arts
events in the last 12 months, not including school per-
formances. In 1993, attendance at three events was mea-
sured as the following: a) art museum or gallery, b)
ballet or dance performance, and c) classical music or
opera performance. In 1998 and 2002, two additional
events were added to this list: d) popular music perform-
ance, and e) non-musical stage play performance. In
2012 and 2016, attendance at two types of event was
measured; a) music, theatre, or dance performance, and
b) art exhibit (including paintings, sculpture, textiles,
graphic design, or photography). Due to these differ-
ences in measurement across years, we collapsed all re-
sponses into a binary variable indicating attendance at
any event in the last 12 months (0 = none, 1 = one or
more). As this does not entirely account for the changes
in question style, we tested whether the changing defin-
ition of arts events altered our findings in sensitivity ana-
lyses (outlined below). For full details of the questions
asked in each wave, see Supplementary Table 2.
Arts activities
Participants self-reported whether they participated in
any kind of arts activity in the last 12 months, including:
a) making art or craft objects, b) taking part in music,
dance, or theatrical performance, and c) playing a mu-
sical instrument (Supplementary Table 2). This was
coded as a binary variable (0 = none, 1 = one or more),
and was measured consistently in 1993, 1998, and 2002.
Creative groups
Participants were asked about the groups or organiza-
tions of which they were a member in 1993, 1994, 2004,
and 2010. The creative groups were hobby or garden
clubs and literary, art, discussion, or study groups (Sup-
plementary Table 2). A binary variable was created indi-
cating membership in either of these group types (0 =
none, 1 = one or more).
Interested non-attendees
In the 2012 and 2016 GSS, participants who responded
to the arts event questions were also asked if there was
an arts event during the last 12 months that they had
wanted to go to but did not attend (0 = no, 1 = yes). In
2012, only participants who had not attended an event
during the last 12 months were asked this question. In
2016, all participants who were asked about arts event
attendance were also asked whether there was an event
that they had wanted to go to but did not attend. As we
aimed to include only participants who were interested
non-attendees, we excluded those who reported attend-
ing an arts event in 2016 (n= 738 excluded).
Exposures
We examined whether a range of demographic, socio-
economic, residential, and health factors were associated
with arts engagement. Demographics included age
(years), sex (male or female), race/ethnicity (White,
Black, or Other) and marital status (married, separated/
divorced/widowed, or never married). Socioeconomic
factors included total number of years of education (0
20 years), parental years of education (highest reported
maternal or paternal education; 020 years), employ-
ment status in the last week (employed, unemployed or
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not currently working, retired, keeping house, or other),
family income in constant dollars (base = 1986; $0 to
$9999, $10,000 to $19,999, $20,000 to $29,999, $30,000
to $49,999, or $50,000+), subjective satisfaction with fi-
nancial situation (not satisfied at all, more or less satis-
fied, or pretty well satisfied), and a subjective rating of
social class (lower class, working class, middle class, or
upper class).
Residential factors included level of urbanicity
(medium to large city with 50,000 people or more; sub-
urb of a medium to large city; unincorporated area of a
medium to large city; small city, town or village of 2500
to 50,000 people; and smaller areas or open country),
number of people living in the household (110), and
whether there was an area within a mile of their home
where they would be afraid to walk alone at night (yes
or no).
Finally, we included a general health rating (excellent,
good, fair, or poor).
Statistical analyses
We used four logistic regression models to test cross-
sectional associations between demographic, socioeco-
nomic, residential, and health exposures and binary arts
engagement outcomes. Each outcome (arts events, arts
activities, creative groups, interested non-attendees) was
modelled separately. Where there was evidence of a
non-linear association between age and arts engagement,
we included a quadratic age term. As a number of simi-
lar exposures were included, multicollinearity was
assessed to ensure that Variance Inflation Factors were
less than 10 [37]. All analyses were weighted to account
for the sub-sampling of non-respondents and the num-
ber of adults in the household using weights supplied by
the GSS [36]. We accounted for clustering of partici-
pants within primary sampling units by using robust
standard errors.
We also tested whether there was any evidence that
associations between arts engagement outcomes and
age, race/ethnicity, class, income, and sex differed over
time. We included an interaction term between each ex-
posure and survey year in separate logistic regression
models. Where there was evidence for an interaction, we
then examined the association between the exposure
and arts engagement separately in each survey year.
For participants with missing data on exposures, we
imputed data using multiple imputation by chained
equations (MICE [38]). We used linear, logistic, ordinal,
and multinomial regression and predictive mean match-
ing according to variable type, generating 50 imputed
data sets (maximum missing data ranged from 10 to
35% in each sample; Supplementary Table 3). The im-
putation model included all variables used in analyses,
auxiliary variables, and the survey weights. Auxiliary
variables were split ballot group, interviewers rating of
the respondents attitude toward the interview and un-
derstanding of questions, respondents rating of their
family income (relative to other Americans), and geo-
graphic mobility since age 16. Imputations were per-
formed separately according to survey year. For creative
groups, several exposures (satisfaction with financial
situation, general health rating, and feeling afraid in
neighborhood) and an auxiliary variable (relative in-
come) were missing for all participants in some years so
were not included in the imputations or analyses. All
other variables were successfully imputed. The results of
analyses did not vary between complete cases and im-
puted data sets (Supplementary Table 4), so findings
from the imputed data are reported. All analyses were
performed using Stata 16 [39].
Sensitivity analysis
We tested whether the changing definition of arts event
attendance altered our findings. In this analysis, we used
the most homogenous measures of arts events, those in-
cluded from 1998 to 2016. We therefore repeated the
main analysis excluding participants from 1993 (which
used a narrower definition of arts events) and examined
whether similar factors were associated with arts event
attendance in this subsample (n= 7094; Supplementary
Table 7).
Results
Arts events
In total, 8684 participants provided data on attendance
at arts events, 53% of whom were female and 78% were
White (Table 1). These participants ranged in age from
18 to 89 years, with a mean age of 46.6 (SD = 17.0).
Overall, 56% had attended an arts event in the last 12
months, although this varied across years (1993: 48%,
1998: 62%, 2002: 66%, 2012: 46%, 2016: 50%).
In the logistic regression model, there was evidence
for associations between several demographic factors
and attending arts events (Table 2). Females had 24%
higher odds (95% CI = 1.101.39) of attendance than
males. In comparison to White participants, Black par-
ticipants had 34% lower odds (95% CI = 0.550.78) of at-
tendance. Participants who had never been married had
37% higher odds (95% CI = 1.141.63) of attendance
than those who were married.
There was evidence that several socioeconomic factors
were associated with attendance. Compared to those
with a family income of less than $10,000, participants
in all other income groups had higher odds of attend-
ance. The highest odds were in the highest income
group. Subjective rating of social class was also associ-
ated with attendance, with higher classes associated with
increasing odds. Each additional year of education was
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Table 1 Demographic characteristics of the samples, with data combined across all included survey years
Events
n= 8684
Activities
n= 4372
Groups
n= 4268
Interested
non-attendees
n= 2061
Percentage
Female 53% 53% 56% 53%
Race/ethnicity
White 78% 81% 81% 70%
Black 14% 12% 12% 20%
Other 8% 7% 7% 10%
Marital status
Married 55% 56% 60% 50%
Separated/divorced/widowed 21% 21% 20% 25%
Never married 24% 23% 20% 25%
Employment status
Employed 63% 65% 62% 57%
Unemployed/not working 6% 5% 6% 7%
Retired 15% 13% 14% 17%
Keeping house 10% 11% 12% 12%
Other 6% 6% 6% 7%
Family income
$0$9999 18% 17% 16% 28%
$10,000$19,999 21% 21% 21% 24%
$20,000$29,999 18% 20% 17% 16%
$30,000$49,999 23% 21% 23% 21%
$50,000+ 20% 21% 23% 11%
Satisfaction with financial situation
Not satisfied at all 28% 27% 34%
More or less satisfied 44% 44% 44%
Pretty well satisfied 28% 29% 22%
Social class
Lower class 7% 5% 6% 13%
Working class 46% 45% 43% 54%
Middle class 44% 46% 48% 32%
Upper class 3% 4% 3% 1%
General health rating
Excellent 28% 32% 21%
Good 47% 47% 42%
Fair 19% 16% 28%
Poor 6% 5% 9%
Level of urbanicity
Med-large city (50,000+) 31% 31% 29% 31%
Suburb 35% 36% 33% 29%
Unincorporated area 13% 9% 15% 18%
Small city or town 11% 14% 11% 9%
Smaller areas or country 10% 10% 12% 13%
Feels afraid in neighborhood 34% 38% 31%
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associated with 1.19 times higher odds (95% CI = 1.16
1.22) of attendance. Parental education was similarly as-
sociated with increased odds of attendance, although the
estimated odds ratio was smaller (OR = 1.05, 95% CI =
1.041.07).
Two residential factors were associated with attend-
ance. Compared to those living in medium to large cit-
ies, the odds of attendance reduced with decreasing level
of urbanicity. The odds of attendance were lowest in
smaller areas or open country. Additionally, for each
additional person in the household, participants had 5%
lower odds (95% CI = 0.900.99) of attendance. Partici-
pants who rated their health as fair (OR = 0.68, 95% CI =
0.560.83) or poor (OR = 0.47, 95% CI = 0.330.66) had
lower odds of attending events than participants who
rated their health as excellent.
Finally, the results suggested that event attendance
varied across survey years, although there was no clear
time trend. In comparison to 1993, the odds of attend-
ance were higher in 1998, 2002, and 2012 but did not
differ in 2016.
Arts activities
Overall, 4372 individuals reported whether they had par-
ticipated in arts activities. These individuals ranged in age
from 18 to 89 years, with a mean age of 44.8 (SD = 17.0).
About 53% were female and 81% were White (Table 1).
On average, 54% reported participating in at least one arts
activity in the last 12 months, and this was relatively stable
across time (1993: 55%, 1998: 51%, 2002: 55%).
Fewer factors were associated with participation in arts
activities than with attendance at arts events (Table 2).
Females had 1.71 times higher odds (95% CI = 1.45
2.00) of participating than males. Both Black (OR = 0.48,
95% CI = 0.380.61) and individuals of Other races/eth-
nicities (OR = 0.70, 95% CI = 0.510.96) were less likely
to report participating than those who were White. Indi-
viduals who were unemployed or not working had
higher odds of participating than those working (OR =
1.44, 95% CI = 1.061.95). As with attending arts events,
increased years of education (OR = 1.08, 95% CI = 1.05
1.12) and parental education (OR = 1.05, 95% CI = 1.02
1.07) were both associated with higher odds of partici-
pating in arts activities. There was no evidence that any
other factors were associated with participation.
Creative groups
Membership of creative groups was reported by 4268
participants, who were similar demographically to partic-
ipants who reported other arts outcomes (Table 1).
Membership in creative groups was lower than attend-
ance at events or participation in activities. Overall, 19%
of participants reported being a member of a creative
group, and this may have decreased over time (1993:
20%, 1994: 16%, 2004: 18%, 2010: 17%).
Despite a lower proportion of participants being mem-
bers of creative groups, membership was associated with
similar factors to arts activities (Table 2). Females had
1.33 times higher odds (95% CI = 1.081.63) of member-
ship than males. There was also evidence that the odds
of membership increased with more education (OR =
1.15, 95% CI = 1.101.20) and parental education (OR =
1.04, 95% CI = 1.011.08). In contrast to arts activities,
those who were never married had 1.58 times higher
odds (95% CI = 1.182.11) of membership than married
participants and the odds of membership increased with
age (OR = 1.01, 95% CI = 1.001.02). Finally, there was
evidence that membership decreased over time, with the
odds decreasing by 32% (95% CI = 0.540.87) from 1993
to 2010.
Interested non-attendees
Overall, 2061 participants reported whether there was
an arts event that they had wanted to go to but did not
attend, 29% of whom were interested non-attendees.
The proportion of interested non-attendees remained
consistent across years (2012: 29%, 2016: 30%).
As with attendance at arts events, there was evidence
that being an interested non-attendee was associated
with race/ethnicity and years of education (Table 2).
Other races/ethnicities had lower odds of being an inter-
ested non-attendee than White individuals (OR = 0.56,
Table 1 Demographic characteristics of the samples, with data combined across all included survey years (Continued)
Events
n= 8684
Activities
n= 4372
Groups
n= 4268
Interested
non-attendees
n= 2061
Mean (SE)
Age 46.61 (0.23) 44.80 (0.33) 45.92 (0.34) 49.14 (0.52)
Years of education 13.44 (0.05) 13.20 (0.07) 13.55 (0.06) 12.55 (0.11)
Parental years of education 12.07 (0.06) 11.85 (0.09) 12.11 (0.09) 11.26 (0.15)
Household size 2.85 (0.02) 2.84 (0.03) 2.88 (0.03) 2.94 (0.06)
Note. Results based on 50 multiply imputed data sets. Events includes participants from survey years 1993, 1998, 2002, 2012, and 2016. Activities includes
participants from 1993, 1998, and 2002. Groups includes participants from 1993, 1994, 2004, and 2010. Interested non-attendees includes participants from 2012
and 2016. SE = standard error
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Table 2 Logistic regression models testing associations between demographic, socioeconomic, residential, and health exposures
and the odds of arts engagement
Model 1: Events
n = 8684
Model 2: Activities
n = 4372
Model 3: Groups
n = 4268
Model 4: Interested
non-attendes
n = 2061
OR 95% CI p OR 95% CI p OR 95% CI p OR 95% CI p
Age 1.01 0.981.03 0.629 1.01 0.981.03 0.605 1.01 1.001.02 0.007 1.00 0.991.01 0.850
Age (quadratic) 1.00 1.001.00 0.302 1.00 1.001.00 0.129 –– – ––
Female 1.24 1.101.39 < 0.001 1.71 1.452.00 < 0.001 1.33 1.081.63 0.008 1.19 0.901.58 0.215
Race/ethnicity
White 1 1 1 1
Black 0.66 0.550.78 < 0.001 0.48 0.380.61 < 0.001 0.94 0.661.33 0.718 0.92 0.611.39 0.696
Other 0.89 0.711.11 0.294 0.70 0.510.96 0.028 1.11 0.741.69 0.606 0.56 0.350.89 0.015
Marital status
Married 1 1 1 1
Separated 1.16 1.001.34 0.056 0.90 0.751.09 0.282 0.91 0.681.22 0.531 1.08 0.751.57 0.671
Never married 1.37 1.141.63 0.001 1.00 0.781.27 0.987 1.58 1.182.11 0.002 1.26 0.861.86 0.236
Employment status
Employed 1 1 1 1
Unemployed 0.93 0.731.19 0.561 1.44 1.061.95 0.021 0.79 0.501.23 0.286 1.41 0.852.34 0.179
Retired 1.15 0.931.43 0.200 1.10 0.831.45 0.523 1.26 0.851.85 0.249 0.89 0.571.39 0.605
Keeping house 0.82 0.671.01 0.057 1.13 0.871.46 0.350 1.38 0.952.00 0.089 0.95 0.621.47 0.831
Other 1.07 0.821.39 0.633 1.35 0.961.89 0.085 1.11 0.711.72 0.651 0.78 0.481.28 0.324
Family income
$0$9999 1 1 1 1
$10,000$19,999 1.27 1.071.51 0.007 0.84 0.651.07 0.162 1.15 0.771.74 0.492 1.13 0.761.68 0.536
$20,000$29,999 1.58 1.291.95 < 0.001 0.96 0.721.27 0.756 1.54 0.972.45 0.067 1.11 0.661.87 0.698
$30,000$49,999 1.80 1.462.22 < 0.001 0.87 0.651.17 0.358 1.42 0.912.23 0.122 1.14 0.731.78 0.557
$50,000+ 2.78 2.173.57 < 0.001 0.81 0.581.13 0.211 1.42 0.892.26 0.137 1.03 0.492.15 0.940
Financial situation
Not satisfied at all 1 1 –– 1
More or less satisfied 0.92 0.801.06 0.267 1.00 0.831.21 0.962 –– 0.70 0.520.96 0.028
Pretty well satisfied 1.03 0.871.21 0.772 1.00 0.811.24 0.978 –– 0.79 0.531.17 0.234
Social class
Lower class 1 1 1 1
Working class 1.20 0.941.53 0.145 1.20 0.861.69 0.285 1.21 0.642.30 0.558 1.02 0.651.62 0.916
Middle class 1.52 1.161.97 0.002 1.03 0.731.46 0.870 1.35 0.712.57 0.359 0.69 0.431.12 0.132
Upper class 1.52 0.992.35 0.058 0.92 0.561.50 0.743 1.67 0.773.62 0.195 0.29 0.081.09 0.066
Years of education 1.19 1.161.22 < 0.001 1.08 1.051.12 < 0.001 1.15 1.101.20 < 0.001 1.11 1.051.17 < 0.001
Parental years of education 1.05 1.041.07 < 0.001 1.05 1.021.07 < 0.001 1.04 1.011.08 0.019 1.03 0.991.08 0.147
General health rating
Excellent 1 1 –– 1
Good 0.88 0.751.03 0.121 0.95 0.791.14 0.577 –– 1.02 0.671.55 0.917
Fair 0.70 0.580.85 < 0.001 0.92 0.711.18 0.492 –– 1.30 0.842.02 0.243
Poor 0.48 0.340.67 < 0.001 0.91 0.631.33 0.634 –– 1.38 0.742.56 0.309
Level of urbanicity
Med-large city 1 1 1 1
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Content courtesy of Springer Nature, terms of use apply. Rights reserved.
95% CI = 0.350.89), and the odds of interested non-
attendance increased with level of education (OR =
1.11, 95% CI = 1.051.17). However, in contrast to
event attendance, those who were more or less satis-
fied with their financial situation had lower odds of
being an interested non-attendee than those who were
not satisfied at all (OR = 0.70, 95% CI = 0.520.96).
There was no evidence that being an interested non-
attendee was associated with gender, marital status,
employment status, family income, social class, paren-
tal education, level of urbanicity, household size, or
general health rating.
Table 2 Logistic regression models testing associations between demographic, socioeconomic, residential, and health exposures
and the odds of arts engagement (Continued)
Model 1: Events
n = 8684
Model 2: Activities
n = 4372
Model 3: Groups
n = 4268
Model 4: Interested
non-attendes
n = 2061
OR 95% CI p OR 95% CI p OR 95% CI p OR 95% CI p
Suburb 0.92 0.791.08 0.311 1.18 0.981.42 0.075 1.06 0.821.38 0.666 1.12 0.771.63 0.558
Unincorporated area 0.79 0.640.96 0.020 0.96 0.751.24 0.771 1.22 0.891.67 0.225 1.15 0.771.73 0.495
Small city or town 0.69 0.580.83 < 0.001 1.08 0.841.41 0.538 1.20 0.881.64 0.255 1.19 0.771.85 0.436
Smaller areas 0.57 0.470.69 < 0.001 0.98 0.751.28 0.874 0.96 0.631.45 0.836 0.63 0.391.02 0.061
Household size 0.95 0.900.99 0.030 1.02 0.951.09 0.572 0.99 0.911.08 0.811 0.96 0.871.05 0.350
Feels afraid in neighborhood 1.06 0.911.24 0.463 0.97 0.801.17 0.714 –– 1.11 0.791.56 0.536
Survey year
11111
22.02 1.692.40 < 0.001 0.89 0.741.06 0.194 0.73 0.521.03 0.074 1.04 0.791.38 0.757
32.27 1.882.73 < 0.001 1.05 0.881.26 0.568 0.77 0.600.99 0.045 –– –
41.25 1.061.48 0.008 –– 0.68 0.540.87 0.002 –– –
5 1.05 0.871.26 0.624 –– – –– – ––
Note. Survey year refers to different years for each arts outcome: for events 1 =1993, 2 = 1998, 3 = 2002, 4 = 2012, 5 = 2016; for activities 1 =1993, 2 =1998, 3 =
2002; for groups 1 = 1993, 2 = 1994, 3 = 2004, 4 = 2010; and for interested non-attendees 1 = 2012, 2 = 2016. These numbers have been added for ease of
presentation; years were used in analyses. For odds ratios, 1 indicates the reference category
Fig. 1 Results of subgroup analyses, with logistic regression models testing associations between exposures and the odds of attending arts
events separately in each survey year (1993 n= 1590, 1998 n= 1432, 2002 n= 1355, 2012 n= 2838, 2016 n= 1469). Odds ratios and 95%
confidence intervals are displayed. For associations between sex and arts events, the odds ratio represents attendance in females compared to
males. For associations between race/ethnicity and arts events, White is the reference category. Associations were estimated in the full logistic
regression models (including all exposures as shown in Table 2), but only results for sex and race/ethnicity are presented
Bone et al. BMC Public Health (2021) 21:1349 Page 8 of 13
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Change across survey years
Next, we tested whether associations between arts en-
gagement outcomes and age, sex, race/ethnicity, class,
and income differed over time. There was no evidence
for interactions between survey year and any exposures
on participation in arts activities, membership of creative
groups, or being an interested non-attendee (Supple-
mentary Table 5). There was also no evidence for inter-
actions between survey year and age, class, or income on
arts event attendance.
However, there was evidence for an interaction be-
tween survey year and sex on event attendance. There
was no linear time trend, as females had higher odds of
attendance than males in 1993 and 2002 but there were
no sex differences in other survey years (Fig. 1; Supple-
mentary Table 6). There was also evidence for an inter-
action between survey year and race/ethnicity on event
attendance. Black participants had lower odds of attend-
ing than White participants, and this difference in-
creased over time (Fig. 1; Supplementary Table 6).
Sensitivity analyses
We have reported findings based on imputed data but
the results of analyses did not vary when limited to
complete cases, as shown in Supplementary Table 4.In
our sensitivity analysis, limiting the sample to the most
homogenous definitions of arts event attendance (i.e. ex-
cluding participants from 1993) did not substantially
alter our findings (Supplementary Table 7).
Discussion
In this study, we examined whether there are social in-
equalities in engagement in the arts, as found in other
health-related behaviors [35]. Between 1993 and 2016,
approximately half of our sample reported attending arts
events, and a similar proportion participated in arts ac-
tivities. In the smaller sample of individuals who com-
pleted the GSS in 2012 and 2016, another one third
were interested non-attendees, who had been interested
in attending an event in the last year but had not gone
to it. Fewer people were members of creative groups,
with approximately one fifth of the sample between
1993 and 2010 reporting group membership. Several
demographic factors were consistently associated with
engagement in the arts. For example, engagement was
higher in females than males, and married individuals
were less likely to engage than those who had never
married. Attendance at arts events and participation in
arts activities also differed according to race/ethnicity,
although creative group membership did not. Socioeco-
nomic factors showed mixed associations with the differ-
ent types of arts engagement. Higher levels of education
and parental education were consistently associated with
all types of engagement. Attendance at arts events was
also associated with higher income and social class, bet-
ter health, and living in more urban areas. However, be-
ing an interested non-attendee of arts events was not
associated with these factors. In contrast to arts events,
we found no evidence that income, social class, health,
or urbanicity were associated with participation in arts
activities and groups. Most of our findings are consistent
with previous research demonstrating that a number of
demographic and socioeconomic factors are associated
with engagement in the arts [13]. Our findings further
advance previous research by using a broader definition
of arts to more accurately reflect the breadth of engage-
ment in the US.
The associations between several demographic factors,
such as sex and marital status, and engagement in all
forms of the arts are consistent with previous evidence
[19,4044]. We also found that race/ethnicity was more
strongly associated with participation in arts activities
than events, as shown previously [22]. This association
was independent of socioeconomic factors, so is unlikely
to be explained by over-representation of ethnic minor-
ities in lower socioeconomic status groups [45]. A report
that also used GSS data found that lower attendance at
arts events by racial/ethnic minorities may be a result of
barriers such as being unable to get to the venue and
not having anyone to go with [23]. These individuals
were also more likely to state celebrating their cultural
heritage as a reason for attending events than those who
were White [23,46]. However, in this study, we found
that Other races/ethnicities were also less likely to be in-
terested non-attendees of arts events than White indi-
viduals. Although this could be a result of the way in
which arts events were defined (limited to music, the-
atre, or dance performances or art exhibits), it may also
indicate that some ethnic/racial groups are less inter-
ested in attending arts events. A lack of cultural equity,
cultural relevance, interest, and inequalities in access are
therefore likely to contribute to the racial/ethnic differ-
ences in arts engagement.
Overall, our findings support previous evidence that
education is most strongly associated with engagement
in the arts [12,13,1824]. However, contrary to some
recent evidence, we did not find that education was
more strongly associated with attending events than
other forms of arts engagement [25]. Education may in-
crease engagement by helping to cultivate cultural tastes
and preferences, raising awareness of activities, and in-
creasing cognitive capacity to engage [47]. Arts educa-
tion specifically may also contribute to this association,
as it is strongly related to both level of education and
arts engagement [20,27,32,48,49]. We found a similar
association with parental education, independent of the
individuals own education, although the magnitude of
association was smaller. This indicates that childhood
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Content courtesy of Springer Nature, terms of use apply. Rights reserved.
socioeconomic status continues to influence engagement
in the arts throughout the lifecourse. Children of parents
with more education may benefit from increased access
to the arts during development and may be more likely
to receive arts education in childhood (e.g. learning to
play an instrument [30]). These individuals may there-
fore have more training and experience, enabling them
to participate in more highly skilled arts activities (e.g.
orchestras).
Consistent with previous evidence for a social gradient
in arts engagement, we found that attendance at arts
events was less likely with lower income and social class,
poorer health, and less urban areas. As being an inter-
ested non-attendee was not associated with these factors,
they are likely to be barriers specifically to attendance.
Individuals across the range of incomes, social classes,
health, and levels of urbanicity were interested in attend-
ing events at similar rates, but actual attendance differed
according to these factors. Previously, individuals with
lower household income and social class were more
likely to report barriers to attending events of cost and
difficulty of getting to a venue, as well as a lack of time
[23,46]. Other research has demonstrated that individ-
uals with poorer physical health may experience more
barriers affecting their perceived capabilities to engage
[30]. Areas that are more urban, such as cities, are likely
to have a larger range of arts events on offer, including
at a variety of times and costs as well as appealing to a
broader audience, and events may be more geographic-
ally dispersed or easier to attend using public transport.
Urbanicity can thus be interpreted as a proxy measure
for the availability of arts events. However, there are also
likely to be area-level factors related to the availability
and accessibility of the arts that, although not measured
in the GSS, require further investigation. In contrast to
arts events, we found no evidence that income, social
class, health, or urbanicity were associated with partici-
pation in arts activities and groups. These types of en-
gagement may be more widely available, include more
diverse activities, be cheaper to participate in, and often
do not require attendance at a specific venue, which may
be hard to reach or not generally attended by certain
groups.
There was some mixed evidence for a social gradient
in interest in arts events. Individuals with higher levels
of education were more likely to be interested non-
attendees, as were people who were more or less satis-
fied with their financial situation (compared to those
who were not satisfied at all). Previous research has sug-
gested that of the different types of arts engagement,
education is most strongly associated with highbrow cul-
tural events [25], which could explain the association
with interest in events. It is unclear why we found evi-
dence for an association with financial satisfaction. We
might conclude that individuals who were satisfied with
their financial situation were not interested non-
attendees because they were financially able to attend
any events of interest, but we found no evidence that fi-
nancial satisfaction was associated with actual event at-
tendance. Additionally, there was no evidence that being
an interested non-attendee was associated with income
or differed between those who were pretty well satisfied
and not at all satisfied with their financial situation. The
relationship between interest in the arts, subjective mea-
sures of satisfaction with financial situation, and more
objective measures of income thus requires further
investigation.
We also investigated changing patterns of arts engage-
ment as there has been concern that arts participation is
decreasing in the US [11,22,32]. We found some evi-
dence that event attendance changed over time, but this
was likely a result of changes in the measure of event at-
tendance, as there was no linear trend. In contrast,
group membership decreased over time. Additionally,
the racial disparity in event attendance, with an over-
representation of White individuals compared to those
of racial/ethnic minorities, increased from 1993 to 2016.
These increasing racial/ethnic inequalities in arts event
attendance were independent of other socioeconomic
factors such as income and education. However, given
the nature of structural racism, this finding should be
interpreted cautiously and requires replication in studies
with consistent measures of event attendance. As this
study spanned a period of 23 years, with event attend-
ance and group membership measured at different
times, specific social and economic events in each year
could also have contributed to the changing patterns of
arts engagement.
Our findings have implications for understanding
health and social inequalities in the US. A number of the
factors that we have identified as associated with arts en-
gagement are also associated with inequalities in access
to health care and health outcomes [1417]. This could
be because arts engagement is a correlate of health, with
both representing a form of capital that can be obtained
by individuals with more material resources, such as in-
come, and non-material resources, such as social sup-
port [47]. Consistent with this, we found evidence that
poorer self-reported health was associated with lower at-
tendance at arts events, although it was not associated
with interest in attending events or participation in arts
activities. Arts engagement could also represent a health
behaviour that leads to improved health outcomes.
There is growing evidence that engagement with the arts
can lead to a range of health benefits, independent of
demographic and socioeconomic factors [9,50]. It is
thus concerning that we have found evidence for differ-
ential engagement in the arts. Future research should
Bone et al. BMC Public Health (2021) 21:1349 Page 10 of 13
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
explore why engagement is lower in these groups, in
particular males, racial/ethnic minorities, and those with
lower education. This is particularly important given
that previous efforts to reduce inequalities in access to
cultural events by expanding facilities and offering free
tickets in Brazil have not been successful [51]. Future re-
search could also investigate whether removing other
barriers to engagement, such as providing the arts online
to avoid high prices and reduce time constraints, could
increase levels of engagement [52]. This could then sup-
port the development of interventions to promote en-
gagement in the arts, and test whether this leads to
improvements in health outcomes.
This study has a number of strengths. The GSS was a
large nationally representative sample and we included
several measures of arts engagement. Although the GSS
has previously been used to study arts engagement [23,
43], research has not generally examined membership of
creative groups in comparison to other forms of engage-
ment or combined data across as many waves of the GSS
as in this study. We tested a range of factors that may be
associated with arts engagement, and mutually adjusted
for these variables in our models. Using multiple imput-
ation means that missing data should not have influenced
our findings. However, this study also has a number of
limitations. We tested cross-sectional associations and
thus cannot rule out the possibility of inverse causality.
There are some factors, such as health, which may have a
bidirectional association with arts engagement. Addition-
ally, the GSS did not measure attendance at arts events
consistently across waves, which is likely to explain the as-
sociation we found between event attendance and survey
year. A broader definition of arts events was used in later
years. However, when limiting our analyses just to this
broader definition, our findings were consistent. Although
our measures of arts engagement were more inclusive
than in many previous studies, they were likely still too
narrow. Standard arts engagement questions are not able
to capture arts engagement in some immigrant communi-
ties [35], and also typically do not cover engagement in
digital or electronic arts activities such as graphic design,
photography, film-making, and music production. This
could have contributed to our findings of lower arts en-
gagement in individuals who were not White and under-
represented arts engagement amongst younger genera-
tions. Future research should aim to measure diverse as-
pects of arts engagement, particularly as the US moves
towards a majority-minority society, in which the non-
Hispanic white population will no longer form the major-
ity of the US population [53].
Conclusions
Given the potential importance of engagement in the
arts for health and wellbeing [9], individuals should be
provided with equal opportunities to participate. Our
findings indicate that social determinants may influence
engagement in the arts throughout the life course. En-
couraging arts activities and creative group membership
may provide one way of widening participation and re-
ducing social inequalities in arts engagement. It will also
be important to recognize that lack of participation may
not merely be due to a lack of interest or motivation but
may be influenced by structural barriers, such as racism,
or a lack of opportunities. Indeed, the nature of many
arts activities that take place in well defined arts spaces
are rooted in white supremacy, creating a foundational
barrier for Black, Indigeouns and other people of color
(BIPOC) groups. Future research is needed to identify
what these barriers are and how they can be removed.
This is particularly important in the wake of COVID-19,
given the closure of many arts venues and the dispropor-
tionate effect on BIPOC individuals and those of lower
socioeconomic status [28,5456].
Supplementary Information
The online version contains supplementary material available at https://doi.
org/10.1186/s12889-021-11263-0.
Additional file 1.
Acknowledgements
We thank Shanae Burch, Nupur Chaudhury, and David Fakunle, thought
leaders on work at the intersections of the arts, equity, and public health in
the US, for their comments on this manuscript. We also gratefully
acknowledge the contribution of the GSS study participants.
Authorscontributions
JKB, FB, and DF designed the study. JKB conducted the analysis and drafted
the manuscript. JKB, FB, MEF, EP, JKS, and DF contributed to the writing,
made critical revisions, and approved the final manuscript.
Funding
The EpiArts Lab, a National Endowment for the Arts Research Lab at the
University of Florida, is supported in part by an award from the National
Endowment for the Arts (186289638-C-20). The opinions expressed are
those of the authors and do not represent the views of the National
Endowment for the Arts Office of Research & Analysis or the National
Endowment for the Arts. The National Endowment for the Arts does not
guarantee the accuracy or completeness of the information included in this
material and is not responsible for any consequences of its use. The EpiArts
Lab is also supported by the University of Florida, the Pabst Steinmetz
Foundation, and Bloomberg Philanthropies. DF is supported by the
Wellcome Trust [205407/Z/16/Z].
Availability of data and materials
The dataset supporting the conclusions of this article is available in the GSS
repository, https://gss.norc.org/get-the-data/stata.
Declarations
Ethics approval and consent to participate
All GSS participants gave informed consent and this study has Institutional
Review Board approval from the University of Florida (IRB201901792) and
ethical approval from University College London Research Ethics Committee
(project 18839/001). All methods were carried out in accordance with
relevant ethical guidelines and regulations, the Helsinki Declaration (2013
revision), and the General Data Protection Regulation.
Bone et al. BMC Public Health (2021) 21:1349 Page 11 of 13
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1
Research Department of Behavioural Science and Health, Institute of
Epidemiology & Health, University College London, London, UK.
2
Center for
Arts in Medicine, University of Florida, Gainesville, Florida, USA.
Received: 24 February 2021 Accepted: 9 June 2021
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... limited access and opportunities), and motivations (e.g. less interest) to engage in arts activities (14)(15)(16). Furthermore, engagement is lower among groups that are disproportionately more likely to experience poorer mental health (17,18), including those from racial/ethnic minority backgrounds, with fewer educational qualifications, of lower socioeconomic status, and living in more deprived areas (19)(20)(21)(22). ...
... Ten covariates that may confound associations between arts and cultural engagement and mental health were included (19,22,27). All covariates were measured at time 1 to retain a larger sample size. ...
Article
Full-text available
Increasing evidence links arts engagement with mental health, but the directionality of the link remains unclear. Applying a novel approach to causal inference, we used non-recursive instrumental variable models to analyse two waves of data from the United Kingdom Household Longitudinal Study (N = 17,927). Our findings reveal bidirectional causal relationships between arts engagement (arts participation, cultural attendance, heritage visits) and mental health (GHQ-12 mental distress, SF-12 MCS mental well-being). After adjusting for Time 1 measures and identified confounders, cultural attendance and heritage visits were reciprocally associated with mental distress and mental well-being, while arts participation was only reciprocally associated with mental well-being. The bidirectional effects between arts engagement and mental health are modest but clearly demonstrated not just from mental health to arts but also from arts to mental health. Our findings indicate that previous evidence of an association between arts engagement and mental health is due to bidirectional causal effects. Interventions that boost arts participation, cultural attendance and heritage visits may help break the negative feedback loop and enhance mental health.
... For example, Black study participants had a 34% lower chance than white participants of attending at least one arts event in the last year. 40 Socioeconomic status was also a major determining factor; "compared to those with a family income of less than $10,000, participants in all other income groups had higher odds of attendance," with the highest rate of attendance corresponding to those in the highest income group of $50,000 and above. 41 In addition, study participants living in larger cities were much more likely to engage with arts events than those living in rural areas, and each additional year of education reported by respondents increased their odds of arts engagement and participation by a factor of 1. 19. 42 While not all gaps in arts access can be explained by these factors, the available data indicates that an area's overall demographics are indeed highly correlated with the degree of access available to residents. ...
... In contrast, substantial social engagement acts as a protective factor against amygdala deterioration, thereby safeguarding emotionally significant memories and mitigating the likelihood of developing dementia [84]. Studies conducted in the United States and Colombia suggest that participation in the arts can lead to a reduction in the prevalence of depression and anxiety and an increase in the health and well-being of individuals [85,86]. ...
Article
Full-text available
Introduction This study protocol specifies the primary research line and theoretical framework of the 2023 Survey of the Psychology and Behavior of the Chinese Population. It aims to establish a consistent database of Chinese residents' psychological and behavioral surveys through multi‐center and large‐sample cross‐sectional surveys to provide robust data support for developing research in related fields. It will track the public's physical and psychological health more comprehensively and systematically. Methods The study was conducted from June 20, 2023 to August 31, 2023, using stratified and quota sampling methods. A total of 150 cities across 800 communities/villages were surveyed, selected from China (Despite extensive coordination, we have been unable to contact our counterparts in the Taiwan region of China to obtain relevant statistical data). The questionnaires were distributed to the public one‐on‐one and face‐to‐face by trained surveyors. The questionnaires included basic information about the individual, personal health status, basic information about the family, the social environment in which the individual lives, psychological condition scales, behavioral level scales, other scales, and attitudes towards topical social issues. Supervisors conducted quality control during the distribution process and returned questionnaires, logically checked and cleaned for data analysis. Discussion Data collection has been finished, and scientific outputs based on this data will support the development of health promotion strategies in China and globally. In the aftermath of the pandemic, it will guide policymakers and healthcare organizations to improve their existing policies and services to maximize the physical and mental health of the Chinese population. Trial Registration This study was filed in the National Health Security Information Platform (Record No.: MR‐37‐23‐017876) and officially registered in the China Clinical Trials Registry (Registration No.: ChiCTR2300072573).
... In the United States there remain substantial differences in arts activity participation rates by race/ethnicity, education level, and household income (Novak-Leonard & Brown, 2011). Participation in arts and cultural engagement has generally declined in the United States, dating back to the latter portion of the twentieth century; these declines have been more dramatic for individuals with lower incomes and less education, thus widening disparities (Bone et al., 2021;DiMaggio & Mukhtar, 2004). ...
... Additionally, colors, as immediate and objective features of an artwork, are processed with relatively minimal cognitive effort and can be perceived almost instantaneously, in under 150 milliseconds (Thorpe & Marlot, 1996). This tendency to derive aesthetic pleasure more often from sensory elements, such as rapid visual processing of colors, and less from cognitively demanding aspects like complexity, may be more pronounced when socioeconomic resources are limited, since this may go hand in hand with reduced access or attempt to discover conceptually varied artworks (Bone et al., 2021;World Health Organization, 2020). With greater access, individuals may become more inclined to shift from relying on immediate sensory impressions to engaging in deeper cognitive processing to inform their aesthetic preferences. ...
Chapter
Full-text available
In the evaluation of artworks, what criteria do individuals prioritize? Are there objective and/or subjective elements that influence the appreciation or dislike of artworks, and do these factors vary based on the socioeconomic resources the individuals have access to or the level of engagement with the arts? To investigate these questions, 138 university students and recent graduates were requested to evaluate and provide commentary on 10 paintings through an open-ended questionnaire. The results indicated that irrespective of socioeconomic class or level of engagement with the arts, participants considered shared subjective and objective elements in their evaluation of artworks. However, the emphasis on subjective elements was more pronounced, with semantic understanding and emotional appraisal being the most prioritized factors. Participants frequently assessed the artworks and justified their preferences based on the personal significance of the artworks and the emotional responses they elicited. Following these subjective elements, more objective criteria such as coloration, art movement and style, complexity level, and figures were identified as significant factors in aesthetic judgments. Notably, this study did not corroborate previous literature asserting that individuals from the same social class share similar aesthetic preferences and judgments.
... Additionally, our search revealed a deficit of dance programs directed toward older people on low incomes or living in low-SES areas, LGBTQI+ individuals, indigenous peoples, people in rural and remote areas, and people experiencing loneliness and social isolation. These groups face greater health disparities [107], reduced access to arts opportunities [2,3,[108][109][110][111], and more significant barriers to physical activity participation [112][113][114][115]. From our scoping review, we can conclude that group dance remains under-utilised as a health and social resource for these populations. ...
Article
Full-text available
Background Dance is a promising health resource for older adults, but empirical evidence remains inconsistent. The lack of synthesised evidence regarding program design, dose, and delivery limits understanding of factors influencing participation and health outcomes. This scoping review aimed to map the scope, range, and effectiveness of dance programs for older people, and identify gaps and opportunities for future research and practice. Methods Searches across five databases (September 2023) identified 148 studies evaluating 116 dance programs (≥4 weeks) for older adults (≥55 years, N = 8060), Dance interventions delivered to clinical groups were excluded. Intervention design and delivery were charted against the TIDieR reporting checklist. Program outcomes including adherence, safety, and positive tests were charted into established taxonomies. Results Demographic information, program details, and implementation were often insufficiently reported. Participant groups differed by age range, with underserved communities underrepresented. Programs varied extensively in key factors including dose, prospective ‘active ingredients’, delivery approach, facilitator expertise, and class size. While dance was physically safe, adherence rates in older adults are comparable to other community exercise programs. Less than 40% of health assessments showed positive change, with more consistent benefits to physical endurance, strength, and function, moderate impacts on psychosocial health, and limited benefits to cognitive and brain health, and falls and falls risk. Conclusion Dance is a meaningful, safe, adaptable, and low-cost health resource for older adults. Key opportunities for advancing research include improved access for underserved groups, program suitability assessments, strategies to support adherence and engagement including theory-informed approaches, and incorporation of participant and practitioner insights. Identification of key ’active ingredients’ and dance program factors may improve understanding of causal pathways and mechanisms to optimise engagement and health impacts. Stronger reporting practices will facilitate comparisons across studies and more robust evidence synthesis. This review provides a critical knowledge foundation to guide future approaches in dance for health and offers reporting recommendations.
... 23 Additionally, across Western countries and Japan, people with higher education and socioeconomic position are more likely to engage in arts. [26][27][28] As there are similar socioeconomic disparities in well-being, 29 previous research in Western countries may have overestimated the impact of arts engagement on well-being due to confounding. Although studies have generally adjusted regression models for various demographic and socioeconomic factors, this can leave residual imbalances between those who do and do not engage in arts and bias results. ...
Article
Full-text available
Introduction Arts engagement is a positive health behaviour that could support the mental and social well-being of ageing populations globally. However, research is predominantly from Western countries, leaving it unclear whether arts engagement can support well-being in Japan, where arts are differently valued and engaged with. The social gradient in arts engagement and well-being may also have led to an overestimation of the impact of participation on well-being in Western countries. We therefore tested whether participation in community arts and cultural groups was associated with subjective well-being and social support after removing confounding by demographic, socioeconomic and health-related factors in Japan and England. Methods We harmonised longitudinal data from the Japan Gerontological Evaluation Study (JAGES) 2016 and 2019 waves and the English Longitudinal Study of Ageing (ELSA) 2014 and 2018 waves to enable cross-country comparisons. We included 9511 adults aged ≥65 years from JAGES and 3133 participants aged ≥65 years from ELSA. Using inverse probability-weighted regression adjustment, we estimated the effect of arts and cultural groups on subsequent life satisfaction, happiness and depressive symptoms (subjective well-being) as well as social support. Results In JAGES, arts and cultural group participation was associated with higher odds of life satisfaction and higher social support scores. In ELSA participants aged ≥65 years, group participation was only associated with higher depressive symptoms. But, in a sensitivity analysis with the full ELSA sample aged ≥50 years (n=5128), this association was no longer present. Instead, group participation was associated with higher social support scores. Conclusion Our findings indicate that arts and cultural group participation can enhance life satisfaction and social support in Japan, with small but more consistent benefits than in England. Facilitating participation in arts and cultural groups could help older adults to maintain a healthy social support network, which may further support their health as they age.
... The measures of gender (male, female; due to availability in Add Health) and race (White, Black, Asian/ Pacific Islander, Other; due to small numbers in non-White groups) were overly simplistic. This approach conflates experiences across diverse gender, racial, and ethnic groups, which might be particularly problematic as these groups may not have equal access to hobbies (Bone et al., 2021). Future research should use more diverse samples and collect more nuanced data on race and ethnicity, while considering the persistence of structural racism in communities, schools, and legal systems (Williams, 2012). ...
Article
Full-text available
Cross-sectional and some longitudinal evidence suggests doing hobbies can reduce substance use, but findings have been inconsistent, and whether associations differ across adolescence remains unclear. This study included 7454 Add Health participants (50% female, 77% White, age mean=14.95 and SD = 1.56). Participants were split into three groups, according to whether they were early (aged 11–14 at baseline), mid (aged 15–16), or late (aged 17–20) adolescents at baseline. The trajectories of binge drinking, marijuana, and tobacco use were analysed in latent growth models across Waves 1–5 (1994–2018). Concurrent associations between substance use and hobby engagement were tested at Waves 1–3 separately in the three age groups. 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 by Wave 3 for binge drinking and marijuana use, when participants were 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. It could explain previous inconsistent findings and demonstrates the importance of considering developmental differences when investigating engagement in hobbies.
Chapter
The adverse effects of poverty on child development are well documented and can have far reaching outcomes. This review of literature looks at the effects of poverty on child development indirectly through parenting. Positive parenting techniques are particularly important in sensitive periods of development, and negative parenting, influenced and exacerbated by the stress of poverty can set children back cognitively and emotionally. A relatively recent area of research explores the effects of creative arts engagement on the developing brain and the academic and social outcomes of children. Many of the positive benefits of arts engagement bolster areas of development that parenting plays a role in shaping. The collection of data suggests that at-risk children have the most to gain form early intervention, long-term arts education.
Article
Background Arts and cultural engagement (ACEng) is ubiquitous across every human culture since palaeolithic times, but in contemporary society, ACEng is unevenly distributed, demographically, socio-economically, geographically and politically. But what are the “determinants” of ACEng (i.e., the facilitators or barriers to people’s engagement) and how can they be optimised? Despite a large body of theory and evidence on individual determinants, this work has largely occurred in disciplinary silos, which has led variously to contrasting discourses and approaches, criticism, and inconsistent findings. What we lack is a rigorous comprehensive understanding of these determinants (both those already theorised and those that have been little recognised as determinants to date) that goes beyond descriptively showing inequalities, instead explaining why these inequalities exist and how they can be overcome. This paper explores the currently recognised determinants of ACEng, and existing theoretical approaches to these determinants. Methods Drawing on the theoretical bases of ecological systems theory, ecosocial theory and complex adaptive systems science, we conducted a review and iterative theorising process. Results We propose a new theoretical framework of the determinants of arts and cultural engagement (RADIANCE) developed through cross-disciplinary literature reviewing, domain mapping, and consensus building. Conclusions Overall, we identified 35 different factors that can act as determinants of ACEng across micro, meso, exo, macro and chrono levels. We broadly categorised these as social (i.e. a primary feature being the interaction of people), tangible (i.e. a primary feature involving physical assets or resources or the production of physical assets), and intangible (i.e. constructs that do not have a primary physical basis but instead have a virtual or imaginary basis). The relevance and implications of this framework for broader research, policy, and practice and case studies of it in use are presented.
Article
Full-text available
There is a large and growing body of evidence on the health benefits of engagement in leisure activities (voluntary, enjoyable non-work activities, such as hobbies, arts, volunteering, community group membership, sports, and socialising). However, there is no unifying framework explaining how leisure activities affect health: what the mechanisms of action are by which engagement with leisure activities leads to the prevention, management, or treatment of mental and physical illness. In this Review, we identify and map over 600 mechanisms of action. These mechanisms can be categorised as psychological, biological, social, and behavioural processes that operate at individual (micro), group (meso), and societal (macro) levels, and are synthesised into a new theoretical framework: the Multi-level Leisure Mechanisms Framework. This framework situates understanding of leisure activities within the theoretical lens of complex adaptive systems and aims to support the design of more theory-driven, cross-disciplinary studies.
Article
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Objectives Previous studies have shown the beneficial impacts of arts participation and cultural engagement on health outcomes. However, this engagement is socially patterned and is also possibly influenced by geographical factors. Study design The aim of this study was to examine the association between geographical factors (spatial setting and neighbourhood characteristics) and arts and cultural engagement amongst adults in the UK. Methods Data analysed were from Understanding Society Wave 2 (2010/12) with a total sample size of 26,215. Logistic and ordinal regression was used to identify geographical predictors for the patterns of the engagement. Results Our results show that there are geographical differences in participation independent of individual demographic and socio-economic backgrounds. In particular, there was more evidence for differences in the participation based on neighbourhood characteristics (e.g. level of area deprivation). We also found some interactions between individual and geographical factors for cultural engagement but not for arts participation. Conclusions This study reveals a geographical and individual socio-economic gradient in arts and cultural engagement. Given the health benefits of arts engagement, improving access to arts and cultural programmes geographically may potentially help to reduce health inequalities.
Article
Full-text available
Context: A significant amount of literature indicates the health benefits of arts engagement. However, as this engagement is socially patterned, differential access to and participation in the arts may contribute to social and health inequalities. Objective: This study aimed to uncover the patterns of participation in arts activities and engagement with culture and heritage among adults in the United Kingdom of Great Britain and Northern Ireland, and to examine whether such patterns are associated with demographic and socioeconomic characteristics. Methodology: We applied latent class analysis to data on arts and cultural participation among 30 695 people in the Understanding Society study. Multinomial logistic regression was used to identify predictors for the patterns of activity engagement. Results: For arts participation, adults were clustered into "engaged omnivores," "visual and literary arts," "performing arts" and "disengaged." For cultural engagement, adults were clustered into "frequently engaged," "infrequently engaged" and "rarely engaged." Regression analysis showed that the patterns of arts activity were structured by demographic and socioeconomic factors. Conclusion: This study reveals a social gradient in arts and cultural engagement. Given the health benefits of arts engagement, this suggests the importance of promoting equal access to arts and cultural programmes, to ensure that unequal engagement does not exacerbate health inequalities.
Article
Full-text available
Objectives Participation in the arts has well-documented benefits for health. However, participation in the arts is socially patterned, and it remains unclear why this is: what factors act as barriers or enablers of individual arts engagement. Therefore this study explored how individual characteristics predict individuals’ capabilities, opportunities and motivations to engage in participatory arts activities. Methods We analysed data from 6,867 adults in the UK (61.2% female, average age 46.7 years) who engage infrequently in performing arts, visual arts, design and crafts, literature-related activities, or online, digital and electronic arts. We constructed a structural equation model to explore the relationship between demographic factors (including age, sex, ethnicity or socio-economic status), health factors (including physical and mental health) or social factors (including living alone, urban density, loneliness or socialising) and perceived barriers to arts engagement. Results Individuals with poorer physical and mental health experienced more barriers affecting their perceived capabilities to engage in the arts, whilst individuals with poorer mental health also described experiencing more barriers affecting their motivations to engage. Individuals of lower SES reported more barriers in terms of opportunities to engage, whilst loneliness was related to more barriers around opportunities and motivations and living alone was associated with more opportunity barriers. Interestingly, adults who were older experienced fewer barriers relating to capabilities or opportunities, as did men, whilst being of white ethnicity was associated with fewer barriers across all three domains. Adults who were more socially engaged or who had poorer physical health experienced fewer barriers relating to motivations. Geographical area of dwelling was not related to any barriers. Conclusions This study has shown for the first time where the barriers leading to differential patterns of arts engagement lie. The findings could inform future behaviour change interventions designed to encourage arts engagement amongst individuals who are least likely to engage.
Article
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Background We examined socioeconomic inequalities in disability-free life expectancy in older men and women from England and the United States and explored whether people in England can expect to live longer and healthier lives than those in the United States. Methods We used harmonized data from the Gateway to Global Aging Data on 14,803 individuals aged 50+ from the U.S. Health and Retirement Study (HRS) and 10,754 from the English Longitudinal Study of Ageing (ELSA). Disability was measured in terms of impaired activities and instrumental activities of daily living. We used discrete-time multistate life table models to estimate total life expectancy and life expectancy free of disability. Results Socioeconomic inequalities in disability-free life expectancy were of a similar magnitude (in absolute terms) in England and the United States. The socioeconomic disadvantage in disability-free life expectancy was largest for wealth, in both countries: people in the poorest group could expect to live seven to nine fewer years without disability than those in the richest group at the age of 50. Conclusions Inequalities in healthy life expectancy exist in both countries and are of similar magnitude. In both countries, efforts in reducing health inequalities should target people from disadvantaged socioeconomic groups.
Article
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Brazil is characterized by a sharp consumption market and cultural activities across its distinct locations and social groups. With this in mind, this paper focuses on the relationship between supply of cultural facilities in Brazilian Metropolitan Regions (MR) and household expenditure on outdoor cultural activities through estimation of a two-stage (households and MRs) multilevel logistic model, using microdata from the Brazilian Consumer Expenditure Survey of 2002–2003 and 2008–2009. It was concluded that there is a strong concentration of expenditure distribution among different socioeconomic groups, and that expenditures on outdoor cultural activities (movies, concerts and arts) have demonstrated to be weakly correlated with the qualities of the different study Brazilian MRs, because greater variability of expenditure occurs within these regions. Thus, we also confirmed the hypothesis that recent advances in cultural policies have not been enough to reverse the inertia of inequality. Therefore, public initiatives in favor of cultural democratization, especially for inclusion of lower classes in cultural spaces, should consider the issue comprehensively, combining institutional supply issues, urban policy and public education.
Article
We are not all in this together. My 32-year history with the HIV/AIDS epidemic in the United States—initially as an HIV/AIDS policy analyst and now as an HIV-prevention researcher—has provided the dubitable opportunity to witness how adroitly deadly viruses spotlight fissures of structural inequality. In the late 1980s, “changing face” was the term often used to describe the epidemic’s transition from one that affected predominantly White and class-privileged gay and bisexual men to one that exacted a disproportionate toll on people at the most marginalized demographic intersections: Black and Latinx gay and bisexual men, cisgender and transgender women, injection drug users, and poor people. (Am J Public Health. Published online ahead of print May 28, 2020: e1–e2. doi:10.2105/AJPH.2020.305766)