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Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: The HUNT study, Norway


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Cultural participation has been used both in governmental health policies and as medical therapy, based on the assumption that cultural activities will improve health. Previous population studies and a human intervention study have shown that religious, social and cultural activities predict increased survival rate. The aim of this study was to analyse the association between cultural activity and perceived health, anxiety, depression and satisfaction with life in both genders. The study is based on the third population-based Nord-Trøndelag Health Study (2006-2008), including 50,797 adult participants from Nord-Trøndelag County, Norway. Data on cultural activities, both receptive and creative, perceived health, anxiety, depression and satisfaction with life were collected by comprehensive questionnaires. The logistic regression models, adjusted for relevant cofactors, show that participation in receptive and creative cultural activities was significantly associated with good health, good satisfaction with life, low anxiety and depression scores in both genders. Especially in men, attending receptive, rather than creative, cultural activities was more strongly associated with all health-related outcomes. Statistically significant associations between several single receptive, creative cultural activities and the health-related outcome variables were revealed. This population-based study suggests gender-dependent associations between cultural participation and perceived health, anxiety, depression and satisfaction with life. The results support hypotheses on the effect of cultural activities in health promotion and healthcare, but further longitudinal and experimental studies are warranted to establish a reliable cause-effect relationship.
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Patterns of receptive and creative cultural activities
and their association with perceived health, anxiety,
depression and satisfaction with life among adults:
the HUNT study, Norway
Koenraad Cuypers,
Steinar Krokstad,
Turid Lingaas Holmen,
Margunn Skjei Knudtsen,
Lars Olov Bygren,
Jostein Holmen
Background Cultural participation has been used both in
governmental health policies and as medical therapy,
based on the assumption that cultural activities will
improve health. Previous population studies and a human
intervention study have shown that religious, social and
cultural activities predict increased survival rate. The aim
of this study was to analyse the association between
cultural activity and perceived health, anxiety, depression
and satisfaction with life in both genders.
Methods The study is based on the third
population-based Nord-Trøndelag Health Study
(2006e2008), including 50 797 adult participants from
Nord-Trøndelag County, Norway. Data on cultural
activities, both receptive and creative, perceived health,
anxiety, depression and satisfaction with life were
collected by comprehensive questionnaires.
Results The logistic regression models, adjusted for
relevant cofactors, show that participation in receptive
and creative cultural activities was significantly
associated with good health, good satisfaction with life,
low anxiety and depression scores in both genders.
Especially in men, attending receptive, rather than
creative, cultural activities was more strongly associated
with all health-related outcomes. Statistically significant
associations between several single receptive, creative
cultural activities and the health-related outcome
variables were revealed.
Conclusion This population-based study suggests
gender-dependent associations between cultural
participation and perceived health, anxiety, depression
and satisfaction with life. The results support hypotheses
on the effect of cultural activities in health promotion and
healthcare, but further longitudinal and experimental
studies are warranted to establish a reliable
causeeeffect relationship.
Previous population studies
and a human inter-
vention study
have shown that religious, social
and cultural activities predict increased survival rate
and good health.
A challenge for research is the inconsistent
concept of culture. Unesco has dened the concept
of culture enclosing not only art or literature, but
also lifestyle, including physical activity, ethics,
human rights and spiritual convictions.
studies emphasise the importance of cultural
capital in the distribution of health.
In his review on the biomedical effects of art
therapies, Pratt
introduced the term creative
cultural activities. In creative cultural activities, the
individuals are actively engaging in a creative
process, typically singing, playing an instrument or
painting. Creative cultural activities include also
social activities such as clubs, parish work and
various physical challenging cultural activities. On
the other hand, according to the study of Turpin,
receptive cultural activities might be activities
where the individuals are receiving some kind of
impressions or experiences without self-doing.
Typically, receptive cultural activities are visiting
museums, art exhibitions, concerts or theatres.
Thus, in the present study, cultural activity is
divided into receptive and creative activity.
Only a few studies have included leisure-time
physical activity in the concept of culture. It has
rather been used as a confounder.
According to the
General Social Survey in 1993,
we choose to
dene physical leisure-time activities in the present
study as cultural activities.
The concept of health is not consistent. Research
has mostly focused on the relationship between
physical activity and other cultural activities and
perceived health,
and cancer.
accordance with Unescosdenition of health,
might also be important to explore the associations
between cultural activities and anxiety and
depression, and between cultural activities and
satisfaction with life (SWL).
Despite the positive association between cultural
activity and health in some studies, there are still
many gaps in the knowledge of cultural activity
and its impact on health.
12 16
In this large population-based Nord-Trøndelag
Health (HUNT) Study, cultural activity and a large
number of health factors were measured.
To the
best of our knowledge, no previous study has
examined the relationship between participation in
receptive and creative cultural activities, and
perceived health (PH), anxiety (Anx), depression
(Dep) and SWL. The aim of this study was there-
fore to analyse such associations with a focus on
possible gender differences.
The data were drawn out from the HUNT Study,
a population-based study of the Nord-Trøndelag
County, Norway. Nord Trøndelag County
(n¼130 000) has a homogenous population and has
Nord-Trøndelag Health Study
Research Center, Levanger,
Department of Public Health
and General Practice, Faculty of
Medicine, Norwegian University
of Science and Technology,
Trondheim, Norway
Psychiatric Department,
Levanger Hospital,
Nord-Trøndelag Health Trust,
Department of Health
Promotion, Nord-Trøndelag
Fylkeskommune, Steinkjer,
Department of Bioscience and
Nutrition, Karolinska Institutet,
Stockholm, Sweden
Department of Community
Medicine and Rehabilitation,
˚University, Umea
Correspondence to
Koenraad Cuypers,
Nord-Trøndelag Health Study
Research Center, Norwegian
University of Science and
Technology, Skjesol Østre,
˚senfjord 7632, Norway;
Accepted 24 March 2011
Cuypers K, Krokstad S, Lingaas Holmen T, et al.J Epidemiol Community Health (2011). doi:10.1136/jech.2010.113571 1 of 6
Research report
a geographical, demographical and occupational structure fairly
representative of the whole of Norway, though lacking a large
The average income and mean educational level are
slightly lower than the national average. The socio-economic
inequality in mortality in the region is at the national level.
18 19
The third survey of the HUNT study (HUNT 3) was
performed in 2006e2008. All citizens in the county aged 13 and
older were invited for a health examination. In the present study,
the 50 797 adult participants (females: 27 754; males: 23 043)
aged 20 years and older were included (overall 54% response rate,
64% in the age groups 40e69). Data were collected by compre-
hensive questionnaires. Questionnaire 1, personally mailed to
each individual, contained three pages, including questions on
PH, physical and mental health, life habits and others (http:// The participants were requested to ll in
questionnaire 1 prior to attending the screening site. Question-
naire 2, including questions about cultural participation, was
given to the attendants after the clinical examinations, asking
them to ll in the questionnaire at home and return it by post.
Participants who completed both Q1 and Q2, and yielded valid
data for constructing indices for receptive and creative activities),
were included in the present study.
Cultural participation
To compute the index for receptive cultural activities, 19 736
females and 15 937 males were included. To compute the index
for the creative cultural activities, 18 906 females and 15 494
males were included.
Receptive cultural participation was assessed by asking the
respondents in separate questions How often in the last
6 months have you been to a museum or art exhibition,
a concert/theatre/lm, a church/chapel, sport-events?The
response alternatives were for all: more than three times
a month, 1e3 times a month, 1e6 times in the last 6 months, or
never.For each cultural activity, the response alternative was
quantied with 1 (never) to 4 (more than three times a month).
Creative cultural activities were assessed by asking in separate
questions: How many times in the last 6 months have you
participated in the following: an association activity or club
meeting, music/singing/theatre, parish work, outdoor activities,
dance, worked out/sports?The response alternatives were:
More than once a week, once a week, 1e3 times a month, 1e5
times in the last 6 months, and never.For each cultural activity,
the response alternative was quantied with 1 (never) to 5 (more
than once a week).
One index for the different receptive (range 4e16) and one for
the different creative (range 6e30) cultural activities were
computed by summing the score for each question. The indices
reect the frequency of participation in the different cultural
Two additional indices were created by summing all different
activities (receptive and creative separately), which the respon-
dents had attended. These indices reect the total number of
different receptive (range 0e4) and creative (range 0e6) cultural
activities in the last 6 months. A respondent who reported
attending all four receptive cultural activities obtained a score of
4, while a respondent who reported participation in all six
creative cultural activities obtained a score of 6.
Outcome variables
Perceived health
Perceived health (PH) was assessed by the question, How is
your health at the moment?with the response alternatives:
very good,’‘good,’‘not so goodand poor.The variable was
dichotomised into one category (coded as 1) very goodand
goodcombined, and a second category (coded as 0) combining
not so goodand poor.
The distribution of PH was similar in those who responded
only to Q1 and those responding to both Q1 and Q2.
Satisfaction with life
Respondents were asked: Thinking about your life at this
moment, would you say that you by and large are satised with
life, or are you mostly dissatised?The response alternatives
were: Very satised,’‘satised,’‘somewhat satised,’‘a bit of
both,’‘somewhat dissatised,’‘dissatisedand very dissatis-
ed.The variable was dichotomised into the categories 1, very
satised, satised and somewhat satised,and 0, including a bit
of both, somewhat dissatised, dissatised, very dissatised.
The responses on SWL by the participants only in Q1 and
those in both Q1 and Q2 were similarly distributed.
Anxiety and depression
Anxiety and depression were measured in Q2 by the Hospital
Anxiety and Depression scale (HADS) (range 0e42). This was
divided into two subscales, HADS-A (anxiety) and HADS-D
(depression) according to previous studies.
20 21
Both scores for
depression and anxiety were recoded into low, 0 (rating 0e7),
and high, 1 (rating 8e42).
Other health variables
The respondents were asked whether they suffered from
a chronic disease which reduced their daily functioning (yes¼1,
no¼0) and whether they had any physical or emotional prob-
lems which limited their social life (Not at all/very little/some-
what/much/was not able to socialise). Physical leisure-time
activity was measured by asking. How frequently do you exer-
cise?1, 2e3 times/week or more, and 0, once/week or less.
Other variables included were daily smoking (1: no; 0: yes),
frequency of alcohol consumption (1: few times/year; 0: weekly).
Socio-economic status (SES) was measured reclassifying the rst
digit in the Norwegian occupation classication (STYRK) into
an approximation to the Erikson Goldthorpe Portocarero social
class scheme
(A: higher-grade professionals; B: lower-grade
professionals; C: non-manual employees; D: small proprietors; E:
artisans and farmers; F: lower-grade technicians, and unskilled
Statistical methods
In separate models, a multiple univariate binary logistic regres-
sion was used to examine the relationships between each
cultural activity and the dependent variables (PH, SWL, anxiety/
depression), controlled for all relevant cofactors (age, SES,
health-related cofactors: chronic disease, limitation in social
contact; and other lifestyle cofactors: physical activity, daily
smoking, body mass index and alcohol consumption).
Multiple univariate binary logistic regression was used to
study the association between the receptive and creative cultural
indices, and PH, SWL and anxiety/depression. In the rst model,
the association was adjusted for age. In the second model, SES,
chronic disease and limitation in social contact were also added.
In the third model, all covariates, also including physical
activity, daily smoking, body mass index and alcohol, were
entered simultaneously to adjust for eventual confounding.
Gender-specic models were performed owing to signicant
interactions between gender and both indices for the receptive
and creative cultural activities in the different models. SPSS
version 16 was used.
2 of 6 Cuypers K, Krokstad S, Lingaas Holmen T, et al.J Epidemiol Community Health (2011). doi:10.1136/jech.2010.113571
Research report
In total, 17 932 women and 14 928 men had completed data on
both the receptive and creative variables. More men than women
reported good/very good PH and low anxiety, while depression
and SWL were distributed equally among genders (table 1).
Analyses showed that more people participated in creative
than in receptive cultural activities, and this was the case in
both genders, and all age- and SES groups. The participation (less
than once/month) in both receptive and creative cultural
activities was strongly age-dependent, increasing from the
youngest age group up to the age group 40e49, and then
successively decreasing by age. The participation decreased by
lower SES. A similar pattern was seen regarding participation in
the number of different cultural activities (data not shown).
Figure 1 (A and B) shows in more detail the association
between cultural participation and SES, illustrating that cultural
participation was especially high in the two highest SES groups
and in the young and middle-aged groups, while declining in the
oldest age groups and the lower SES groups.
Socio-economic groups are dened into six scales from the
Erikson Goldthorpe Portocarera social class scheme: A, higher-
grade professionals, managers in large industrial establishments;
B, lower-grade professionals, higher-grade technicians, supervi-
sors of non-manual employees; C, non-manual employees,
higher and lower grade; D, small proprietors, farmers and self-
employed workers in primary production; E, lower-grade tech-
nicians, supervisors of manual workers and skilled manual
workers; F, unskilled workers, agricultural workers.
The descriptive data (table 2) revealed that the number of
participants reporting respectively good health, good satisfaction
with life, low anxiety and low depression increased in relation to
increasing number, and frequency of, participation in different
cultural activities. SWL, low anxiety and low depression showed
similar patterns.
Single receptive and creative cultural activities
Perceived health
Fully adjusted univariate binary logistic regression models,
testing the single components of receptive and creative cultural
activities, revealed that for receptive cultural activities, only one
activity (attending a sport event) was associated with good/very
good health in women. In men, however, all receptive cultural
activities were statistically signicant associated with good/very
good health (table 3).
Active participation in creative cultural activities (association
activity or club meeting, music, singing, theatre, outdoor activi-
ties, dance and working out/sports) was associated with good/
very good health in women. In men, in contrast, participation in
parish work was signicantly associated with good/very good
health, in addition to participation in association meeting,
outdoor activities, dance and working out/sports (table 3).
Satisfaction with life
The following receptive cultural activities were associated with
good SWL: been to church, and sports event in women. In men,
attendance for all receptive cultural activities was signicantly
associated with good SWL (table 3). In women, the following
creative cultural activities were statistically associated with
Table 1 Participants in the third survey of the Nord-Trøndelag Health
Study (2006e2008) with complete answers on all questions about
receptive and creative cultural activity*
Female n: 17932 Male n: 14928
n% n%
Age groups
20e29 1732 10 977 7
30e39 2812 16 1752 12
40e49 3825 21 3040 20
50e59 4023 22 3746 25
60e69 3219 18 3225 22
70e79 1678 9 1666 11
80+ 643 4 522 4
Perceived health
Not so good/poor 4643 27 3339 23
Very good/good 12636 73 11116 77
High score 2284 13 1281 9
Low score 15140 87 13255 91
High score 1688 10 1482 10
Low score 15665 90 13030 90
Satisfaction with life
Bit of both/very dissatisfied 2365 13 1766 12
Very satisfied/somewhat
15207 87 12848 88
The variation in the number of respondents on perceived health, anxiety, depression and
satisfaction with life is due to missing data.
*Data shown are number and percentage of female and male respondents, distributed in age
groups and responses about perceived health, anxiety, depression and satisfaction with life.
Figure 1 Relationship age groups, socio-economic groups and amounts
of different receptive cultural activities in females (A) and males (B).
Cuypers K, Krokstad S, Lingaas Holmen T, et al.J Epidemiol Community Health (2011). doi:10.1136/jech.2010.113571 3 of 6
Research report
high SWL: participation in association meeting, music, singing,
theatre, outdoor activity, dance, and working out/sports. Men
who participated actively in association meeting, outdoor
activity, dance, workout and sports reported a signicantly
good SWL.
The receptive cultural activities been to museum, art exhibition,
concert, theatre, lm and sports events, in women, and all
receptive cultural activities, including been to church/chapel, in
men, were associated with low anxiety scores (table 3). In
Table 2 Cultural activities by perceived health, satisfaction with life, anxiety and depression in both
genders combined
good health
with life
Low anxiety
Low depression
n: 31734, % n: 32185, % n: 31960, % n: 31866, %
Receptive cultural activities
1 activity/6 months 69.3 84.8 86.1 87.2
2 different activities/6 months 77.0 87.0 89.4 91.6
3 different activities/6 months 81.1 90.3 91.5 93.2
4 different activities/6 months 84.0 91.4 92.6 94.0
Creative cultural activities
1 activity/6 months 66.3 84.1 85.7 86.5
2 different activities/6 months 74.6 85.8 88.2 90.1
3 different activities/6 months 79.7 89.0 90.9 92.5
4 different activities/6 months 83.5 91.0 91.9 93.7
5 different activities/6 months 83.9 91.0 92.5 94.1
Index receptive cultural activities
Never 71.8 85.7 87.4 88.6
1e6 times/6 months 82.1 90.6 92.2 93.6
1e3 times/month 81.8 92.3 90.8 92.2
Index creative cultural activities
Never 68.1 84.8 86.5 87.2
1e5 times/6 months 81.4 89.4 91.1 92.9
1e3 times/month 85.5 91.4 93.3 94.4
Data shown are percentages reporting very good/good health, very satisfied/satisfied/somewha t satisfied with life, low anxiety score
(<8) and low depression score (<8), using the Hospital Anxiety and Depression scale.
Table 3 Associations between each receptive, creative cultural activity and good perceived health, good satisfaction with life, low anxiety and low
Good health Good satisfaction with life
Female Male Female Male
OR (95% CI) p Value OR (95% CI) p Value OR (95% CI) p Value OR (95% CI) p Value
Receptive cultural activity
Museum/art exhibition 1.10 (1.02 to 1.18) 0.11 1.14 (1.04 to 1.25) 0.005 1.02 (0.94 to 1.10) 0.67 1.10 (1.00 to 1.22) 0.05
Concert/theatre/film 1.04 (0.98 to 1.11) 0.26 1.14 (1.06 to 1.22) 0.001 1.02 (0.95 to 1.09) 0.62 1.16 (1.06 to 1.26) 0.001
Church/chapel 1.01 (0.95 to 1.07) 0.79 1.11 (1.03 to 1.18) 0.003 1.20 (1.12 to 1.28) 0.0005 1.28 (1.19 to 1.39) 0.0005
Sports event 1.07 (1.02 to 1.13) 0.01 1.10 (1.04 to 1.16) 0.001 1.21 (1.15 to 1.29) 0.0005 1.29 (1.21 to 1.38) 0.0005
Creative cultural activity
Association/club meeting 1.09 (1.04 to 1.14) 0.0005 1.12 (1.08 to 1.18) 0.0005 1.17 (1.11 to 1.23) 0.0005 1.11 (1.06 to 1.17) 0.0005
Music/singing/theatre 1.07 (1.03 to 1.13) 0.002 1.01 (0.97 to 1.06) 0.60 1.06 (1.01 to 1.12) 0.01 1.00 (0.95 to 1.05) 0.96
Parish work 1.06 (0.98 to 1.16) 0.15 1.20 (1.07 to 1.34) 0.002 1.09 (0.99 to 1.20) 0.09 1.06 (0.95 to 1.19) 0.32
Outdoor activity 1.08 (1.05 to 1.12) 0.0005 1.12 (1.08 to 1.17) 0.0005 1.08 (1.04 to 1.12) 0.0005 1.06 (1.01 to 1.11) 0.01
Dance 1.14 (1.08 to 1.21) 0.0005 1.09 (1.02 to 1.18) 0.02 1.14 (1.07 to 1.21) 0.0005 1.12 (1.03 to 1.22) 0.01
Workout/sports 1.06 (1.03 to 1.10) 0.0005 1.13 (1.09 to 1.17) 0.0005 1.08 (1.04 to 1.11) 0.0005 1.08 (1.03 to 1.12) 0.0005
Low anxiety score Low depression score
Receptive cultural activity
Museum/art exhibition 1.09 (1.01 to 1.19) 0.03 1.13 (1.01 to 1.27) 0.03 1.13 (1.03 to 1.24) 0.01 1.33 (1.20 to 1.50) 0.0005
Concert/theatre/film 1.14 (1.06 to 1.22) 0.0005 1.28 (1.16 to 1.41) 0.0005 1.21 (1.12 to 1.32) 0.0005 1.39 (1.27 to 1.52) 0.0005
Church/chapel 1.04 (0.97 to 1.10) 0.31 1.14 (1.04 to 1.25) 0.003 1.11 (1.03 to 1.19) 0.007 1.03 (0.95 to 1.11) 0.52
Sports event 1.18 (1.11 to 1.25) 0.0005 1.21 (1.12 to 1.30) 0.0005 1.10 (1.03 to 1.18) 0.006 1.11 (1.04 to 1.19) 0.002
Creative cultural activity
Association/club meeting 1.18 (1.12 to 1.24) 0.0005 1.16 (1.10 to 1.23) 0.0005 1.12 (1.06 to 1.19) 0.0005 1.18 (1.12 to 1.25) 0.0005
Music/singing/theatre 1.03 (0.98 to 1.08) 0.21 1.04 (0.98 to 1.10) 0.20 1.03 (0.98 to 1.09) 0.31 1.08 (1.02 to 1.15) 0.005
Parish work 1.05 (0.96 to 1.16) 0.29 0.98 (0.86 to 1.10) 0.69 1.06 (0.95 to 1.18) 0.34 1.07 (0.95 to 1.20) 0.29
Outdoor activity 1.09 (1.05 to 1.13) 0.0005 1.08 (1.03 to 1.13) 0.003 1.09 (1.04 to 1.14) 0.0005 1.09 (1.04 to 1.14) 0.0005
Dance 1.11 (1.05 to 1.18) 0.0005 1.07 (0.97 to 1.18) 0.16 1.10 (1.03 to 1.18) 0.005 1.06 (0.97 to 1.15) 0.20
Workout/sports 1.07 (1.04 to 1.11) 0.0005 1.10 (1.05 to 1.15) 0.0005 1.08 (1.04 to 1.12) 0.0005 1.11 (1.06 to 1.15) 0.0005
Data shown are adjusted OR and 95% CI from a logistic regression model relating each receptive and creative cultural activity to good health (1: very good, good; 0: not so good, poor), good
satisfaction with life (1: very satisfied, satisfied, somewhat satisfied; 0: bit of both, somewhat dissatisfied, dissatisfied, very dissatisfied), low anxiety score (1: low; 0: high), and low depression
score (1: low; 0: high). The models are adjusted for age, socio-economic status, chronic disease, limitation in social contact, physical exercise, daily smoking, body mass index and alcohol consume.
4 of 6 Cuypers K, Krokstad S, Lingaas Holmen T, et al.J Epidemiol Community Health (2011). doi:10.1136/jech.2010.113571
Research report
women, participation in association meetings, outdoor activi-
ties, dance and working out/sports were signicantly associated
with low anxiety scores. Men, participating in association
meetings, outdoor activities and working out/sports reported
lower anxiety scores.
Attendance for each individual receptive cultural activity was
signicantly associated with low depression scores in women.
In men, three receptive cultural activities (been to museum/
exhibition, been to concert, theatre, lm and sports event) were
associated with low depression scores. Women who participated
in association meetings, outdoor activity, dance and working
out/sports reported lower depression scores. In men, partici-
pating in association meetings, music, singing, theatre, outdoor
activity and working out/sports was signicantly associated
with lower depression scores (table 3).
Indices of cultural activities
In both women and men, both indices of receptive cultural
activities and creative cultural activities were signicantly
associated with good health, good SWL, low anxiety and low
depression after adjusting for all confounders (table 4). At rst,
the effect estimates for the association between the indices of
cultural activities and good SWL, low anxiety and depression
increased when adjusted for age and then decreased after further
adjusting for the other co-variables.
These data showed that in both women and men, participation
in both receptive and creative cultural activities was associated
with good health, good SWL, a low anxiety score and a low
depression score, when adjusted for socio-economy and other
relevant cofactors. In both women and men, a doseeresponse
effect was indicated. The frequency of cultural participation and
the number of different activities were positively associated
with good health, SWL, a lower anxiety score and a lower
depression score. The study revealed that men who engaged
specically in receptive, rather than creative, cultural activities
reported better health-related outcomes.
As expected, cultural participation was strongly associated
with socio-economy. An important question was whether the
association between cultural participation and PH, anxiety,
depression and SWL was due to socio-economy or other
confounding factors. However, after adjusting for relevant
confounding factors, it seemed that cultural participation was
independently associated with good health, a low depression
score and SWL dependent on gender.
Our results may be in concordance with Katz-Gerro,
stated that the relationship between health and socio-economy
may not be fully explained by better access to healthcare, work
conditions, social ties and health behaviours. Wilkinson
similar tendencies in the distribution of cultural attendance in
relation to social variables and physical activity.
These data showed, in concordance with Cuypers,
that a high participation in receptive and/or creative
cultural activities may induce a higher engagement in physical
activities (data not shown). Thus, it is possible that attending
cultural events may serve as a marker for a healthy lifestyle.
On the other hand, it seems that attending receptive cultural
activities is associated less with good health than participating
in creative cultural activities in women. This may indicate that
for women, it is the difference in how they perceive their health
as to whether they attend receptive or creative cultural activi-
ties. Or this may express a gender-dependent difference in the
effect of the receptive cultural activities.
Several other studies have also demonstrated an association
between cultural activities and health. In concordance with the
present study, Bygren
2 15
and Wilkinson
also demonstrated
a positive association between different cultural activities and
health outcome. Konlaan
found a positive effect on longevity
by attending art, museum, cinema and concert. Iwasaki
that relaxing leisure (listening music, reading, TV) was the
strongest positive predictor of coping with stress, while social
leisure (being with friends, social activities) and cultural leisure
(attending concerts, ballet, theatre and museums) predicted
better mental and PH.
In contrast with other studies where gender has often been
handled as a confounding factor,
2 5
we established an interaction
between participation in cultural activities and gender. We
found, in agreement with the study of Hyyppä,
clear gender-
dependent effects of participation in different cultural activities.
Furthermore, our study shows a slight but consistent stronger
relationship between the receptive cultural activities and
SWL, anxiety and depression in both women and men.
However, the association in women between creative cultural
activities seemed to be stronger with PH. By contrast, in men
the relationship between the participation in receptive cultural
activities and PH is stronger than the relationship between the
creative activities and PH. This may indicate a distinctive
difference between the effects (doseeresponse) of participation
in receptive and creative cultural activities.
and others
suggest that psycho-neuro-immu-
nological theories may be of interest when trying to explain the
effects of participating in cultural activities. Konlaan et al
found that physical exercise improved blood lipids, and cultural
participation improved blood pressure and prolactin. A possible
pathway of the positive inuences of participating in cultural
activities may be found in the stress reduction that decreases
the oxidative DNA damage and the formation of 8-hydrox-
ydeoxyguanosine, elevated levels of which are linked to the
development of disease.
The strength of this study is that the data allow the effects of
cultural participation to be studied as part of a general health
Table 4 Associations between the cultural activities index and good
health, good satisfaction with life, low anxiety and low depression in
both genders
Female Male
OR (95% CI) OR (95% CI)
Good health
Index receptive cultural activities 1.03 (1.01 to 1.06) 1.09 (1.06 to 1.12)
Index creative cultural activities 1.05 (1.03 to 1.07) 1.07 (1.05 to 1.09)
Good satisfaction with life
Index receptive cultural activities 1.08 (1.05 to 1.11) 1.14 (1.10 to 1.18)
Index creative cultural activities 1.06 (1.04 to 1.07) 1.04 (1.02 to 1.06)
Low anxiety
Index receptive cultural activities 1.09 (1.05 to 1.12) 1.13 (1.09 to 1.17)
Index creative cultural activities 1.06 (1.04 to 1.07) 1.06 (1.04 to 1.08)
Low depression
Index receptive cultural activities 1.10 (1.06 to 1.13) 1.12 (1.08 to 1.16)
Index creative cultural activities 1.05 (1.04 to 1.07) 1.07 (1.06 to 1.09)
Data shown are adjusted OR with 95% CI from a stepwise multivariable logistic regression
model (adjusted for age, SES, chronic disease, limitation in social contact, and physical
exercise, daily smoking, body mass index, alcohol drinking) relating index receptive and
creative cultural activities to respectively perceived health (1: very good, good; 0: not so
good, poor), satisfaction with life (1: very satisfied/satisfied/somewhat satisfied; 0: bit of
both/somewhat dissatisfied/dissatisfied/very dissatisfied), anxiety (1: low; 0: high) and
depression (1: low; 0: high).
Cuypers K, Krokstad S, Lingaas Holmen T, et al.J Epidemiol Community Health (2011). doi:10.1136/jech.2010.113571 5 of 6
Research report
study with a large number of participants and with generally
high attendance rates in the middle age groups. Additionally, we
have operationalised a large number of different cultural activi-
ties, which has increased the participation rate in all layers of the
population. This method gives the best possible and broadest
overview over the cultural activity patterns of a population.
Furthermore, the study documents how the frequency in
participation and each individual cultural activity are associated
with not only PH but also other determinants of well-being,
adjusted for several possible confounding cofactors.
The associations between cultural participation and public-
health outcomes are probably more complicated than any study
design and range of variables might grasp. The measurement of
the social phenomenon is complicated. Another weakness is the
problem with evaluating the weighting of each item in
combined variables such asconcert/cinema and in the index for
creative cultural activities: physical activities and organisations,
theatre. We do not know exactly which cultural activity of the
subgroups the answer refers to.
Being cross-sectional, this study cannot determine causee
effect relationships. Another question to be put forward is the
clinical relevance of the results of this study. Although, the ORs
are very small and the CIs narrow, small changes at the popu-
lation level, however, can lead to large effects on disease risk.
There might also have been a vague selection bias. In this study,
participants had to be able to attend the screening site and be able
to ll in questionnaires, so the very sick, for example, bed-ridden
patients, could not attend. Also, the very sick cannot participate
easily in cultural life. On the other hand, we can imagine that
the slightly sick might have abundant time to participate in
cultural activities and participated in the survey. Additionally,
individuals with very good health cannot improve their health
much, but may strengthen it, thus preventing ill health. This
may be difcult to measure in the context of this kind of study.
This population-based study suggests gender-dependent associ-
ations between cultural participation and PH, anxiety, depres-
sion and SWL. The results indicate that the use of cultural
activities in health promotion and healthcare may be justied.
On the other hand, the limitations of this study implicate that
further longitudinal and experimental studies are warranted to
establish the causeeeffect relationship.
Acknowledgements The Nord-Trøndelag Health (HUNT) Study is a collaboration
between HUNT Research Center (Faculty of Medicine, Norwegian University of
Science and Technology (NTNU)), Nord-Trøndelag County Council and The
Norwegian Institute of Public Health.
Funding Public County Council Nord Trondelag, Norway.
Competing interests None.
Ethics approval Ethics approval was provided by the Norwegian Data Inspectorate,
The Directorate of Health and the Regional Committee for Medical Research Ethics.
Contributors All coauthors contributed equally in the development and writing of the
Provenance and peer review Not commissioned; externally peer reviewed.
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What is already known on this subject
<Previous population studies and a human-intervention study
have shown that religious, social and cultural activities predict
increased survival rate.
What this study adds
<This study revealed a gender-dependent association between
participation in cultural activities and good health, low
anxiety- and depression scores, and satisfaction with life in
a population.
<Receptive cultural activities seem to have a stronger
association with perceived health, anxiety, depression and
satisfaction with life than the creative cultural activities.
6 of 6 Cuypers K, Krokstad S, Lingaas Holmen T, et al.J Epidemiol Community Health (2011). doi:10.1136/jech.2010.113571
Research report
... Other evidence for the role of arts engagement in life satisfaction comes from observational studies. Cross-sectionally, there is extensive evidence that many forms of arts engagement are associated with enhanced life satisfaction, including dancing and attending cultural events, art clubs, museums, and heritage sites (37)(38)(39)(40)(41)(42). Longitudinally, visiting heritage sites, museums, galleries, and other cultural events has been associated with higher life satisfaction three years later (43). ...
... Participating in the arts may also enhance resilience, another form of subjective wellbeing that describes one's ability to recover from or adjust easily to change, through processes such as supporting coping, buffering stress, reducing catastrophising and suicidal ideation, and managing grief. Scoping reviews have outlined evidence for using the arts to support coping, including theatre arts and dramatic play for children to learn how to cope with adversities (35); use of musical activities, particularly listening to music, to cope with stress during adolescence (36); music interventions to reduce coping anxiety in people with cancer (37); and expressive arts such as music, movement, art making, and drama to cope with loss (38). However, several of these reviews have concluded that further evidence is needed, including from high-quality trials and longitudinal studies including more representative samples. ...
... A second framework for distinction considers the level of interaction present in each activity, such that activities can involve low levels of interaction (i.e., receptive) or high levels of interaction (i.e., active). This conceptual framework (receptive vs. active) was initially developed and validated within arts education (Burns et al., 2020;Cuypers et al., 2012;Martin et al., 2013) and has clear alignments with multiple classification frameworks developed in science education (discussed below; Dabney et al., 2012;Dou et al., 2019;Nazier, 1993). Because nomenclature varies across these previously developed frameworks, a contribution of this study is the development of an integrated framework that offers conceptual clarity about how the level of interaction present in unstructured out-ofschool science activities can be considered as either receptive or active. ...
... As noted above, nomenclature of discussing the level of interaction within an unstructured activity has varied across prior research. Despite this, there are clear alignments between the description and categories of activities identified in science education research (Dabney et al., 2012;Dou et al., 2019;Nazier, 1993) and the well-established labels of receptive and active developed in arts education (Burns et al., 2020;Cuypers et al., 2012;Martin et al., 2013). Nazier (1993) identified "hobbies" as a category of unstructured activities, which included activities such as "making and taking things apart" and "chemistry sets" (p. ...
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Students' out‐of‐school science participation has been identified as a factor that supports adaptive science outcomes. Researchers have largely investigated students' out‐of‐school science participation in terms of structured science activities (e.g., attending a science camp), with far less consideration of how students' involvement in unstructured out‐of‐school science activities (e.g., using at‐home science kits) may also be associated with students' aspirations and achievement in science. Research in this area has established a conceptual framework by which activities can be categorized by the activity's level of interaction (i.e., whether receptive or active). Although this conceptual framework is useful to understand the types of unstructured activities in which students engage, this research has tended to overlook the fact that students often participate in more than one out‐of‐school unstructured activity. The present investigation addressed this dearth of research by examining the extent to which different typologies of student participation in out‐of‐school receptive and active unstructured activities existed. The study also examined if these profiles were uniquely associated with students' aspirations and achievement in science above and beyond the effects of their current level of in‐school participation. The study employed a latent class analysis of N = 996 Australian high school students (40.60% girls) from six schools serving predominately above average socioeconomic status Australian high school students. Four distinct profiles of out‐of‐school participation in unstructured activities were found: Optimal, Receptive, Active, and Minimal Out‐of‐School Participation (OSP). The Optimal OSP and Receptive OSP profiles were associated with the higher aspirations (beyond students' in‐school participation), and both were significantly higher than the Active OSP and Minimal OSP profiles. Students' in‐school participation was most strongly associated with students' achievement. These findings suggest that encouraging students' participation in unstructured activities, especially receptive unstructured activities, and their in‐school participation may be viable avenues by which to improve students' science aspirations and achievement.
... Experiencing or viewing art, known as receptive art engagement, has also found to be associated with positive health and wellbeing. 44,45 While historically the focus in art therapy has been on active artmaking, receptive art engagement activities such as visiting galleries, museums, and exhibitions are being reported to enhance wellbeing, stimulate introspection, and enhance attention to the self. 46 This study indicates that an integration and focus on receptive engagement in AT needs to be developed for bedside sessions and medical settings, in general, especially when the client may not be able to engage in an active art making session. ...
This study aimed to investigate the feasibility of facilitating four sessions of art therapy intervention with a primary focus on implementation and acceptability. The exploratory aim was on assessing the impact of art therapy on self-reported outcomes on anxiety and mood among 5 individuals (aged 18+ years) hospitalized for burn injuries and to understand their perceptions of engagement with art therapy. A convergent mixed methods small N design was adopted wherein both quantitative and qualitative data are gathered and then integrated, and an individual served as his/her own control when assessed before and after art therapy. Anxiety was assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety short-form of the emotional distress bank, and mood was assessed using the Positive and Negative Affect Schedule (PANAS). There was a statistically significant decrease in anxiety scores and negative mood scale. Positive mood scale scores tended to improve after art therapy though were not statistically significant. Thematic analysis of qualitative data indicates that art therapy improves a) symptom management, b) facilitates emotional expression and c) insight, d) brings out symbolic and metaphorical representations, and e) allows tactile and sensory exploration of art media. This study demonstrated that art therapy can be successfully implemented with acute burn patients and can have promising psychosocial benefits. More research in needed to determine the impact and effectiveness of art therapy with burn patients, in ways that is meaningful to the patients.
... If this were the case, one might expect that the more enjoyable the experience with art is, the better improvement to aspects of wellbeing. They may be tied to shared social, communal factors (Roberts et al., 2011;Cuypers et al., 2012), escapism or removal from daily routine (see Kaplan, 1995), or even experiences of beauty as part of an aesthetic experience (Fancourt and Finn, 2019;Mastandrea et al., 2019). However, such aspects have received little attention systematically and need further research to examine which parts of art experiences are particularly important to impact wellbeing. ...
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When experienced in-person, engagement with art has been associated—in a growing body of evidence—with positive outcomes in wellbeing and mental health. This represents an exciting new field for psychology, curation, and health interventions, suggesting a widely-accessible, cost-effective, and non-pharmaceutical means of regulating factors such as mood or anxiety. However, can similar impacts be found with online presentations? If so, this would open up positive outcomes to an even-wider population—a trend accelerating due to the current COVID-19 pandemic. Despite its promise, this question, and the underlying mechanisms of art interventions and impacts, has largely not been explored. Participants (N = 84) were asked to engage with one of two online exhibitions from Google Arts and Culture (a Monet painting or a similarly-formatted display of Japanese culinary traditions). With just 1–2 min exposure, both improved negative mood, state-anxiety, loneliness, and wellbeing. Stepdown analysis suggested the changes can be explained primarily via negative mood, while improvements in mood correlated with aesthetic appraisals and cognitive-emotional experience of the exhibition. However, no difference was found between exhibitions. We discuss the findings in terms of applications and targets for future research.
Experience is one of the most important constructs in tourism and leisure and as such has received much attention in the scientific tourism and leisure literature. However, at the same time, in the same literature, there is remarkably little conceptual clarity about what exactly constitutes an experience. Recent accounts have tried to change this status quo and have suggested various constituent processes of experience that have already been pick up by various tourism and leisure researchers.This dissertation focuses on emotions as one of the crucial building blocks of experience, as emotions have been argued to be a determining factor for making leisure experiences memorable. Only when experiences are memorable, they can lead to downstream experience outcomes, such as evaluations and behavior. In particular, this dissertation focuses on the temporal dynamics of emotions over the course of tourism and leisure experiences, as it is these temporal dynamics in specific that are of relevance for an experience's memorability and thus its evaluation. The aim of the dissertation was thus to study the relationship between the temporal dynamics of emotions in a tourism and leisure experience and how this experience was evaluated. To this end, a variety of tourism and leisure experiences were examined at different timescales across four empirical studies: from an experience in its entire length (VR movie and musical theatre show) and the individual episodes within an experience (musical theatre show) to the individual events that are the ignitors of an emotional response to begin with (attending to artworks). Several research methods were used in tandem to get a more comprehensive picture of the emotional dynamics at play: from a newly developed self-report-based Experience Reconstruction Method (ERM) to fine-grained physiological measures that can measure emotions with sub-second precision from both body (skin conductance) and brain (EEG). Findings show that the temporal dynamics of emotions in tourism and leisure experiences are strongly related to evaluations of those same experiences. However, this relationship is not straightforward. First, not all episodes within an experience are equally strongly related to its overall evaluations: some are positively related to overall experience evaluations, some are negatively related and some are not related at all. In capturing the temporal dynamics of emotion throughout an entire experience, average emotion measures seem a better representation than peak-and-end related measures of emotion. However, for individual episodes within that experience, peak measures of emotion provide a better representation than average measures of emotion. In capturing these measures of emotion, both established physiological measures of emotion (i.e., skin conductance and EEG) and the newly developed ERM have their merits. ERM-based measures prevail over skin conductance measures for evaluating structured experience designs and design interventions, yet skin conductance prevails over ERM-based measures when predicting overall evaluations from the temporal dynamics of the emotions throughout an experience. Finally, approaching experience as a temporal phenomenon that can be cut into experiential episodes allows for better predicting how an experience will be evaluated than approaching experience as a single. In further enhancing our understanding of experience, it is thus wise to keep an eye on the aspect of time.
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Subculture, includes animation, comics, games (ACG), and idol fan culture, is popular among young generations in Japan. Previous studies have shown different psychological outcomes within different subcultural groups; however, underlying mechanisms remain unclear. This study proposes that subcultural identity may play a crucial role in mental health outcomes by interweaving social support and reputation. We examined the interplay between subcultural identity, social support, reputation, and different psychological outcomes through structural equation modeling (N=300). Furthermore, we trained neural networks (NN) by applying a deep learning algorithm to predict psychological outcomes of different subcultures. The results suggest identity related to anime, idol, and hip-hop was positively associated with anxiety, aggression, depressive symptoms, and suicidal tendencies. By contrast, fashion and sports identities associated with no adverse or positive psychological outcomes. Perceived reputation mediates adverse psychological outcomes in the ACG, idol, and hip-hop groups. The highest accuracy in our NN reached 71%, indicating that NN could be an effective tool for predicting mental problems. Our work points up an urgent need to improve the mental health of the young generation by de-stigmatizing discriminated cultural groups.
The mental health of young people (YP) is a major public health concern that has worsened during the COVID-19 pandemic. Whilst engaging with culture and the arts may have mental health benefits there is a dearth of experimental research regarding the impact of online arts and culture on depression and anxiety in YP. In particular online interventions, which may improve accessibility. Objective We aimed to compare a co-produced online intervention encompassing the diverse human stories behind art and artefacts, named Ways of Being (WoB), with a typical museum website, the Ashmolean (Ash) on negative affect (NA), positive affect (PA) and psychological distress (K10). Methods In this parallel group RCT, 463 YP aged 16-24 were randomly assigned, 231 to WoB and 232 to Ash. Results Over the intervention phase (an aggregate score including all post-allocation timepoints to day-five) a group difference was apparent in favour of WoB for NA (WoB-Ash n=448, NA -0.158, p=0.010) but no differences were detected for PA or K10 and differences were not detected at week six. Group differences in NA in favour of WoB were detected in specific subgroups, e.g. ethnic minorities and males. Across participants (from both groups) mean K10 and NA improved between baseline and six weeks despite increased COVID-19 restrictions. Trial recruitment was rapid, retention high and feedback positive with broad geographical, occupational and ethnic diversity. Conclusions Online engagement with arts and culture has the potential to impact on mental health in a measurable way in YP with high unmet mental health needs.
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The health–beneficial value of urban green spaces (UGS) is increasingly accepted by scholars. However, compared to the large number of studies focused on UGS–health associations, whether UGS in high-density cities could reduce public health expenditures remains less investigated. In particular, few studies have examined the association of UGS quality with health expenditures. Therefore, we conducted a cross-sectional study in downtown Shanghai to examine such associations. A population-based household survey (n = 1000) was conducted to collect relevant information about different aspects of health expenditure and the characteristics of UGS. Specifically, a new method was proposed to measure UGS quality based on the supply–demand of 20 types of UGS activities. We also measured the perceived quality of different types of UGS and quantified the amount of UGS using GIS based on remote sensing data. Regression models were applied for statistical analysis. The results showed that both UGS quality based on user needs and perceived UGS quality have a significant negative association with total health expenditures. This study provides insights for UGS quality measurement, contributes to the understanding of the health-related economic benefits of UGS, and also highlights the importance of UGS optimization in high-density urban areas.
People visit art museums for many reasons—to see something beautiful or famous, to learn more about art, or to experience a sense of awe. Recently, there has been increased interest in how art museum engagement can promote flourishing. Little is known, however, about how the professionals shaping these art museum experiences (e.g., curators, educators, front of house staff) view art museums as institutions that can promote flourishing outcomes. In the present research, we examined the perceptions of 208 art museum professionals regarding the functions of art museums and their ability to impact both well-being (e.g., empathy, self-acceptance) and ill-being (e.g., anxiety, loneliness) factors. The findings suggest that art museum professionals feel that the well-being of visitors should be emphasized as a goal more strongly than it currently is, and that there are some well-being and ill-being components (e.g., empathy, helping, closed-mindedness) that should receive greater attention than others.
Cultural activities might serve as a buffer to the negative effects of the COVID-19 pandemic on mental health. Frequencies of participants’ cultural activities in terms of participation in digital cultural offerings or self-initiated cultural activities during the pandemic are examined, and whether prior cultural engagement and valuing of culture have an impact on this participation. It is explored whether both forms of cultural activities are directly connected with psychological well-being, namely, optimism concerning COVID-19, and whether this relationship is mediated by autonomy, relatedness and aesthetic experience. Regression and mediation analysis were calculated (N = 398). Both cultural activities were related to increased aesthetic experience and perceived autonomy, but only participation in digital cultural offerings was connected to increased perceived relatedness. Relatedness, in turn, was connected to increased optimism. The results reflect the protective function of cultural activities on psychological well-being, demonstrating the importance of cultural life in times of adversity.
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This article examines the extent to which different cultural preferences are associated with occupational class and other stratifying dimensions in contemporary American society. Building on existing research that tends to analyze leisure activities and cultural tastes separately, I construct cultural profiles that combine participation in leisure activities and tastes in music. Using this method allows me to go beyond the common highbrow/lowbrow distinction. I analyze data from the 1993 culture module of the General Social Survey and find four cultural types: highbrow, popular, outdoor nature, and youth music. I discuss the association of the four culture types with different dimensions of stratification. The findings support the conclusion that, while class indeed matters, the main determinants of cultural preferences are race, gender, education, and age. /// [Spanish] Este trabajo examina el contexto en el cual las preferencias culturales están asociadas con la clase ocupacional y otras dimensiones de estratificación en la sociedad americana contemporánea. Basándome sobre una investigación existente que tiende analizar separadamente las actividades recreacionales y los gustos culturales, construyo perfiles culturales que combinan la participación de actividades recreacionales y gustos en música. La utilización de este método me permite ir más allá de la distinción intelectual y no intelectual. Analizo información del módulo de cultura de 1993 del Estudio Social General y encuentro cuatro tipos culturales: intelectual, popular, gusto por la naturaleza, y música juvenil. Discuto sobre la asociación de los cuatro tipos de cultura con dimensiones diferentes de estratificación. Los resultados apoyan una conclusión de que mientras que la clase en realidad interviene, los determinantes principales de las preferencias de cultura son raza, género, educación y edad. /// [Chinese] (Unicode for Chinese abstract). /// [Japanese] (Unicode for Japanese abstract).
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Bourdieu's (1987 [1979]) theorization of cultural capital treats attitudes, preferences, and behavior as forms of embodied cultural capital. 1 As such, these are often considered parallel forms of embodied cultural capital that receive different empirical manifestations in various works (Lamont and Lareau 1988), without attention to the implications of choosing one operationalization of cultural capital over another. In this essay we focus on two dominant measures of cultural capital in research on cultural consumption: cultural tastes, which represent preferences and cultural participation, which represents behavior. We argue a need to clarify the theoretical distinction between the two by thinking of preferences as antecedents of behavior. The literature on cultural consumption can be described as following three paths. First, studies that have used either cultural tastes or cultural participation as interchangeable indicators of cultural capital (e.g., Peterson 2005; Sullivan and Katz-Gerro 2007). Second, studies that have used tastes and participation in tandem without expecting them to perform differently (e.g., DiMaggio 1982; Lamont 1992; Erickson 1996; Kraaykamp 2002; Warde 2008). Third, more recently several discussions favor treating tastes and participation as two distinct dimensions of cultural capital (Lahire 2004; Silva 2006; Rössel 2008). While most studies in this area ignored the distinction between tastes and participation, some discussed the implications and advantages of using either tastes or participation in measuring cultural capital. Two views have emerged. The first view argues in favor of using taste because it represents a category of engagement that is more refined than participation (Silva 2006). It speaks more directly to Bourdieu's notion of cultural disposition as a form of aesthetic appreciation that depends on a trained capacity cultivated by the family and the educational system. Bourdieu's empirical approach includes many more indicators of taste than indicators of participation (Bourdieu 1984, appendix 1) and by his theoretical approach symbolic knowledge plays a more important role than conspicuous consumption.
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The concept of cultural capital is well known in museum studies from pioneering visitor research conducted and reported by Pierre Bourdieu in the 1960s. This paper examines the concept in the light of the criticism that, whilst it illuminates the dynamics of cultural consumption and inequality in advanced capitalist societies, its socio-genesis is less well understood. It is argued that the historical sociology of fine art reproduction provides an opportunity to (i) enlarge our understanding of its formation and (ii) to explore the cultural character of the copy and the sociology of the body. The paper draws on Marx's concept of primitive accumulation, on Connerton's distinction between incorporated and inscribing practices and on Bourdieu's distinction between three states of cultural capital.
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The second Nord-Trøndelag Health Study in 1995-97 (HUNT 2) was partly a follow-up study of HUNT 1, conducted in 1984-86. HUNT 2 comprised, however, a larger scientific program. The large amount of information collected from each participant, and the large number of participants in a wide age range covering an entire county population, make HUNT one of the largest health studies ever performed. This paper describes the survey covering persons aged 20 years and older. In total, 66.7% of men (n=30,860) and 75.5% of women (n=35,280) participated, the highest participation was in age group 60-69 and the lowest among the young and the elderly. Data collected from several questionnaires and with blood and urine samples and various clinical measurements, some of them in sub-samples of the study population, comprise a huge database for research. All data for each person are linked, and data are also linked to various health registries; all data handling being supervised by The Data Inspectorate and The Regional Ethical Committee. Procedures for data access are established, and more than 100 researchers are currently working on HUNT data. A large number of scientific papers in various disciplines are published, among them 15 doctoral theses (June 2003). The research potential of the HUNT biobank is still not fully exploi- ted, but initiatives are taken. In line with other population based studies both in Norway and abroad, there was a decline in participation rate from HUNT 1 to HUNT 2 (16.9%). This has raised concern about the validity of future population based health studies. However, the good local and national network and the support from the population, make up a good platform also for future health studies in Nord-Trøndelag.
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Attendance at cultural events is associated with better survival and self-rated health. This study aimed to determine whether attendance at cinemas, theater, art galleries, live music shows, and museums was associated with cancer-related mortality. A randomly selected, cancer-free cohort of Swedish adults aged 25–74 years (n = 9011), formed in 1990–91, was followed up to 31 December 2003. The outcome measure was cancer-related mortality. The main independent variable was a cultural attendance index. A proportional hazards analysis adjusted for age, sex, chronic conditions, disposable income, educational attainment, smoking status, leisure time physical activity, and urban/non-urban residency was conducted. Rare and moderate attendees were 3.23 (95% CI: 1.60–6.52) and 2.92 (95% CI: 1.52–5.62) times, respectively, more likely to die of cancer during the follow-up period than frequent attendees. The effect was observed only among residents of urban areas. The results, if replicated, imply that promoting attendance at cultural events could lead to improved urban population health.
Aims: This study describes inequalities and trends in health according to socioeconomic status in the Nord-Trøndelag Health Study (HUNT I and II) and contribute to the ongoing discussion on the magnitude of inequalities in health in the Nordic welfare states. To produce data comparable to recent European studies, occupational data in the HUNT Study were reclassifi ed according to the international Erikson Goldthorpe Portocarero (EGP) social class scheme. Methods: Two cross-sectional health surveys were undertaken with a 10-year interval, HUNT I (1984-86) and HUNT II (1995-97). This was a primary healthcare, total-county population study, participants for this analysis being men aged 25-69 years. Results: A consistent pattern was found of increasing health problems with decreasing socioeconomic status for four health variables: Self-perceived health, temporary disability, any long-standing health problem, and chronic conditions. The prevalence ratio between the highest and lowest status groups for “perceived health less than good” was 2.0 in the first survey and 2.1 in the second 10 years later. The magnitude of differences for the other health outcomes was at this level or smaller, with no signifi cant overall time trend from the mid-1980s to the mid-1990s. Conclusions: The magnitude of socioeconomic gradients in health in this study seemed somewhat smaller than results from national studies, and on the average compared to studies from other European countries; there was no detectable time trend in health differentials. International comparative studies have suggested considerably larger inequalities in health according to social class in Norway using national data.
SUMMARY The purpose of this study was to assess how changes in the habit of attending cultural events in the community might predict self-reported health. This study made use of data based on two interviews, 8 years apart, with 3793 adults aged 25‐74 years from a simple random sample of the Swedish population. The subjects were interviewed in 1982‐1983 and re-interviewed using the same questionnaire in 1990‐1991. The setting was a Swedish interview survey of living conditions comprising a random sample of the adult population. Self-reported health status was the main outcome measure. The variables used for control purposes were baseline health status according to the survey of 1982‐1983, age (at baseline), type of residence, geographical region of domicile, and socio-economic status (level of education). A correlation was found between perceived poor health and all the independent variables, as well as an influence in the expected direction for all of them; poor education, increasing age and a low degree of urbanization all predicted poorer perceived health. In the full model (including all nine independent variables), those who became culturally less active between the first and second occasion, or those who were culturally inactive on both occasions, ran a 65% excess risk of impaired perceived health compared with those who were culturally active on both occasions. Furthermore, those who changed from being culturally less active to being more active had about the same level of perceived risk as those active on both occasions. These results could be in agreement with a causal influence of stimulation and suggest that cultural stimulation is a ‘perishable commodity’. While recruiting new consumers would in that case promote health, continued frequent replenishment of the cultural stimulation may be just as important.
The aim of this study was to assess the specific biomedico-social effects of participating in cultural events and gentle physical exercise effects apart from the general effect of participating in group activities. This was a randomized controlled investigation using a factorial design, where attending cultural events and taking easy physical exercise were tested simultaneously. The 21 participants, aged between 18 and 74 y were from a simple random sample of people registered as residents in Umeå, a town in northern Sweden. Among the 1000 in the sample, 21 individuals (11 men, 10 women) were recruited into the experiment. Two out of the 21 subjects dropped out and were discounted from our analysis. Nine people were encouraged to engage in cultural activity for a two-month period. Diastolic blood pressure in eight of these nine was significantly reduced following the experiment. There were no marked changes observed in either systolic or diastolic blood pressure in those not required to engage in any form of extra-cultural activity. A decrease in the levels of both adrenocorticotropical hormone (ACTH) and s-prolactin was observed in culturally stimulated subjects, whereas the average baseline s-prolactin level of 7 ng/l for the non-culturally stimulated group was unchanged after the experiment. Physical exercise produced an increase in the high density lipoprotein (HDL) cholesterol level and in the ratio of HDL to LDL (low density lipoprotein). It was concluded that cultural stimulation may have specific effects on health related determinants. Public Health (2000) 114, 316–319
The aim of this study was to compare a dimensional and a categorical approach to diagnosis, using as an illustration co-occurring symptoms of anxiety and depression concerning description, associations and predictive power. We analysed data from 60 869 individuals with valid ratings on the Hospital Anxiety and Depression Scale (HADS) and on mental impairment in the age range of 20 to 89 years of the cross-sectional Nord-Trøndelag Health Study 1995-1997. There was a wide variation of the dimensional symptom level (subscale scores) within both diagnostic categories (cut-offs > > or = 8 on both subscales), as is usually true with categorical and dimensional diagnosis. The dimensional (Spearman) correlation coefficients between anxiety and depression was 0.51 compared to 0.38 for the categorical. The power to predict impairment was weaker with the categorical than with the dimensional approach of the HADS, showing fewer statistically significant coefficients in the logistic regression models and lower area under curve (0.82 versus 0.87). This is an example illustrating the impact use of dimensional diagnoses would have on research and clinical practice.
Population studies demonstrate that attending cultural events is conducive to improved health when baseline health, income, education, and health habits are taken into account. Animal experiments suggest possible mechanisms. We studied the link in humans between attending cultural events and health in a randomized controlled trial. Members of the local government officers' union in the health services in Umeå, Sweden, were invited to the experiment and 101 people registered for fine arts visits once a week for 8 weeks. They chose films, concerts, or art exhibitions visits, or singing in a choir and were then randomized into 51 cases, starting at once, and 50 controls starting after the trial. Health was assessed before randomization and after the experimental period using the instrument for perceived health, short form (SF)-36, and tests of episodic memory, saliva-cortisol and immunoglobulin. The results were analyzed using a mixed design analysis of variance. The SF-36 Composite Score called physical health improved in the intervention group and decreased among controls during the experiment (F(1,87) = 7.06, p = .009). The individual factor of the SF-36 called social functioning, improved more in the intervention group than among controls (F(1,98) = 8.11, p = .005) as well as the factor vitality (F(1,98) = 5.26, p = .024). The six other factors and the Mental Health Composite Score, episodic memory, cortisol and immunoglobulin levels did not change otherwise than among controls. Mechanisms are left to be identified. Fine arts stimulations improved perceived physical health, social functioning, and vitality.