An Evidence-Based Framework for the Use of Arts and Culture in Public Health.

OBJECTIVES: In recent years, increasing efforts have been made to apply arts- and culture-based strategies to public health concerns. Accumulating studies point to the value of these strategies for addressing social determinants of health in ways that center communities, cultures, and lived experiences. However, this work has lacked a common framework to support application and advancement. The objectives of this study were to examine knowledge, experience, and evidence related to the uses of arts and culture in public health in the United States and to develop a pilot version of an evidence-based framework to guide cross-sector development and research. METHODS: Using a convergent mixed-methods design with sequential elements, this study drew upon findings from a national field survey, seven focus groups, eight structured working-group dialogues, and a five-day structured dialogue and writing process with 12 interdisciplinary thought leaders. Data were integrated to develop a pilot evidence-based framework. RESULTS: The study identified six broad ways in which arts and culture can be used in public health and 59 specific outcomes that can be addressed through arts and cultural strategies. The framework identifies evidence supporting the effects of arts and culture on each outcome, along with mechanisms that may mediate or moderate these effects. CONCLUSION: The pilot framework clearly links arts and culture practices with public health outcomes. In doing so, it provides both a resource for current practice and a model for the continued development of interdisciplinary tools that support health researchers and practitioners in utilizing arts and culture resources to advance community health and health equity.

The Changing Relationship Between Hobby Engagement and Substance Use in Young People: Latent Growth Modelling of the Add Health Cohort.

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.

Cross-sectional and longitudinal associations between arts engagement, loneliness, and social support in adolescence.

PURPOSE: Although arts engagement holds promise for reducing loneliness and enhancing social support, previous research has focussed on older adults. We investigated whether arts engagement was associated with loneliness and social support during adolescence. METHODS: We included 11,780 adolescents aged 11-21 years from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative cohort study. We measured whether adolescents engaged in school-based arts activities (band, book club, chorus, choir, cheerleading, dance, drama club, newspaper, orchestra) at wave one (1994-1995). Loneliness and perceived social support from peers were measured at waves one and two (1996). We used logistic regression to test whether arts engagement was associated with concurrent and subsequent loneliness and social support. RESULTS: Arts engagement was not associated with concurrent or subsequent loneliness. Compared to not engaging, doing one or more school-based arts activities was associated with 59% higher odds of high social support concurrently (odds ratio [OR] = 1.59, 95% CI = 1.32-1.91). However, this cross-sectional association was attenuated after adjusting for demographic, socioeconomic, and health-related covariates (adjusted OR [AOR] = 1.16, 95% CI = 0.95-1.42). In contrast, doing arts activities was associated with 28% higher odds of reporting high social support one year later (AOR = 1.28, 95% CI = 1.03-1.59), independent of covariates and previous social support. CONCLUSIONS: Extracurricular arts activities are associated with increased odds of reporting good subsequent social support from peers. This may be because they provide opportunities for social engagement, developing friendships, and building a sense of community. Exploring these associations in more detail should be a priority, enabling better understanding of this strategy for enhancing social ties during adolescence.

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

Objectives: There is a social gradient in both arts engagement and wellbeing that may have led to an overestimation of the impact of arts engagement on wellbeing. We tested whether participation in community arts groups was associated with wellbeing after removing confounding by demographic, socioeconomic, and health-related factors.Methods: Using propensity score matching, we analyzed data from 12,055 older adults in the Health and Retirement Study. We measured community arts groups participation and concurrent life satisfaction (evaluative wellbeing), positive and negative affect (experienced wellbeing), and purpose in life, constraints on personal control, and mastery (eudaimonic wellbeing).Results: After matching, arts group participation was associated with higher positive affect (average treatment effect on the treated [ATT] = 0.18, 95% CI = 0.12-0.24), life satisfaction (ATT = 0.09, 95% CI = 0.04-0.15), purpose in life (ATT = 0.07, 95% CI = 0.02-0.13), and mastery (ATT = 0.07, 95% CI = 0.01-0.14) than not participating. Participation was not associated with negative affect or constraints on personal control. In sensitivity analyses, these associations were maintained four years later.Conclusion: Arts group participation was associated with the positive elements of evaluative, experienced, and eudaimonic wellbeing. Facilitating participation in community arts groups could help to promote healthy aging, enabling a growing segment of the population to lead more fulfilling and satisfying lives.

Defining "Arts Participation" for Public Health Research.

Arts participation has been linked to positive health outcomes around the globe. As more research is taking place on this topic, there is heightened need for definitions for the complex concepts involved. While significant work to define "arts participation" has taken place in the arts sector, less work has been undertaken for the purpose of researching the arts in public health. This study developed a definition for "arts participation" to guide a national arts in public health research agenda and to advance and make more inclusive previous work to define the term. A convergent mixed-methods study design with sequential elements was used to iteratively develop a definition that integrated the perspectives of field experts as well as the general public. Literature review was followed by four iterative phases of data collection, analysis, and integration, and a proposed definition was iteratively revised at each stage. The final definition includes modes, or ways, in which people engage with the arts, and includes examples of various art forms intended to frame arts participation broadly and inclusively. This definition has the potential to help advance the quality and precision of research aimed at evaluating relationships between arts participation and health, as well as outcomes of arts-based health programs and interventions in communities. With its more inclusive framing than previous definitions, it can also help guide the development of more inclusive search strategies for evidence synthesis in this rapidly growing arena and assist researchers in developing more effective survey questions and instruments.

Who Engaged in Home-Based Arts Activities During the COVID-19 Pandemic? A Cross-Sectional Analysis of Data From 4,731 Adults in the United States.

Arts engagement is a health-related behavior that may be influenced by social inequalities. While the COVID-19 pandemic provided new opportunities for some people to engage in the arts, it might have created barriers for others. We aimed to examine whether there was social patterning in home-based arts engagement during the pandemic in the United States, and whether predictors of engagement differed according to the type of arts activity. We included 4,731 adults who participated in the United States COVID-19 Social Study between April and July 2020. Three types of home-based arts engagement were considered: reading for pleasure, arts or crafts activities, and digital arts activities. Using logistic regression models, we tested cross-sectional associations between a broad range of demographic, socioeconomic, psychosocial, and health-related factors as well as adverse events and worries during lockdown and each type of arts engagement. The factors most strongly associated with all three types of arts engagement were social support, social network size, age, race/ethnicity, keyworker status, and experiencing physical or psychological abuse during the pandemic. However, most socioeconomic and health-related factors were not associated with arts engagement, including household income and mental and physical health problems. Overall, our findings indicate that the social gradient in arts engagement was reduced in the first 4 months of the COVID-19 pandemic in the United States. Given the health benefits of arts engagement, the potential diversification of arts audiences during the pandemic is promising for both population-level health and wellbeing and the future of the arts and cultural sector.

Arts and Cultural Engagement, Reportedly Antisocial or Criminalized Behaviors, and Potential Mediators in Two Longitudinal Cohorts of Adolescents.

Arts and cultural engagement is a potential strategy for reducing or preventing reportedly antisocial or criminalized behaviors (those previously and problematically termed as "delinquent") in adolescence. However, most research to date has focused on arts-based interventions and has not tested arts and cultural engagement in large population-based longitudinal studies. This study investigated whether arts and cultural engagement reduced reportedly antisocial or criminalized behaviors in two large nationally representative cohorts, the National Longitudinal Study of Adolescent to Adult Health (n = 10,610; 50% female, 72% White, age range = 11-21 mean = 15.07) and the National Education Longitudinal Study of 1988 (n = 15,214; 50% female, 73% White, age range = 13-16 mean = 14.38). Structural equation modelling also allowed exploration of two potential mechanisms that might link arts and cultural engagement to reportedly antisocial or criminalized behaviors (self-control and attitudes towards these behaviors). More arts and cultural engagement was associated with fewer reportedly antisocial or criminalized behaviors, better self-control scores, and fewer positive perceptions of reportedly antisocial or criminalized behaviors concurrently and one to two years later. Arts and cultural engagement may provide opportunities for adolescents to realize positive developmental outcomes, reducing their risk of reportedly antisocial or criminalized behaviors.

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

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.

Toward a Culture of Health in the United States: Introducing the HPP Arts in Public Health Supplement.

The arts-and the arts and culture sector-offer fertile ground for achieving a culture of health in the United States. The arts and artists are agents of change and can help enable this vision and also address the most critical public health issues we are contending with, including COVID-19 and racism. The arts provide means for engaging dialogue, influencing behaviors, disrupting paradigms and fueling social movements. The arts uncover and illuminate issues. They engage us emotionally and intellectually. They challenge assumptions. They call out injustice. They drive collective action. They heal-making arts + public health collaboration very relevant in this historic moment. In this special Health Promotion Practice supplement on arts in public health, you'll find powerful examples and evidence of how cross-sector collaboration between public health and the arts can advance health promotion goals and impacts, and make health promotion programs not only more accessible to diverse populations but also more equitable and effective in addressing the upstream systems, policies, and structures that create health disparities. You will see how the arts can empower health communication, support health literacy, provide direct and measurable health benefits to individuals and communities, and support coping and resilience in response to COVID-19. This issue itself exemplifies cross-sector collaboration, as it was created through partnership between Health Promotion Practice, the Society for Public Health Education, ArtPlace America, and the University of Florida Center for Arts in Medicine, and presents voices from across the public health, arts, and community development sectors.

Systematic Review of Arts-Based Interventions to Address Suicide Prevention and Survivorship in Australia, Canada, the United Kingdom, and the United States of America.

Study Objective. Suicide is a serious health problem that is shaped by a variety of social and mental health factors. A growing body of research connects the arts to positive health outcomes; however, no previous systematic reviews have examined the use of the arts in suicide prevention and survivorship. This review examined how the arts have been used to address suicide prevention and survivorship in nonclinical settings in Australia, Canada, the United Kingdom, and the United States of America. Design and Setting. Ten bibliographic databases, five research repositories, and reference sections of articles were searched to identify published studies. Articles presenting outcomes of interventions conducted between 2014 and 2019 and written in English, were included. Primary Results. Nine studies met inclusion criteria, including qualitative, quantitative randomized controlled trials, quantitative nonrandomized, quantitative descriptive, and mixed-methods studies. The programs studied used film and television (n = 3), mixed-arts (n = 3), theatre (n = 2), and quilting (n = 1). All nine interventions used the arts to elicit emotional involvement, while seven also used the arts to encourage engagement with themes of health. Study outcomes included increased self-efficacy, awareness of mental health issues, and likelihood for taking action to prevent suicide, as well as decreases in suicidal risk and self-harming behaviors. Conclusions. Factors that influence suicide risk and survivorship may be effectively addressed through arts-based interventions. While the current evidence is promising with regard to the potential for arts programs to positively affect suicide prevention and survivorship, this evidence needs to be supplemented to inform recommendations for evidence-based arts interventions.

The Arts and Health Communication in Uganda: A Light Under the Table.

This qualitative interview study brings the voices of 27 public health leaders, health communication experts, and artists who work in public health in Uganda together to articulate the principles and practices that make the country a shining example of effective, evidence-based use of the arts for health communication. The specific aim of the study was to identify best practices, theoretical foundations, and other factors that contribute to the success of arts-based health communication campaigns in Uganda. The study presents four primary themes related to use of the arts for health communication in Uganda: (1) the arts empower health communication; (2) the arts engage people emotionally; (3) effective programs are highly structured; and (4) professionalism is critical to program effectiveness. The findings suggest that the arts humanize, clarify, and empower health communication. The arts can attract attention and engage target populations, reduce hierarchical divisions and tensions that can challenge communication between health professionals and community members, make concepts clearer and more personally and culturally relevant, and communicate at an emotional level wherein concepts can be embodied and made actionable. The findings articulate why and how the arts are an effective means for health communication and can guide best practices.

Leisure engagement in older age is related to objective and subjective experiences of aging.

Leisure engagement has potential to slow health and functional decline in older age. However, the benefits of different leisure domains for different aspects of aging remains unclear. In 8771 older adults from the Health and Retirement Study (a longitudinal panel study), we measured engagement in physical, creative, cognitive, and community activities. Outcome-wide analyses used 23 aging experiences across seven domains eight years later (daily functioning, physical fitness, long-term physical health problems, heart health, weight, sleep, subjective perceptions of health). Physical activity was related to more positive experiences in all domains but heart health eight years later. Creative engagement was positively related to aging experiences in four domains longitudinally. Cognitive and community engagement were less consistently related to aging experiences. Physical and creative activities may influence important aging metrics, reducing age-related decline and keeping older adults functionally independent for longer, potentially limiting increasing healthcare costs.

Participatory and Receptive Arts Engagement in Older Adults: Associations with Cognition Over a Seven-Year Period.

There is growing evidence for the impact of arts engagement on later life cognition. However, confounding by socioeconomic factors may have led to an overestimation of this association. We analyzed data from 4,344 older adults in the Wisconsin Longitudinal Study. We measured participatory (e.g. painting, making music, crafts) and receptive (e.g. concert, play, museum) arts engagement separately. Participants completed six neurocognitive tests measuring two distinct domains of cognitive function (episodic/working memory and executive function/language) concurrently and seven years later. We used inverse probability of treatment weighting (IPTW) to remove confounding by a range of demographic and socioeconomic factors. Engaging in participatory or receptive arts for up to one hour per week (but not more frequently) was associated with better subsequent executive function/language. Similarly, engaging in receptive arts activities for up to three hours per week (but not more frequently) was associated with better subsequent episodic/working memory. These effects were of similar sizes to doing vigorous physical activity for up to one hour per week. However, our findings also highlight key methodological issues when exploring the relationship between arts engagement and cognition that should be considered in future studies, including measurement bias, life-course stage, length of follow-up, variation in outcomes, attrition, and missing data.

Arts Engagement as a Health Behavior: An Opportunity to Address Mental Health Inequities.

The significance of mental health inequities globally is illustrated by higher rates of anxiety and depression amongst racial and ethnic minority populations as well as individuals of lower socioeconomic status. The COVID-19 pandemic has further exacerbated these pre-existing mental health inequities. With rising mental health concerns, arts engagement offers an accessible, equitable opportunity to combat mental health inequities and impact upstream determinants of health. As the field of public health continues to shift its focus toward social ecological strategies, the social ecological model of health offers an approach that prioritizes social and structural determinants of health. To capture the impacts of arts engagement, this paper creates an applied social ecological model of health while aiming to advocate that engaging in the arts is a protective and rehabilitative behavior for mental health.

Leisure Engagement and Self-Perceptions of Aging: Longitudinal Analysis of Concurrent and Lagged Relationships.

OBJECTIVES: There is evidence to suggest that leisure engagement may influence self-perceptions of aging, but disentangling potential bidirectionality in this relationship is challenging. A better understanding of the directionality of this association is essential for designing more effective interventions to promote healthy aging. We, therefore, tested concurrent effects and lagged effects in both directions for a univariate measure of leisure engagement as well as specific domains of community, cognitive, creative, and physical activities. METHODS: A total of 17,753 adults aged 50 or above living in the United States from the Health and Retirement Study were included in the analysis. They provided 32,703 observations over 3 waves between 2008/2010 and 2016/2018. Data were analyzed using structural equation modeling with both concurrent and lagged associations between self-perceptions of aging and leisure engagement, controlling for confounders including age, gender, ethnicity, socioeconomic position, and health conditions. RESULTS: We found consistent evidence for leisure engagement as a predictor of self-perceptions of aging. There was also evidence for a reciprocal relationship where leisure engagement was predicted by older adults' self-perceptions of aging. Similar results were observed for specific domains of leisure engagement. DISCUSSION: Our findings provide empirical support for the potential benefits of leisure engagement on positive self-perceptions of aging, regardless of the type of activities. Our study also highlights the importance to consider the directionality in researching leisure engagement and self-perceptions of aging.

When Artists Go to Work: On the Ethics of Engaging the Arts in Public Health.

Collaboration between the arts and health sectors is gaining momentum. Artists are contributing significantly to public health efforts such as vaccine confidence campaigns. Artists and the arts are well positioned to contribute to the social conditions needed to build trust in the health sector. Health professionals, organizations, and institutions should recognize not only the power that can be derived from the insights, artefacts, and expertise of artists and the arts to create the conditions that make trust possible. The health sector must also recognize that, while it can gain much from partnership with artists, artists risk much-namely, the public's trust-when they are in such partnerships. This essay unpacks these claims and considers the care and ethical considerations that must be brought to these partnerships to yield constructive pathways for ethical collaboration as well as for both establishing public trust and continuing to hold the health care profession accountable for becoming more trustworthy.

Longitudinal Associations Between Arts Engagement and Flourishing in Young Adults: A Fixed Effects Analysis of the Panel Study of Income Dynamics.

There is growing evidence on the impact of arts engagement on flourishing. However, social gradients in arts engagement and flourishing may have led to an overestimation of this impact, and there is a lack of longitudinal research in young people. We aimed to test the longitudinal associations between arts engagement and flourishing in emerging adults, accounting for observed and unobserved individual characteristics. We included 3,333 participants aged 18-28 from the Transition into Adulthood Supplement of the Panel Study of Income Dynamics. We measured flourishing across emotional, psychological, and social wellbeing, and frequency of engagement in artistic, musical, or theatrical organized activities, biennially 2005-2019. We analyzed data using fixed effects regression and Arellano-Bond methods to control for bidirectional relationships. Increases in arts engagement were associated with increases in flourishing, before and after adjusting for time-varying confounders. This relationship was driven by enhanced psychological and social wellbeing. After controlling for bidirectionality, increases in arts engagement predicted subsequent improvements in flourishing and social wellbeing. In sensitivity analyses, residential area was a moderator; arts engagement was only associated with increased flourishing in metropolitan (and not non-metropolitan) areas. Increases in arts engagement are associated with enhanced flourishing within individuals, and these associations hold across many subgroups of the population. Those in non-metropolitan areas may have fewer opportunities for arts engagement. Future work must consider how funding can be distributed to ensure that the arts are accessible across communities and geographical areas, providing all young people with opportunities to experience their potential benefits. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-022-00133-6.

Receptive and participatory arts engagement and subsequent healthy aging: Evidence from the Health and Retirement Study.

RATIONALE: Arts engagement is associated with prolonged longevity, but it remains unclear whether it is also associated with increases in the portion of people's lives for which they remain healthy. We investigated whether receptive and participatory arts engagement were associated with healthy aging two and four years later. METHOD: We included 1269 older adults from the Health and Retirement Study (HRS), a longitudinal study of individuals aged 50 and above in the United States. Participants who completed the HRS 2014 Culture and the Arts Module and who were alive in 2016 and 2018 were eligible. We measured the number of participatory arts activities engaged in (e.g., crafts, dancing) and frequency of receptive arts engagement (e.g., going to a gallery or performance) in the past year. Healthy aging was a binary outcome, conceptualized as no major chronic diseases, no cognitive impairment, good physical functioning, and good mental health. RESULTS: In logistic regression models, doing receptive arts once a month or more was associated with higher odds of healthy aging four years later compared to never engaging (odds ratio [OR] = 1.80, 95% CI = 1.10, 2.96). However, this evidence was attenuated after adjusting for demographic and socioeconomic covariates (adjusted OR = 1.44, 95% CI = 0.84, 2.46). The number of participatory arts activities engaged in was not associated with healthy aging two or four years later. In sensitivity analyses, there was some evidence that receptive engagement was associated specifically with higher odds of good physical functioning four years later. CONCLUSIONS: The lack of consistent associations between receptive and participatory arts engagement and healthy aging was unexpected given previous evidence for links between arts engagement and each of the four domains of healthy aging. Our findings highlight key methodological issues that should be explored in further research with larger nationally representative samples, longer follow-ups, and more detailed measures of arts engagement.

Associations between extracurricular arts activities, school-based arts engagement, and subsequent externalising behaviours in the Early Childhood Longitudinal Study.

Adolescent externalising behaviours are associated with numerous long-term negative outcomes, although most research is intervention-based as opposed to risk reduction. Arts engagement has been associated with numerous beneficial factors linked to externalising behaviours, yet direct evidence linking them in longitudinal studies is lacking. Data from the Early Childhood Longitudinal Study were used, with baseline at 5th grade and outcomes measured at 8th grade. Ordinary least squares (OLS) regression was used to examine individual-level associations between extracurricular and school-based arts engagement with externalising behaviours. OLS regression was also used to examine associations between school-level arts classes and facilities with an administrator-reported index of externalising behaviours in the school. All models were adjusted for sociodemographic factors. Individual-level analyses were clustered by school. At the individual level, engaging in a greater number of extracurricular arts activities was associated with fewer externalising behaviours, although there was no association for school-based arts engagement. There were no school-level associations between arts classes or adequate arts facilities and externalising behaviours. Our results suggest extracurricular arts activities may be beneficial in reducing the risk for externalising behaviours, but the relationship is seen at an individual-level of engagement rather than based on school-level provision or facilities.