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Id 189
Author Bygren, L.O.; Konlaan, B.B.; Johansson, S.E.
Title Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions

Bygren LO, Konlaan BB, Johansson SE. Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions. BMJ. 1996;313(7072):1577-1580.

Keywords attendence cultural events; survival; social problems; music; cinema; dance
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Abstract The importance of stimulating activities is obvious, and there is hardly any need for medical arguments for attending a theatre, cinema, or sports events, for reading books and periodicals, or for making music. Cultural activity might be thought to increase resistance to a broad spectrum of diseases or be the impetus to start dealing with problems. The mechanism for a positive effect could perhaps be that it is inspirational for handling everyday social problems, thus enhancing people's reflection on their life situation and enabling them to prepare for coming events in their mind. More importantly, such activity provides direct vicarious emotional arousal without damage or side effects in real life. And we know that the organism responds with changes in the humoral nervous system—for example, verbal expression of traumatic experiences through writing or talking improves physical health, enhances immune function, and is associated with fewer medical visits. In addition, other gains have been documented in the therapeutic use of music in the treatment of autistic children, as well as the treatment of cancer and other related pain. Pictures of works of art have been used to stimulate older people. Negative effects of cultural activities could be that people lose their sense of reality and identify with asocial models of behaviour and are themselves encouraged towards asocial behaviour. Many of the selective factors determining attendance at different kinds of events are correlated with survival. Educational level is one such factor. Furthermore, disease itself influences the ability to take part in activities and the kinds of activities possible to pursue. Attending cultural events widens a social network and gives the feeling of belonging to a group, and this in itself could be the important determinant of survival. Perhaps cultural behaviour is so intermingled with life as a whole that it is impossible to discern its influence. We investigated the possible influence of cultural stimulation on survival.

Metodology A simple random sample was drawn of 15 198 people aged 16–74 years. Of them, 12 982 people (85%) were interviewed by non-medical interviewers between 1982 annd 1983 in the Swedish annual survey of living conditions,8 which is an interview survey conducted on a random sample of about 8000 people a year. It covers several components of living conditions such as health, economic resources, education, employment, and housing. In the years 1982–3 the interview went into some depth about leisure time activities. Those interviewed were followed up for survival until 31 December 1991. Risks per person year at each year of follow up were computed. The interviews were mainly conducted in the interviewees' homes, but about 11% were telephone interviews. Overall, 307 people were excluded from the analyses because they gave only partial responses about leisure time activities, leaving 12 675 (83%) for our analysis. The interviewees were not aware of our interest in the relation between leisure time activities and health. In all, 847 respondents, who were aged 16–74 at the time of the interviews, died during the follow up. Background covariates used for control were age, sex, educational level, income, disease prevalence, social network, smoking, and physical exercise. One independent variable was constructed out of attendance at various cultural and sports events such as cinema, theatre, concerts and live music, art exhibitions, other exhibitions or museums, sermons, or sports events. Another variable was an index based on the reading of books or periodicals. The third independent variable reflected making music and singing in a choir. Age was controlled for in 10 year age bands. Educational level was described as at least college level (> 12 years at school) or at least high school level (10–12 years at school). The reference group was those having only a primary education (

Findings 6301 men and 6374 women were followed up; 533 men and 314 women died during this period. The control variables influenced survival in the expected directions except for social network for men; a significant negative effective was found when the analysis was made separately for men and women. We found an influence on mortality when the eight control variables were controlled for in people who rarely attended events compared with those attending most often, the relative risk being 1.57 (95% confidence interval 1.18 to 2.09). Hence, Attendance at cultural events may have a positive influence on survival. Long term follow up of large samples with confounders that are well controlled for and with the cultural stimulation more highly specified should be used to try to falsify the hypothesis before experiments start.
Open Access NO
DOI 10.1136/bmj.313.7072.1577
Search Database Researcher knowledge
Technique Survey of living conditions; Structured Interviews; Proportional Hazard Model;
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