A Chapter A Day Association of Book Read
A Chapter A Day Association of Book Read
A Chapter A Day Association of Book Read
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Social Science & Medicine 164 (2016) 44e48
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Article history: Although books can expose people to new people and places, whether books also have health benefits
Received 20 October 2015 beyond other types of reading materials is not known. This study examined whether those who read
Received in revised form books have a survival advantage over those who do not read books and over those who read other types
11 July 2016
of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635
Accepted 15 July 2016
Available online 18 July 2016
participants in the nationally representative Health and Retirement Study who provided information
about their reading patterns at baseline. Cox proportional hazards models were based on survival in-
formation up to 12 years after baseline. A dose-response survival advantage was found for book reading
Keywords:
Reading
by tertile (HRT2 ¼ 0.83, p < 0.001, HRT3 ¼ 0.77, p < 0.001), after adjusting for relevant covariates including
Longevity age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression. Book
Aging reading contributed to a survival advantage that was significantly greater than that observed for reading
Mortality newspapers or magazines (tT2 ¼ 90.6, p < 0.001; tT3 ¼ 67.9, p < 0.001). Compared to non-book readers,
Cognition book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A
survival advantage persisted after adjustment for all covariates (HR ¼ .80, p < .01), indicating book
readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-
book readers. Cognition mediated the book reading-survival advantage (p ¼ 0.04). These findings suggest
that the benefits of reading books include a longer life in which to read them.
© 2016 Elsevier Ltd. All rights reserved.
While most sedentary behaviors are well-established risk fac- Reading books tends to involve two cognitive processes that
tors for mortality in older individuals (Wullems et al., 2016; de could create a survival advantage. First, it promotes “deep reading,”
Rezende et al., 2014; Katzmarzyk and Lee, 2012; Muennig et al., which is a slow, immersive process; this cognitive engagement
2013), previous studies of a behavior which is often sedentary, occurs as the reader draws connections to other parts of the ma-
reading, have had mixed patterns of outcomes. That is, some found terial, finds applications to the outside world, and asks questions
that reading reduces the risk of mortality (Agahi and Parker, 2008; about the content presented (Wolf et al., 2009). Cognitive
Jacobs et al., 2008), whereas others found that it has no effect engagement may explain why vocabulary, reasoning, concentra-
(Bygren et al., 1996; Menec, 2003). However, previous studies often tion, and critical thinking skills are improved by exposure to books
combined different types of reading material and have not (Stanovich et al., 1995; Stanovich and Cunningham, 1998; Wolf
compared the health benefits of reading-material type; also, the et al., 2009). Second, books can promote empathy, social percep-
mechanism for the possible protective effect was not identified. We tion, and emotional intelligence, which are cognitive processes that
speculated that books engage readers’ minds more than newspa- can lead to greater survival (Bassuk et al., 2000; Djikic et al., 2013;
pers and magazines, leading to cognitive benefits that drive the Kidd and Castano, 2013; Shipley et al., 2008; Olsen et al., 1991).
effect of reading on longevity. In the following study, we were able Better health behaviors and reduced stress may explain this process
to build on previous studies by examining the potential survival (Bassuk et al., 2000).
advantage of books. We predicted that the survival advantage for The current study hypothesized that book reading provides a
reading books would be greater than the survival advantage of survival advantage, and that this advantage is mediated by cogni-
reading newspapers and magazines. tive engagement. To determine if the advantage is specific to the
immersive nature of book reading, we also examined whether
there is a survival advantage to reading periodicals (i.e., newspa-
pers and magazines). Cognitive engagement might also occur while
* Corresponding author.
reading thought-provoking periodicals, however this engagement
E-mail address: becca.levy@yale.edu (B.R. Levy).
http://dx.doi.org/10.1016/j.socscimed.2016.07.014
0277-9536/© 2016 Elsevier Ltd. All rights reserved.
A. Bavishi et al. / Social Science & Medicine 164 (2016) 44e48 45
is more likely to occur when reading books due to the tendency of variables were included as covariates in all models. No significant
book authors to present themes, characters and topics in greater differences existed in age, race, health, job status, or marriage
length and depth (Stanovich and Cunningham, 1992). Accordingly, status between groups at the 0.05 level. To be conservative, models
we hypothesized that the survival advantage would be stronger were also adjusted for all of these covariates (See Table 1.).
when reading books compared to periodicals.
1.2. Measures
1. Methods
1.2.1. Predictor: reading
1.1. Participants Time spent reading books and time spent reading periodicals
were assessed by the CAMS questions: “How many hours did you
The study cohort was drawn from the Health and Retirement actually spend last week reading books?” and “How many hours
Study (HRS), collected by the University of Michigan's Institute of did you actually spend last week reading newspapers or maga-
Social Research and supported by the National Institute on Aging. zines?” These were assessed in the first year that participants
The HRS has conducted national telephone surveys biennially since responded to the CAMS, which was used as their baseline year.
1992 among adults over age 50. In 2001, the off-year Consumption Following the model of previous studies, reading was split into
and Activities Mail Survey (CAMS) was added, which contained three levels (Agahi and Parker, 2008; Bygren et al., 1996); the first
questions about reading habits. All individuals completed identical tertile was the reference group. The tertiles constructed for: books
telephone questionnaires and had identical follow-up procedures. were: 0, 0.01e3.49, 3.5 or more hours per week. The tertiles con-
This dataset follows individuals from the first year they answered structed for periodicals were: 0e2, 2.01e6.99, 7 or more hours per
the CAMS to December 31, 2012. Respondent level weights from the week. Total reading scores were calculated as a sum of the tertiles of
HRS were used in all survival analyses in order to correct for the book and periodical reading, with scores ranging from 2 to 6. The
oversampling design and for differential non-response. This average time spent reading per week was 3.92 hours for books and
weighting design makes the sample representative of the United 6.10 hours for periodicals. The two types of reading were not
States population (Health and Retirement Study, 2014). strongly correlated (weighted Pearson and polychoric r ¼ 0.23), and
The final sample consisted of 3635 individuals that were fol- 38% of the sample (n ¼ 1390) read only books or only periodicals;
lowed over 34,496 person-years, with 27.4% of the sample dying this allowed them to be treated as separate constructs.
during an average 9.49 years of follow-up. Consistent with the older
population, the sample was predominantly (62%) female. 1.2.2. Survival
Chi-square tests revealed that book readers differed from non- Vital status was determined by matching participants to the
book readers in that a higher proportion was female, college National Death Index (National Death Index, 2015). Follow-up time
educated, and in the higher-wealth group (all p < 0.001); These was calculated from the first CAMS survey until either death or
Table 1
Cohort demographics.
*: p < 0.05.
46 A. Bavishi et al. / Social Science & Medicine 164 (2016) 44e48
December 31, 2012. product of a and b was used to estimate the strength of the medi-
ation. To calculate the significance of the mediation 95% confidence
1.2.3. Mediator: cognitive engagement intervals for the model were generated using bootstrapping with
Cognitive engagement was assessed with total cognitive score 10,000 samples (Hayes, 2013). This method allows for greater po-
(available in the supplemental Imputation of Cognitive Function wer in the analysis and more robust confidence intervals.
Measures) which is a summary variable based on 8 items, including The mediation effect was assessed using the SAS macro pro-
immediate recall, delayed recall, serial 7s, backwards count from vided by Hayes (2013). Mortality status (dead or alive) as of
20, object naming, President naming, Vice President naming, and December 31, 2012 was used as the outcome variable. In these
date naming. These items covered recall and mental status; reading analyses, book reading in 2001 was used as the predictor, the
has been found to be positively associated with both components cognitive score in 2004 was used as the mediator and survival was
(Wolf et al., 2009; Stanovich et al., 1995; Stanovich and examined from 2004 to 2012. The models adjusted for all covariates
Cunningham, 1998). as well as baseline cognitive score.
This HRS cognitive measure has been validated for use in pop- All analyses were completed in SAS 9.4 (Cary, NC). These ana-
ulation surveys (Herzog and Wallace, 1997). During each wave of lyses had a significance threshold of p < 0.05.
the survey, response rates exceeded 80% (Ofstedal et al., 2005).
Total cognitive score in 2004 was used for a mediation analysis after
adjusting for cognitive score in 2000; the change in cognitive score 2. Results
ranged from a twenty point drop to a thirteen point gain (standard
deviation ¼ 4.31). On average, the cognitive score dropped 1.47 In support of the prediction, book reading was associated with
points over these 4 years. significantly greater survival for both the second and third tertiles,
with adjustment for all covariates (HRT2 ¼ 0.83, p < 0.001;
1.2.4. Covariates HRT3 ¼ 0.77, p < 0.001). During follow-up 33% of non-book readers,
Covariates were included that could influence reading or sur- died, compared to 27% of book readers. Hazard ratios for reading
vival, as indicated by our sample demographics and previous periodicals were also obtained (HRT2 ¼ 1.01, p < 0.001; HRT3 ¼ 0.89,
studies (Jacobs 2008, Agahi 2008, Menec 2003, Bygren 1996). They p < 0.001), with a protective effect seen only for the third tertile.
included individual comorbidities (cancer, lung disease, heart dis- The HRs for reading books were significantly more protective than
ease, stroke, arthritis, diabetes, and hypertension), visual acuity, those obtained for reading periodicals when compared by tertile
wealth, marriage status, job status, depression, age, sex, race, self- using t-tests (tT3 ¼ 90.6, p < 0.001; tT3 ¼ 67.9, p < 0.001). The total
rated health, and education. Self-rated health was reported on a reading effect (summation of books and periodicals tertile) was also
five-point scale from poor to excellent. Visual acuity was self- advantageous per total reading point (HR ¼ 0.92, p < 0.001)). As
reported on a six-point scale from blind to excellent. Wealth was described above, this overall protective effect appears to be driven
calculated by the Rand HRS dataset as the sum of l relevant financial by books.
components (e.g., real estate, stocks, bank accounts, bonds) minus The second and third tertiles of book reading were combined to
the sum of debts (RAND HRS Data, 2014), and was included as a further explore the book effect. This was simplified to any-book
continuous variable. Marriage and job status were dichotomized reading vs. no-book reading. Fig. 1 presents unadjusted survival
(married vs. not; employed vs. not). Depression was quantified curves for book readers compared to non-book readers (HR ¼ 0.76,
using a yes-or-no question: “Much of the time during the past p < 0.001). When readers were compared to nonreaders at 80%
week, you felt depressed.” Race was categorized as Black, White, or mortality (the time it takes 20% of a group to die), nonbook readers
other. Education level was used as continuous, quantified by the lived 85 months (7.08 years), whereas book readers lived 108
number of school years. These covariates were used in all multi- months (9.00 years) after baseline. Thus, reading books provided a
variate models. 23-month survival advantage. After adjustment for all covariates,
the survival advantage persisted (HR ¼ 0.80, p < 0.001).
1.3. Statistical analyses As an indication of the robustness of the effect, the survival
advantage remained for book readers when stratified by sex (males,
Chi-square tests were completed in order to determine baseline HR ¼ 0.81, p < 0.001; females, HR ¼ 0.80, p < 0.001); health status
comparability between groups. Unadjusted-Kaplan-Meir curves
were plotted to differentiate between book readers and non-book
readers and a log-rank test was conducted. The proportional haz-
ards assumption was checked by assessing the parallelism of the
log (-log (survival)) plots. Adjusted Cox proportional hazards
models were constructed, using book reading and periodical
reading as predictors of survival. These analyses all included
respondent weights. To examine the robustness of the findings,
sensitivity analyses for differential right censoring were also con-
ducted by following participants through 2006, 2008, and 2010
instead of through 2012.
Following the mediation steps suggested by Hayes (2013), the
total association effect (c) was calculated by a logistic regression of
book reading on mortality, and the mediation effect of cognitive
score was calculated using the product of the coefficient method.
The association between book reading and cognitive score (a) was
calculated by using a linear-regression model; the association be-
tween cognitive score and mortality (b) was calculated with a lo- Fig. 1. Survival Advantage Associated with Book Reading. Unadjusted survival curves
gistic model. This model also yielded the indirect effect of book comparing book readers to non-readers (HR ¼ 0.77, p < 0.001). At 80% mortality, a 23-
reading on mortality, after adjustment for cognitive score (c’). The month survival advantage is found.
A. Bavishi et al. / Social Science & Medicine 164 (2016) 44e48 47
Acknowledgments Katzmarzyk, P.T., Lee, I.M., 2012. Sedentary behaviour and life expectancy in the
USA: a cause-deleted life table analysis. BMJ open 2 (4), e000828.
Kidd, D.C., Castano, E., 2013. Reading literary fiction improves theory of mind.
This work was supported by the National Institutes of Health Science 342 (6156), 377e380.
(R01AG032284). The Health and Retirement Study is supported by Menec, V.H., 2003. The relation between everyday activities and successful aging: a
the National Institute on Aging (NIA U01AG009740) and is con- 6year longitudinal study. J. Gerontol. Ser. B Psychol. Sci. Soc. Sci. 58 (2),
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ducted by the University of Michigan Institute of Social Research, Muennig, P., Rosen, Z., Johnson, G., 2013. Do the psychosocial risks associated with
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figure. SurveyeNational Death Index dataset. Ann. Epidemiol. 23 (6), 355e360.
National Death Index. (2015). Retrieved from http://www.cdc.gov/nchs/ndi.htm.
National Endowment for the Arts, 2009. Reading on the Rise a New Chapter in
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