The vitality of the cultural life of Naples relies also on five prestigious Universities, among which the Federico II University of Naples, founded in by the Emperor Frederick II, is the oldest public university in the world. In the city are located several research centers whose contribution to biomedicine, engineering, aero spatial science, volcanology, marine biology are internationally recognized. In , Anton Dohrn funded the Zoological Station in Naples, the first marine biology center in the world exclusively dedicated to research and advanced teaching.
To our knowledge, the effects on psychological well-being of this kind of unique, culturally rich urban environments characterized by a long, troubled history but also by an exceptionally stimulating sensory, aesthetic and emotional cultural ecosystem, have not yet been studied systematically.
However, the peculiarity of such environments may be very helpful in improving our understanding of the factors that promote psychological well-being. The urban environments that generally sit in high positions in world rankings of quality of life, and are therefore legitimized as good practices to orientate and inspire city planners worldwide, tend to be highly functional, well-organized ones, whereas cities like Naples fare poorly.
But cultural charm and vibrancy are elusive concepts that do not simply boil down to, say, the quality and variety of local cultural events. Clearly, the effect of the urban environment, and of its cultural richness more specifically, on subjective well-being should matter in the definition of what we mean by quality of life.
With this study, we want to investigate this overlooked point as part of a more general reflection on the relationship between heritage cities and well-being. It is therefore natural to ask to what extent this contraposition reflects into the perceptions of well-being of residents, and whether the unique socio-cultural circumstances of the city provide a counter-balancing effect to the negative impact of other environmental factors, also in terms of resilience to urban hardships.
This research question also presents potentially interesting implications for other urban environments characterized by similar contrasts, and highlights the so far mostly disregarded role of local culture as a basis for innovative public health interventions in otherwise dysfunctional urban environments.
Moreover, as it is commonly maintained that Neapolitan residents have developed local adaptive strategies of their own to cope with the challenging urban environment they have to deal with on a daily basis, we ask whether resilience functions as an effective mediator of the relationship between leisure and well-being. If socially relevant forms of environmental adaptation have occurred, they should in principle be traceable in terms of locally specific forms of urban resilience.
Well-being and resilience are important features for maintaining normal human functioning, in particular when facing traumatic and stressful life events. Well-being is a dynamic construct that builds upon several social, psychological, and physical dimensions, such as life satisfaction evaluative well-being , social and family relationships, social roles and activities, sense of purpose and meaning in life eudemonic well-being , and feelings of happiness, sadness, anger, stress, and pain hedonic well-being [ 16 , 17 , 18 ].
Since the publication in of the Report of the Stiglitz-Sen-Fitoussi Commission for the measurement of economic performance and social progress, leisure activities are included as a key indicator in all major measures and indexes of subjective well-being, life satisfaction, and happiness [ 23 , 24 , 25 , 26 ]. Leisure time provides people with a sense of fulfilment and personal autonomy, enables them to feel positive emotions, and to acquire valuable skills and knowledge [ 27 ].
Participation in leisure activities creates opportunities for socialization and contributes to social cohesion, by allowing people to connect to and network with others [ 28 ]. Leisure also provides opportunities to promote life balance, facilitating improved coping with daily life stress [ 29 , 30 , 31 ]. The physical activity component of leisure, in turn, is significantly associated with pursuit and maintenance of personal health [ 32 ], health-related quality of life [ 33 , 34 ], and psychological well-being [ 35 ], and is actively promoted as a good habit among healthy adults [ 36 ].
In this regard, focusing on leisure as a determinant of psychological well-being, and consequently as a source of health benefits, paves the way to possible new approaches to public policy. Even more so in public health, where leisure plays a more central and active role than commonly maintained, and particularly in a peculiar, and potentially critical, urban environment such as Naples.
In this paper, we explore the association between leisure under the form of cultural, social, physical activity and well-being in a group of residents of the metropolitan area of Naples, assessing the role of resilience as a mediating factor in such relationship. The questionnaire used in the present study is anonymous, in that no information was collected that could serve in any possible way to identify the participants name, surname, address, postal code, telephone or mobile phone number, e-mail date of birth, income information.
Participation in the survey was voluntary. Trained GENS personnel gave all the necessary information regarding the scope and aims of the study to the individuals willing to participate in the survey. The anonymous questionnaire paper and pen was handed and explained to each participant, who was requested to fill the questionnaire and hand it back to GENS personnel on the spot. On request, GENS personnel assisted participants in filling the questionnaire.
In order to ensure that all the social groups would be represented in the sample, the questionnaires were randomly collected in different areas across various neighborhoods of Naples. It is important to point out that in the city of Naples, low-, middle- and high-income people typically co-habit in the same neighborhood, although in different proportions, and often even in the same building.
In the present study, we analyze the responses of adults aged 18— The sample size is comparable to those of analogous studies such as the surveys on subjective psychological well-being SPWB carried out in Italy by Chasseny et al.
In , Grossi et al. The questionnaire used in this survey is anonymous and not anonymized. Anonymity refers to data collected from respondents who are completely unknown to anyone associated with the survey. Only the respondent knows that he or she participated in the survey, and the survey researcher cannot identify, in any possible way, the participants.
No one, including the investigator, can link an individual person to the responses. The questionnaire we collected fulfills these requirements, in that it does not contain: Name and surname, address, ZIP code, ID or social security number, contact information of any kind phone, or e-mail address. As consequence, individuals participating in this survey cannot be discerned in any way by anyone of the researchers involved.
For these reasons, anonymous surveys do not require ethical approval. In fact, in an anonymous survey, a written consent would have the paradoxical effect of compromising anonymity. Thus, the usual position in anonymous surveys is that a positive response from a respondent is, in itself, evidence of consent. The anonymous questionnaire, in Italian, collected information covering socio-demographic and health-related data on relevant determinants of subjective well-being:.
Demographic information. Here we adopted a short form PGWB-S of the original psychological general well-being index [ 38 ], developed and validated in its Italian version by Grossi et al.
Moreover, PGWB-S calls for a shorter time of administration and presents a better response rate and a lower rate of missing data. An Italian version of CD-RISC2 was not available, and an ad hoc translation was prepared adopting the conventional forward—backward procedure [ 43 ]. Cultural and social activities. We chose, in particular, the following: movies, theater, concerts, opera and ballet, museum exhibitions, reading, dancing, social activities, and charity work.
Participants had to indicate whether or not they engaged in any of these activities, and also their frequency of participation over the last year, as follows: once a week, once a month, every six months, or once a year. The list of leisure activities was prepared according to the Special Eurobarometer report on cultural access and participation [ 44 ]. Lifestyle habits.
Participants had to indicate whether or not they engaged in the following habits: smoking, diet, physical activity, as well as their preferred mode of transportation and patterns of computer use. Diagnosed diseases. We considered the following list: diabetes, respiratory diseases, skin diseases, gastritis, anemia, depression, osteoporosis, kidney diseases, migraine, anxiety, heart failure, arrhythmias, ischemic heart diseases, cancer, allergy, arthritis, myocardial infarction, hypertension, obesity, liver disease, back pain, colitis, none, and other.
Zero-order correlations among key study variables were analyzed in terms of Pearson product moment correlations between continuous variables and point-biserial correlations between binary and continuous variables. Before analysis, qualitative variables were transformed in artificially dichotomized variables.
Multiple regression analysis was performed with SPWB and resilience as dependent variables. For each dependent variable, separate regression models were run for both physical activity and participation to cultural and social activities. Gender and number of diseases were included as covariates in the analyses because they showed significant zero-order correlations with both PGWB and resilience.
Before performing multiple regression analysis several assumptions were tested. The linearity assumption has been tested with scatterplots. Q-Q-Plot was used to test whether the errors between observed and predicted values were normally distributed. Finally, a scatterplot of residuals versus predicted values was performed to check for homoscedasticity.
In order to test the significance of the mediation effect, the Sobel test was used [ 47 ]. To estimate the ratio of mediated to total effect, we used the method described by Preacher and Kelley [ 48 ]. The R statistical computing environment was used for all analyses [ 49 ]. The main characteristics of the sample population are outlined in Table 1. The sample consisted of females and males. The average age of the overall sample was Considering that we did not collect questionnaires from participants below 18 years of age, the age distribution of the sample in our study accorded with the structure of the Neapolitan population, according to Italian Institute of Statistics.
Retired people represent The average value of PGWB score in the overall population amounted to The average value of resilience score in the overall population was 5. In the population analyzed, the average number of reported diagnosed diseases was 2.
Cardiovascular diseases heart failure, arrhythmias, ischemic heart diseases, myocardial infarction were reported by Depression and anxiety were reported by 5. On average, females participate to 4. The number of diagnosed diseases showed evidence of negative association with SPWB but not with resilience.
SPWB scores were lower in females; this finding agrees with previous studies. We also found as expected a strong association between resilience and SPWB. Finally, both participation in social activities and physical activity showed evidence of association with resilience as well as with SPWB. To further analyze the relationship between participation in cultural and social activities and physical activity and resilience, we used a multiple regression approach.
The aim was to separate the possible effects of the two variables on resilience. Since other variables were also significantly associated with resilience, they were included in the regression models. Two models were studied: Model 1a, which included physical activity as an independent variable, and Model 1b, which included cultural activity as an independent variable. The results of the regression analyses investigating the relationship between resilience and these two variables are shown in Table 3 and Table 4.
Regression models with Resilience as the dependent variable: Model 1a physical activity. Residual standard error: 1. Regression models with Resilience as the dependent variable: Model 1b cultural activity.
It is intriguing to note that both physical and cultural activities were the independent variables most strongly related to resilience, being the only variables that reached statistical significance in the two models. To explore the relationship between participation in cultural, social, and physical activity and SPWB, we used the same approach described above.
Here again two models were studied: Model 2a, which included physical activity as an independent variable, and Model 2b, which included cultural activity as an independent variable. In both models, SPWB was set as a dependent variable and resilience added as an independent variable.
The results are reported in Table 5 and Table 6. Regression models with self-reported psychological well-being SPWB as the dependent variable: Model 2a physical activity.
Residual standard error: Regression models with self-reported psychological well-being SPWB as the dependent variable: Model 2b cultural activity. Model 2a, which included resilience and physical activity as independent variables, explained Age did not present any statistically significant relationship with SPWB.
Model 2b, which included resilience and cultural activity as independent variables, explained Age did not show any statistically significant relationship with SPWB in this model either. In our population, we found a statistically significant relationship between physical and cultural activity, on the one hand, and both resilience and well-being, on the other.
Therefore, we explored the possibility that resilience mediates, at least in part, the relationship of the two variables with SPWB. We verified this hypothesis through a mediation analysis approach. Considering a system with three variables X , Y and W , all correlated with each other, this approach is aimed at answering the following questions: 1 how much of the association between X and Y can be explained through the effect of X on W , and sequentially on Y ; and 2 is there still a direct association between X and Y after adjusting for the effects through W?
Two mediation models were tested: resilience mediating the relationship between physical activity and well-being, and resilience mediating the relationship between cultural activity and well-being. This finding indicates that, at least in part, resilience mediates the association of both physical and cultural activity with well-being. Following this approach, we found that the ratio of indirect to total effect for physical activity was 0. Thus, resilience plays a significant role in the relationships between physical activity and well-being, as well as between cultural activity and well-being.
In both cases, it seems to act as a partial mediator, accounting for about one third of the total effect of each variable on SPWB. Leisure activities, physical, cultural or social, contribute to resilience and well-being by helping to cope with stress. In this article, we have analyzed, in a sample of citizens of the metropolitan area of Naples, the relationship between leisure activities both regular physical exercise and participation in cultural and social activities on subjective well-being, and the role of resilience in this relationship.
Residents of the metropolitan area of Naples participating in this survey scored on average in the area of moderate distress according to Chassany et al. SPWB We cannot rule out that the low SPWB score of the sample population of residents of the metropolitan area of Naples reflects the detrimental effects of the economic and social crisis that has affected Naples since In particular, we must consider that Naples has not shown signs of socio-economic recovery, despite the fact that most cities and regions in the Eurozone are now finally performing beyond expectations, and thus the prospect of socio-economic stagnation remains unchallenged, with a likely negative impact on SPWB.
To the best of our knowledge, evaluations of the resilience score of Naples residents were lacking so far. This score is lower than the 6. Given the diversity of these societies in a global perspective, cultural factors and contexts may account for the differences in resilience score reported above.
Another relevant aspect of our study is the role of cultural participation. According to Eurostat and Eurobarometer data [ 44 , 52 ], the percentage of people participating in cultural activities should be calculated on the basis of participation intensity, and thus only attendees with medium, high and very high participation levels should be considered.
Moreover, we considered physical activity. The WHO estimates indicate that, in Europe, more than one third of adults and two thirds of adolescents are insufficiently active, and, according to the WHO physical activity fact sheet [ 53 ], one in four adults globally is not active enough. As for Italy, The importance of physical activity as both a preventive and therapeutic measure for several non-communicable diseases, like cardiovascular diseases, is a possible explanation for this observation.
However, we cannot rule out that also self-aesthetic reasons and compliance to current body image standards may have played a role. To investigate the relationship among the variables of interest, we have performed a correlation analysis. The inverse relation between leisure activity and age is well documented, and apparently indicates that a progressive disengagement from leisure activities is part of growing older. Consistently, the number of diagnosed diseases is negatively correlated with SPWB.
Considering the close relationship between subjective psychological well-being and health, this connection becomes particularly important while aging, when the prevalence of chronic illness increases. In this respect, high levels of SPWB have been associated with a decreased risk in mortality in general [ 55 , 56 ]. Interestingly, in in our study sample, resilience did not correlate with number of diseases.
In our sample population, the two dimensions of resilience apparently contribute differentially to the total Resilience score. On average, our group of subjects was more able to react to adversity 3. A possibly telling explanation is that, after years of troubled history, the only way to survive was effectively reacting to adversity. However, below the surface, the Neapolitan collective psychology is characterized by a deep disenchantment, often turning into desperate irony and a tragic sense of life, that undoubtedly belongs to the ethos of the city.
Magical thinking and religiosity mix in the effort to regain a sense of control upon uncertain events [ 57 ], not unlike what happens in cities characterized by similar mixes of functional and dysfunctional aspects such as Rio de Janeiro and New Orleans.
The root of Neapolitan resilience is therefore to be sought in a blend of unconscious fear of powerful, uncontrollable forces and a strong determination to survive. Within the sample analyzed, we found evidence of lower SPWB levels in females, confirming the SPWB gender differential in favor of males that is commonly found in the literature [ 41 , 59 , 60 , 61 ]. We also confirmed a strong positive association between resilience and SPWB [ 61 , 62 , 63 , 64 , 65 ]. Finally, both participation in social activities and physical activity were positively associated with resilience, as well as with SPWB.
Since the seminal work of Konlaan et al. Apart from observational studies, intervention studies have also demonstrated the efficacy of leisure activities in the promotion of well-being [ 67 , 68 , 69 ].
Moreover, leisure helps to build up resilience, as a form of stress survival strategy [ 70 ]. The results reported above indicate a positive association of cultural, social, and physical activity with SPWB and resilience. Thus, we applied a multiple regression approach to separate the possible effects of cultural and social activities and physical activity on resilience. Leisure activities Model 1a included physical activity as independent variable, and Model 1b included cultural and social activities as independent variable explained a relatively low share of the total variance in resilience.
These were, however, the independent variables most strongly related to resilience and the only variables reaching statistical significance. We then applied the same approach to investigate the relationship between leisure activities and SPWB. Model 2a, including physical activity and resilience as independent variables, explained Model 2b including cultural and social activities as independent variable explained In particular, we tested two mediation models: 1 does resilience mediate the relationship between physical activity and well-being?
Our results indicated that resilience plays a significant role in the relationship between physical activity and well-being, as well as between cultural and social activities and well-being.
In both cases, resilience seems to act as a partial mediator, accounting for about one third of the total effect of each variable on SPWB. Quoting Diener et al. Engagement in leisure activities is a free choice that individuals can also modify and adjust during the course of their lives. In any event, leisure activities produce positive emotions, which can counteract the effects of negative emotions, as well as generate positive thoughts and experiences, which in turn can help people face adversity and bounce back from negative experiences.
Starting from Konlaan et al. Cultural and social engagement may then qualify as preventive interventions at the population level. Participation in social and cultural activities favors social interaction and connection, stimulates curiosity and cognition, and provides a sense of existential fulfillment. In other words, participation in social and cultural activities stimulates dispositions that are conducive to various forms of human and social development which positively reflect into quality of life and subjective well-being, and this seems to be confirmed also for a relatively problematic urban environment such as Naples.
Though our findings indicate that resilience plays a significant role in the relationship between physical activity and well-being, as well as between cultural activity and well-being, and though these results may have important implications for the well-being of adults of all ages, this study has several limitations.
Self-report questionnaires enable the collection of a large amount of quantitative data, and generalization of the findings is possible, if the sample is randomly collected.
Nevertheless, we are aware of the limitations of using self-report questionnaires, whose main disadvantage might be the possibility of providing invalid or biased answers. In particular, respondents may not answer truthfully because of social desirability, acquiescent and non-acquiescent response bias, and clarity of the items. However, some of the problems can be countered through the careful design and application of self-reporting measures.
This is the approach applied in the SPWB questionnaire, where half of the question are reversed. The cross-sectional design of the study limited our ability to infer direction of causality. A longitudinal design would better support the conclusion that resilience is in part responsible of the link between physical health and well-being, and between cultural activity and well-being [ 73 , 74 , 75 ].
However, this is not always true. In this regard, Pek and Hoyle note that in recent years there has sometimes been a superficial use of longitudinal design, and this did not allow to overcome the weaknesses of cross-section design [ 76 ]. Moreover, this problem is associated with the difficulties that arise when taking ongoing measurements on the same sample in order to prepare a longitudinal design.
We are aware that the results of the mediation model in the current study should be interpreted with caution, and future research is needed to give a definite response. Considering that welfare costs are one of the major sources of public finance deficits in the EU, and that health care systems all over Europe struggle to remain socially and financially sustainable, to find resource-effective tools to promote health and prevent diseases is a key priority.
Recent research by Tawakol et al. This work indicates there is a route linking health to well-being and resilience in the brain-immune system axis, and in both cases the crucial step is the relief of stress or the enhancement of the reward circuitry. If to cure is an institutional responsibility of the health care system, to care is a responsibility of everyone. In this view, in the design of public health prevention and promotion interventions, a systemic approach is called for, drawing upon a wide, diverse yet closely integrated spectrum of expertise.
Even in complex, and to some extent dysfunctional, urban environments such as Naples, thinking of leisure activities as a driver of health promotion and disease prevention may be effective. Moreover, the role of local culture and history in shaping the behavior of residents and in enhancing their capacity to cope with stressors through shared meaningful experiences and culturally specific forms of resilience should not be overlooked.
Our study shows how major aspects of urban culture, as crystallized in the resilience construct, may play a complex mediating role in the relationship between forms of human cultivation such as cultural, social and physical activities, and well-being. More learning and experimentation is called for to assess the full potential of such dimensions in inspiring innovative public health approaches.
Conceptualization, S. All authors have read and agreed to the published version of the manuscript. National Center for Biotechnology Information , U. Published online Mar Find articles by Sergio Cocozza. Find articles by Giuseppe Matarese. Gayle D. Find articles by Gayle D. Find articles by Donatella Tramontano. Author information Article notes Copyright and License information Disclaimer. Received Feb 15; Accepted Mar 5.
This article has been cited by other articles in PMC. Abstract We explored the relationship between cultural and social participation, physical activity, and well-being in a group of residents of the metropolitan area of Naples, Italy and the role that resilience plays in this relationship.
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