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RESEARCH REPORT
Elvis to Eminem: quantifying the price of fame through early
mortality of European and North American rock and pop stars
Mark A Bellis, Tom Hennell, Clare Lushey, Karen Hughes, Karen Tocque, John R Ashton
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
See end of article for
authors' affiliations
. . . . . . . . . . . . . . . . . . . . . . . .
Correspondence to:
Mark A Bellis, Centre for
Public Health, Liverpool John
Moores University, Castle
House, North Street,
Liverpool L3 2AY, UK;
m.a.bellis@ljmu.ac.uk
Accepted 6 April 2007
. . . . . . . . . . . . . . . . . . . . . . . .
J Epidemiol Community Health 2007;61:896–901. doi: 10.1136/jech.2007.059915
Background: Rock and pop stars are frequently characterised as indulging in high-risk behaviours, with high-
profile deaths amongst such musicians creating an impression of premature mortality. However, studies to
date have not quantified differences between mortality experienced by such stars and general populations.
Objective: This study measures survival rates of famous musicians (n = 1064) from their point of fame and
compares them to matched general populations in North America and Europe.
Design: We describe and utilise a novel actuarial survival methodology which allows quantification of excess
post-fame mortality in pop stars.
Participants: Individuals from North America and Europe performing on any album in the All-Time Top 1000
albums from the music genres rock, punk, rap, R&B, electronica and new age.
Results: From 3 to 25 years post fame, both North American and European pop stars experience significantly
higher mortality (more than 1.7 times) than demographically matched populations in the USA and UK,
respectively. After 25 years of fame, relative mortality in European (but not North American) pop stars begins
to return to population levels. Five-year post-fame survival rates suggest differential mortality between stars
and general populations was greater in those reaching fame before 1980.
Conclusion: Pop stars can suffer high levels of stress in environments where alcohol and drugs are widely
available, leading to health-damaging risk behaviour. However, their behaviour can also influence would-be
stars and devoted fans. Collaborations between health and music industries should focus on improving both
pop star health and their image as role models to wider populations.
Famous pop and rock stars are frequently characterised as
having "live fast, die young" lifestyles.
1 2
Thus, media
regularly document music celebrities who die prematurely,
often with drug or alcohol abuse implicated either directly in
their death (eg, overdose of Janis Joplin) or in association with
fatal accidents or mental health conditions (eg, suicide of Kurt
Cobain). However, while qualitative reviews support rock and
pop stars suffering high levels of stress, depression and
substance use,
2–4
quantitative studies of mortality amongst
such individuals are almost completely absent.
5 6
Consequently,
discussions of premature mortality in pop and rock stars
typically rely on cursory comparisons of musicians' ages of
death with life expectancy in the general population. However,
such calculations are likely to be misleading for several reasons.
Young deaths of popular musicians receive widespread media
coverage, yet relatively little attention is paid to numerous
premature deaths routinely occurring in the general population
(for instance, in 2004 there were 43 146 deaths under the age of
55 in England and Wales and 373 074 in the USA).
7 8
Pop and
rock stars can disappear from public attention as they age and
deaths in older musicians may go relatively unnoticed, leaving a
disproportionate impression of premature death. The pop star
phenomenon is also a relatively recent cultural development
and, with many stars still young, higher ratios of young to older
deaths are inevitable. Furthermore, this same effect will reduce
the proportion of deaths from cancer and heart disease and
elevate proportions from causes more common to youths (ie,
alcohol, drugs, accidents, suicides and violence).
9
The numbers of individuals who achieve pop star fame are
relatively small, and while their morbidity and mortality may
be of major concern to the music industry,
10
their direct
contribution to population health statistics is minimal. How-
ever, the actions and behaviours of pop and rock stars are
watched worldwide by millions of fans, would-be performers and
performing musicians who follow their genre's leaders. Such
stars are important role models for young people and can be
influential in shaping their behaviour and identity.
11–13
Thus,
being a fan of certain music genres is associated with higher
levels of drug use (eg, house music,
14
hard rock and heavy
metal)
15
and a variety of other risk-taking behaviours (eg, "hard"
rap and violence,
16
heavy metal and sexual behaviour).
17
Consequently, the behaviour and resultant morbidity and
mortality associated with rock and pop stardom may have a
disproportionate influence on the health of the wider population.
Furthermore, public health interventions are now utilising rock
and pop stars in health promotion campaigns (eg, Jon Bon Jovi in
a US anti-drugs campaign).
13
However, such interventions are
developed with few measures of how music fame relates to ill
health or examination of the risks posed by associating health
messages with potentially risk-taking lifestyles. Using a cohort of
famous musicians (n = 1064) from a range of popular music
genres, we measure survival rates from their point of fame,
compare them to matched general populations in North America
(USA and Canada only) and Europe and, based on our findings,
examine both their own health prospects and the positive and
negative contributions pop stars can make to public health. In
doing so we explore a novel methodology for examining survival
in a specific population where lack of population denominators
precludes conventional techniques.
M E T H O D S
In 2000, an international poll of over 200 000 individuals (fans,
experts and critics) identified the All-Time Top 1000 Albums.
18
Being a solo performer or group member with a listed album was
the primary inclusion criterion defining the cohort of pop stars
(although compilation and soundtrack albums were excluded,
n = 11; table 1). Using websites (eg, allmusic.com, wikipedia.
org, billboard.com, theofficialcharts.com, softshoe-slim.com and
8 9 6
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answers.com), biographies, encyclopaedias and published
anthologies,
1 19 20
individuals' dates of birth, survival status on
31 December 2005 (alive or dead) and, where appropriate, date
and reported cause of death were identified (tables 1 and 2).
Individuals were excluded where date of birth or nationality was
unknown (table 1) and those from the music genre classifica-
tions of country, blues, jazz, vocal, celtic, folk, bluegrass and
spoken word were also removed leaving only the mainstream
popular categories of rock, punk, rap, R&B (rhythm and blues),
electronica and new age.
21
Finally, as only European and North
American pop and rock stars were present in sufficient numbers
to generate survival curves, the final sample was limited to these
geographical areas, therefore excluding artists of other nation-
alities (eg, Bob Marley). To provide an objective measure of age
at fame, we used pop stars' age at the earliest date of chart
success (n = 807) or release of their earliest album in the All-
Time Top 1000 Albums (n = 257). Chart success was measured
as when an individual first appeared on an album in the Top 40
UK Official Chart (n = 488) or Top 40 USA Billboard 200
(n = 187). For those never having Top 40 albums, a Top 40 single
in the UK chart (n = 27) or USA Billboard Hot 100 (n = 1)
was substituted and, for remaining artists, a Top 40 album or
single in a specialist US chart (Pop, n = 84; Black, n = 13;
Heatseekers, n = 7) was used. Thus, the earliest date of fame was
1956 for Elvis Presley and the latest 1999 for Eminem (Marshal
Mathers).
For each pop star, we calculated total years of survival since
becoming famous and compared this to their expected survival
based on general populations (matched to pop stars for sex,
nationality, ethnicity and age at the point of fame). Here, we
utilised the actuarial survival method (ie, age standardised
relative survival).
22
This method matches each artist in the
dataset with the corresponding annual survival probabilities
experienced by an average individual of the same age and sex
(and race) in the general population in or near their year of
fame. Reference survival probabilities are taken from cohort life
tables (ie, historic survival expectation of a group of individuals
with the same year of birth). Thus, for European artists, we
used UK historic cohort male and female life tables (1956–99
tables)
23
with population denominators adjusted using the 2001
UK census. Equivalent cohort life tables have been published
annually for US populations, but the race-specific population
denominators used are known to have been problematic,
especially in the period 1980–91.
24
Therefore, we estimated
cohort tables from the US decennial (period) life tables
25
applying survival rates from the 1959–61 decennial tables to
the years 1956–64, survival rates from the 1969–71 tables to the
years 1965–74 and so on. No decennial tables have been
published for 1999–2001, so we applied corresponding annual
period life tables for 2001. Cohort life tables were then
estimated from the successive period life tables by use of an
offset transposition matrix. Race-specific US tables were
calculated for whites (male and female) and blacks (male
and female) (in 1959–61 decennial tables, "non-white" was
used as black was not specified). Hence, six sets of life tables
were utilised to generate reference survival rates: UK males, UK
females, US black males, US black females, US white males and
US white females. Age standardised relative survival was
calculated for all years up to the end of 2005 as pop star
survival expressed as a percentage of the average of the
corresponding survival probabilities from the matched refer-
ence populations. Confidence intervals (95% CIs) were also
calculated. As there are no calibrated CIs for survival
probabilities in the UK national life tables, differences are
assumed to be significant when matched population survival
rates fall outside of the 95% CIs for pop stars. For other
comparisons, statistical significance was assessed using x2 and
Mann Whitney U tests undertaken in SPSS.
R E S U L T S
In the final sample (n = 1064), North American and European
pop stars did not differ significantly in year of birth or sex
although North American stars were more likely to be R&B or
rap artists (table 2). Overall, 100 pop stars had died (table 2)
with 7.3% of women having died and 9.6% of men (x2 = 0.550,
p = 0.458). Crude mortality for European artists was around
half that for North American artists (table 2) with median age
of death among those who had died being 41.78 and
35.18 years for North American and European pop stars,
respectively (Z = 0.322, p = 0.747). Mortality just 5 years post
fame was 2.4% overall but dropped from 3.5% in those reaching
fame before 1980 to 1.6% in following years (x2 = 4.172,
p,0.05). In both North American and European samples, a
chronic drug- or alcohol-related problem or overdose was
identified as associated with over a quarter of deaths (table 2).
There were non-white artists in both European and North
American samples with European pop stars being more likely to
be white (table 2). Although numbers of deaths were small,
crude mortality for non-white pop stars in North America
(16.82% died) was higher than that for whites (11.89%),
although this failed to reach statistical significance (x2 = 1.880,
p = 0.170). Mortality rates for North American white stars
(11.89%) were also higher than those for European white stars
(5.74%; x2 = 11.217, p,0.001). Such analyses, however, do not
account fully for the age and sex composition of populations,
nor for the extent to which differential survival of the general
populations in North America and Europe may also have
affected pop stars. To address these issues, we calculate survival
relative to the general population standardised by age, sex and,
in North America, ethnicity.
Figure 1 presents the age standardised relative survival in
both continents by years of fame. Relative survival is
consistently below 100% for both European and North
American artists (ie, pop star survival is always below that of
the matched general populations). In the first year of fame, the
upper confidence limit exceeds 100% of the matched population
survival for both European and North American artists, and for
North American artists this is also true for the second year of
fame. However, with the exception of the European sample in
Table 1 Sample selection: exclusions and inclusions from
the All Time Top 1000 Albums
Number (%)
Albums 1000 (100.00)
Excluded
Compilation albums 2 (0.20)
Soundtracks 9 (0.90)
Additional albums by artists already included* 222 (22.20)
Included 767 (76.70)
Individuals (from 767 albums) 1285 (100.00)
Excluded
Excluded genre 78 (6.07)
Not from North America or Europe 40 (3.11)
Classed as a missing person 1 (0.08)
Included 1166 (90.74)
Missing data (from 1166 individuals)
No nationality and date of birth 36 (3.09)
No nationality 2 (0.17)
No date of birth 64 (5.49)
Included (final sample) 1064 (91.25)
*Where additional albums included new band members such individuals
were also included in the final dataset.
Genres: R&B (rhythm and blues), rock, electronica, new age, punk and rap
were included and bluegrass, blues, vocal, celtic, country, folk, jazz and
spoken word were excluded.
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year eight when the upper 95% CI for European pop star
mortality exceeds expected mortality for the general population
(fig 1), pop star mortality exceeds matched population
mortality for all other years until after 25 years of fame.
Further, European standardised pop star survival is consistently
better than North American standardised survival (beyond the
second year of fame) and, as length of fame increases, the gap
between European and North American pop stars widens
(fig 1). During this period, both North American and European
artists experience mortality rates more than 1.7 times those for
their counterpart general populations (table 3). However, after
25 years of fame the European and North American experi-
ences differ sharply. For European artists, relative survival
probability then increases until it is not significantly different
from the population average (fig 1). By contrast, North
American relative survival of pop stars demonstrates an
increasing divergence from both their matched population
survival and European pop star survival (fig 1).
To illustrate how differences relate to contrasting general
population mortality, we calculate pop star survival as
estimated by Kaplan Meier survival curves plotted against
corresponding matched general population curves. Figure 2
shows not only that survival for European artists is significantly
higher than that for North American artists but also that there
are substantial differences in survival between the two
reference general populations (despite the two datasets not
differing in age and sex). Thus, population survival at 35 years
projected from cohort life tables for the North American
reference population is 84% compared to 91% at 35 years for
the corresponding European population projected from UK life
tables. Consequently, the increasing gap in age standardised
relative survival between North American and European pop
stars occurs despite a greater fall in survival in the North
American matched population than in Europe (fig 2).
D I S C U S S I O N
In order to carry out a quantitative study of pop star mortality,
we have had to make a number of assumptions. Firstly, our
choice of sample utilised a specific international survey.
18
However, its size, independence from this research and timing
(recent but with enough time since polling for new artists to
potentially experience some mortality) made it the most
suitable choice. Our definition of date of fame was objective
but had no established epidemiological criteria for fame on
which to draw. However, as earliest date of chart success was
used for most artists, this will tend to produce more
conservative estimates of the effect of fame on mortality, with
a choice of later dates of fame potentially exaggerating its
immediate impact. Further, data were collected from a range of
sources rather than official records of cause of death (table 1).
Again, however, we cross-referenced over 430 websites, books
and other sources, and although official data may have been
beneficial, cause of death in such records may be contentious.
Finally, we had to apply US and UK population mortality
measures as proxies for North America and Europe. While
differences may exist between countries, in each continent the
vast majority of pop stars were from the UK or the USA
(table 2). Consequently, although techniques have had to be
creative, the results represent, at the least, a conservative
estimate of additional mortality relating to musical fame and a
substantial advance on descriptive assessments of individual
pop star deaths.
Our results show that at between 2 and 25 years of fame,
both North American and European pop stars tend to
experience two to three times the risk of mortality expected
in an average population matched by age, sex and, in North
America, ethnicity (figs 1 and 2). Initially, pop stars experience
similar relative mortality in both continents (table 3). However,
results here contradict a common perception that pop and rock
stars inhabit an environment independent of continent and
wholly different from that of the general population in their
countries of origin. Thus, although pop stars in both North
America and Europe suffer similar relative increases in
mortality (compared with local populations), differences in
absolute levels of pop star mortality (North America vs Europe)
are also consistent with geographical differences between
Table 2 Characteristics of pop stars sample by geographical region
Characteristics Total Europe North America p*
Sample size (n) 1064 503 561
Main country (%) UK and USA, 94.64 UK, 94.43 USA, 94.83 0.773
Year of birth (median) 1957 1957 1956 0.597
Year of fame (median) 1981 1980 1985 0.164
Male (%) 90.98 92.25 89.84 0.171
White (%) 88.53 97.02 80.93 ,0.001
Pop genre (%)
Rock 89.76 94.83 85.2 ,0.001
R&B 3.85 0.4 6.95 ,0.001
Electronica 1.88 3.38 0.53 ,0.001
New age 0.38 0.8 0 0.106
Punk 0.28 0.6 0 0.21
Rap 3.85 0 7.31 ,0.001
Dead 31/12/2005 (%) 9.4 5.57 12.83 ,0.001
Likely cause of death (% of dead)
Chronic disorder (drug/alcohol) 8 3.57 9.72 0.544
Drug/alcohol overdose 19 28.57 15.28 0.128
Accident (drug/alcohol related) 4 7.14 2.78 0.665
Other accident 16 21.43 13.89 0.535
Suicide 3 3.57 2.78 0.657
Violence 6 3.57 6.94 0.867
Cardiovascular disease 14 3.57 18.06 0.12
Cancer 20 21.43 19.44 0.823
Other 10 7.14 11.11 0.823
*p (probability) describes differences between North American and European pop stars. Medians are compared using Mann Whitney U tests, while percentages are
compared using x2.
Chronic drug and alcohol disorders include liver, kidney and gastrointestinal diseases explicitly linked with substance use. Many of those deaths classed as suicides,
violence related and other accidents, while likely to be linked with substance use, have only been categorised as alcohol- and drug-associated where references
specifically detailed the link.
8 9 8 B e l l i s , He n n e l l , L u s h e y , e t a l
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general populations (ie, North American pop stars and North
American general populations die earlier; fig 2). Further, at
25 years post fame even the relative effects of stardom in each
continent diverge. Here, European pop star mortality begins to
return towards general population levels, while North
American star mortality remains high (fig 2). This effect is
not related to differences in ethnicity and, although not shown
here, differences in relative survival between North American
and European artists remain strong even when non-white
American artists are excluded. In fact, as the general population
survival for North American blacks is so much poorer than that
for whites, exclusion of non-whites from both North American
pop stars and matched populations increases differences
between European and North American stars after 25 years of
fame.
Divergence in mortality 25 years post fame might be
explained by differences in longer-term experience of fame
with more performing in later years (eg, nostalgic or reunion
tours), continued media interest and associated stress and
substance use in North American pop stars.
26
However, this
divergence may also reflect the pop star experience in North
America being more likely to generate chronic ill health. In both
continents, those reaching 25 years' fame also have a median
age when chronic conditions and healthcare needs begin to
escalate (around 50 years old; table 3).
27
However, the North
American pop stars appear more susceptible to chronic
conditions (eg, cardiovascular disease; table 2) and conse-
quently their associated excess mortality may continue later
into life than the excess acute drug- and alcohol-related deaths
more common in Europe (table 2). Moreover, the prognosis for
pop stars who find themselves with poor health and impover-
ished in later life could also be substantially worse in North
America should they have no health insurance.
28
Consistent with other studies of pop stars, a disproportionate
amount of their mortality appears to be related to alcohol and
drug use (table 2).
4 6
Pop stars' health and, in particular,
substance use and other risk-taking tendencies should be
addressed by the music industry not just in the short term but,
Figure 1 North American and European
pop stars: age-standardised relative survival
by years of fame. CI, confidence interval.
Table 3 European and North American pop stars' crude mortality and mortality ratio relative to the general population by years of
fame
Years
of fame
Sample
size
Average
age (years) Survived Died
Sample
mortality
Lower Upper Reference
mortality*
Mortality
ratio95% CI 95% CI
European 0 503 24 502 1 0.20 0.01 1.10 0.00 NA
5 503 29 496 7 1.39 0.56 2.85 0.46 3.05
10 457 34 445 12 2.63 1.36 4.54 0.98 2.68
15 375 39 360 15 4.00 2.26 6.51 1.63 2.46
20 337 44 321 16 4.75 2.74 7.60 2.56 1.86
25 253 48 233 20 7.91 4.90 11.94 3.97 1.99
30 152 53 141 11 7.24 3.67 12.58 6.08 1.19
35 102 58 90 12 11.76 6.23 19.65 8.85 1.33
North American 0 561 26 561 0 0.00 0.00 0.66 0.00 NA
5 561 31 544 17 3.03 1.77 4.81 0.98 3.10
10 495 36 466 29 5.86 3.94 8.32 2.08 2.82
15 362 40 337 25 6.91 4.52 10.03 3.57 1.93
20 291 46 261 30 10.31 7.06 14.39 5.49 1.88
25 262 50 226 36 13.74 9.81 18.51 7.96 1.73
30 196 55 157 39 19.90 14.55 26.18 11.30 1.76
35 144 59 105 39 27.08 20.02 35.11 15.77 1.72
*Reference population mortality is calculated from published UK cohort life tables for European populations and from cohort life tables calculated from US decennial
(period) life tables for North America (see Methods section for details).
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with a prolonged period of increased mortality following fame,
their long term health should also be examined. Encouragingly,
comparisons of 5-year mortality in those reaching fame before
and after 1980 suggest that immediate increases in mortality
following fame have reduced. However, even in the 1980s and
1990s, 1.6% of pop stars had died within 5 years of fame.
Qualitative studies of those who reach professional or semi-
professional rock and pop musician status (but not stardom)
suggest they also suffer elevated levels of stress, depression
and substance use.
3 10 29
While links between pop stars and
this group of other professional and semi-professional musi-
cians are largely unstudied, the size of this group and the
opportunity for genre leaders to influence their behaviour
should not be underestimated. In the late 1970s, there were
an estimated 5000 bands in the San Francisco Bay Area
alone,
30
while in the UK, one in ten children (age 7–16) aspire
to be a pop star when they grow up.
31
Television programmes
such as The X Factor (UK) indicate how many more would
follow this path given the chance (eg, over 100 000 people
applied for The X Factor 2006).
32
More broadly, debate
continues over whether individuals attracted even as fans to
certain music genres (eg, rap music) associated with risk
taking (eg, drug use) are already involved in risk taking
when they start to follow this music or whether they
subsequently develop such behaviour.
16
However, recent studies
suggest that preference for certain genres actually precedes
development of problem behaviours and consequently music
associations (eg, being a rap fan) may contribute to anti-social
behaviour.
33
The methodological approach developed here (although
analogous to methods utilised for measuring mortality in soap
opera characters)
34
provides a novel technique for assessing
differential mortality and survival for populations observed
over an extended time period. Importantly, it is applicable
where conventional techniques to calculate population-stan-
dardised mortality ratios are precluded by an inability to
estimate appropriate population denominators. Here, these
methodologies have quantified significant additional mortality
associated with rock and pop stardom. This study could not
Figure 2 Comparative survival curves for
North American and European pop stars
and demographically matched general
populations.
Wh a t t h i s p a p e r a d d s
N Using rock and pop stars we explore and describe a
novel methodology for examining survival in specific
populations where lack of population denominators
precludes conventional techniques.
N Results indicate that rock and pop stars suffer nearly
double the mortality of demographically matched gen-
eral populations in North America and Europe.
N Internationally rock and pop stars, along with other
media celebrities, are being utilised to promote positive
health messages. However, results suggest caution should
be exercised when utilising rock and pop stars until more
is understood about how their personal profiles influence
public behaviour.
P o l i c y i m p l i c a t i o n s
N While policy has directed considerable attention to the
health of the most deprived, relatively little work has
addressed t he heal t h of t he rich and famous. I n
particular, the behaviour of celebrity individuals may
influence significant proportions of young people and
should be better understood.
N Despite some indications that mortality relating to pop
stardom has fallen in recent years, it remains substan-
tially higher than in the general population. Such
mortality is likely to be accompanied by more wide-
spread morbidity among the most famous as well as
lesser celebrities and would-be pop stars. Collaborative
work between health and music industries should be
undertaken to address this.
N Increasingly, communication of health-promoting mes-
sages to young people is being undertaken by pop stars
and other celebrity figures. However, more needs to be
learnt about how such interventions actually affect young
people's behaviour and whether they work to promote
positive heal th messages or, conversely, risk-taking
lifestyles.
9 0 0 B e l l i s , He n n e l l , L u s h e y , e t a l
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distinguish whether pop fame contributed to reduced survival
or whether those achieving fame were already predisposed to
additional mortality. Consequently, despite some signs that
mortality associated with pop star fame may have reduced in
recent decades, the continued excess health risk experienced by
such artists should be further examined. In particular, in the
music industry, factors such as stress, changes from popularity
to obscurity, and exposure to environments where alcohol and
drugs are easily available, can all contribute to substance use as
well as other self-destructive behaviours.
29
Here, just as in the
general population, levels of substance use, suicide, violence
and other risk behaviours can be reduced not just on an
individual basis but through altering the environment.
35
More widely, public health consideration needs to be given to
preventing music icons promoting health-damaging behaviours
amongst their emulators and fans. Stars could play an
important part in improving health behaviours and, across a
variety of countries, major figures have been used to promote
health messages. However, the success of such interventions
largely depends on how much of pop stars' appeal to young
people is as a result of their links with risk-taking behaviours.
Although poorly understood, the strength of such links and
ability to alter them determines, in part, pop stars' negative
effects on public health and potential to act as positive health
models. Where pop star behaviour remains typified by risk
taking and substance use, it is unlikely that youths will see any
positive health messages they champion as credible and
potentially risky behaviours may actually be promoted.
Consequently, collaborations between public health and music
industries should not just focus on affecting the behaviour of
fans but should also consider improving the health behaviour
of artists to both protect them from ill-health and premature
mortality and to ensure any status as positive health role
models is sustainable and credible.
A C K N O WL E D G E M E N T S
Our sincere thanks to Sara Edwards, Beccy Manning, Sara Hughes, Phil
Wheater and Jeremy Hooper for the significant contributions they have
made identifying and collating information utilised in this paper. Many
other individuals have also provided texts, references and website
addresses that helped us to develop this paper and we are grateful for
their help.
Authors' affiliations
. . . . . . . . . . . . . . . . . . . . . . .
Mark A Bellis, Clare Lushey, Karen Hughes, Karen Tocque, John R Ashton,
Centre for Public Health, Liverpool John Moores University, Liverpool, UK
Tom Hennell, Public Health Group, Government Office for the North West
of England, Manchester, UK
Competing interests: None declared.
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