Male health is an important issue which has not received the attention it deserves. Males have life expectancies that are significantly shorter than those of females, and the gap is widening. Predictions from the Global Burden of Disease Study 2013 suggest that by 2030, females will be outliving males by 7.2 years.1 A significant amount of this excess mortality is attributable to key lifestyle factors2,,3—including poor diet, sedentary behaviours, smoking and use of alcohol and other drugs —that are more prevalent in males than females.4 In addition, males are less likely to visit health professionals, use health services or participate in preventive programmes.5 Progress in the area of male health—and probably female health too—has been hampered by a failure to take into account the role of gender as a key determinant of health. This is despite the powerful role that gender plays at a biological, psychological and social level. Internationally, there have been some excellent longitudinal studies that have involved sizeable numbers of males and have looked at very relevant social determinants of health (e.g. workplace- and employment-related factors),6 but these have not explicitly focused on gender and associated constructs, such as masculinity. One of the reasons for this is that studies involving both males and females, by necessity, seek information from participants that is relevant to both but do not ‘drill down’ into factors relating to one and not the other. This means, for example, that they have not explored the way in which characteristics that might be regarded as traditionally masculine, like risk-taking, self-reliance and stoicism, might influence health behaviours and health outcomes. They also have not taken into account exposures that relate to societal expectations placed on males, such as job stresses associated with the traditional ‘breadwinner’ role. A few longitudinal studies on male health have been instituted around the world, but these have only focused on adults and have not involved national samples.7,8 This limits their potential for informing current knowledge about the impact of age- and cohort-related effects of gender on male health, and for tracking the trajectory of the development of masculine norms affecting health-related behaviours. It also limits their generalizability. In 2011, in recognition of the dearth of evidence on the gender-related and other factors that influence male health across the lifespan, the Australian Government (through its Department of Health) commissioned our team to conduct the Australian Longitudinal Study on Male Health. It did this as part of its commitment to improving the health of Australian males and making the health system more responsive to their distinctive needs. This commitment was articulated in the Australian Government’s National Male Health Policy, released in 2010.9 The Policy explicitly identified the need to generate evidence on male health and its determinants to help guide the development and implementation of policies, programmes and initiatives. A ‘given’ when the study was commissioned was that it should involve a national sample of males aged between 10 and 55, and this led to the study being called Ten to Men. The overarching objectives of the study were also outlined at the commissioning stage. They are to: examine male health and its key determinants, including social, economic, environmental and behavioural factors that affect the length and quality of life of Australian males; address a range of key research questions about the health of Australian males, including their health behaviours and risk and protective factors (e.g. risky behaviours, key life transition points, social and economic environments in which they work and live and use of health and other services); and identify policy opportunities for improving the health and well-being of males and providing support for males at key life stages, particularly for those at risk of poor health. We recruited a national sample of 15 988 males between October 2013 and July 2014. At recruitment, 1087 participants were aged 10–14 (boys), 1017 were aged 15–17 (young men) and 13 884 were aged 18–55 (adults). We used a stratified, multi-stage, cluster random sampling design to recruit our participants. Our primary sampling unit was the household. Households were defined as private dwellings (thereby excluding non-private dwellings or institutional settings such as hotels, motels, hostels, hospitals, nursing homes, short-stay caravan parks, military bases/barracks, prisons and correctional facilities, boarding schools, university residences, convents and monasteries). We invited every eligible male in an individual household to take part in the study. To be eligible, a potential participant had to be male, aged 10–55 at the time of recruitment, an Australian citizen or permanent resident and resident in the selected household, noting that part-time residents, such as boys in shared-care arrangements were eligible if they were resident at the time of recruitment of the household, and sufficiently proficient in English to complete the study questionnaire or interview, described below. We identified households through a sampling strategy that was guided by the structure of the Australian Statistical Geographical Standards (ASGS).10 The ASGS comprises a hierarchy of five spatial units, beginning with Mesh Blocks which aggregate up to Statistical Area 1s (SA1s) which in turn aggregate up to SA2s. SA2s combine to form SA3s, and SA3s combine to form SA4s.This structure is overlaid by a Remoteness Area classification schema which defines areas as major cities (accounting for 70% of the population), inner regional (18%), outer regional (9%), remote (1%) and very remote (1%).10 Sampling males in the major cities stratum was straightforward; we obtained a random sample of SA1s proportional to size (interpreted as the number of boys in the SA1, as enumerated in the Australian Bureau of Statistics 2011 Census of Population and Housing)1. Sampling males in the inner and outer regional strata was slightly more complex because we had to consider the areas that fieldworkers would be required to cover. In these areas, we selected a random sample of SA2s proportional to size and then randomly sampled SA1s within these SA2s. This process led to the enumeration of 622 SA1s in total, 363 (58%) in major cities, 144 (23%) in inner regional areas and 115 (12%) in outer regional areas. It is worth noting here that our sampling strategy was not designed to guarantee representation from each of Australia’s eight states and territories, but in fact SA1s from each were included in the final pool. As Figure 1 shows, we approached all 104 884 households in the 622 SA1s, and made contact with 81 400 (78%) of these. In total, 33 724 (32%) households were found to be in scope (i.e. to have at least one male resident aged 10–55). We identified 45 510 in-scope males in these households and, as noted above, 15 988 (35%) of these returned useable data. This 35% figure represents our best estimate of a response fraction; it is not possible to be more precise than this because we do not know the proportion of uncontacted households that would have been in scope, and nor do we know whether there were unidentified in-scope males in any of the contacted households. Household and individual responses. Table 1 compares our cohort with all Australian males on salient socio-demographic factors, using data from the 2011 Census. In the interests of comparability, the Census data analysis is restricted to males aged 10–55 and living in major cities or inner or outer regional areas. We have also only considered characteristics that are applicable across the full 10–55 year age range, and so have not examined variables like marital status, employment status, level of education or income level. The age of Ten to Men participants is shifted towards older males, relative to the Census distribution. They are more likely to be born in Australia, but similar proportions are of Aboriginal or Torres Strait Island descent. Higher proportions reside in inner and outer regional areas, reflecting the fact that we deliberately oversampled in these areas. The pattern with respect to residence in areas of social disadvantage, as measured by the Index of Relative Socio-Economic Disadvantage (IRSD), shows that Ten to Men males mirror the general population of Australian males reasonably well. In summary, the Ten to Men cohort differs in some respects from the Australian male population but, as we demonstrate later in this paper, participants show sufficient variability in key exposure and outcome variables to permit the exploration of many relevant and unexplored questions relating to the health of males. We have calculated sample weights based on the inverse of the probability of selection at the level of the individual participant, which can be applied in cases where generalizability to the overall population is important. Comparison of Ten to Men participants with all Australian malesa aData for all Australian males taken from 2011 Census and restricted to males aged 10–55 and living in major cities or inner or outer regional areas. Comparison of Ten to Men participants with all Australian malesa aData for all Australian males taken from 2011 Census and restricted to males aged 10–55 and living in major cities or inner or outer regional areas. As noted above, our cohort was recruited between October 2013 and July 2014 and we collected Wave 1 (baseline) data during this period. Data on the boys were collected via an interview with participants themselves and a questionnaire completed by one of their parents. Data on the young men and adults were collected via two self-complete questionnaires, one tailored to each of these major age groups. The intention is that the cohort will be actively followed up every 2–3 years. Wave 2 data collection began in November 2015.Once again, we are using interviews and parent-complete questionnaires for the boys and self-complete questionnaires for the rest of the cohort. However, wherever possible we are encouraging the adults and young men to complete their questionnaires online, which was not an option in Wave 1. Those who do not choose to do this will be mailed a questionnaire, and those who do not return the mailed questionnaire will be visited by a fieldworker who will drop and collect the questionnaire. We piloted this staged data collection process, and the results augur well for maximizing retention; our current estimate is that 75% of the cohort will participate in Wave 2. In addition to the active follow-up at each wave, we will passively follow participants by linking their interview/questionnaire data to a range of health and other administrative datasets, beginning with the Medicare Benefits Schedule (which provides information services delivered on a fee-for-service basis by general practitioners, medical specialists and various other providers) and the Pharmaceutical Benefits Scheme (which provides information on government-subsidized medications). We also plan to link our primary Ten to Men data with the National Death Index and various disease registries (e.g. the Australian Cancer Database, which holds records of all cancers diagnosed in Australia). In addition, we are proposing linkage to geospatial data on residential and work locations. We have also proposed a series of sub-studies (including one that would involve the collection of biospecimens), some of which might involve between-wave data collection. The domains and constructs measured at Wave 1 are outlined in Table 2. These were guided by the National Male Health Policy in general and the objectives that the study was designed to achieve in particular. Some constructs were applicable across all age groups, whereas others were relevant to one age group (e.g. boys) but not others (e.g. young men and adults). Domains and constructs in the Wave 1 questionnaires/interviews, by age group Domains and constructs in the Wave 1 questionnaires/interviews, by age group Wherever possible, we selected validated instruments to measure the constructs, selecting ones that had been used in an interview format for boys and ones that had been developed as self-complete measures for young men and adults. For example, we used the Conformity to Masculine Norms Inventory (CMNI-22)11,12 and the Alcohol Use Disorders Identification Test (AUDIT)13 to examine masculinity and alcohol use in adults and young men, and the Pediatric Quality of Life Inventory (PedsQL) General Well-being Scale14,15 and the Spence Children’s Anxiety Scale (SCAS)16,17 to examine well-being, social and in We also questions that had been in other national and such as the Australian Health the Longitudinal Study of Australian the Australian Longitudinal Study on Health the and the Study For we used the support from the to examine social support in and questions on and behaviours from the for males from all age groups. In addition, we to that Census be made where For example, we collected information on in a way that it to be to the Australian and of similar constructs were measured for the we to instruments that be used across age when this was and For example, we used a on that was used in the it across all age groups. we used the Health for adults and an of the for young men and Table provides data on key of the health of the Ten to Men including health status, and health and health behaviours. The of of young men and of their health as The health in the by more than of the relevant age group in the were and in and in young men and and in adults. of selected and and health behaviours, by age in number of participants for each are to by a from the Pediatric Quality of Life Inventory (PedsQL) General Scale14,15 for boys and young men and a from the Health for adults. These questions participants to their health on a from to by a based on the format used in the Australian Health which whether the participant has been by a or other health that has the and, if whether has been for or had of it in the that were to on of their by questions from the for and questions for young men and of questions relate to of the smoking in adults was by questions based on the Australian Health smoking in boys and young men was using questions from the Australian Alcohol and using the the Alcohol Use Disorders Identification Test of selected and and health behaviours, by age in number of participants for each are to by a from the Pediatric Quality of Life Inventory (PedsQL) General Scale14,15 for boys and young men and a from the Health for adults. These questions participants to their health on a from to by a based on the format used in the Australian Health which whether the participant has been by a or other health that has the and, if whether has been for or had of it in the that were to on of their by questions from the for and questions for young men and of questions relate to of the smoking in adults was by questions based on the Australian Health smoking in boys and young men was using questions from the Australian Alcohol and using the the Alcohol Use Disorders Identification Test The of some individual with age (e.g. the of was in boys and in adults). This that the cohort will opportunities for the of and the risk and protective factors associated with their the a number of the behavioural risk factors we examined are in our cohort (e.g. of boys in as do of young men and of which the potential for of health of Table some the between selected and For these data suggest that there is a the males live from major cities, the more likely they are to live with the of an alcohol at or and in For young men and the are similar but less The between and is more with living in an inner regional area the risk for adults but to be protective for young men and and by adults and boys and young men in number of participants for each are to by a which live with the or effects of an using the the Alcohol Use Disorders Identification Test by questions from the for and questions for young men and of questions relate to of the by a based on the format used in the Australian Health which whether the participant has been by a or other health that has and, if whether has been for or had of it in the that were to on of their for young men not and by adults and boys and young men in number of participants for each are to by a which live with the or effects of an using the the Alcohol Use Disorders Identification Test by questions from the for and questions for young men and of questions relate to of the by a based on the format used in the Australian Health which whether the participant has been by a or other health that has and, if whether has been for or had of it in the that were to on of their for young men not Table the for adults and their with employment For all males who are or than males in than males who are the but not in and by employment status, adults in number of participants for each are to by a which live with the or effects of an using the the Alcohol Use Disorders Identification Test by questions from the that relate to of the by a based on the format used in the Australian Health which whether the participant has been by a or other health that has and, if whether has been for or had of it in the and by employment status, adults in number of participants for each are to by a which live with the or effects of an using the the Alcohol Use Disorders Identification Test by questions from the that relate to of the by a based on the format used in the Australian Health which whether the participant has been by a or other health that has and, if whether has been for or had of it in the and some as to the of questions that can be by Ten to Men. more analysis is required of the variables and potential need to be taken into of the Wave 1 data will also be required because its that it is not possible to the of For example, the health of males who are not in education and are the is likely to at least in part be by the fact that it males who are on poor health led to their employment but for those who would to be or their employment be a on their health. of these will be as of data are Ten to Men is the longitudinal study to male health, that boys and men, to be to The study is important for the reasons outlined as a males than females on many health and the complex of biological, social, environmental and on their health has received In has been to being male for health. Ten to Men has the to knowledge in this particularly because it male gender-related constructs (e.g. and factors (e.g. significant life like a for the of Ten to Men is the age range of the cohort. The of 10 to some of the key during which have an important influence on health and well-being as boys in the cohort through and into The of that of our cohort has not to associated with older which in turn as Ten to Men we will be to identify cases of their age of and examine the risk and protective factors associated with The age at recruitment also opportunities for the health of key later life such as of the Ten to Men also has the of involving a national than a sample from a or a As a our participants are in of where they they their their to and other their and the health they This range of exposures and the potential for Ten to Men to examine and the in the health of males. A is in addition to data on a range of constructs and sufficient numbers to and questions of these data with some Ten to Men is also some data. At the of each during Wave participants were invited to and around did These data will the to which these men themselves and will to identify significant not included in the In addition to being in their these data will also be for and study design in longitudinal A final is the potential to examine between males in the cohort. We approached
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