Introduction

Ten to Men: The Australian Longitudinal Study on Male Health is the first large-scale, nationally representative, longitudinal study to focus exclusively on investigating and improving the health and wellbeing of males in Australia. It is also the largest longitudinal study of male health in the world. Funded by the Department of Health (DoH), it was established in 2012 to investigate five broad research themes in relation to Australian males: physical health; social and environmental determinants of health; health-related behaviours; mental health and wellbeing; and health services and knowledge. Moving forward, the study is guided by - and seeks to address the priority areas and key issues of - the National Men's Health Strategy 2020-2030.¹

The Ten to Men (TTM) sample includes over 16,000 males who were aged between 10 and 55 years at recruitment. The sample comprises three distinct cohorts: boys (aged 10-14 years), young men (15-17 years), and adults (18 years and above). Data collection for the study was undertaken by the University of Melbourne across two 'waves' (time periods) in 2013/14 and 2015/16 (Waves 1 and 2, respectively). Wave 3 of data collection, managed by the Australian Institute of Family Studies (AIFS), was undertaken from July to December 2020.

Similar to how insights are gleaned from the Australian Longitudinal Study on Women's Health² (Brown et al., 1996) about the health and wellbeing of females in Australia, data collected for TTM help improve our understanding of the characteristics and behaviours of boys, young men and adult males nationwide, and how certain factors are associated with a range of health outcomes. Indeed, previous publications using TTM data have examined diverse issues affecting Australian males such as sleep apnoea (Chamara Visanka et al., 2016), sexual functioning among men with disabilities (Bollier, King, Shakespeare, Hocking, & Kavanagh, 2019), associations between job stressors and suicide (Milner, Currier, Lamontagne, Spittal, & Pirkis, 2017), correlates of self-rated health (Koelmeyer, Currier, et al., 2016), and diabetes (Koelmeyer, Shyamali, & Dallas, 2016).

This Insights report is designed to promote Ten to Men, showcase the breadth of data collected, and disseminate its findings in an accessible format to diverse audiences, including health care providers, the general public, researchers and policy makers. Above all, it aims to provide a broad overview of the health of males in Australia and highlight specific concerns affecting this group: poor mental health, weight issues and obesity, involvement in 'risk' behaviours such as heavy alcohol use, and sub-optimal rates of health and social support service use.

This report presents data from Waves 1 and 2 of Ten to Men. Using data from both waves enables the identification and investigation of changes to the health status of males in Australia over time. Further data collections will facilitate the identification and monitoring of longer-term trends including transitions in and out of various health states and associated behaviours. This will be invaluable for informing timely, targeted and evidence-based policy and practice to achieve the best health outcomes for males and the broader Australian community.

The four chapters in this report comprise themes purposely aligned with priority areas in the National Men's Health Strategy 2020-2030. The chapters are:

1. Mental health of Australian males. Depression, suicidality and loneliness. This chapter focuses on experiences of depression, anxiety, loneliness and suicidal thoughts and behaviours among Australian males.
2. Alcohol use among Australian males. This chapter analyses alcohol use patterns among boys, young men and adults in Australia, including an investigation of factors associated with engaging in moderate-to-high risk alcohol consumption.
3. Overweight and obesity among Australian males. This chapter investigates the significant public health concerns of overweight and obesity among Australia's male population, including an examination of shifts between 'healthy', 'overweight' and 'obese' weight classifications between TTM data collection waves.
4. Health literacy and health service use among Australian men. This chapter examines patterns of health and support service use among adult males, in addition to identifying barriers to service use and health service literacy.

Cohort characteristics at recruitment

The Ten to Men cohort (N = 16,021 at Wave 1) was recruited throughout major cities and inner and outer regional areas of Australia between October 2013 and July 2014. At baseline, participants were aged between 10 and 55 years; the average age was 32.61 years (SD = 13.15). Sub-cohorts included boys aged 10-14 (n = 1,099), young men 15-17 years (n = 1,026), and adult males aged 18-55 years (n = 13,896). The recruitment methodology and characteristics of the cohort at baseline have been described in detail elsewhere (Pirkis et al., 2017); however, a brief overview of the sample is provided below, with comparisons between the sample's characteristics and those of the Australian male population aged 10-55 years included where possible, as per 2011 Census data (n = 6,729,687).³

Around three-quarters of the cohort (75%) were born in Australia, a comparable proportion to Australian males aged 10-55 at the 2011 Census (74%). The remaining participants were most commonly born in Southern Asia (5%), the United Kingdom (4%) and New Zealand (3%). Around 11% typically spoke a language other than English at home. A higher proportion - approximately 20% - of Australian males were estimated to mainly speak a language other than English at home, according to the 2011 Census.

Only a minority of participants (approximately 3%) identified as Indigenous Australian (Aboriginal and Torres Strait Islander), which was consistent with around 3% of Australian males aged 10-55 who identified as Indigenous at the 2011 Census. Close to three-quarters (73%) resided in major cities at recruitment, compared to 18% who lived in inner regional areas and 9% in outer regional areas. These figures match well with 2011 Census data: 71% of males aged 10-55 lived in major cities, 17% in inner regional areas, and 9% in outer regional areas.

In terms of geographical location at recruitment, participants most commonly resided in NSW (32%) and Victoria (26%), followed by Queensland (20%), Western Australia (10%), South Australia (7%), Tasmania (2%), the ACT (2%) and the Northern Territory (1%). These proportions were very similar to those recorded for males aged 10-55 in the 2011 Census: NSW (32%), Victoria (25%), Queensland (20%), Western Australia (11%), South Australia (7%), Tasmania (2%), the ACT (2%) and the Northern Territory (1%).

Among adult TTM participants at baseline (n = 13,891), the vast majority (around 92%) identified as heterosexual. Of the rest, approximately 2% identified as homosexual, 2% identified as bisexual, and a further 2% of participants were unsure about their sexual identity. Sixty-two per cent were married or in a de facto relationship, whereas just under one-third (32%) had never been married. Around 6% were divorced, separated or widowed. In comparison, at the 2011 Census, around 45% of adult males aged 10-55 were married, 46% had never married, and 9% were divorced, separated or widowed.

At recruitment, most (83%) adult participants reported being employed, 10% reported being unemployed and looking for work, and 7% reported being out of the labour force. In comparison, 77% of adult Australian males aged 18-55 were employed at the 2011 Census.

With regard to highest education level among adult participants, 41% had a certificate or diploma, 29% had at least one university degree, whereas the highest level of education for a further 29% was Year 12 (i.e. finished high school) or less. In comparison, 2011 Census data indicated that around 34% of Australian men aged 18-55 had a certificate or diploma, and 19% of men aged 18-55 had at least one university degree.

References

• Bollier, A.-M., King, T., Shakespeare, T., Hocking, J., & Kavanagh, A. (2019). Sexual functioning in men with and without disabilities: Findings from a representative sample of Australian men. The Journal of Sexual Medicine. doi:10.1016/j.jsxm.2019.07.021
• Brown, W. J., Bryson, L., Byles, J. E., Dobson, A. J., Manderson, L., Schofield, M., & Williams, G. (1996). Women's Health Australia: Establishment of the Australian Longitudinal Study On Women's Health. Journal of Women's Health, 5(5), 467-472.
• Chamara Visanka, S., Dallas, R. E., Dianne, C., Jennifer, L. P., Adrian, L., Caroline, L. et al. (2016). Sleep apnoea in Australian men: Disease burden, co-morbidities, and correlates from the Australian Longitudinal Study on Male Health. BMC Public Health, 16(3), 51-61. doi:10.1186/s12889-016-3703-8
• Koelmeyer, R., Currier, D., Spittal, M. J., Schlichthorst, M., Pirkis, J. E., & English, D. R. (2016). Age matters: Exploring correlates of self-rated health across four generations of Australian males. Behavioral Medicine, 42(3), 132-142. doi:10.1080/08964289.2015.1121132
• Koelmeyer, R., Shyamali, C. D., & Dallas, R. E. (2016). Diabetes in young adult men: Social and health-related correlates. BMC Public Health, 16(3), 63-69. doi:10.1186/s12889-016-3704-7
• Milner, A., Currier, D., Lamontagne, A. D., Spittal, M. J., & Pirkis, J. (2017). Psychosocial job stressors and thoughts about suicide among males: A cross-sectional study from the first wave of the Ten to Men cohort. Public Health, 72. doi:10.1016/j.puhe.2017.02.003
• Pirkis, J., Currier, D., Carlin, J., Degenhardt, L., Dharmage, S. C., Giles-Corti, B., Gordon, I. R. et al. (2017). Cohort profile: Ten to Men (the Australian Longitudinal Study on Male Health). International Journal of Epidemiology, 46(3), 793-794i. doi: 10.1093/ije/dyw055