Insights #1 report – Overview and key findings

Content type
Insights Report
Published

September 2020

Project
Part of a collection

Overview

This report presents data from Waves 1 and 2 of Ten to Men. The four chapters in this report comprise themes purposely aligned with priority areas in the National Men's Health Strategy 2020-2030, including:

  1. Mental health of Australian males. Depression, suicidality and loneliness
  2. Alcohol use among Australian males. 
  3. Overweight and obesity among Australian males
  4. Health literacy and health service use among Australian men. 

Introduction

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

(n = 13,896). The recruitment methodology and characteristics of the cohort at baseline: 10 years; average age 32.61 years; 55 years

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.

 

The recruitment methodology and characteristics of the cohort by nationality: 4% United Kingdom; 75% Australia; 5% Southern Asia; 3% New Zealand

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.

The recruitment methodology and characteristics of the cohort by residence: 73% major city; 18% inner regional; 9% outer regional.

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%).

The recruitment methodology and characteristics of the cohort by location: 4% United Kingdom; 75% Australia; 5% Southern Asia; 3% New Zealand

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.

The recruitment methodology and characteristics of the cohort by relationship status: 62% married or de facto; 32% never married; 6% 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.

The recruitment methodology and characteristics of the cohort by education: 29% at least one university degree; 41% certificate of diploma; 29% year 12 highest level of education.

1 See www1.health.gov.au/internet/main/publishing.nsf/Content/national%20mens%20health-1

2 See www.alswh.org.au

3 Sample weights (for TTM participants) were produced for the study dataset to reduce the effect of bias in sample selection and participant non-response. These weights were used in analyses in the four empirical chapters of this report, except where stated otherwise.

Key findings

Key findings

Australian males are more likely than females to experience certain health concerns, including bowel and skin cancer, obesity, diabetes and stroke. They are more likely to engage in risk behaviours such as alcohol and other drug use. Males have a heightened risk of mortality, yet are more likely to think that their health is fine and that they can independently manage health concerns. Men are also less likely to engage with health services compared to women. Importantly, poor health experienced by males can also impact their families, friends and the wider community.

To monitor health trends among males in Australia, and to improve understanding of diverse health issues affecting boys and young and adult men of differing ages, locations and backgrounds, the Australian Government commissioned the Ten to Men study. Comprising around 16,000 males aged 10-55 years who resided in urban, regional and rural parts of the country at recruitment (2013/14), it is the first large-scale, nationally representative, longitudinal study to focus exclusively on investigating and improving the health and wellbeing of males in Australia.

This report investigates specific health concerns and related issues affecting boys and young and adult men across the country:

  1. poor mental health, including experience of depression, anxiety, loneliness, and suicidal thoughts and behaviours
  2. alcohol use
  3. overweight and obesity
  4. health literacy and engagement with Australia's health care system.

These topics align with a number of priority areas identified in the National Men's Health Strategy 2020-2030, including: mental health, chronic conditions, conditions where men are over-represented, and injuries and risk taking.

Overall, the Ten to Men findings presented throughout this report indicate that, problematically, Australian males who are particularly vulnerable, disadvantaged or marginalised continue to be disproportionately affected by certain health concerns. For example, unemployed males and those in areas of greater disadvantage were significantly more likely to experience mental health issues. Indigenous boys and young men had almost double the odds of being overweight or obese compared to those who were non-Indigenous. Study findings from two waves of data collection also suggest that many males who experience ill-health, or who are engaging in unhealthy behaviours (e.g. moderate- to high-risk alcohol use), do not transition to stable healthier states or practices over at least the short term. It should be noted that, with only two waves of data collection to date, it is possible that study participants did transition to healthier states/practices, but relapsed; this is something to be explored further with additional waves of data collection.

Study data did indicate that there are opportunities for professional intervention to address ill-health among Australian males. For example, most men with diagnosable mental health problems reported they had recently seen a general practitioner (GP). Men who were overweight or obese were also significantly more likely to be engaged with health care providers (e.g. GPs, dietitians and specialist services). Helping both clients and service providers identify and leverage such opportunities, especially in general practice and primary care settings, could be beneficial for the treatment and/or referral of men to dedicated health care services and resources.

Specific findings relating to the above areas are summarised below.

Mental health

  • Mental ill-health remains high among Australian men, with up to 25% experiencing a diagnosed mental health disorder in their lifetime, and 15% experiencing a disorder in a 12-month period.
  • Anxiety was the most common mental health disorder among Australian boys (those aged 10-14 years), at 9%.
  • A significant proportion of men who experienced depression at a given point in time continued to experience it, or relapsed. Of those with self-reported severe depression in 2013/14, 40% still reported experiencing severe depressive symptoms in 2015/16.
  • Loneliness was significantly associated with experiences of depression and suicidality among Australian men, above and beyond area-level socio-economic disadvantage and unemployment.
  • Young men (Australian males aged 15-17 years) were the most likely to experience suicidal escalation from 2013/14 to 2015/16. Just under 3% of young men escalated to make a first suicide attempt in that time.
  • Many Australian males were not accessing professional support from mental health specialists. While over 80% of men with depression, anxiety and/or any suicidality in the past year had seen a GP, only around 40% had seen a mental health professional.

Alcohol use

  • Around one-fifth of Australian boys aged 10-14 years have ever consumed 'more than a sip or taste' of alcohol. This group are more likely to have friends who have drunk alcohol in the past year, compared to boys who have never drunk alcohol.
  • Younger adult males, especially those aged 18-24 years, typically drink at riskier levels than their older counterparts.
  • Young men (15-17 years old) who have drunk alcohol before the recommended age of 18 are more likely to engage in riskier alcohol consumption patterns in early adulthood.
  • The majority of adult Australian men have drunk alcohol in the past year (88%), of which only a minority - one third - drink at moderate- to high-risk levels.
  • Australian men who drank more frequently were significantly more likely to typically drink greater volumes of alcohol per session.
  • Many adult males - around three-quarters - engaging in moderate-to-high-risk alcohol consumption did not transition to and maintain low-risk patterns over time.

Overweight and obesity

  • The proportion of Australian males classified as overweight or obese increases with age: in 2013/14, around 20% of boys aged 10-14, 29% of young men aged 15-17, 40% of men aged 18-24, 60% of men aged 25-34, and more than 70% of men aged 35-57 were overweight or obese.
  • With age, it appeared difficult for Australian males to maintain a 'normal' or healthy weight. Among those classified as initially being of a healthy weight, 91% of 10-14 year olds were still at a healthy weight two years later, compared to 82% of 18-24 year olds and 77% of 45-57 year olds.
  • Very few males who were classified as overweight or obese in 2013/14 had transitioned to a healthy weight in 2015/16. For example, around 90% of men aged 35-57 who were overweight or obese remained so two years later.
  • Men who were overweight or obese in both 2013/14 and 2015/16 were more likely to experience chronic health problems including cardiovascular and respiratory conditions, diabetes and arthritis.
  • Among adult Australian men, risk factors for being overweight or obese included low physical activity, frequent medication use, poor diet, heavy smoking, heavy drinking and lower overall life satisfaction.

Health literacy and health service use

  • Although the vast majority of Australian men - 95% in 2013/14 - considered their health to be important, only around two-thirds actively looked after their health.
  • GPs were the most commonly accessed health service among adult Australian males in 2015/16.
  • Around 30% of Australian men were not getting regular (i.e. annual) check-ups.
  • Less than half of adult Australian males had visited a dentist in the past year. For example, in 2015/16 only around one-third of those aged 18-44 had seen a dentist in that time.
  • A minority of Australian men - around 7% in 2015/16 - reported being unable to access health care when they needed it. Common barriers among this group included cost (52%) and long waiting times (35%).
  • Men who identified as Indigenous Australian had around 70% higher odds of experiencing barriers to health service use than non-Indigenous men. Further, only 25% of Indigenous men had private health insurance, compared to over half (59%) of non-Indigenous men.
Citation

Daraganova, G., & Quinn, B. (Eds.). (2020). Insights #1: Findings from Ten to Men – The Australian Longitudinal Study on Male Health 2013-16. Melbourne: Australian Institute of Family Studies.

References

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