Masculinity and Health Behaviors in Australian Men

Psychology of Men & Masculinity 2007, Vol. 8, No. 4, 240 –249 Copyright 2007 by the American Psychological Association 1524-9220/07/$12.00 DOI: 10.10...
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Psychology of Men & Masculinity 2007, Vol. 8, No. 4, 240 –249

Copyright 2007 by the American Psychological Association 1524-9220/07/$12.00 DOI: 10.1037/1524-9220.8.4.240

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Masculinity and Health Behaviors in Australian Men James R. Mahalik and Mico´l Levi-Minzi

Gordon Walker

Boston College

Monash University

Approaching men’s health behaviors from a gender socialization framework, the authors hypothesized that Australian men’s health behaviors would significantly relate to their conformity to traditional masculine norms. A total of 253 Australian men recruited through university and community settings completed the Health Behavior Inventory (HBI) and the Conformity to Masculine Norms Inventory (CMNI). Masculinity scores related to Australian men reporting more health risk behaviors and fewer health promotion behaviors. Follow-up analyses also indicated that Masculinity scores related to specific HBI items and that CMNI subscales significantly predicted the HBI Total scores. The authors discuss the relationship between traditional masculine socialization and harmful health behaviors, potential interventions, limitations to the study, and future research. Keywords: men’s health behaviors, masculinity, international health

Men die at younger ages than women in most countries around the world (White & Cash, 2003; World Health Organization, 2000). In the United States, for example, mortality statistics indicate that men die 5.4 years earlier than women, have a 43% greater age-adjusted death rate than women, and die at higher rates than women from 14 of the 15 leading causes of death except for Alzheimer’s disease (Arias, Anderson, Kung, Murphy, & Kochanek, 2003). Many factors such as biology and access to resources such as health care influence health and longevity. However, health scientists increasingly believe that modifiable health behaviors such as diet, exercise, substance use, use of social support, safety practices, and management of stress and anger are the most important contributors to health. Research estimates that 50% of morbidity and mortality are due to such health behaviors (Mokdad, Marks, Stroup, & Gerberding, 2004). A wealth of research evidence also documents a consistent pattern that men are more

James R. Mahalik and Mico´l Levi-Minzi, Department of Counseling, Developmental, and Educational Psychology, Boston College; Gordon Walker, Department of Psychology, Monash University. Correspondence concerning this article should be addressed to James R. Mahalik, Champion Hall 312, Boston College, Chestnut Hill, MA 02467. E-mail: [email protected]

likely than women to engage in over 30 health risk behaviors that increase the risk of disease, injury, and death (see Courtenay, 2000, for a review). Although these findings about sex differences bring attention to an important phenomenon, they explain little about the processes that may be responsible for the observed differences (Mechanic, 1978) and ignore important within-group differences in men (Addis & Mahalik, 2003). One potential explanation is offered by those who view gender role socialization as contributing to men’s greater frequency of health risk behaviors. From this perspective, health risk behaviors may be manifestations of how some men construct masculinity (Courtenay, 2001). Men may anticipate their world from their experiences of being male in society (e.g., being told to be tough, self-reliant) and may take— or not take— certain actions based on their understanding of their world (e.g., ignore pain, refuse help). For example, “when a boy at age 8 scrapes his knee, he’s told ‘big boys don’t cry’ . . . . That teaches him not to listen to what his body is telling him. What’s going to happen when that boy is 50 years old and having chest pain?” (Jean Bonhomme quoted by Shelton, 2000, p. 2). It is not difficult to identify other examples of how men’s traditional constructions of masculinity may contribute to their health behaviors.

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MAHALIK, WALKER, AND LEVI-MINZI

A man may construct being masculine as going to work when sick, driving when sleepy or intoxicated, or ignoring health risks associated with tobacco use or an unhealthy diet. He might engage in high-risk recreational or health practices such as unsafe sexual practices or choose not to wear safety equipment or seek help from health professionals as ways of enacting his masculine identity. “When a man brags, ‘I haven’t been to a doctor in years’, he is simultaneously describing a health practice and situating himself in a masculine arena” (Courtenay, 2001, p. 1389). In this way, traditional constructions of masculinity can be antithetical to healthy behaviors and beliefs (Harrison, Chin, & Ficarrotto, 1992; Lippa, Martin, & Friedman, 2000). A recent cross-national study assessing male college students in both Kenya and the United States examined traditional masculinity in relation to a comprehensive list of health behaviors including diet, exercise and fitness, substance use, preventive care, social support, safety, and managing anger and stress. Results indicated that masculinity related to fewer healthpromoting behaviors and more health risk behaviors for men from both countries (Mahalik, Lagan, & Morrison, 2006). This finding supported previous research that traditional masculinity relates to greater substance abuse (Blazina & Watkins, 1996; Liu & Iwamoto, 2007; Mahalik et al., 2003; Neff, Prihoda, & Hoppe, 1991; Pleck, Sonenstein, & Ku, 1994), coronary prone behavior (Watkins, Eisler, Carpenter, Schechtman, & Fisher, 1991), sexual promiscuity (Pleck et al., 1994), violence and aggression (Locke & Mahalik, 2005; Mahalik et al., 2003), and less willingness to see mental health providers (Addis & Mahalik, 2003). Because masculinity predicted health behaviors for both Kenyan and U.S. men, Mahalik et al. (2006) suggested that the results may be generalizable to men in other countries. Other scholars also suggest that there is “a great deal of overlap in masculine ideologies among cultural groups, reflecting many cultures’ historically common societal needs for defense, reproduction, and social arrangements” (Kilmartin & Berkowitz, 2005, pp. 24 –25). However, as both masculinity and health are culturally constructed (Kimmel, 2000; Norbeck & Lock, 1987), different relationships between mascu-

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linity and health behaviors may occur for men in other countries. The purpose of this study was to determine whether Mahalik et al.’s (2006) findings would be replicated in a sample of Australian men. Similar to men in other countries around the world, Australian men die at younger ages and have higher rates of injury and illness in comparison to Australian women (Australian Institute of Health and Welfare, 2004; Gregory, Lowy, & Zwar, 2006). For example, Australian men have higher death rates for malignant cancer, heart disease, respiratory disease, diabetes, accidents, and suicide (Australian Bureau of Statistics, 2002). Between the ages of 15 and 24, Australian men are three times more likely to die as Australian women; between the ages of 25 and 64, Australian men are twice as likely to die (Department of Human Services Victoria, 1999a, 1999b; Pattison, 1998) It has also been suggested that Australian men’s poorer health may be attributable to their health behaviors. Australian men are more likely than Australian women to eat high-fat foods, exercise less after the age of 35, drink alcohol excessively, smoke, use illegal drugs, engage in life-threatening behaviors, avoid their general practitioner and preventive care, and not admit to experiencing emotional stress (Commonwealth Department of Health and Aged Care [CDHAC], 1998; Gibson & Denner, 2000; Huggins, 1998). Australian masculinity scholars and professional groups interested in Australian men’s health suggest that traditional masculinity contributes to Australian men’s poorer health practices (Bambrick, 2001; Biddulph, 1995; Connell et al., 1998; Royal Australian College of General Practitioners, 2006; Taylor, Stewart, & Parker, 1998). Although any large group such as a nation is comprised of many distinct masculinities (Connell, 1995; Kimmel, 2000), Australia has several historical and current influences on masculine identity that may contribute to Australian men’s health behaviors. The athlete is one salient masculine image as sports are an important part of Australian culture, with over 20% of Australians over 15 years of age participating in regular organized sports activities (Australian Bureau of Statistics, 2005). Other masculine images distinctive to Australia include the bushman, the mate, the larrikin, and the ocker (Lucas, 1998). The bushman was a pioneer in

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the rugged Australian landscape and needed to be physically tough and brave. Mateship is an important influence on masculine behavior affecting the way Australian men relate to each other; it developed from men’s reliance on other men in mutually dependent relationships as a “mate” for survival during the pioneering period of Australia’s history. The larrikin is somewhat of a prankster who challenges the rules of social convention and authority. The ocker is usually an image of a working man who is “rough around the edges” (Australian National Dictionary Centre, 2007). These male images have been held up to Australian men to emulate. The athlete reflects values of strength and endurance, the bushman reflects values of physical toughness and stoicism, the mate values egalitarianism and concern for the welfare of others, the larrikin can help challenge mindless social convention, and the ocker reflects working-class sensibilities eschewing high culture and refined manners. However, these masculine images can have negative implications for health behaviors. The athlete may be admired for ignoring injury and self-care when hurt; the bushman takes dangerous risks; the mate can reflect misogyny and fear of femininity; the larrikin is often characterized by drunkenness, brawling, and visiting brothels; and the ocker is gets frequently portrayed as sitting around the pub drinking his beer. Although it is likely that only a portion of men in Australian enact masculinity in these stereotypical ways, it is also likely that elements from these various masculine images contribute to Australian men’s view of masculinity and themselves. In sum, like men in most countries, Australian men experience higher mortality and morbidity than Australian women, and they engage in more health risk behaviors. Cultural constructions of masculinity in Australia have been viewed as contributing to their higher frequencies of health risk behaviors. Our intention in this study was to replicate previous research examining masculinity in relation to men’s health behaviors and determine whether these findings could be generalized to Australian men. We hypothesized that traditional masculinity would be significantly positively related to health risk behaviors and significantly negatively related to health promotion behaviors.

Method Participants and Procedures Two hundred fifty-three Australian men participated in the study. They averaged 32.98 years of age. The modal participant was single, heterosexual, employed full-time, earning over $60,000, and had completed tertiary– university education (see Table 1 for demographic characteristics). The participants were men living in the metropolitan area of Melbourne, Australia, and were recruited using two approaches. Undergraduate male students who were mostly first year were recruited from a public university in the southwest of Australia. These students were recruited from a range of classes including psychology, business, and law. Adult men in the community were recruited by undergraduate research assistants contacting men through snowballing techniques and through clubs such as sporting clubs and service organizations (e.g., Rotary Club). All men were invited to take part in the study following a short description about the nature of the study (i.e., “to better understand men’s experiences”) after which interested men received questionnaire packets along with a stamped envelope for returning the forms to the researcher. Participants took approximately 30 min to complete the materials at a place and time of their choosing and returned materials to the second author through the post. No participants were compensated for completing the survey materials.

Measures To assess behaviors and beliefs associated with health risk behaviors, Courtenay’s 48-item Health Behavior Inventory (HBI) was used (Courtenay, McCreary, & Merighi, 2002). The 48 items assess diet (e.g., “I limit the amount of red meat I eat by eating more chicken, fish, or grains and beans”), exercise and fitness (e.g., “At least 3 times each week I engage in physical activity that lasts at least 20 minutes and makes me breathe deeply and my heartbeat faster”), substance use (e.g., “I drink more than 2 alcoholic drinks a day”), preventive care (e.g., “I get my blood pressure checked every year”), social support (e.g., “I have a close friend or family member that I talk to

MAHALIK, WALKER, AND LEVI-MINZI

Table 1 Demographic Characteristics of Australian Participant Men

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Characteristic Age, years Mean ⫽ 32.98 SD ⫽ 13.14 Relational status Single Married Cohabitating Divorced/separated Widowed Did not report Sexual orientation Heterosexual Homosexual Unsure Did not report Employment status Full-time Part-time Full-time student Unemployed Retired Did not report Annual income ⬍$19,999 $20,000–$29,000 $30,000–$39,000 $40,000–$49,000 $50,000–$59,000 ⬎ $60,000 Did not report Education Tertiary-university education Secondary-high school TAFE-vocational education Primary-elementary school Did not report Ethnicity Australian British North American South American Northern European Southern European Asian African Other Did not report

n

150 63 24 14 1 1 235 10 3 5 91 55 85 12 3 7 77 18 20 21 17 96 4 117 90 31 2 13 144 15 1 1 11 14 36 2 9 20

Note. N ⫽ 253. Annual income reported in Australian dollars.

about things that are bothering me”), safety (e.g., “I buckle my safety belt when driving or riding in a motor vehicle”), anger and stress

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(e.g., “I get irritated and mad when waiting in lines”), beliefs about masculinity (e.g., “I believe a person should always try to control his or her emotions”), perceived invulnerability (e.g., “I believe it is unlikely that I will have a health problem in the near future”), and personal control over health (e.g., “I believe I have control over my future health”). The items are answered on a 5-point Likert scale ranging from 1 ⫽ always to 5 ⫽ never and have considerable face validity (e.g., “I drink more than 2 alcoholic drinks a day”). In addition, research using Courtenay’s HBI indicates that men engage in riskier behaviors and hold riskier beliefs than women, that traditional masculinity relates to more health risk behaviors, and that there are significant racial and ethnic group differences on HBI scores compared to both men in the United States and men from different countries (Courtenay et al., 2002; Mahalik et al., 2006). In this study, we report a Total HBI score summing 43 of the 48 items, with higher scores reflecting health promoting behaviors after reverse coding the health risk behavior items (␣ ⫽ .77). We did not add the five beliefs about masculinity items because of the potential content overlap with the Conformity to Masculine Norms Inventory (CMNI; Mahalik et al., 2003). In addition to the Total score and factor scores, we also examined individual items because we were also interested in the individual behaviors assessed by the items (e.g., eating fruit, wearing sunscreen, consulting a health professional). To assess masculinity, the CMNI was administered. The inventory consists of 94 items answered on a 4-point scale (0 ⫽ strongly disagree to 3 ⫽ strongly agree) designed to assess conformity to an array of masculinity norms found in the dominant culture in U.S. society. Mahalik et al. (2003) identified 11 distinct factors labeled as Winning, Emotional Control, Risk-Taking, Violence, Dominance, Playboy, Self-Reliance, Primacy of Work, Power Over Women, Disdain for Homosexuals, and Pursuit of Status. In addition, the CMNI Total score is the sum of the 94 items and reflects overall conformity to masculine norms in the dominant culture in U.S. society. Mahalik et al. (2003) reported that CMNI Total score significantly related to other masculinity measures and significantly and positively related to psychological distress, social dominance, aggression, and the desire to be more

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muscular and was significantly and negatively related to favorable attitudes toward psychological help seeking. Internal consistency for the CMNI Total score was .94 with a test–retest reliability coefficient over a 2- to 3-week period of .95 (Mahalik et al., 2003). In this study, ␣s ranged from .73 to .90 for 10 of the masculinity norms (␣ ⫽ .68 for Dominance) and .92 for the Total score.

Results Preliminary analyses indicated that no variable was missing more than six cases, and the linear trend option in SPSS (SPSS Inc., Chicago, IL) was used for any missing values. To determine if masculinity related to Australian men’s health behaviors, three sets of analyses were conducted. First, the Total CMNI score (Masculinity) was correlated with the Total HBI score. Results indicated that Australian men with higher traditional masculinity reported more health risk behaviors and fewer health promotion behaviors (r ⫽ .31, p ⬍ .001). Second, Masculinity was correlated with all the individual items of the HBI. To correct for familywise cumulative error for this second set of analyses, alpha was set at .0023 (i.e., .05 (one-tailed)/43 items), with r values greater than or equal to .19 indicating statistical significance below .0023 (one-tailed). For dietrelated items, the higher Australian men scored on Masculinity, the less likely they were to eat fiber (r ⫽ .20) or fruit (r ⫽ .29). For prevention items, Masculinity was associated with not wearing sunscreen or protective clothing in the sun (r ⫽ .23). For managing stress and anger items, Masculinity related to getting into fights when really angry (r ⫽ ⫺.35), getting angry when caught in traffic (r ⫽ ⫺.28), getting mad when waiting in lines (r ⫽ ⫺.36), and allowing things to build up until a temper loss (r ⫽ ⫺.33). For items addressing responses to physical or psychological problems, Masculinity related to not having a friend to talk to about things that are bothersome (r ⫽ .30), not finding it easy to express feelings to others (r ⫽ .39), not consulting a mental health professional if feeling sad or depressed for longer than a month (r ⫽ .22), and not consulting a health care provider when having unfamiliar physical symptoms (r ⫽ .21).

The third set of analyses sought to determine which of the 11 masculine norms predicted the HBI Total score. A stepwise regression analysis was conducted with the 11 masculinity norms of the CMNI as the predictor variables and the HBI Total score as the criterion variable (see Table 2 for means, standard deviations, and intercorrelations of predictor and criterion variables). Examining the HBI Total score indicated that a three-step model was significant, F(3, 249) ⫽ 14.23, p ⬍ .001, R ⫽ .38, R2 ⫽ .15. In this model, Playboy (␤ ⫽ .21, p ⬍ .001, ⌬R2 ⫽ .09), Self-Reliance (␤ ⫽ .17, p ⬍ .01, ⌬R2 ⫽ .04), and Violence (␤ ⫽ .17, p ⬍ .05, ⌬R2 ⫽ .03) all significantly positively related to HBI Total scores (see Table 3). As Australian men reported conforming more to masculine norms of being sexually promiscuous, self-reliant, and violent, they were less likely to engage in health-promoting behaviors and the more likely they were to engage in health risk behaviors. No multicollinearity was evident as none of the dimensions had more than one variance proportion greater than .50 (see Tabachnick & Fidell, 2001).

Discussion Results from each of the analyses supported our hypothesis that traditional masculinity would be related to health behaviors in a sample of Australian men. The first analysis found that global masculinity as measured by the CMNI Total score related to the Total HBI score, with the second set of analyses indicating that specific health behaviors and health beliefs also related to global masculinity. The regression analysis indicated that specific masculinity norms predicted the HBI Total score. The findings from this study support previous research that traditional masculinity relates to an array of health risk behaviors (Blazina & Watkins, 1996; Liu & Iwamoto, 2007; Locke & Mahalik, 2005; Mahalik et al., 2003; Neff et al., 1991; Pleck et al., 1994; Watkins et al., 1991). More specifically, this study replicates Mahalik et al.’s (2006) cross-national findings that traditional masculinity accounted for significant variance in an array health behaviors for men in different countries. This finding provides additional evidence that the relationship between masculinity and men’s health practices may be

4.17 5.34 4.49 4.43 4.02 1.89 5.62 2.85 3.31

5.52 2.55 23.44

13.78 14.83 14.63 9.91 8.34 5.67 12.02 7.03 9.05

14.92 10.16 120.34

p ⬍ .001.

Note. N ⫽ 253. * p ⬍ .05. ** p ⬍ .01.

***

14.90

123.70

1. Total Health Behavior Inventory 2. Winning 3. Emotional Control 4. Risk Taking 5. Violence 6. Power Over Women 7. Dominance 8. Playboy 9. Self-Reliance 10. Primacy of Work 11. Disdain for Homosexuals 12. Pursuit of Status 13. CMNI Total

SD

M

Variable

.05 ⫺.01 .31***

.16** .15* .22*** .26*** .21*** .16* .29*** .24*** ⫺.05

1

.03 .21** .40*** .20** .17** .48*** .27*** .24*** ⫺.12 .59***

.27*** .49*** .71***

3

.27*** .26*** .36*** .37*** .56*** .29*** .21** .28***

2

.32*** .17** .30*** .19** ⫺.00 .22*** .15 .60***

⫺.11 .13* .38***

5

.38*** .10 .18** .23*** .09 ⫺.17**

4

.37*** .08 .69***

.26*** .46*** .28*** .20**

6

.15* .42*** .53***

.29*** .15* .16*

7

.08 .13* .59**

.20** .03

8

.14* ⫺.09 .48***

.14*

9

.04 .03 .31***

10

.11 .49***

11

Table 2 Means, Standard Deviations, and Intercorrelations of Health Behavior Inventory Total Score and Conformity to Masculinity Norms Inventory (CMNI) Factors and Total

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.32***

12

MAHALIK, WALKER, AND LEVI-MINZI 245

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Table 3 Stepwise Regression Results Predicting Health Behavior Inventory Total Scores Using Conformity to Masculine Norms Factors Variable

B

SE



Playboy Risk taking Violence

.55 .88 .57

.17 .32 .21

.21*** .17** .17**

Note. N ⫽ 253. Results are from the third step in the regression analysis, F(4, 248) ⫽ 14.23, p ⬍ .001, multiple R ⫽ .38, R2 ⫽ .15, adjusted R2 ⫽ .14. ** p ⬍ .01. *** p ⬍ .001.

generalizable to men in different countries to the extent that there are overlapping masculine ideologies among different nationalities. The findings also support a gender constructionist perspective that men’s health practices may be ways of demonstrating masculine identity (Courtenay, 2001). This conclusion gives credence to persons concerned with Australian men’s poorer health and the belief that traditional masculinity in Australia may contribute to Australian men’s health practices (Bambrick, 2001; Biddulph, 1995; Connell et al., 1998; Royal Australian College of General Practitioners, 2006; Taylor et al., 1998). Our findings provide some evidence that one contribution to Australian men being more likely than Australian women to eat high-fat foods, exercise less after the age of 35, drink alcohol excessively, smoke, use illegal drugs, engage in lifethreatening behaviors, avoid their general practitioner and preventive care, and not admit to experiencing emotional stress (CDHAC, 1998; Gibson & Denner, 2000; Huggins, 1998) may be that these health behaviors are part of their identity as men. Our findings that the masculine norms of Self-Reliance, Playboy, and Violence predicted overall health risk behaviors also supports previous research reporting that specific masculine norms were associated with health behaviors. For example, Liu and Iwamoto (2007) reported that Power Over Women predicted binge alcohol use and Disdain for Homosexuals, Playboy, and Violence predicted marijuana use. These findings suggest that some constructions of masculinity may be more important than others in understanding masculinity’s relationship to men’s health behaviors. We think it likely that cultural variations in masculinity are likely to

lead to some norms being useful predictors in some populations of men, with other norms explaining health behaviors in other populations. Limitations to the study include reliance on self-report measures from participants with all of the accompanying potential sources of error. Second, although our findings suggest that there is a significant relationship between masculinity as assessed by the CMNI and men’s health behaviors in Australia, our correlational analyses do not allow us to make causal conclusions about traditional masculinity causing poorer health practices. Also, several of the analyses reported significant but modest relationships between the masculinity and health behavior variables. Although there is increasing evidence that masculinity relates to poorer health practices for men in different countries, future research should cross-validate these findings in other countries, as well as other cultural groups, as masculinity and health are both socially constructed. Because our modal participant was single, heterosexual, university educated, and earned a middle class income (Australian Bureau of Statistics, 2006), the generalizability of the findings should be made cautiously. However, the participant men in our study had a range of employment, education, life stages, and income levels that are more representative of adult men than demographics in previous studies that examined college males only (Mahalik et al., 2006). Future research should address these limitations, identify moderators and mediators between masculinity and health behaviors, and explore other contributions to men’s health practices. For example, research on the social norms approach consistently demonstrates that youths overestimate how often their peers use alcohol, cigarettes, and drugs and that interventions that correct misperceived social norms are effective in reducing youth substance abuse (Perkins, 2003). Recent research finds that men’s health behaviors are predicted by their perceptions of how normative health behaviors are in other men (Mahalik, Burns, & Syzdek, 2007). Efforts might be made to improve men’s health by making the perceptions of health promotion behaviors more normative and health risk behaviors more aberrant. Such interventions might be useful to reduce the disparities in

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MAHALIK, WALKER, AND LEVI-MINZI

mortality and morbidity between men and women thereby improving the health of men, their families, and communities. Given that health behaviors contribute as much as 50% of the variance in mortality and morbidity statistics (Mokdad et al., 2004), findings that masculinity relates to men’s health behaviors raises several implications for practice. Health professionals might address gender and health behaviors more directly in working clinically with men. For example, men’s reluctance or difficulty in changing health behaviors related to self-care may be entangled with men’s gender identity. Another potentially useful strategy may be to modify men’s problematic constructions of masculinity. For example, cognitive therapy–style interventions could aim at modifying men’s masculine-related cognitive schemas that interfered with healthy behaviors to promote men’s health (see Mahalik, 1999; Mahalik & Morrison, 2006). Applied to health behaviors related to masculinity such as “I believe a person should not admit being sick to others,” several cognitive interventions might be aimed at changing such health beliefs. For example, men might be asked to search for disconfirming evidence of this belief (e.g., “Were there any times when you rebounded quicker when you admitted you were sick and took care of yourself?”). They might also encourage men to see the illogic of a current masculine health belief (e.g., “Does it make any sense to be running yourself down and getting yourself sicker?”). These techniques might be useful in modifying a man’s personal constructs to increase health-promoting behaviors and reduce health risk behaviors. Such interventions would be a logical extension of research finding men’s constructions of masculinity as significant predictors of health behaviors. In conclusion, findings from the study of Australian men in our sample add additional evidence that traditional masculine norms are related to health risk behaviors. Masculine norms of being sexually promiscuous, selfreliant, and violent were specifically related to health risk behaviors. These findings support both previous research and those who suggest that health risk behaviors may be manifestations of how some men construct masculinity (Courtenay, 2001). We also suggest that health professionals should attend to gender roles as

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one potential contributor in men’s poorer health and earlier mortality.

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MAHALIK, WALKER, AND LEVI-MINZI

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Acknowledgment of Ad Hoc Reviewers-2007 Psychology of Men and Masculinity extends its thanks to the following individuals who contributed their time and expertise to the journal by serving as reviewers. Matthew Jakupcak Wizdom Powell Hammond Joel Wong

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