Masculine Ideals and Health in Older Men: Findings From the Wisconsin Longitudinal Study

Masculinities and Identities

Sex is classified by socially defined biological criteria that place females and males into distinct groups, leading to the application of sex categories in everyday life. Understanding of these sex categories is extended to normative attitudes and social activities within these groups and is defined as gender. People representing the female sex category are often gendered as women and expected to express feminine traits, while those representing the male sex category are often gendered as men and are expected to express masculine traits. Our study of masculine ideals is guided by the theory of “doing gender” which is the act of engaging in socially agreed activities that convey feminine and masculine conventions while conceiving other people as participants in these processes (West & Zimmerman, 1987). Men are often expected to do masculinity by engaging in interactions that display dominance over women who, in contrast, are expected to do femininity. Gender is negotiated through relationships of power that socially advantage men (Courtenay, 2000). By studying men’s beliefs of masculinity, we can understand how they internalize and externalize “doing gender” through masculine activities and their health outcomes. For instance, in a study about men and masculinity, older men reported a “blueprint” or cultural narrative based on 1950s and 1960s masculinity that included not being a “sissy,” being lauded for success, stoicism, and maintaining competitiveness (Thompson & Langendoerfer, 2016). The men in our study correspond with similarly aged men.

Masculinity is said to be a social determinant of health because stoic health practices and behaviors among men inform how we construct self and gender (Evans et al., 2011). Men may disconnect from traits that are considered feminine, such as dependence and vulnerability, to ultimately face risk and discomfort (Courtenay, 2000). As such, masculinity in the context of health often displays self-assurance, self-reliance, virility, and so on. In middle age, men may address their bodily changes by assuming a sense of responsibility, through strategies such as discipline, exercise, routine, and monitoring, to attempt to obstruct aging (Hurd Clarke & Lefkowich, 2018). With older men, it becomes more difficult to adhere to hegemonic masculine norms, so they are often faced with redefining themselves. As such, reaffirming androcentric social expectations hinges not only on hegemonic masculinity but also on perceived successful aging that shapes help-seeking behaviors among older men (Smith et al., 2007). Such an approach can affect health care seeking by which older men may be reluctant to consult with their health provider about their illness (Chapple & Ziebland, 2002; Smith et al., 2007). Older men may view themselves as either the virtuous regular health care user or masculine infrequent health care user (Noone & Stephens, 2008). From a mental health perspective, men recovering from depression may cultivate value through association with hegemonic masculine norms such as control and responsibility (Emslie et al., 2006; Hochschild, 2018). When investigating older men, it is imperative that the physical and psychological are considered just as much as the cultural forces that shape masculine normativity throughout the life course.

Health Lifestyles

Health lifestyles result from the interplay of agentic choices and social structure (Cockerham, 2005; Mollborn et al., 2021). Characteristics such as age, education, gender, race, and social class can influence life chances and influence certain dispositions and health practices. As such, social norms related to masculinity guide men’s social practices which translate to health behaviors (Evans et al., 2011). Considering injury and illness are associated with fragility and vulnerability, men’s circumvention of health-seeking behaviors is often understood as avoidance of femininity. Stronger beliefs in hegemonic masculinity are associated with less preventive care among older men (Springer & Mouzon, 2011). Inadequate achievement of masculine norms, such as breadwinner status, productivity, and familial respect, is linked to men’s depression (Apesoa-Varano et al., 2018; Smith et al., 2022). Evidence suggests that health behaviors influence most of the leading causes of death among men (Griffith et al., 2016). Masculine ideals reflect men’s beliefs about the way they believe gender ought to be, and this influences their lifestyle choices. Health behaviors such as substance use, risky sexual activity, and high-risk sports are influenced by the desire to achieve power and social status but ultimately undermine men’s health maintenance and promotion. In each phase of the life course, the meaning of masculinity evolves and, in turn, reshapes masculine performance (Griffith, 2012). However, the social and cultural pressures to fulfill masculinity persist throughout the life course and influence different role strains and stressors for older men.

Men’s Health

SRH is a measure that is commonly used in health research to investigate health, trends, and inequalities. Prior literature has identified that men report higher SRH than women, but this reverses later in life, particularly when physical functioning deficits are present (Zajacova et al., 2017). Despite men reporting better health than women, men are occasionally present in the poorest of health categories (Idler, 2003). This gender paradox is likely due to the different ways that men and women evaluate and report their health (Zajacova et al., 2017). More specifically, women are known to be more inclusive about mild and chronic conditions, while men tend to focus on serious and life-threatening conditions, thus, men’s chronic illness is important to examine. It is important to examine men’s mental health outcomes such as depressive symptomatology (Smith et al., 2018, 2022), as older men are at high risk for depression due to disability, loss, and isolation (Drentea, 2018; Smith et al., 2018). Because health and mental health are shaped by gender and culture, adding masculine ideals to this line of research can reveal links that further explain older men’s perception of health.

Masculine Activities

Men can continue to enact gender through stereotypically masculine activities. Due to their competitiveness, skillset, and expertise, sportsmen have served as ambassadors for contemporary Western masculinity. Social contexts that include competitive sports have been well-documented by sociologists as facilitators of masculine expression, regulation, and development (Barrett, 2014). Older men who engage in sports are often continuing a practice they had in their younger years (Thandi et al., 2018). Those who attempt to reengage with sports that were practiced in their earlier years might be intimidated due to a perceived diminished masculine identity and, as such, prefer to engage in sports with men their own age (Blake et al., 2022; Drummond, 2008). As older men experience fewer avenues to affirm their masculinity, sports engagement serves as an activity for developing comradery, empowerment, and health-related behaviors. In a scoping review, Blake et al. (2022) reported that, among middle-aged men, sports team involvement was associated with greater SRH, although there was no strong evidence of increased mental health. Men may engage in vigorous exercise (Grzywacz and Marks, 2001). Vigorous physical activity helps men maintain their physique and is a way of maintaining one’s masculinity and health. Staying active helps the health and aging experience. They may also redefine their masculinity by engaging in other typically masculine-defined activities such as hunting, fishing, and home and car repair. Similarly, they may socialize with other men in voluntary associations and men’s groups such as Lions Clubs and Masonic groups.

For our sample in Wisconsin in the 1950s, and even in contemporary American society, there is a strong culture of hunting and fishing among men. Like sports, hunting and fishing are ways to show one’s athleticism. Being a handyman, working on cars, and taking pride in one’s home through repairs was a typical masculine activity that also showed that the man was providing for the home. Senior men’s group activities for this generation may include volunteer groups such as church activities and Veteran’s groups (Fischer et al., 1991). As men age, continuing to engage in these masculine activities may help with their health in that they help men stay active and validate who they are. Alternatively, the activities may be detrimental to men’s health because they call upon masculine ideals. We know little about how older men’s masculine ideals and participation in masculine activities are related to their health.

Hypotheses

Three hypotheses test our ideas about masculine ideals’ influence on health outcomes among men. The first hypothesis addresses masculinity’s influence on health. (H1) Masculine ideals will be associated with worse SRH, greater chronic conditions, and greater depressive symptomatology. (H2a) Vigorous physical activity will be positively associated with SRH and negatively associated with chronic conditions and depressive symptomatology. (H2b) Sports team involvement, senior men’s group involvement, hunting/fishing, and repairs will be negatively associated with SRH and positively associated with chronic conditions and depressive symptomatology. (H3) Masculine activities will explain some of the effects of masculine ideals on SRH, chronic conditions, and depressive symptomatology.

Data

Results from the WLS, a long-term cohort study of men and women who graduated from Wisconsin high schools, were used for this investigation. The WLS was used because it includes unique modules that relate to masculine ideals and masculine social participation (Herd et al., 2014). The WLS began with a 1/3 sample of all Wisconsin high school graduates in 1957 and followed them over time. A randomly selected sibling born between 1930 and 1948 was additionally included in the survey (Herd et al., 2014). The WLS started with 19,046 respondents. Following other researchers who used this study, we included both graduates and siblings to increase generational diversity (Pudrovska, 2010). We restricted our sample to male respondents (n = 9,408), followed by those who responded to the 2011 mail survey that included questions related to masculine ideals (n = 3,621). We excluded individuals who were missing reports of age (n = 134), education (n = 165), and alcohol use (n = 137) as well as mail survey responses related to tobacco use (n = 87), sports participation (n = 198), hunt/fish (n = 464), repair (n = 367), senior men’s group (n = 250), and vigorous exercise (n = 543), leading to an analytical sample of n = 2,594. The WLS is available via the Inter-university Consortium for Political and Social Research (ICPSR) and, as such, our institution does not require IRB approval.

Dependent Variables

SRH for both waves was measured through an item that asks: “How would you rate your health at the present time?” on a 5-point Likert-type scale that demonstrates better health with a higher number response. We recoded this item into the following three categories: (1) Fair/Very Poor; (2) Good; and (3) Excellent. Fair and Very Good were collapsed into one category because there were few in each category.

Chronic Illness was a count variable with seven conditions including doctor diagnosis of hypertension, high blood sugar, diabetes, cancer, heart condition, stroke, joint, and/or mental illness. It ranges from zero to seven conditions.

Depressive Symptomatology was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). This scale asks how many days during the past week the respondent felt about various topics such as “feel bothered by things that usually don’t bother you?,” “think your life had been a failure?,” and “feel happy?.” It included 20 questions and ranged from four response categories (i.e., less than 1 day; 1–2 days; 3–4 days; 5–7 days). Results were summed and could range from 0 to 60. When accounting for the subpopulation, CES-D was 0 to 44. The alpha reliability was .86.

Independent Variables

Masculine Ideals were measured as a trichotomous variable composed of seven items (Cronbach’s alpha coefficient: .66) from the Hegemonic Masculine for Older Men Scale which have been used in several studies (Campos-Castillo et al., 2020; Pudrovska, 2010; Springer & Mouzon, 2019). The seven items were as follows: “To what extent do you agree that. . .”: (1) when a husband and wife make decisions about buying major things for the home, the husband should have the final say?, (2) a man should always try to project an air of confidence even if he really doesn’t feel confident inside?, (3) It bothers me when a man does something that I consider feminine?, (4) men have greater sexual needs than women?, (5) when a man is feeling pain he should not let it show?, (6) in some kinds of situations a man should be ready to use his fists?, and (7) being larger, stronger-looking, and more muscular makes men more attractive to women? Each of these 5-point Likert-type scale items was reverse-coded so that a higher number reflects more masculine ideals: (1) “Strongly Disagree”; (2) “Disagree”; (3) “Neither Agree nor Disagree”; (4) “Agree”; and (5) “Strongly Agree.” Following prior research (Springer & Mouzon, 2019), our trichotomous indicator was coded so that the bottom 25% were labeled “Masculinity Rejectors,” the middle 50% were labeled “Masculinity Endorsers,” and the top 25% were labeled “Masculinity Idealists” (Springer & Mouzon, 2019).

Covariates

Age was measured using respondents’ age during the 2011 wave of the survey which ranged from 47 to 91. Education was measured through an item that summarizes “years of regular education based on most recent degree” which was categorized into five groups: (1) less than high school diploma; (2) high school diploma; (3) some college; (4) bachelor’s degree; and (5) graduate/professional degree. Tobacco use was measured with a binary variable that asked, “Have you ever smoked cigarettes regularly in your entire life?” Alcohol use was measured with a binary variable that asked, “Have you ever drunk alcoholic beverages, such as beer, wine, liquor, or mixed alcoholic drinks?”

We included five variables that we and previous research (Springer & Mouzon, 2019) typify as masculine activities. Respondents were asked about involvement in various clubs and organizations over the past 12 months. Sports Team Involvement was measured through the item that asks, “What is your level of involvement with sports teams?” For clarity, the measure is asking about actual participation in sports activity. Senior Men’s Group was measured through the item that asks, “In the past 12 months, how involved have you been with a group for senior men or women?” Both these questions were provided with five response options, (1) Not Involved; (2) Very Little; (3) Some; (4) Quite a Bit; and (5) A Great Deal, that were recoded into a binarized variable that distinguished no participation from any participation. The variables Hunt/Fish, Repairs, and Vigorous Physical Activity were informed by questions that asked, “During the past year, about how many hours per month did you spend . . .” “hunting or fishing in season?,” “making home repairs, car repairs, or doing other handy work?,” and “doing vigorous physical activities that you do alone, such as jogging, swimming, biking, or going to the gym by yourself?,” respectively. We recoded these three variables to distinguish those who reported 0 h from those who reported 1+ h. All missing and non-applicable responses were removed before statistical analyses.

Analytic Strategy

We first calculated descriptive statistics for our sample and presented them as percentages and means of the study variables. We next conducted three separate linear regression analyses to examine reports of SRH, chronic conditions, and depressive symptomatology. Each outcome-specific regression was progressively adjusted so that masculine ideals were included in Model 1, demographic characteristics (i.e., age, education) were included in Model 2, health behaviors (i.e., tobacco use, alcohol use) were added in Model 3, and masculine activities (i.e., sports team involvement, hunt/fish, repairs, senior men’s group, vigorous physical activity) were added in Model 4. All analyses were conducted on Stata, release 17.

Limitations:

Although our study provides a unique insight into how masculinity informs the health of older men, it is not without its limitations. First, though our study relied on a well-known study, these data are limited to older men from one U.S. state. It represents predominantly white men who graduated high school in Wisconsin (Herd et al., 2014). As such, the sample raises generalizability concerns as it pertains to men of color and those representing younger generations. While a few of the siblings did not graduate high school, adding some variation in age and education, the sample was still very limited to this particular group of men. Second, our study’s sample is represented by a select group of respondents who were randomly assigned, answered, and returned the WLS mail-in questions. Therefore, our sample, and possibly results, might have had been different if these surveys were completed in-person. While these limitations are important to consider, especially when using WLS data, its rich history, important and original measures, and strong participation rates yield it to be important and useful data in social sciences (Herd et al., 2014; Smith et al., 2022).