Would the Marlboro Man get massage? Even after all the horseback riding, probably not.

New research shows middle-aged men who strongly idealize masculinity are almost 50 percent less likely than other men to seek preventative health care services. This study was the first population-based analysis of men’s masculinity beliefs and preventative health care compliance.

“This research strongly suggests that deep-seated masculinity beliefs are one core cause of men’s poor health, inasmuch as they reduce compliance with recommended preventative health services,” said Kristen W. Springer, the study’s primary investigator.

The health care services studied were three commonly recommended annual procedures for middle-aged men: a complete exam/physical, flu shot and a prostate examination.

Previous research indicates that, compared to women, a man’s life expectancy at birth is five years less and that men have higher rates of 12 of the 15 leading causes of death. Forgoing or delaying preventative and primary health is known to be an important contributor of poor health among middle-aged and older individuals.

The new research was presented at the 104th annual meeting of the American Sociological Association.