Abstract
Understanding current pubic hair removal (PHR) practices is vital for public health, given the prevalence among U.S. adults. This study updates the understanding of PHR practices, motivations, and correlates in a nationally representative sample of adult men. In April 2023, through a probability-based internet panel survey (Ipsos KnowledgePanel®), we found that nearly half (46.7%) of respondents reported lifetime PHR, with 29.2% reporting PHR in the past 30 days. Statistically significant differences were observed in sexual orientation, age, socioeconomic status, sexual activity, and social media use. A higher proportion of Gay and Bisexual men (GBM) reported lifetime PHR (76.5%) compared with heterosexual men (44.6%), with GBM having nearly 3 times greater odds of reporting lifetime PHR (OR = 2.891, 95%CI [1.2, 6.7]). Being sexually active in the past month statistically significantly predicted both lifetime PHR (OR = 1.884, 95%CI [1.2, 2.9]) and past 30-day PHR (OR = 2.849, 95%CI [1.8, 4.6]). Age also emerged as a significant predictor, as men aged 25 to 34 years (OR = 2.275, 95%CI [1.0, 5.0]) and 45 to 54 years (OR = 2.493, 95%CI [1.1, 5.6]) had higher odds of reporting lifetime PHR compared with those aged 18 to 24 years. This study provides valuable insights and updated national data on the prevalence, methods, and frequency of PHR among men in the United States. Given the correlations between PHR practices and factors such as sexual orientation, sexual activity, and age, these findings can equip educators and health care providers with data to foster better health outcomes through acknowledging and addressing the interplay between individual choices and broader social and cultural factors.
Keywords: study, cross-sectional, questionnaires and surveys, men, pubic hair, pubic hair removal, hairiness, prevalence, sexual behavior, sexual and gender minorities, racial groups
Introduction
Pubic hair removal (PHR) is a prevalent practice among men in the United States, though not quite as prevalent as women.(Eltobgy et al., 2024) Understanding current PHR practices is important for public health efforts, as evidenced by a large-scale probability survey of 18- to 65-year-olds which showed positive correlations between PHR practices and lifetime sexually transmitted infections (STIs) (Osterberg et al., 2017). Also, the practice of anal grooming has been associated with reported rectal STIs among Gay and Bisexual men (GBM) (Gaither et al., 2020), who are a priority population likely to use PHR services (Gaither et al., 2020; Martins et al., 2008). Prior to this study, data from the most recent national study focusing on U.S. men’s PHR practices were collected in 2013, over a decade ago (Gaither et al., 2017); thus, this study aims to provide an updated understanding of PHR practices, motivations, and correlates in a U.S. nationally representative sample of adult men.
Methods
A probability-based internet panel survey (Ipsos KnowledgePanel®; Ipsos, 2023), including a nationally representative sample of U.S. adult panelists aged ≥18 years, was conducted in April 2023 to assess PHR prevalence, methods, and motivations. All study procedures and data collection instruments were reviewed and approved by the lead authors’ institutional review board. The KnowledgePanel® includes a representative sample of adults in the U.S. general (noninstitutionalized) population, stratified by factors relevant to the study. Further details regarding KnowledgePanel® methods are reported elsewhere (Ipsos, n.d.; Walsh-Buhi et al., 2024). Findings from this study include only men (N = 495) and were derived from a total of 1017 adults who were surveyed.
Measures
Demographic data were collected on participant age, race, socioeconomic status (SES), sexual orientation, marital status, education, geographic region, sexual activity status, and social media use (see Table 1). Categories used to measure race and geographic region were assessed based on the U.S. Census (Race, n.d.; The Geography Division. Census Regions and Divisions of the United States [Internet], n.d.). To assess sexual orientation, respondents chose from a list of options: (a) Gay or Lesbian, (b) Straight, (c) Bisexual, or (d) Something else. The variable was then recoded dichotomously as Heterosexual (straight) and Gay and Bisexual men (GBM), which included all other selections. Participants were also provided a list of options to indicate marital status: (a) now married, (b) widowed, (c) divorced, (d) separated, (e) never married. The variable was then recoded into three categories: currently married, previously married, and never married. Specific information about participants’ sexual activity was also obtained (see Table 1).
Table 1.
Demographic Characteristics of Men Respondents (N = 495, Unless Otherwise Noted)
| Characteristic | Number (%) of men |
|---|---|
| Sexual orientation (N = 467) | |
| Straight/Heterosexual | 424 (90.9) |
| Bisexual | 7 (1.4) |
| Gay | 28 (5.9) |
| Something else | 8 (1.7) |
| Geographic region | |
| Northeast | 87 (17.5) |
| Midwest | 108 (21.7) |
| South | 188 (37.9) |
| West | 113 (22.8) |
| Race/ethnicity | |
| White, Non-Hispanic | 320 (64.7) |
| Black or African American, Non-Hispanic | 57 (11.5) |
| Another race, Non-Hispanic | 21 (4.3) |
| Hispanic | 80 (16.2) |
| Multiple races, Non-Hispanic | 16 (3.2) |
| Age in years | |
| 18–24 | 57 (11.4) |
| 25–34 | 82 (16.6) |
| 35–44 | 94 (19.0) |
| 45–54 | 72 (14.5) |
| 55–64 | 83 (16.8) |
| 65+ | 107 (21.6) |
| Education | |
| No high school diploma or GED | 39 (7.8) |
| High school diploma or GED | 138 (27.8) |
| Some college or Associate’s degree | 126 (25.5) |
| Bachelor’s degree | 105 (21.1) |
| Master’s degree or higher | 88 (17.7) |
| Marital status | |
| Married | 281 (56.8) |
| Widowed, separated, or divorced | 55 (11.0) |
| Never married | 159 (32.1) |
| Engaged in sexual activity, past 30 days | 231 (48.2) |
| Frequency of sexual activity, past 30 days (N = 231) | |
| Several times a day | 4 (1.7) |
| Once a day | 6 (2.6) |
| A few times a week | 104 (45.0) |
| Less frequently | 117 (50.7) |
| Specific sexual acts (past 30 days) (N = 224, unless otherwise noted) | |
| Vaginal sex | 186 (83.3) |
| Performed anal sex | 20 (8.9) |
| Received anal sex (N = 221) | 13 (5.8) |
| Performed oral genital sex (N = 222) | 123 (55.4) |
| Received oral genital sex (N = 223) | 125 (56.4) |
| Performed oral anal sex (N = 222) | 25 (11.4) |
| Received oral anal sex | 19 (8.4) |
| Used hands to stimulate partner’s genitals (N = 223) | 181 (81.0) |
| Partner used hands to stimulate your genitals | 165 (73.5) |
| Used sex toys with a partner | 47 (21.0) |
Note. Sexual activity status was determined based on responses to the question “Over the past month (30 days), how often have you engaged in sexual activity with another person that involved stimulating one or both of your genital or anal areas by hands, mouth, or penis/vagina?” If respondents selected anything other than “I have not engaged in any sexual activity over the past month,” they were coded as sexually active with a partner.
Frequency of social media use was assessed using an item adapted from the Pew Research Center Survey (2024). It measured average reported use of social media sites using the following response options: (1) almost constantly, (2) several times a day, (3) about once a day, (4) several times a week, (5) less often, and (6) never. The variable was dichotomized so that individuals who reported using social media sites at least once a day were coded as frequent users and all others were coded as nonfrequent users.
Those respondents who reported practicing PHR in their lifetime were asked to rate their agreement with 20 motivating factors for seeking PHR removal using a 4-point Likert-type scale. See Table 2 for all items and means/standard deviations related to these motivating factors.
Table 2.
Methods and Frequency of Pubic Hair Removal (PHR) Among U.S. Men (N = 495, Unless Otherwise Noted)
| Question | Number (%) |
|---|---|
| PHR ever (Lifetime) a | 231 (46.7) |
| Recent PHR (Past 30 days) b | 145 (29.2) |
| Lifetime PHR methods (N = 231) | |
| Shaving with razor or trimming with scissors | 230 (99.4) |
| Hair removal creams/gels | 32 (13.8) |
| Self- or at-home waxing | 12 (5.2) |
| Waxing or sugaring by professional in salon | 10 (4.2) |
| Laser hair removal or electrolysis | 5 (2.0) |
| Past 30-day PHR methods (N = 145) | |
| Shaving with razor or trimming with scissors | 144 (99.3) |
| Hair removal creams/gels | 10 (6.9) |
| Self- or at-home waxing | 4 (2.8) |
| Waxing or sugaring by professional in salon | 3 (2.1) |
| Laser hair removal or electrolysis | 3 (2.1) |
| Ever had all pubic hair removed—Yes (N = 231) | 83 (35.8) |
| Frequency of pubic hair trimming or removal (N = 231) | |
| Daily | 2 (0.9) |
| Weekly | 34 (14.6) |
| Monthly | 59 (25.5) |
| Every few months | 79 (34.0) |
| Every year | 7 (3.2) |
| Used to trim or remove, but not anymore | 23 (10.2) |
| Have not done this regularly | 27 (11.6) |
| Preferred pubic hair style (N = 257) | |
| Trimmed | 113 (43.9) |
| Partial removal of hair but not fully bare | 40 (15.7) |
| Hair-free (bare) | 27 (10.6) |
| It varies | 33 (12.8) |
| Natural (no removal) | 44 (16.9) |
| Motivations for PHR (limited to only men who reported PHR ever, N = 231) | M out of 4 (SD)c |
| Makes me feel cleaner (N = 230) | 3.12 (0.84) |
| More comfortable that way (N = 231) | 3.09 (0.89) |
| Makes oral sex easier (N = 222) | 2.91 (1.05) |
| Makes oral sex better (N = 222) | 2.88 (1.04) |
| Helps me feel sexy (N = 228) | 2.71 (0.93) |
| Makes sex better (N = 223) | 2.68 (1.01) |
| Part of my routine (N = 226) | 2.66 (1.06) |
| Makes sex feel more comfortable (N = 222) | 2.66 (1.03) |
| I think my partner finds it sexy (N = 228) | 2.65 (0.93) |
| Partner told me it looks sexy (N = 228) | 2.34 (1.02) |
| Most people my age keep pubic hair that way (N = 227) | 2.22 (0.93) |
| Form of self-expression (N = 224) | 2.12 (1.02) |
| Seen it done that way in porn (N = 226) | 2.03 (1.07) |
| Worried about partner judging/finding unattractive (N = 224) | 1.98 (0.97) |
| Makes me look younger (N = 223) | 1.89 (0.98) |
| Special occasion (e.g., Valentine’s Day) (N = 224) | 1.82 (0.99) |
| Going on vacation (N = 225) | 1.78 (0.99) |
| I believe I will look better in a swimsuit (N = 227) | 1.76 (0.99) |
| Attending healthcare visit with genitals exposed (N = 228) | 1.63 (0.98) |
| People on social media do it (N = 227) | 1.41 (0.74) |
Lifetime PHR: N was determined by responses to the items with the stem, “Which of the following methods have you ever (in your lifetime) used to either fully or partially remove your pubic hair?” Men who indicated having used any of the PHR methods in their lifetime were coded as having removed their pubic hair. b Recent PHR: N was determined by responses to the items with the stem, “Which of the following methods have you used in the last month (30 days) to either fully or partially remove your pubic hair?” Those who responded “yes” to any of the PHR methods were coded as having removed their pubic hair in the past month. c Item responses were 1 = Strongly disagree, 2 = Somewhat disagree, 3 = Somewhat agree, 4 = Strongly agree.
We assessed differences in characteristics of men who reported ever engaging in PHR practices in their lifetime compared with those who had never engaged in PHR practices. We then assessed differences in men who reported having engaged in PHR over the past month compared with those who had not done so within the past 30 days.
Statistical Analysis
All analyses were conducted in SPSS Version 28. Missing or incomplete data were excluded listwise from analyses. Ipsos created statistical weights to account for under- or over-response and all analyses herein employ the weighted data. Analyses included (a) descriptive statistics and frequency counts regarding men’s PHR prevalence, methods, and motivations; (b) examination of various correlates (e.g., race/ethnicity, age, sexual orientation) of PHR between men who engaged in PHR for both timeframes: (a) lifetime PHR and (b) past 30-day PHR using chi-square tests for categorical variables and analyses of variance (ANOVAs) for ordered categorical and continuous variables; and (c) two multivariable logistic regression models to assess which factors were associated with PHR among men—outcomes: (a) lifetime PHR and (b) past 30-day PHR.
Results
Pubic Hair Removal Practices
Of participating men (N = 495), nearly half (46.7%, n = 231) reported lifetime PHR, with 29.2% of those reporting last 30-day PHR (see Table 2). Shaving with a razor and trimming with scissors were the most prevalent PHR methods reported by men for both lifetime (99.4%) and past 30-day (99.3%) PHR. Just over one-third of men (35.8%) reported that they had ever removed all their pubic hair. Of 257 men responding, slightly below half (43.9%) noted their preferred pubic hair style as trimmed.
Pubic Hair Removal Motivations
As displayed in Table 2, the primary motivation reported for PHR was cleanliness (M = 3.12, SD = 0.84), followed closely by comfort (M = 3.09, SD = 0.89), and makes oral sex easier (M = 2.91, SD = 1.05). The least common motivations were related to social media influence (M = 1.41, SD = 0.74) and attending health care visits (M = 1.63, SD = 0.98).
Differences Between Pubic Hair Removers and Nonremovers
Analyzing differences between pubic hair removers and nonremovers, we found statistically significant distinctions in sexual orientation, age, SES, sexual activity, and social media use (see Table 3). A higher proportion of GBM (76.5%) reported lifetime PHR compared with heterosexual men (44.6%), and a similar pattern was evident for past 30-day PHR. Age-wise, younger respondents (18–24 years) and those in the oldest age group (65 years and older) were less likely to report lifetime PHR (35.1% and 24.5%, respectively) and past 30-day PHR (19.6% and 15.0%, respectively), compared with respondents in the other age groups. Respondents with higher incomes, sexually active men, and frequent social media users were also more likely to report both lifetime and last 30-day PHR. We found no differences based on race/ethnicity, marital status, education, or geographic region.
Table 3.
Differences Between Pubic Hair Removers and Nonremovers
| Removed pubic hair ever | Removed pubic hair in past 30 days | |
|---|---|---|
| Independent variables | n (%) or mean (SD) | n (%) or mean (SD) |
| Between-Group Analyses | ||
| Race | (N = 496) | (N = 495) |
| White, non-Hispanic | 152 (47.4) | 93 (29.1) |
| Black, non-Hispanic | 23 (40.4) | 13 (22.8) |
| Other, non-Hispanic | 10 (47.6) | 7 (33.3) |
| Hispanic | 38 (46.9) | 26 (32.1) |
| Multiracial, non-Hispanic | 8 (50.0) | 5 (31.3) |
| Between-group comparison χ2 (p) | 1.054 (.902) | 1.666 (.797) |
| SES—ANOVA | 5.33 (1.616) | 5.46 (1.595) |
| Between-group comparison | F(1, 493) = 8.277 (.004)** | F(1, 494) = 9.085 (.003)** |
| Sexual Orientation | (N = 458) | (N = 458) |
| Heterosexual | 189 (44.6) | 117 (27.6) |
| Gay or Bisexual | 26 (76.5) | 17 (50.0) |
| Between-group comparison χ2 (p) | 12.856 (<.001)*** | 7.634 (.006)** |
| Marital Status | (N = 496) | (N = 496) |
| Currently married | 131 (46.5) | 85 (30.1) |
| Previously married | 26 (47.3) | 16 (29.1) |
| Unmarried | 74 (46.5) | 44 (27.7) |
| Between-group comparison χ2 (p) | 0.012 (.994) | 0.300 (.861) |
| Education—ANOVA | 3.01 (0.977) | 3.01 (0.972) |
| Between-group comparison | F(1, 494) = 1.638 (.197) | F(1, 494) = 0.614 (.434) |
| Categorical Age | (N = 496) | (N = 495) |
| 18–24 years | 20 (35.1) | 11 (19.6) |
| 25–34 years | 49 (59.8) | 32 (39.0) |
| 35–44 years | 56 (58.9) | 37 (39.4) |
| 45–54 years | 43 (59.7) | 26 (36.1) |
| 55–64 years | 37 (44.0) | 23 (27.4) |
| 65 years and older | 26 (24.5) | 16 (15.0) |
| Between-group comparison χ2 (p) | 40.516 (<.001)*** | 23.255 (<.001)*** |
| Geographic Region | (N = 495) | (N = 496) |
| Northeast | 43 (49.4) | 28 (32.2) |
| Midwest | 48 (44.9) | 34 (31.5) |
| South | 88 (46.8) | 52 (27.7) |
| West | 51 (45.1) | 31 (27.4) |
| Between-group comparison χ2 (p) | 0.507 (.917) | 1.032 (.794) |
| Sexually Active | (N = 479) | (N = 480) |
| Past month | 136 (58.9) | 97 (42.0) |
| Not sexually active in past month | 93 (37.5) | 46 (18.5) |
| Between-group comparison χ2 (p) | 21.989 (<.001)*** | 31.686 (<.001)*** |
| Social Media Use | (N = 488) | (N = 487) |
| Frequent user | 144 (55.2) | 93 (35.6) |
| Not a frequent user | 88 (38.8) | 52 (23.0) |
| Between-group comparison χ2 (p) | 13.103 (<.001)*** | 9.231 (.002)** |
Note. SES = Socioeconomic Status. Individuals who reported using social media sites at least once a day were coded as frequent users and those who used them less frequently were coded as nonfrequent users.
p < .10, *p < .05, **p < .01, ***p < .001.
Predictors of Pubic Hair Removal
Only statistically significant factors associated with lifetime and past 30-day PHR (at the bivariate level, described above) were included in two subsequent multivariable logistic regression models. These analyses revealed several predictors of PHR (see Table 4). For example, sexual orientation was a statistically significant predictor; GBM had nearly 3 times greater odds of reporting lifetime PHR (OR = 2.891, 95%CI [1.2, 6.7]) compared with heterosexual men. Being sexually active in the past month statistically significantly predicted both lifetime PHR (OR = 1.884, 95%CI [1.2, 2.9]) and past 30-day PHR (OR = 2.849, 95%CI [1.8, 4.6]). Finally, age emerged as a statistically significant predictor, with respondents aged 25 to 34 years (OR = 2.275, 95%CI [1.0, 5.0]) and 45 to 54 years (OR = 2.493, 95%CI [1.1, 5.6]) having greater odds of reporting lifetime PHR compared with respondents in the 18- to 24-year-old reference group.
Table 4.
Predictors of Pubic Hair Removal (N = 453)
| Ever removed pubic hair | Removed pubic hair in past 30 days | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| b (SE) | p | OR | 95% CI | R2 | b (SE) | p | OR | 95% CI | R2 | |||
| Predictor | Lower | Upper | Lower | Upper | ||||||||
| .175 | .170 | |||||||||||
| SES | 0.08 (.06) | .220 | 1.080 | 0.955 | 1.222 | 0.10 (.07) | .147 | 1.108 | 0.965 | 1.271 | ||
| Categorical age | ||||||||||||
| 18–24 years | Reference category | Reference category | ||||||||||
| 25–34 years | 0.82 (.40) | .039* | 2.275 | 1.044 | 4.959 | 0.76 (.45) | .089 | 2.132 | 0.890 | 5.107 | ||
| 35–44 years | 0.71 (.40) | .072 | 2.038 | 0.938 | 4.429 | 0.41 (.45) | .369 | 1.493 | 0.623 | 3.575 | ||
| 45–54 years | 0.91 (.41) | .026* | 2.493 | 1.117 | 5.561 | 0.52 (.46) | .253 | 1.687 | 0.688 | 4.138 | ||
| 55–64 years | 0.27 (.40) | .502 | 1.310 | 0.596 | 2.879 | 0.12 (.47) | .799 | 1.126 | 0.452 | 2.808 | ||
| 65 years and older | −0.45 (.40) | .261 | 0.640 | 0.294 | 1.393 | −0.43 (.48) | .365 | 0.648 | 0.254 | 1.657 | ||
| Sexual Orientation | 1.06 (.43) | .014* | 2.891 | 1.241 | 6.737 | 0.66 (.38) | .086 | 1.925 | 0.911 | 4.068 | ||
| Sexually Active | 0.63 (.22) | .004** | 1.884 | 1.230 | 2.885 | 1.05 (.24) | < .001*** | 2.849 | 1.768 | 4.590 | ||
| Frequent Social Media User | 0.28 (.21) | .193 | 1.884 | 0.871 | 1.990 | 0.32 (.23) | .176 | 1.370 | 0.869 | 2.160 | ||
Note. OR = adjusted odds ratio. *p < .05, **p < .01, ***p < .001.
Discussion
This research examined PHR practices, motivations, and associated characteristics among a U.S. nationally representative sample of adult men. Findings indicate sexual orientation, age, and recent sexual activity are significant factors associated with men’s PHR practices.
In their 2013 national sample, while Gaither et al. (2017) found that Black men had lower odds of PHR, compared with White men, there was no association of PHR with race after adjusting for covariates. Similarly, we found no associations between race/ethnicity and PHR in our 2023 sample. While Gaither et al. (2017) found no association between the gender of men’s sexual partners with PHR, we found GBM had nearly 3 times greater odds of reporting lifetime PHR compared with heterosexual men in our sample; of course, identifying as GBM does not necessarily mean their current partner is male. As in Gaither et al.’s (2017) sample, sexual activity predicted PHR in lifetime and past 30-day PHR in our sample, and age continued to predict PHR in our sample, but only for lifetime PHR. Regarding PHR motivations, Gaither et al. (2017) reported sex, hygiene, and routine care as most commonly reported motivators; similarly, in our sample, men most commonly reported cleanliness, comfort, and making oral sex easier.
Regarding limitations, this study relied on self-report data, which may be subject to possible biases (Rosenman et al., 2011) and recall issues (Althubaiti, 2016). The cross-sectional design also limits our ability to establish temporal associations (X. Wang & Cheng, 2020). While U.S. nationally representative, our sample may not be generalizable to the unhoused, incarcerated (E. A. Wang et al., 2019), or non-English speakers (Brodeur et al., 2017). Finally, our sample was based on Ipsos’s standard measure of gender, which was binary (male/female) rather than assessing a more diverse spectrum of identities. We recommend future research implement more inclusive measures of gender to ensure a comprehensive understanding of PHR practices.
Despite these limitations, our research represents an important extension of Gaither et al.’s (2017) findings. We assessed predictors of PHR at two different timepoints (Gaither et al. only assess one timepoint), providing more nuance into time-based PHR, as well as a wider range of PHR correlates, allowing us a preliminary understanding of the association between social media use frequency and PHR habits.
From a health perspective, having an awareness of how often, and why, men engage in PHR can be critical, as methods of hair removal can result in various health risks such as skin irritation, infections, or more severe complications like abscesses or increased susceptibility to STIs (Osterberg et al., 2017). In addition, by studying PHR, researchers can better understand how societal norms and beauty standards affect personal hair removal decisions over time. Understanding why men choose to remove their pubic hair could help address issues related to body dissatisfaction or the psychological impacts of adhering to or deviating from prevailing beauty standards. Further, learning that age is a predictor of PHR practices suggests that diverse groups may view/engage with PHR differently, necessitating tailored health communications and interventions. Finally, as PHR is linked with sexual activity, researchers can equip educators and health care providers with data to support better health outcomes, informed by a deep understanding of the interplay between individual choices and broader social and cultural factors.
In conclusion, this study provides valuable insights and updated data and information on the prevalence, methods, and frequency of PHR practices among men in the United States. Further research can continue to enhance our comprehension of the factors influencing PHR practices and their implications for men’s health and well-being.
Supplemental Material
Supplemental material, sj-docx-1-jmh-10.1177_15579883241279830 for Pubic Hair Removal Practices and Motivations Among a Nationally Representative Sample of U.S. Men by Eric R. Walsh-Buhi, Hannah Javidi, Margaret L. Walsh-Buhi, Debby Herbenick and Rebecca F. Houghton in American Journal of Men’s Health
Footnotes
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Support for this research came from faculty start-up funds, provided to the first author by Indiana University.
ORCID iD: Eric R. Walsh-Buhi 
https://orcid.org/0000-0002-1690-5352
Supplemental Material: Supplemental material for this article is available online.
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Supplementary Materials
Supplemental material, sj-docx-1-jmh-10.1177_15579883241279830 for Pubic Hair Removal Practices and Motivations Among a Nationally Representative Sample of U.S. Men by Eric R. Walsh-Buhi, Hannah Javidi, Margaret L. Walsh-Buhi, Debby Herbenick and Rebecca F. Houghton in American Journal of Men’s Health