This edition of JournalWatch is, appropriately, themed around US politics.
A recent study asked if vaccination rates showed any association with voting patterns across US states. Crunching the data, the researchers got the answer they expected … and a little more. Their findings should be food for thought for those implementing public health interventions of all kinds, writes Dr Melissa Stoneham.
Dr Melissa Stoneham writes:
Given the startling outcome of the recent United States Presidential election, it seems appropriate to showcase a “blue states” verses “red states” peer reviewed journal article that illustrates differences in vaccination rates across these states.
In a nutshell, the article demonstrates that parents in “blue states” (Democrats) are more likely to vaccinate their teenagers against Human Papillomavirus, or HPV, and other diseases when compared with the “red states” (Republican).
HPV vaccine shyness
The study, published in the American Journal of Public Health and led by Dr Steven Bernstein from the Yale School of Public Health, shows that differences in vaccination rates can potentially reflect cultural norms and political beliefs.
The article indicated that States that are more politically conservative which are the “red states,” tend to shy away from vaccines for young people, including the vaccine against human papillomavirus (HPV), a sexually transmitted disease. The “blue states” are described as being more socially and politically liberal.
In their analysis, the researchers examined polling data from the 2012 Presidential election and vaccination coverage statistics for the HPV, tetanus-containing (Tdap) and meningococcal (MCV4) vaccinations from the 2012 National Immunisation Survey-Teen. These three vaccines were selected as they are all currently recommended for routine use in adolescents aged 11 to 12.
A range of variables were factored in and included a variety of socio-demographic factors such as median household income, education, and ethnicity.
The analysis showed that the blue states had a 10% higher HPV vaccination rate for girls (median coverage for one or more doses 63.4% V 56.0%), and a nearly 25% higher HPV vaccination rate for boys (median coverage for one or more doses 47.4% V 33.9%).
Voting and vaccination: not just about sex
The authors suggest that the findings imply a direct association between voting patterns and vaccination coverage. The fact that the authors actually controlled for many of the things that might explain differences in health promoting behaviours such as median income, education levels and insurance, yet still identified that the impact of political preferences mattered, is an interesting finding.
In an interview, Dr Bernstien explained that, initially, the research team hypothesised that differences in HPV vaccination coverage would exist due to the “misplaced fear” that vaccinating against HPV — a sexually transmitted infection that accounts for nearly all cervical cancers — encourages earlier sexual behaviour among girls.
While their data supported this hypothesis, the team was amazed to find that the higher vaccination rates in the blue states were not confined to use of the HPV vaccine. The blue states had a 6% higher rate of vaccination for Tdap (median coverage 90.1% V 84.8%), and a 14% higher vaccination rate for MCV4 (median coverage 79.3% V 72.8%).
This surprised the researchers because tetanus and meningococcal disease are bacterial infections that are not sexually transmitted and these vaccines don’t necessarily carry the stigma and controversy associated with HPV. From these results, the research team concluded that the association between vaccination coverage and state voting patterns is not merely limited to the HPV vaccine.
Political allegiance as a public health challenge
The researchers quote other studies that found similar results in the areas of mental health, obesity and women’s reproductive health, suggesting that a complex mixture of psychological, social, and political factors may play a role in driving decisions about vaccination (and other health related issues). Differing worldviews between blue and red states, such as trust in government, religious beliefs, and the importance of personal versus public responsibility may impact decision-making.
In America, preference for a smaller role of government in personal decision making is typically associated with more Republican views.
Armed with information on these types of trend, at least in the Unites States, public health professionals might gain a better understanding of the associations between voting behaviour and health promoting behaviours such as vaccination coverage.
Currently, the extent to which certain factors or determinants such as social values, trust in science and beliefs in the role of government, contribute to differences in vaccination coverage is unclear. The current study is quantitative in nature and as we know, that only tells part of the story.
Complementing the findings with some qualitative data, anecdotes and stories describing the motivations or beliefs that underpin these behaviours would increase the public health profession’s awareness about the myriad of reasons for the differences in vaccination coverage.
The article: Bernstein S, North A, Schwartz J &Niccolai L. State-Level Voting Patterns and Adolescent Vaccination Coverage in the United States, 2014. Am J Public Health. 2016 Oct.
The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.
The Journals reviewed include:
Australian & New Zealand Journal of Public Health (ANZJPH)
Journal of Public Health Policy (JPHP)
Health Promotion Journal of Australia (HPJA)
Medical Journal of Australia (MJA)
Journal for Water Sanitation and Hygiene Development
Tobacco Control (TC)
American Journal of Public Health (AMJPH)
Health Promotion International (HPI)
American Journal of Preventive Medicine (AJPM)
These reviews are then emailed to all JournalWatch subscribers and are placed on the PHAIWA website. To subscribe to JournalWatch click here.