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Who votes for public health? U.S. senator characteristics associated with voting in concordance with public health policy recommendations (1998-2013).

ABSTRACT: The voting behaviors of elected officials shape the public's health. Little is known, however, about the characteristics of elected officials who vote in concordance with public health policy recommendations. This article presents the results of study conducted with the aims of: 1) testing the hypothesis that US Democrat Senators vote in concordance with American Public Health Association (APHA) policy recommendations more frequently than US Republican Senators, 2) identifying US Senator characteristics independently associated with voting in concordance with APHA, and 3) assessing trends in APHA voting concordance by political party.We created a legislative dataset of 1434 votes cast on 111 legislative proposals by 184 US Senators during the years 1998 through 2013. Mixed effects linear regression models were used to estimate the independent contributions of political party, gender, geographic region, and year effects to annual APHA voting concordance. Votes were nested within Senators who were nested within States to account for non-independence and models considered potential for time and spatial patterns in the data.Adjusting for covariates and accounting for serial and spatial autocorrelation, Democrats averaged 59.1 percentage points higher in annual APHA voting concordance than Republicans (95% CI: 55.5, 62.7), females averaged 7.1 percentage points higher than males (95% CI: 1.9, 12.3), and Northeastern Senators averaged 16.1 percentage points higher than Southern Senators (95% CI: 9.1, 23.1).Elected official's political party affiliation, gender, and geographic region are independently associated with public health voting decisions and should be considered when targeting and tailoring science-based policy dissemination strategies.

SUBMITTER: Purtle J

PROVIDER: S-EPMC5768995 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Who votes for public health? U.S. senator characteristics associated with voting in concordance with public health policy recommendations (1998-2013).

Purtle Jonathan J Goldstein Neal D ND Edson Eli E Hand Annamarie A

SSM - population health 20161223

<h4>Background</h4>The voting behaviors of elected officials shape the public's health. Little is known, however, about the characteristics of elected officials who vote in concordance with public health policy recommendations. This article presents the results of study conducted with the aims of: 1) testing the hypothesis that US Democrat Senators vote in concordance with American Public Health Association (APHA) policy recommendations more frequently than US Republican Senators, 2) identifying ...[more]

PMID: 29349211

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Project description:BackgroundPublic health policies and recommendations aim to be informed by the best available evidence. Evidence underpinning e-cigarettes policy recommendations has been necessarily limited due to the novelty of the technology and the lack of long-term epidemiological studies and trials. Some public health bodies have actively encouraged e-cigarette use whilst others have raised concerns over introducing new health risks and renormalising tobacco smoking. Using citation network analysis we investigated the author conflicts of interest and study funding statements within sources of evidence used by public health bodies when making recommendations about e-cigarette policy.MethodsWe conducted citation network analysis of public health recommendation documents across four purposively selected diverse jurisdictions: WHO, UK, Australia, and USA. We extracted all citations from 15 public health recommendation documents, with more detailed data collected for influential citations (used in 3+ recommendation documents). We analysed the relationships between the sources of evidence used across jurisdictions using block modelling to determine if similar groups of documents were used across different jurisdictions. We assessed the frequency and nature of conflicts of interest.Results1700 unique citations were included across the 15 public health recommendation documents, with zero to 923 citations per document (median = 63, IQR = 7.5-132). The evidence base underpinning public health recommendations did not systematically differ across jurisdictions. Of the 1700 citations included, the majority were journal articles (n = 1179). Across 1081 journal articles published between 1998-2018, 200 declared a conflict of interest, 288 contained no mention of conflicts of interest, and 593 declared none. Conflicts of interest were reported with tobacco (3%; n = 37 journal articles of 1081), e-cigarette (7%; n = 72), and pharmaceutical companies (12%; n = 127), with such conflicts present even in the most recent years. There were 53 influential citations, the most common study type was basic science research without human subjects (e.g. examination of aerosols and e-liquids) (n = 18) followed by systematic review (n = 10); with randomised control trial being least common (n = 4). Network analysis identified clusters of highly-cited articles with a higher prevalence of conflicts of interest.ConclusionPublic health bodies across different jurisdictions drew upon similar sources of evidence, despite articulating different policy approaches to e-cigarettes. The evidence drawn upon, including the most influential evidence, contained substantial conflicts of interest (including relationships with e-cigarette and tobacco industries). Processes to explicitly manage conflicts of interest arising from the underlying evidence base may be required when developing public health recommendations.

Project description:ImportanceIn the U.S. presidential election of 2016, substantial shift in voting patterns occurred relative to previous elections. Although this shift has been associated with both education and race, the extent to which this shift was related to public health status is unclear.ObjectiveTo determine the extent to which county community health was associated with changes in voting between the presidential elections of 2016 and 2012.DesignEcological study with principal component analysis (PCA) using principal axis method to extract the components, then generalized linear regression.SettingGeneral community.ParticipantsAll counties in the United States.ExposuresPhysically unhealthy days, mentally unhealthy days, percent food insecure, teen birth rate, primary care physician visit rate, age-adjusted mortality rate, violent crime rate, average health care costs, percent diabetic, and percent overweight or obese.Main outcomeThe percentage of Donald Trump votes in 2016 minus percentage of Mitt Romney votes in 2012 ("net voting shift").ResultsComplete public health data was available for 3,009 counties which were included in the analysis. The mean net voting shift was 5.4% (+/- 5.8%). Of these 3,009 counties, 2,641 (87.8%) had positive net voting shift (shifted towards Trump) and 368 counties (12.2%) had negative net voting shift (shifted away from Trump). The first principal component ("unhealthy score") accounted for 68% of the total variance in the data. The unhealthy score included all health variables except primary care physician rate, violent crime rate, and health care costs. The mean unhealthy score for counties was 0.39 (SD 0.16). Higher normalized unhealthy score was associated with positive net voting shift (22.1% shift per unit unhealthy, p < 0.0001). This association was stronger in states that switched Electoral College votes from 2012 to 2016 than in other states (5.9% per unit unhealthy, p <0.0001).Conclusions and relevanceSubstantial association exists between a shift toward voting for Donald Trump in 2016 relative to Mitt Romney in 2012 and measures of poor public health. Although these results do not demonstrate causality, these results suggest a possible role for health status in political choices.

Dataset Information

Who votes for public health? U.S. senator characteristics associated with voting in concordance with public health policy recommendations (1998-2013).

Publications

Who votes for public health? U.S. senator characteristics associated with voting in concordance with public health policy recommendations (1998-2013).

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