Political orientation, political environment, and health behaviors in the United States

Political voting in the United Kingdom 2019 general election and risk of living with obesity in a nationally representative sample

BACKGROUND

Limited evidence from the United States suggests that county/state rates of people with obesity are positively associated with voting for the Republican Party presidential candidate, although this question has not yet been studied at the individual level, and/or outside of the United States, where the health and political systems are very different in other countries.

OBJECTIVES

Using individual level data, assess differences in rates of people with obesity according to political voting in the United Kingdom 2019 general election, and examine whether people living in constituencies won by Members of Parliament (MPs) from the Conservative Party were more likely to be living with obesity than those living in constituencies won by MPs from other parties.

METHODS

Data was obtained by the Ipsos KnowledgePanel where panellists are recruited via a random probability unclustered address-based sampling method. 4000/14,016 panellists were randomly invited to provide data on socio-demographics, health outcomes, voting behaviour and height/weight.

RESULTS

2668/4000 (67%) of invitees provided data, 95/2668 (3.5%) were not eligible to vote, with the remaining 2573 (96.5%) included. Conservative Party voters were more likely to be living with obesity than those who voted Labour (OR:1.42 95% CI (1.01-1.99)) or Liberal Democrats (1.54 95% CI (1.00-2.37)). Conservative Party voters on average had significantly higher BMI scores than those voting Labour and Liberal Democrats; BMI mean difference 0.88 points (95% CI: 0.16-1.61) between Conservative and Labour voters, and 1.04 points (95% CI: 0.07-2.02) between Conservatives and Liberal Democrats voters. There was no evidence participants living in constituencies won by Conservative MPs were more likely to be living with obesity than constituencies won by other party MPs.

CONCLUSION

Governments and public health agencies may need to focus on the political affiliation of the public when developing strategies to reduce the number of people with obesity.

Investigating the Relation of Political Orientation and Vaccination Outcomes: Identifying the Roles of Political Ideology, Party Affiliation, and Vaccine Hesitancy

Popular press and academic articles alike suggest that political orientation is a primary determinant of vaccination willingness, vaccination, and vaccine word-of-mouth (i.e., sharing of information regarding vaccines). In the current article, we test the validity of these suggestions, and we also assess the differential roles of political ideology (e.g., liberal-conservative) and party affiliation (e.g., Democrat-Republican) as well as the mediating effect of vaccine hesitancy's dimensions. To do so, we perform a four-wave survey study with 223 participants that completed all waves. Our results support that political orientation indeed relates to our outcomes of interest. Our results also show that political ideology has a more pronounced effect than party affiliation, and the vaccine hesitancy dimensions of Health Risks and Healthy mediate many of these relations. From these results, we suggest many directions for future research and practice, including the integration of political discourse theories in studies on political orientations and vaccination.

Exploring and contextualizing the associations among political identification, vaccine risk and benefit perceptions, and vaccine acceptance

There is considerable research on the influence of political partisanship on vaccine acceptance. However, the current study is one of the first to investigate how political identification is related to risk and benefit perceptions vis-à-vis vaccines. Based on survey data collected in the United States regarding four different vaccines at three points in time (n = 383 for April-June 2012; n = 364 for March 2020; n = 334 for April-May 2020), Democrats were found to have more positive attitudes toward vaccinations in general and hold more favorable risk and benefit perceptions of pandemic and routine vaccines overall compared to Republicans. However, the onset of a pandemic can serve as an equalizing force and motivate similar risk and benefit perceptions across party lines, but this force can wane quickly when the information environment is politicized. For political partisans who are ideologically oriented to be more hesitant toward vaccines, two conditions can help sustain their favorable vaccine perceptions during a pandemic: (a) when they identify with the governing political party, and (b) when there are consistent reassurances of vaccine safety and effectiveness from their partisan leadership. Given that risk and benefit perceptions were found to be consistently associated with vaccine acceptance across contexts in this study, communication aimed at encouraging vaccinations should always address the risks and benefits of a vaccine in ways that are tailored for individuals with different political affiliations.

Social cognition, personality and social-political correlates of health behaviors: Application of an integrated theoretical model

OBJECTIVE

Dispositional, intra-personal constructs such as personality traits and generalized beliefs are consistently related to health behaviors, but relatively few studies have tested the theory-based mechanisms by which these constructs relate to health behaviors and compared them across behavior type. In the current study we tested an integrated theoretical model in which belief-based social cognition constructs (attitudes, subjective norms, perceived behavioral control) were proposed to mediate effects of personality traits (conscientiousness, extroversion) and socio-political beliefs (political beliefs, locus of control, free will beliefs) on participation in three health-related behaviors: physical activity, COVID-19 vaccination, and sugar-sweetened beverage restriction.

METHODS

Proposed integrated model effects were tested in a five-week prospective correlational study. Finnish residents completed measures of personality, socio-political, and social cognition constructs with respect to physical activity participation (N = 557), COVID-19 vaccination uptake (N = 1,115), and sugar-sweetened beverage restriction (N = 558) and self-reported their behavior at follow-up.

RESULTS

Structural equation models revealed direct effects of intention on behavior, and of social-cognition constructs on intention, across all behaviors. We also found indirect effects of political beliefs on behavior mediated by social cognition constructs and intentions for COVID-19 vaccination and sugar-sweetened beverage restriction behaviors, indirect effects of conscientiousness on behavior mediated by social cognition constructs and intentions for physical activity and sugar-sweetened beverage restriction behaviors, and indirect effects of health locus of control on behavior mediated by social cognition constructs and intentions for physical activity behavior. Finally, we found a negative total effect of populist beliefs on behavior for COVID-19 vaccination behavior.

CONCLUSION

Findings contribute to an evidence base for the effects of dispositional and social cognition constructs of health behaviors, point to a possible mechanism by which these generalized constructs relate to health behavior, and outline how the pattern of effects varies across the different behaviors.

Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study

BACKGROUND

The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI).

OBJECTIVE

This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ≥43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions.

METHODS

A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions.

RESULTS

The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03).

CONCLUSIONS

To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life.

Nutritional Criminology: Why the Emerging Research on Ultra-Processed Food Matters to Health and Justice

There is mounting concern over the potential harms associated with ultra-processed foods, including poor mental health and antisocial behavior. Cutting-edge research provides an enhanced understanding of biophysiological mechanisms, including microbiome pathways, and invites a historical reexamination of earlier work that investigated the relationship between nutrition and criminal behavior. Here, in this perspective article, we explore how this emergent research casts new light and greater significance on previous key observations. Despite expanding interest in the field dubbed 'nutritional psychiatry', there has been relatively little attention paid to its relevancy within criminology and the criminal justice system. Since public health practitioners, allied mental health professionals, and policymakers play key roles throughout criminal justice systems, a holistic perspective on both historical and emergent research is critical. While there are many questions to be resolved, the available evidence suggests that nutrition might be an underappreciated factor in prevention and treatment along the criminal justice spectrum. The intersection of nutrition and biopsychosocial health requires transdisciplinary discussions of power structures, industry influence, and marketing issues associated with widespread food and social inequalities. Some of these discussions are already occurring under the banner of 'food crime'. Given the vast societal implications, it is our contention that the subject of nutrition in the multidisciplinary field of criminology-referred to here as nutritional criminology-deserves increased scrutiny. Through combining historical findings and cutting-edge research, we aim to increase awareness of this topic among the broad readership of the journal, with the hopes of generating new hypotheses and collaborations.

The influence of political ideology on clinical trial knowledge, invitation, and participation among adults in the United States

BACKGROUND

Clinical trials remain a critical component of medical innovation. Evidence suggests that individuals' political ideologies may impact their health behaviors. However, there is a paucity of literature examining the relationship between political ideologies and clinical trial knowledge and participation.

METHODS

Study data were derived from Health Information National Trends Survey 5 Cycle 4 (n = 3300), which was conducted from February to June 2020. We used participants' characteristics to estimate the prevalence of clinical trial knowledge and participation. We used multivariable logistic regressions to investigate whether political ideology had a significant impact on clinical trial knowledge and participation. Jack-knife replicate weights were applied for population-level estimates.

RESULTS

Most participants were White (64.2%), earned above US$50,000 (62.4%), and lived in urban areas (88.0%). About 59.2% reported having some knowledge of clinical trials, and only 8.9% had ever been invited to participate in clinical trials. A total of 37.0%, 29.5%, and 33.5% of the population endorsed moderate, liberal, and conservative political viewpoints respectively. In the adjusted logistic regression analysis, compared to conservatives, liberals (adjusted odds ratio, 1.92; 95% confidence interval, 1.31-2.80) and moderates (adjusted odds ratio, 1.43; 95% confidence interval, 1.09-1.88) had significantly greater odds of having knowledge of clinical trials. Also, liberals had higher odds of receiving invitations to participate in clinical trials (odds ratio, 1.76; 95% confidence interval, 1.08-2.85; p = 0.023) and greater odds of trial participation (odds ratio, 3.90; 95% confidence interval, 1.47-10.33; p = 0.007) compared to moderates.

CONCLUSIONS

The mechanism underlying the higher rates of clinical trial invitations to liberals is unclear and requires further comprehensive investigation. Similarly, further qualitative studies are needed to understand the attributes that promote knowledge and increased likelihood of clinical trial participation among liberals. This will provide crucial insight to help design interventions that further involve conservatives and moderates in clinical trials and scientific enterprise.

Political orientation predicts the use of conventional and complementary/alternative medicine: A survey study of 19 European countries

BACKGROUND

People align their beliefs and behaviors, including those related to health, increasingly along politically ideological lines.

OBJECTIVE

We investigated whether individual political orientation (PO) predicts the use of conventional (CM) and complementary/alternative medicine (CAM) across Europe.

METHODS

We used cross-sectional samples representative of persons aged 15 and over from 19 European countries (ESS 2015; round 7; N = 35,572). We assessed PO based on participants' vote choice in the most recent national election, using expert ratings of party positioning along five political-ideological dimensions: left-right general; left-right economic; Green/alternative/libertarian vs. Traditional/authoritarian/nationalist; anti-elite; and anti-corruption. Use of CM was defined as having consulted a general practitioner or specialist, and use of CAM as having used acupuncture, acupressure, Chinese medicine, homeopathy, herbal treatment, hypnotherapy, or spiritual healing.

RESULTS

Participants with an anti-corruption PO were less likely to use CM and more likely to use CAM than other Europeans. Participants with a Green/alternative/libertarian PO were more likely to use CAM than others. Poorer health moderated the association between anti-corruption PO and CM, such that people in poor health tended to use CM regardless of their political leanings, but health status did not moderate the association between PO and CAM use.

CONCLUSIONS

The results show that political and socio-cultural views are associated with how the European lay public engages with healthcare and complementary/alternative services, but the relevant boundary lines do not lie along the left-right dimension. People who preferred parties favoring expanded freedoms were more likely to use complementary/alternative services, but likely for other reasons than to seek cures for diseases in a traditional biomedical sense. Concerns about corruption among the lay public may be more relevant for conventional healthcare than has been recognized.

Reliability but not bias: Developing a scale to measure preferred channels for risk information during the COVID pandemic

To develop a new measure of preferred sources for risk information, two studies asked respondents to indicate what channels they were reliant on for information about COVID-19, from 25 news channels ranging across the political spectrum. Unexpectedly, dependencies clustered around level of reliability rather than the political orientation of the news channel. In other words, each cluster included media channels from both the left and right side of the political spectrum, while dependencies clustered into sources that varied by the degree to which their content is reliable. Participants who turned to lower reliability channels indicated lower risk perceptions, less accurate probability estimations, reduced vaccination intentions, and lower protective behavioral intentions. Those inclined to use higher reliability channels indicated higher risk perceptions, more accurate probability estimations, increased vaccination intentions, and higher protective behavioral intentions. These relationships are discussed in terms of implications for our understanding of source reliance and risk perception, information sufficiency, and implications for both future research and public health interventions.

A Smartphone Intervention to Promote a Sustainable Healthy Diet: Protocol for a Pilot Study

BACKGROUND

Changing current dietary patterns into sustainable healthy diets (ie, healthy diets with low environmental impact and socioeconomic fairness) is urgent. So far, few eating behavior change interventions have addressed all the dimensions of sustainable healthy diets at once and used cutting-edge methods from the field of digital health behavior change.

OBJECTIVE

The primary objectives of this pilot study were to assess the feasibility and effectiveness of an individual behavior change intervention toward the adoption of a more environmentally sustainable healthy diet as a whole and changes in specific relevant food groups, food waste, and obtaining food from fair sources. The secondary objectives included the identification of mechanisms of action that potentially mediate the effect of the intervention on behaviors, identification of potential spillover effects and covariations among different food outcomes, and identification of the role of socioeconomic status in behavior changes.

METHODS

We will run a series of ABA n-of-1 trials over a year, with the first A phase corresponding to a 2-week baseline evaluation, the B phase to a 22-week intervention, and the second A phase to a 24-week postintervention follow-up. We plan to enroll 21 participants from low, middle, and high socioeconomic statuses, with 7 from each socioeconomic group. The intervention will involve sending text messages and providing brief individualized web-based feedback sessions based on regular app-based assessments of eating behavior. The text messages will contain brief educational messages on human health and the environmental and socioeconomic effects of dietary choices; motivational messages to encourage the adoption of sustainable healthy diets by participants, providing tips to achieve their own behavioral goals; or links to recipes. Both quantitative and qualitative data will be collected. Quantitative data (eg, on eating behaviors and motivation) will be collected through self-reported questionnaires on several weekly bursts spread through the study. Qualitative data will be collected through 3 individual semistructured interviews before the intervention period, at the end of the intervention period, and at the end of the study. Analyses will be performed at both the individual and group levels depending on the outcome and objective.

RESULTS

The first participants were recruited in October 2022. The final results are expected by October 2023.

CONCLUSIONS

The results of this pilot study will be useful for designing future larger interventions on individual behavior change for sustainable healthy diets.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/41443.

Sexual Orientation and Gender Identity-Related State-Level Policies and Perceived Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the United States

ObjectivesWe examined the associations between state-level policies and the health of lesbian, gay, bisexual, and transgender (LGBT) older adults. Methods: Using data from the 2018-2020 Behavioral Risk Factor Surveillance System surveys, we assessed physical and mental health by the tally of points for enacted LGBT-related policies (Low= <0-49.9% of possible points, High= 50-100% of possible points) in 10,032 sexual minority (i.e., lesbian, gay, and bisexual) and 1,072 transgender (non-sexual minority) adults aged 50 and older from 41 states. Results: Sexual minority adults in low tally states had greater odds of reporting fair or poor general health and 14 or more days of poor physical health in the past 30 days. Transgender participants in low tally states also had greater odds of reporting fair or poor general health. Discussion: Lesbian, gay, bisexual, and transgender adults have significantly greater risk of poor health if they live in a state with fewer LGBT anti-discriminatory policies enacted.

Flu Vaccine Uptake in Caregivers and Noncaregivers: Implications for Policy and Practice

INTRODUCTION

Caregivers are a critical and highly used health care resource. Caregivers may experience adverse health outcomes and practice less self-care, including obtaining vaccinations, while serving in their roles. Influenza (flu) is a common infectious disease responsible for millions of doctor visits, hospitalizations, and approximately 43,000 US deaths annually that can largely be prevented by receiving seasonal vaccinations. We aimed to estimate and compare the prevalence of flu vaccination among caregivers and noncaregivers. We hypothesized that caregivers would have a lower prevalence of flu vaccination than noncaregivers and that sociodemographic variables, health-related variables, and caregiving-specific characteristics would be associated with vaccine uptake.

METHODS

We analyzed Behavioral Risk Factor Surveillance System data from 2016 through 2018 on 154,170 respondents from 27 US states and the District of Columbia. We used bivariate analysis to estimate the difference in flu vaccination uptake among caregivers and noncaregivers and logistic regression to estimate differences after adjusting for individuals' characteristics.

RESULTS

Logistic regression indicated no significant difference in flu vaccine uptake between caregivers and noncaregivers. Caregiving characteristics such as years in a caregiver role, weekly time spent caregiving, relationship to care recipient, and recipient's risk for flu complications were also nonsignificant. Sociodemographic factors such as marital status, income, health insurance coverage, and race had a significant impact on flu vaccine uptake.

CONCLUSION

Although no significant differences in flu vaccine uptake were found between caregivers and noncaregivers, flu vaccine coverage remains low in both groups. Evidence-based programs and policies to improve vaccine coverage in the caregiver and general populations remains a public health priority.

The interplay between partisanship, risk perception, and mental distress during the early stages of the COVID-19 pandemic in the United States

COVID-19 is a profoundly partisan issue in the U.S., with increasing polarization of the Republicans' and Democrats' responses to the COVID-19 pandemic and their precautionary actions to reduce virus transmission. Nevertheless, it remains unclear whether and how partisan gaps in many aspects of the pandemic are linked to mental health, which has increasingly been a major concern. This study examined the association between political partisanship and mental health by assessing the mediating and moderating relationships between risk perception, expected infection severity of COVID-19, and partisanship in terms of mental health during the early stages of the pandemic. The data were drawn from a cross-sectional web survey conducted between March 20 and 30, 2020, with a sample of U.S. adults (N = 4,327). Of those participants, 38.9% and 29.6% were Democrats and Republicans, respectively. The results indicate that Democrats were more likely to experience COVID-induced mental distress than Republicans, and higher risk perception and expected infection severity were associated with mental distress. Furthermore, risk perception and expected infection severity of COVID-19 mediated approximately 24%-34% of the associations between political partisanship and mental distress. Finally, the adverse mental health impact of risk perception and expected infection severity appeared to be much stronger for Republicans than Democrats. The findings suggest that political partisanship is a key factor to understanding mental health consequences of the COVID-19 outbreak in the U.S.

Leading the way: competencies of leadership to prevent mis-implementation of public health programs

Public health agencies are increasingly concerned with ensuring that they are maximizing limited resources by delivering effective programs to enhance population-level health outcomes. Preventing mis-implementation (ending effective activities prematurely or continuing ineffective ones) is necessary to sustain public health efforts and resources needed to improve health and well-being. The purpose of this paper is to identify the important qualities of leadership in preventing mis-implementation of public health programs. In 2019, 45 state health department chronic disease employees were interviewed via phone and audio-recorded, and the conversations were transcribed verbatim. Thematic analysis focused on items related to mis-implementation and the manners in which leadership were involved in continuing ineffective programs. Final themes were based on a Public Health Leadership Competency Framework. The following themes emerged from their interviews regarding the important leadership competencies to prevent mis-implementation: '(1) leadership and communication; (2) collaborative leadership (3) leadership to adapt programs; (4) leadership and organizational learning and development; and (5) political leadership'. This first of its kind study showed the close interrelationship between mis-implementation and leadership. Increased attention to public health leader competencies might help to reduce mis-implementation in public health practice and lead to more effective and efficient use of limited resources.

The relationship between health and political ideology begins in childhood

We investigate whether childhood health status influences adult political ideology and whether health at subsequent life-stages, adolescent personality traits, or adolescent academic aptitude mediate this relationship. Using a national longitudinal cohort sample, we found that better health among children under age 10 was positively related to conservative political ideology among adults over age 64. Children with excellent health compared to very poor health were 16 percentage points more likely to report having a conservative political ideology in adulthood. Children with excellent health compared to very poor health were 13 percentage points less likely to report having a liberal political ideology in adulthood. Adults who had excellent health as children were 30 percentage points more likely to report conservative ideology than liberal ideology. However, the difference in ideological position for adults who had very poor childhood health was negligible. That is, the health and ideology relationship is being driven by those who were healthier early in life, after controlling for family income and material wealth. No evidence was found for mediation by adolescent heath, adult heath, adolescent personality traits, or adolescent academic aptitude. The magnitude of the coefficient for childhood health was substantively and statistically equivalent across race and sex. We discuss the possibility that, instead of being mediated, childhood health may actually be a mediator bridging social, environmental, and policy contexts with political ideology. We also discuss the potential of social policy to influence health, which influences ideology (and voting participation), which eventually circles back to influence social policy. It is important to understand the nexus of political life and population health since disparities in voice and power can exacerbate health disparities.

COVID-19 health practices and attitudes in the United States: the role of trust in healthcare

Aim

Individual-level COVID-19 vaccination and related preventive health behaviors is politically polarized in the United States. We examined whether the current polarization in COVID-19 health behavior may be explained by differences in trust in healthcare, locus of control, or insurance status.

Subject and methods

Our sample includes 553 US adults recruited on Amazon MTurk. We assessed odds ratios of currently vaccinated, or willing to be vaccinated if unvaccinated using logistic regression. We assessed count of routine changes and positive attitudes toward facemasks using negative binomial regression.

Results

Trust in healthcare was found to be an important determinant of all COVID-19 related health behavior measured in our study. Further, the effects on COVID-related attitudes/behavior from trust in healthcare are large in magnitude. For instance, our results suggest that individuals at or above the upper quartile of trust in healthcare are around 20 percentage points more likely to be vaccinated than those at or below the lower quartile. Further, we find that the effect of trust in healthcare on adherence or endorsement of COVID-19 mitigation strategies is distinct from political affiliation, i.e., the effect on COVID-19 related health behavior is independent of the polarization across political party lines. Locus of control was not associated with adherence/attitude toward COVID-19 mitigation strategies. Insurance status was only found to be positively associated with odds of being vaccinated.

Conclusion

Our study highlights the importance of increasing trust in healthcare as a means to protect public health in the wake of major public health crises.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01737-9.

Political environment and mortality rates in the United States, 2001-19: population based cross sectional analysis

OBJECTIVE

To assess recent trends in age adjusted mortality rates (AAMRs) in the United States based on county level presidential voting patterns.

DESIGN

Cross sectional study.

SETTING

USA, 2001-19.

PARTICIPANTS

99.8% of the US population.

MAIN OUTCOME MEASURES

AAMR per 100 000 population and average annual percentage change (APC).

METHODS

The Centers for Disease Control and Prevention WONDER database was linked to county level data on US presidential elections. County political environment was classified as either Democratic or Republican for the four years that followed a November presidential election. Additional sensitivity analyses analyzed AAMR trends for counties that voted only for one party throughout the study, and county level gubernatorial election results and state level AAMR trends. Joinpoint analysis was used to assess for an inflection point in APC trends.

RESULTS

The study period covered five presidential elections from 2000 to 2019. From 2001 to 2019, the AAMR per 100 000 population decreased by 22% in Democratic counties, from 850.3 to 664.0 (average APC -1.4%, 95% confidence interval -1.5% to -1.2%), but by only 11% in Republican counties, from 867.0 to 771.1 (average APC -0.7%, -0.9% to -0.5%). The gap in AAMR between Democratic and Republican counties therefore widened from 16.7 (95% confidence interval 16.6 to 16.8) to 107.1 (106.5 to 107.7). Statistically significant inflection points in APC occurred for Democratic counties between periods 2001-09 (APC -2.1%, -2.3% to -1.9%) and 2009-19 (APC -0.8%, -1.0% to -0.6%). For Republican counties between 2001 and 2008 the APC was -1.4% (-1.8% to -1.0%), slowing to near zero between 2008 and 2019 (APC -0.2%, -0.4% to 0.0%). Male and female residents of Democratic counties experienced both lower AAMR and twice the relative decrease in AAMR than did those in Republican counties. Black Americans experienced largely similar improvement in AAMR in both Democratic and Republican counties. However, the AAMR gap between white residents in Democratic versus Republican counties increased fourfold, from 24.7 (95% confidence interval 24.6 to 24.8) to 101.3 (101.0 to 101.6). Rural Republican counties experienced the highest AAMR and the least improvement. All trends were similar when comparing counties that did not switch political environment throughout the period and when gubernatorial election results were used. The greatest contributors to the widening AAMR gap between Republican and Democratic counties were heart disease (difference in AAMRs 27.6), cancer (17.3), and chronic lower respiratory tract diseases (8.3), followed by unintentional injuries (3.3) and suicide (3.0).

CONCLUSION

The mortality gap in Republican voting counties compared with Democratic voting counties has grown over time, especially for white populations, and that gap began to widen after 2008.

The harmful effects of partisan polarization on health

Partisan polarization significantly drives stress and anxiety among Americans, and recent aggregate-level studies suggest polarization may be shaping their health. This individual-level study uses a new representative dataset of 2,752 US residents surveyed between December 2019 and January 2020, some US residents report more days of poor physical and mental health per month than others. Using negative binomial models, zero inflated models, and visualizations, we find evidence that polarization is linked to declines in physical health: the more distant an individual feels politically from the average voter in their state, the worse health outcomes he or she reports. By uncovering the individual-level political correlates of health, this study aims to encourage further study and attention to the broader consequences of political polarization on American communities.

Trust in COVID-19 information sources and perceived risk among smokers: A nationally representative survey

BACKGROUND

Public health officials have classified smoking as a risk factor for COVID-19 disease severity. Smokers generally have less trust in health experts than do nonsmokers, leading to reduced risk perceptions. This study addresses smokers' trust in information sources about COVID-19 and how trust is associated with perceived COVID-19 susceptibility and severity among smokers.

METHODS AND FINDINGS

A nationally representative sample of 1,223 current smokers were surveyed between October and November 2020, indicating their level of trust in COVID-19 information sources, and their perceptions of risk from COVID-19. Multiple differences in trustworthiness emerged; smokers trusted their personal doctor for information about COVID-19 more than other information sources, while news media were generally distrusted. In addition, the FDA was trusted less than the NIH and CDC. Several "trust gaps" were observed, indicating disparities in levels of trust associated with gender, ethnicity, education, and political orientation, which had the strongest association with trust of all factors. Political orientation was also a significant predictor of COVID-19 risk perceptions, but there was no independent effect of political orientation when accounting for trust, which was predictive of all risk perception outcomes.

CONCLUSIONS

Trusted sources, such as personal doctors, may most effectively convey COVID-19 information across political orientations and sociodemographic groups. News media may be ineffective at informing smokers due to their low credibility. The results suggest that trust may explain the apparent effect of political orientation on COVID-19 risk perceptions. Implications for researchers, communication professionals, and policy makers are discussed.

It's Politics, Isn't It? Investigating Direct and Indirect Influences of Political Orientation on Risk Perception of COVID-19

Public response to the COVID-19 pandemic provides a unique opportunity to study risk perception in relation to political orientation. We tested a risk perception model of how political orientation influences risk perception of an emerging infectious disease and how it moderates other influences. Two nationwide online surveys in South Korea (N = 2,000) revealed that conservatives showed a higher risk perception regarding an emerging infectious disease, and political orientation can even moderate the influence of perceived risk characteristics on risk perception such as how a liberal orientation exhibited a greater outrage effect of perceived unfairness on COVID-19 risk perception. Also, the frequency of media use is positively related to higher risk perception. The implications of the direct and moderating effects of political orientation are discussed in the context of the studies of political orientation as well as risk perception.

State-level political partisanship strongly correlates with health outcomes for US children

The Cook Partisan Voting Index (PVI) determines how strongly a state leans toward the Democratic or Republican Party in US presidential elections compared to the nation. We set out to determine the correlation between childhood health outcomes and state-level partisanship using PVI. Sixteen measures of childhood health were obtained from several US governmental agencies for 2003-2017. The median PVI for every state was calculated for the same time period. Pearson's rho determined the correlation between PVI and each health outcome. Multiple regression was also conducted, adjusting for educational attainment and percentage of non-White residents. We also compared childhood health in moderately Democratic and Republican states (5-9.9% more Democratic/Republican than the national mean) and, similarly, for extremely Democratic and Republican states (10% or more Democratic/Republican than the national mean), using Wilcoxon tests. For all 16 health measures, the median values in Democratic-leaning states represented better outcomes than Republican-leaning states (9/16 had a beta value for linear regression associated with P < 0.05). When compared to Republican states, the median values in moderately Democratic states represented better outcomes for 14 of 16 health measures (9/14 associated with P < 0.05). Similarly, the median values for extremely Democratic states represented better outcomes with regard to all 16 health measures, when compared to Republican-leaning states (8/16 associated with P < 0.05).Conclusions: Democratic-leaning states displayed superior outcomes for multiple childhood health measures when compared to Republican counterpart states. Future research should investigate the significance of these findings and attempt to determine which state-level policies may have contributed to such disparate health outcomes. What is Known: • In the United States, many health disparities exist among children along racial, economic and geographic lines. • Many US states lean strongly towards either the Democratic or Republican political parties in federal elections. What is New: • Trends for multiple measures of childhood health vary in association with the political partisanship of the state being examined. • Multiple barometers of childhood health are superior in Democratic-leaning states, while no measures are better in Republican-leaning states.

Walking the party line: The growing role of political ideology in shaping health behavior in the United States

OBJECTIVE

To assess the extent to which political ideology affects COVID-19 preventive behaviors and related beliefs and attitudes in the U.S.

METHODS

Two surveys, one using a convenience sample and another using a nationally representative sample, were conducted in September and November 2020, respectively. Multiple regressions compared political ideology with identified COVID-19 risk factors and demographics as well as knowledge measures. Surveys were followed by a review of the emerging COVID-19 behavioral literature (completed in January 2021) to assess the frequency of ideological effects in publicly reported data.

RESULTS

In the survey data, political ideology was a significant predictor for all dependent variables in both surveys, and the strongest predictor for most of them. Out of 141 estimates from 44 selected studies, political ideology was a significant predictor of responses in 112 (79%) and showed the largest effect on COVID-19-related measures in close to half of these estimates (44%).

CONCLUSIONS

This study reinforces previous research that found partisan differences in engaging in behaviors with long-term health consequences by showing that these ideologically-driven differences manifest in situations where the possibility of severe illness or death is immediate and the potential societal impact is significant. The substantial implications for public health research and practice are both methodological and conceptual.

The clashing nature of rebelliousness: Nontraditional attitudes and counter-normative behaviors show divergent associations with intelligence

OBJECTIVE

Prior literature indicates that nontraditional attitudes are linked to higher intelligence. However, such attitudes in adolescence often accompany counter-normative, delinquent-type behaviors, which are themselves negatively linked with intelligence. This points to the possibility of suppression in the relationship between intelligence and nontraditional attitudes.

METHOD

We analyzed a large community sample of 17 year olds (N = 3330) with data on intelligence, nontraditional attitudes, and a diverse collection of self- and teacher-reported counter-normative behaviors. Developmental questions for these relationships were examined through cross-sectional comparisons between the adolescents and their parents as well as longitudinal analysis of the adolescent sample across emerging adulthood.

RESULTS

Youth who endorsed nontraditional attitudes had lower school grades, earlier age at first sex, heavier substance use, and were perceived as more oppositional by their teachers. Each of these problem behaviors was inversely related to intelligence. Accordingly, the positive correlation between nontraditional attitudes and intelligence was much weaker in adolescents as compared to their middle-aged parents. Longitudinal analyses revealed that the association between nontraditional attitudes and intelligence strengthens in early adulthood.

CONCLUSIONS

Associations between intelligence and sociopolitical attitudes can be obscured even by seemingly distal psychological characteristics.

United We Stand, Divided We Fall: Sociopolitical Predictors of Physical Distancing and Hand Hygiene During the COVID-19 Pandemic

Most health models emphasize individual factors in predicting health behavior. However, in the context of COVID-19 where the immediate response to stopping the spread of the virus requires collective efforts and change, other sociopolitical factors need to be considered. Prior research points to health behaviors being impacted by neighborhood and national social relations, social identification, confidence in government and political orientation. This research, though, is generally piecemeal (or specific), tends to be cross-sectional, and is usually not oriented to pandemics. These issues are addressed in the current research. A two-wave study with a representative sample of Australians (N _{Wave 1} = 3028) gathered during COVID-19 examined sociopolitical factors at the local and national level as predictors of health behaviors one month later. Four models were tested. These encapsulated geographic levels (local or national) and two health behaviors (hand hygiene or physical distance). In the three of the four models, social identification was a significant predictor of health behavior, while controlling for sociodemographic and individual-level measures. There were more mixed results for social relations and confidence in government. There is evidence that to better promote health behaviors sociopolitical factors need to be more prominent in public policy and health behavior models.

Are face masks a partisan issue during the COVID-19 pandemic? Differentiating political ideology and political party affiliation

Popular press articles have asserted that those with certain political orientations are less likely to wear face masks during the COVID‐19 pandemic. We propose that this relation is due to differential information shared by political parties rather than values associated with face mask wearing. We further propose that, when assessed together, political party affiliation (e.g., Republican, Democrat) but not political ideology (e.g., conservative, liberal) predicts face mask wearing, and this effect is mediated by perceptions of efficacy doubts but not perceptions that face masks infringe upon the wearer's independence. We performed a three‐wave, time‐separated survey study with 226 participants. Each proposal was supported. When assessed together, political party affiliation but not political ideology significantly predicted face mask wearing, and a significant indirect effect was observed via perceptions of efficacy doubts but not independence. Our results support that face mask wearing is a unique preventative action, which should be understood using political theory.

Viewing the US presidential electoral map through the lens of public health

Health, disease, and mortality vary greatly at the county level, and there are strong geographical trends of disease in the United States. Healthcare is and has been a top priority for voters in the U.S., and an important political issue. Consequently, it is important to determine what relationship voting patterns have with health, disease, and mortality, as doing so may help guide appropriate policy. We performed a comprehensive analysis of the relationship between voting patterns and over 150 different public health and wellbeing variables at the county level, comparing all states, including counties in 2016 battleground states, and counties in states that flipped from majority Democrat to majority Republican from 2012 to 2016. We also investigated county-level health trends over the last 30+ years and find statistically significant relationships between a number of health measures and the voting patterns of counties in presidential elections. Collectively, these data exhibit a strong pattern: counties that voted Republican in the 2016 election had overall worse health outcomes than those that voted Democrat. We hope that this strong relationship can guide improvements in healthcare policy legislation at the county level.

How to fairly allocate scarce medical resources? Controversial preferences of healthcare professionals with different personal characteristics

The scarcity of medical resources is widely recognized, and therefore priority setting is inevitable. This study examines whether Portuguese healthcare professionals (physicians vs nurses): (i) share the moral guidance proposed by ethicists and (ii) attitudes toward prioritization criteria vary among individual and professional characteristics. A sample of 254 healthcare professionals were confronted with hypothetical prioritization scenarios involving two patients distinguished by personal or health characteristics. Descriptive statistics and parametric analyses were performed to evaluate and compare the adherence of both groups of healthcare professionals regarding 10 rationing criteria: waiting time, treatment prognosis measured in life expectancy and quality of life, severity of health conditions measured in pain and immediate risk of dying, age discrimination measured in favoring the young over older and favoring the youngest over the young, merit evaluated positively or negatively, and parenthood. The findings show a slight adherence to the criteria. Waiting time and patient pain were the conditions considered fairer by respondents in contrast with the ethicists normative. Preferences for distributive justice vary by professional group and among participants with different political orientations, rationing experience, years of experience, and level of satisfaction with the NHS. Decision-makers should consider the opinion of ethicists, but also those of healthcare professionals to legitimize explicit guidelines.

Analysis of Social Media Discussions on (#)Diet by Blue, Red, and Swing States in the U.S

The relationship between political affiliations and diet-related discussions on social media has not been studied on a population level. This study used a cost- and -time effective framework to leverage, aggregate, and analyze data from social media. This paper enhances our understanding of diet-related discussions with respect to political orientations in U.S. states. This mixed methods study used computational methods to collect tweets containing "diet" or "#diet" shared in a year, identified tweets posted by U.S. Twitter users, disclosed topics of tweets, and compared democratic, republican, and swing states based on the weight of topics. A qualitative method was employed to code topics. We found 32 unique topics extracted from more than 800,000 tweets, including a wide range of themes, such as diet types and chronic conditions. Based on the comparative analysis of the topic weights, our results revealed a significant difference between democratic, republican, and swing states. The largest difference was detected between swing and democratic states, and the smallest difference was identified between swing and republican states. Our study provides initial insight on the association of potential political leanings with health (e.g., dietary behaviors). Our results show diet discussions differ depending on the political orientation of the state in which Twitter users reside. Understanding the correlation of dietary preferences based on political orientation can help develop targeted and effective health promotion, communication, and policymaking strategies.

Effects of Age, Gender, Health Status, and Political Party on COVID-19-Related Concerns and Prevention Behaviors: Results of a Large, Longitudinal Cross-sectional Survey

Background

With conflicting information about COVID-19, the general public may be uncertain about how to proceed in terms of precautionary behavior and decisions about whether to return to activity.

Objective

The aim of this study is to determine the factors associated with COVID-19–related concerns, precautionary behaviors, and willingness to return to activity.

Methods

National survey data were obtained from the Democracy Fund + UCLA Nationscape Project, an ongoing cross-sectional weekly survey. The sample was provided by Lucid, a web-based market research platform. Three outcomes were evaluated: (1) COVID-19–related concerns, (2) precautionary behaviors, and (3) willingness to return to activity. Key independent variables included age, gender, race or ethnicity, education, household income, political party support, religion, news consumption, number of medication prescriptions, perceived COVID-19 status, and timing of peak COVID-19 infections by state.

Results

The data included 125,508 responses from web-based surveys conducted over 20 consecutive weeks during the COVID-19 pandemic (comprising approximately 6250 adults per week), between March 19 and August 5, 2020, approved by the University of California, Los Angeles (UCLA) Institutional Review Board for analysis. A substantial number of participants were not willing to return to activity even after the restrictions were lifted. Weighted multivariate logistic regressions indicated the following groups had different outcomes (all P<.001): individuals aged ≥65 years (COVID-19–related concerns: OR 2.05, 95% CI 1.93-2.18; precautionary behaviors: OR 2.38, 95% CI 2.02-2.80; return to activity: OR 0.41, 95% CI 0.37-0.46 vs 18-40 years); men (COVID-19–related concerns: OR 0.73, 95% CI 0.70-0.75; precautionary behaviors: OR 0.74, 95% CI 0.67-0.81; return to activity: OR 2.00, 95% CI 1.88-2.12 vs women); taking ≥4 medications (COVID-19–related concerns: OR 1.47, 95% CI 1.40-1.54; precautionary behaviors: OR 1.36, 95% CI 1.20-1.555; return to activity: OR 0.75, 95% CI 0.69-0.81 vs <3 medications); Republicans (COVID-19–related concerns: OR 0.40, 95% CI 0.38-0.42; precautionary behaviors: OR 0.45, 95% CI 0.40-0.50; return to activity: OR 2.22, 95% CI 2.09-2.36 vs Democrats); and adults who reported having COVID-19 (COVID-19–related concerns: OR 1.24, 95% CI 1.12-1.39; precautionary behaviors: OR 0.65, 95% CI 0.52-0.81; return to activity: OR 3.99, 95% CI 3.48-4.58 vs those who did not).

Conclusions

Participants’ age, party affiliation, and perceived COVID-19 status were strongly associated with their COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Future studies need to develop and test targeted messaging approaches and consider political partisanship to encourage preventative behaviors and willingness to return to activities.

Limited knowledge and distrust are important social factors of out-patient' s 'inappropriate diagnosed seeking behaviour': a qualitative research in Shanghai

AIMS

This study is designed to present out-patient's 'inappropriate diagnosed seeking behaviour' in tertiary hospitals and interpret its association with some potential social factors.

METHODS

A qualitative study based on grounded theory was designed in this paper. The participates were recruited by a two-stage process. The field observation and in-depth interview were adopted for data collection. Multi-round (five rounds) sampling and continuing data analysis were adopted as well.

RESULTS

Totally 26 out-patients from three tertiary hospitals in Shanghai were involved. Four focused codes, including 'limited policy-related knowledge', 'limited health-related knowledge', 'distrust on related policy' and 'distrust on medical networks', were identified. Then, a theoretical model about the association of out-patient's 'limited knowledge' with 'distrust' and its relationship with 'inappropriate first-diagnosed seeking behaviour' in tertiary hospitals was developed.

CONCLUSION

'Inappropriate first-diagnosed seeking behaviour' of the out-patients in tertiary hospitals is closely associated with their limited knowledge and related distrust. Great effort on improving publics' knowledge and rebuilding a benign trust relationship with out-patients and the medical networks is found to be essential for guiding publics' appropriate first-diagnosed health behaviour in various levels of medical institutions.

COVID-19 stress and eating and drinking behaviors in the United States during the early stages of the pandemic

The coronavirus SARS-CoV-2 (COVID-19) pandemic has created widespread stress. Since many people cope with stress by eating, the current study investigated whether eating behaviors shifted among U.S. adults after the emergence of the pandemic. Data from national, crowdsourced surveys conducted on March 31st, 2020 and February 13th, 2019 were compared. Average levels of eating to cope and food addiction symptoms did not appear to shift during the early stages of the pandemic; however, U.S. adults ate about 14% more added sugars. Moreover, greater stress in response to the pandemic was associated with greater eating to cope, added sugars intake, food addiction symptoms, drinking to cope, and drinking frequency. These associations differed by the presence of state-level stay-at-home orders, perceived vulnerability to disease, age, U.S. political party affiliation, and gender. Although eating behaviors did not appear to majorly shift during the early stages of the pandemic, stress from the pandemic may intensify some maladaptive coping tendencies among U.S. adults.

The ideological divide in confidence in science and participation in medical research

In the United States, the wide ideological divergence in public confidence in science poses a potentially significant problem for the scientific enterprise. We examine the behavioral consequences of this ideological divide for Americans' contributions to medical research. Based on a mass survey of American adults, we find that engagement in a wide range of medical research activities is a function of a latent propensity to participate. The propensity is systematically higher among liberals than among conservatives. A substantial part of this ideological divide is due to conservative Americans' lower confidence in science. These findings raise important issues for the recruitment of subjects for medical studies and the generalizability of results from such studies.

Individual differences in social distancing and mask-wearing in the pandemic of COVID-19: The role of need for cognition, self-control and risk attitude

In the United States, while the number of COVID-19 cases continue to increase, the practice of social distancing and mask-wearing have been controversial and even politicized. The present study examined the role of psychological traits in social distancing compliance and mask-wearing behavior and attitude. A sample of 233 U.S. adult residents were recruited from Amazon Mechanical Turk. Participants completed scales of social distancing compliance, mask-wearing behavior and attitude, need for cognition, self-control, risk attitude, and political ideology. Epidemiological information (seven-day positive rate and the number of cases per 100,000) was obtained based on the state participants resided in. As a result, epidemiological information did not correlate with social distancing compliance mask-wearing. Political ideology, on the other hand, was a significant factor, with a more liberal tendency being associated with greater engagement in social distancing compliance and mask-wearing behavior an attitude. Importantly, those who were more risk averse, or had a higher level of self-control or need for cognition practiced more social distancing and mask-wearing, after controlling for demographics, epidemiological information, and political ideology. Furthermore, for mask-wearing behavior, political ideology interacted with both need for cognition and self-control. Collectively, the study revealed the psychological roots of individual differences in social distancing and mask-wearing compliance.

COVID-19 Echo Chambers: Examining the Impact of Conservative and Liberal News Sources on Risk Perception and Response

The coronavirus disease 2019 (COVID-19) pandemic has created substantial challenges for public health officials who must communicate pandemic-related risks and recommendations to the public. Their efforts have been further hampered by the politicization of the pandemic, including media outlets that question the seriousness and necessity of protective actions. The availability of highly politicized news from online platforms has led to concerns about the notion of "echo chambers," whereby users are exposed only to information that conforms to and reinforces their existing beliefs. Using a sample of 5,000 US residents, we explored their information-seeking tendencies, reliance on conservative and liberal online media, risk perceptions, and mitigation behaviors. The results of our study suggest that risk perceptions may vary across preferences for conservative or liberal bias; however, our results do not support differences in the mitigation behavior across patterns of media use. Further, our findings do not support the notion of echo chambers, but rather suggest that people with lower information-seeking behavior may be more strongly influenced by politicized COVID-19 news. Risk estimates converge at higher levels of information seeking, suggesting that high information seekers consume news from sources across the political spectrum. These results are discussed in terms of their theoretical implications for the study of online echo chambers and their practical implications for public health officials and emergency managers.

Promoting the use of evidence in health policymaking in the ECOWAS region: the development and contextualization of an evidence-based policymaking guidance

Background

The Economic Commission of the West African States (ECOWAS), through her specialised health Institution, the West African Health Organization (WAHO) is supporting Members States to improve health outcomes in West Africa. There is a global recognition that evidence-based health policies are vital towards achieving continued improvement in health outcomes. The need to have a tool that will provide systematic guide on the use of evidence in policymaking necessitated the production of the evidence-based policy-making (EBPM) Guidance.

Methods

Google search was performed to identify existing guidance on EBPM. Lessons were drawn from the review of identified guidance documents. Consultation, interaction and interviews were held with policymakers from the 15 West African countries during WAHO organized regional meetings in Senegal, Nigeria, and Burkina Faso. The purpose was to elicit their views on the strategies to promote the use of evidence in policymaking to be included in the EBPM Guidance. A regional Guidance Validation Meeting for West African policymakers was thereafter convened by WAHO to review findings from review of existing guidance documents and validate the EBPM Guidance.

Results

Out of the 250 publications screened, six publications fulfilled the study inclusion criteria and were reviewed. Among the important issues highlighted include: what evidence informed decision-making is; different types of research methods, designs and approaches, and how to judge the quality of research. The identified main target end users of the EBPM Guidance are policy/decision makers in the West African sub-region, at local, sub-national, national and regional levels. Among the key recommendations included in the EBPM Guidance include: properly defining/refining policy problem; reviewing contextual issues; initiating policy priority setting; considering political acceptability of policy; commissioning research; use of rapid response services, use of policy advisory/technical/steering committees; and use of policy briefs and policy dialogue.

Conclusion

The EBPM Guidance is one of the emerging tools that can enhance the understanding of evidence to policy process. The strategies to facilitate the use of evidence in policymaking outlined in the Guidance, can be adapted to local context, and incorporated validated approaches that can be used to promote evidence-to-policy-to-practice process in West Africa.

Space and Place in Alcohol Research

PURPOSE OF REVIEW

To summarize the recent literature on social and physical environments and their links to alcohol use and identify empirical research strategies that will lead to a better understanding of alcohol use in contexts.

RECENT FINDINGS

Recent research has continued to describe the importance of neighborhood and regional contexts on alcohol use, while a smaller emerging scientific literature assesses the impacts of contexts on drinking.

SUMMARY

The dynamic, longitudinal, and multiscale processes by which social and physical structures affect social interactions and substance use have not yet been uncovered or quantified. In order to understand and quantify these processes, assessments of exposures (e.g., how individuals use space) and risks within specific locations are essential. Methods to better assess these exposures and risks include model-based survey approaches, ecological momentary assessment (EMA) and other forms of ecologically- and temporally-specific analyses, affiliation network analyses, simulation models, and qualitative/multi-methods studies.

Being Healthy, Being Sick, Being Responsible: Attitudes towards Responsibility for Health in a Public Healthcare System

Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases (LHL)’s 2015 Health Survey (N = 2689), this study examined the public’s attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities’ responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the association between attitudes towards health responsibilities and individual lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies (including information, health incentives, prevention and regulations). The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of ‘self-inflicted’ conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial.

Exploring Differences in the Rate of Type 2 Diabetes Among American Cities: How Urbanization Continues to Challenge the Traditional Epidemiological View

As the world’s largest urban regions continue to expand, a concomitant rise in non-communicable diseases, particularly type 2 diabetes, poses an increasingly ominous challenge to experts in the field of public health. Given that the majority of the world’s population (54%) resides in urban areas, a figure likely to reach two-thirds by 2050, this issue presents serious implications for medical practitioners as well as policymakers seeking to manage long-term healthcare costs while sustaining historic increases in life expectancy. To explore how these trends are continuing to affect the United States, a multiple regression analysis was conducted using data provided by the Centers for Disease Control and Prevention (CDC) through their initiative, 500 Cities: Local Data for Better Health. The regression models revealed that larger cities reported significantly higher rates of type 2 diabetes even after controlling for variables that have been perennially linked to disease onset (e.g., levels of obesity, sedentary behavior). Implications are discussed, most notably the argument for moving beyond the ‘food desert’ paradigm when identifying and explaining which characteristics of larger cities place their residents at increased risk. This approach could help reveal opportunities for intervention that may not have garnered sufficient attention in the extant literature.

Political parties and mortality: The role of social status and personal responsibility

Previous research findings across a variety of nations show that affiliation with the conservative party is associated with greater longevity; however, it is thus far unclear what characteristics contribute to this relationship. We examine the political party/mortality relationship in the United States context. The goal of this paper is two-fold: first, we seek to replicate the mortality difference between Republicans and Democrats in two samples, controlling for demographic confounders. Second, we attempt to isolate and test two potential contributors to the relationship between political party affiliation and mortality: (1) socioeconomic status and (2) dispositional traits reflecting a personal responsibility ethos, as described by the Republican party. Graduate and sibling cohorts from the Wisconsin Longitudinal Study were used to estimate mortality risk from 2004 to 2014. In separate Cox proportional hazards models controlling for age and sex, we adjusted first for markers of socioeconomic status (such as wealth and education), then for dispositional traits (such as conscientiousness and active coping), and finally for both socioeconomic status and dispositional traits together. Clogg's method was used to test the statistical significance of attenuation in hazard ratios for each model. In both cohorts, Republicans exhibited lower mortality risk compared to Democrats (Hazard Ratios = 0.79 and 0.73 in graduate and sibling cohorts, respectively [p < 0.05]). This relationship was explained, in part, by socioeconomic status and traits reflecting personal responsibility. Together, socioeconomic factors and dispositional traits account for about 52% (graduates) and 44% (siblings) of Republicans' survival advantage. This study suggests that mortality differences between political parties in the US may be linked to structural and individual determinants of health. These findings highlight the need for better understanding of political party divides in mortality rates.