Georgia State University ScholarWorks @ Georgia State University Public Health Theses School of Public Health Spring 5-17-2013 A County-Level Analysis of the Relationship between Voter Behavior as a Proxy for Partisan Ideology, Income, and the Effects on Health Morbidity and Mortality Measures Sarah M. Trimmer Institute of Public Health Follow this and additional works at: https://scholarworks.gsu.edu/iph_theses Recommended Citation Trimmer, Sarah M., "A County-Level Analysis of the Relationship between Voter Behavior as a Proxy for Partisan Ideology, Income, and the Effects on Health Morbidity and Mortality Measures." Thesis, Georgia State University, 2013. https://scholarworks.gsu.edu/iph_theses/262 This Thesis is brought to you for free and open access by the School of Public Health at ScholarWorks @ Georgia State University. It has been accepted for inclusion in Public Health Theses by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact [email protected]. ABSTRACT Sarah Marie Trimmer A County-Level Analysis of the Relationship between Voter Behavior as a Proxy for Partisan Ideology, Income, and the Effects on Health Morbidity and Mortality Measures (Under the direction of: Sheryl M. Strasser, PhD) Introduction: Domestic research studies focused on the interrelationships between political ideology characteristics inherent in policy decisions and the contributions these political determinants exert over health indicators and outcomes are limited. Studying the contexts and directionality of ideology, political partisanship, policy and the effects on population health has important implications for the field of public health. Upstream social and economic policy determinants both connected and unconnected to health play a role in creating and perpetuating disparities, especially for those in lower socioeconomic stratum. Given the paucity of research that focuses on political and policy support of health at the county-level, this study sets out to utilize the University of Wisconsin Population Health Institute’s (UWPHI) annual County Health Rankings data and examine them within the context of county-based majority political partisanship and economic measures. Methods: This exploratory ecological study examined differences between independent variables: partisan voting behavior (trichotomized as conservative, moderate, and liberal) and median per capita household income in U.S. dollars (by quartile) on dependent variables related to mortality (years of productive life lost) and morbidity (number of poor mental and physical health days) at the county-level to compare differences in political and ideological underpinnings that may act as influencers on health outcomes. Of particular interest were the potential differences seen at the lower income quartile. Multiple data sources were combined and matched to all 3,140 counties located in the U.S. Two-way between-subjects ANOVA statistical tests were conducted to determine if there is an effect of partisan voter index category on the three aforementioned dependent variables related to health outcomes, and median per capita income by quartile. Results: There was a statistically significant main interaction between median per capita household income by quartile and partisan voter index category on years of productive life lost, F(6,2789) = 19.3, p < .000, partial η2 = .040. While there were also statistically significant interactions between the independent and dependent variables of poor mental and physical health days, results of those analyses should be interpreted with caution. Pertaining to years of productive life lost, post hoc analyses of significant interactions revealed significant differences at the lower income quartile, but not in the expected direction. The conservative category had statistically significant lower years of productive life lost in comparison to the liberal category (M = -8.21, SE = 1.47, p = .000). Also, there were significant differences detected in the upper quartile suggesting that the liberal category has lower years of productive life lost in comparison to the conservative category (M = 7.06, SE = 1.06, p = .000). Conclusion: Results should be interpreted with caution and suggest more research and methodological refinements are needed, particularly related to categorizing county-level political dynamics. INDEX WORDS: County Health Rankings, political partisanship, voter behavior, health morbidity and mortality, health disparities. i A COUNTY-LEVEL ANALYSIS OF THE RELATIONSHIP BETWEEN VOTER BEHAVIOR AS A PROXY FOR PARTISAN IDEOLOGY, INCOME, AND THE EFFECTS ON HEALTH MORBIDITY AND MORTALITY MEASURES Sarah M. Trimmer B.S., University of Wyoming A Thesis Submitted to the Graduate Faculty of Georgia State University in Partial Fulfillment of the Requirements for the Degree MASTER OF PUBLIC HEALTH ATLANTA, GEORGIA 2013 ii A COUNTY-LEVEL ANALYSIS OF THE RELATIONSHIP BETWEEN VOTER BEHAVIOR AS A PROXY FOR PARTISAN IDEOLOGY, INCOME, AND THE EFFECTS ON HEALTH MORBIDITY AND MORTALITY MEASURES by Sarah M. Trimmer Approved: Sheryl Strasser, PhD Committee Chair Scott Weaver, PhD Committee Member April 26. 2013 Date iii ACKNOWLEDGMENT First and foremost, thank you to my thesis committee Dr. Strasser and Dr. Weaver. I have been incredibly lucky to have a small group of people who have contributed to my growth and development as a professional, a researcher and a human. Steven, I am grateful for your selfless support and sense of humor throughout the entire graduate school process. It made all the difference. Dr. Anne Bowen taught me almost everything I know about conducting research while I worked at the University of Wyoming. She nurtured and encouraged my natural abilities and inspired me to invest in the next level of my education. At some later juncture when I return to academia for doctoral studies, a part of that reason will be because of my time with Anne teaching me the ropes; I'll be ready for it when the time comes because of her. Mr. John Bayer has changed the trajectory of my life in so many ways. He taught me how to be a better thinker and problem solver. His investments in me whether it was time, intellectual conversation, debate, the passing on of knowledge or wisdom has thoroughly prepared me to tackle the bumps in life with confidence, to fearlessly challenge the status quo and to act as an objective seeker and advocate for the truth. iv AUTHOR’S STATEMENT In presenting this thesis as a partial fulfillment of the requirements for an advanced degree from Georgia State University, I agree that the Library of the University shall make it available for inspection and circulation in accordance with its regulations governing materials of this type. I agree that permission to quote from, to copy from, or to publish this thesis may be granted by the author or, in his/her absence, by the professor under whose direction it was written, or in his/her absence, by the Associate Dean, College of Health and Human Sciences. Such quoting, copying, or publishing must be solely for scholarly purposes and will not involve potential financial gain. It is understood that any copying from or publication of this dissertation which involves potential financial gain will not be allowed without written permission of the author. Sarah M. Trimmer v NOTICE TO BORROWERS All theses deposited in the Georgia State University Library must be used in accordance with the stipulations prescribed by the author in the preceding statement. The author of this thesis is: Student’s Name: Sarah Marie Trimmer Street Address: 339 South 5th Street City, State, and Zip Code: Douglas, WY 82633 The Chair of the committee for this thesis is: Professor’s Name: Sheryl Strasser, PhD Department: Institute of Public Health College: Health Sciences Georgia State University P.O. Box3995 Atlanta, Georgia 30302-3995 Users of this thesis who not regularly enrolled as students at Georgia State University are required to attest acceptance of the preceding stipulation by signing below. Libraries borrowing this thesis for the use of their patrons are required to see that each user records here the information requested. NAME OF USER ADDRESS DATE TYPE OF USE (EXAMINATION ONLY OR COPYING) vi CURRICULUM VITAE SARAH M. TRIMMER 339 South 5th Street, Douglas, WY 82633 | 307-220-4160 | [email protected] EDUCATION Georgia State University, Atlanta, GA Master of Public Health – Policy and Management 2013 University of Wyoming, Laramie, WY Bachelor of Science – Kinesiology and Health Promotion 2005 AWARDS AND HONORS Presidential Management Fellowship Finalist, Office of Personnel Management - U.S. Government 2013 Health Disparities Fellowship, Center of Excellence on Health Disparities - Georgia State University 2011 – 2013 ACADEMIC EXPERIENCE Georgia State University, Atlanta, GA Graduate Research Assistant 2011 – 2013 Provided research support for projects related to racial/ethnic differences in alternative tobacco use among adolescents and young adults; and prescription drug abuse/misuse. PROFESSIONAL EXPERIENCE Wyoming Department of Workforce Service, Research & Planning, Casper, WY Summer Intern 2012 Data entry, data collection via telephone interviews, special project on the impact of healthcare reform in Wyoming. Fay W. Whitney, School of Nursing, University of Wyoming, Laramie, WY Senior Project Coordinator 2008 - 2011 Coordinated and administered grant activities and projects. Performed direct oversight and management of the operations of the Nightingale