title: State-Level Voting Patterns and Adolescent Vaccination Coverage in the United States, 2014.
abstract: To examine state-level associations between voting patterns and adolescent coverage for at least 1 dose of human papillomavirus (HPV), tetanus-containing (Tdap), and meningococcal (MCV4) vaccination.
  
  
  
  We classified states as "blue" (Democratic affiliation) or "red" (Republican affiliation) based on the Presidential election results in 2012. We used multivariable models to adjust for potential confounding by sociodemographic and health care access characteristics and vaccination policies. For HPV, separate models were fitted for boys and girls.
  
  
  
  Adolescent vaccination coverage was significantly higher in blue states than red states for each vaccine (P < .05). The adjusted percent differences between blue and red states were 10.2% for HPV among girls, 24.9% for HPV among boys, 6.2% for tetanus-containing vaccine, and 14.1% for MCV4.
  
  
  
  State-level voting patterns are independently and significantly associated with coverage for routinely recommended adolescent vaccines. These differences may reflect population-level differences in cultural norms and social values.
  
  
  
  Strategies to increase coverage at the individual, community, or structural level should consider local political settings that may facilitate or hinder effectiveness.
authors.affiliation: Steven Bernstein is with the Department of Emergency Medicine, Yale Cancer Center, New Haven, CT, and the Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven. Linda M. Niccolai and Anna North are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale Cancer Center. Jason Schwartz is with the Department of Health Policy and Management, Yale School of Public Health, New Haven.
authors.forename: Steven
authors.initials: S
authors.lastname: Bernstein
authors.affiliation: Steven Bernstein is with the Department of Emergency Medicine, Yale Cancer Center, New Haven, CT, and the Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven. Linda M. Niccolai and Anna North are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale Cancer Center. Jason Schwartz is with the Department of Health Policy and Management, Yale School of Public Health, New Haven.
authors.forename: Anna
authors.initials: A
authors.lastname: North
authors.affiliation: Steven Bernstein is with the Department of Emergency Medicine, Yale Cancer Center, New Haven, CT, and the Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven. Linda M. Niccolai and Anna North are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale Cancer Center. Jason Schwartz is with the Department of Health Policy and Management, Yale School of Public Health, New Haven.
authors.forename: Jason
authors.initials: J
authors.lastname: Schwartz
authors.affiliation: Steven Bernstein is with the Department of Emergency Medicine, Yale Cancer Center, New Haven, CT, and the Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven. Linda M. Niccolai and Anna North are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale Cancer Center. Jason Schwartz is with the Department of Health Policy and Management, Yale School of Public Health, New Haven.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
mesh_terms: D000293:Adolescent; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D032541:Mass Vaccination; D022401:Meningococcal Vaccines / Q000008:administration & dosage; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D011057:Politics; D012737:Sex Factors; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines