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.

The Link between Democratic Institutions and Population Health in the American States.

CONTEXT: This project investigates the role of state-level institutions in explaining variation in population health in the American states. Although cross-national research has established the positive effects of democracy on population health, little attention has been given to subnational units. The authors leverage a new data set to understand how political accountability and a system of checks and balances are associated with state population health. METHODS: The authors estimate error correction models and two-way fixed effects models to estimate how the strength of state-level democratic institutions is associated with infant mortality rates, life expectancy, and midlife mortality. FINDINGS: The authors find institutions that promote political accountability are associated with lower infant mortality across the states, while those that promote checks and balances are associated with longer life expectancy. They also find that policy liberalism is associated with better health outcomes. CONCLUSIONS: Subnational institutions play an important role in population health outcomes, and more research is needed to understand the link between democracy and health. The authors are the first to explore the link between democratic institutions and population health within the United States, contributing to both the social science literature on the positive effects of democracy and the epidemiological literature on subnational health outcomes.

Trends in State-Level Opinions toward the Affordable Care Act.

CONTEXT: This article argues that the devolution of the Affordable Care Act (ACA) to the states contributed to the slow progression of national public support for health care reform. METHODS: Using small-area estimation techniques, the authors measured quarterly state ACA attitudes on five topics from 2009 to the start of the 2016 presidential election. FINDINGS: Public support for the ACA increased after gubernatorial announcement of state-based exchanges. However, the adoption of federal or partnership marketplaces had virtually no effect on public opinion of the ACA and, in some cases, even decreased positive perceptions. CONCLUSIONS: The authors' analyses point to the complexities in mass preferences toward the ACA and policy feedback more generally. The slow movement of national ACA support was due partly to state-level variations in policy making. The findings suggest that, as time progresses, attitudes in Republican-leaning states with state-based marketplaces will become more positive toward the ACA, presumably as residents begin to experience the positive effects of the law. More broadly, this work highlights the importance of looking at state-level variations in opinions and policies.

The Role of Public Opinion-Does It Influence the Diffusion of ACA Decisions?

We consider two ways that public opinion influenced the diffusion of ACA policy choices from 2010 through 2014. First, we consider the policy feedback mechanism, which suggests that policy decisions have spillover effects that influence opinions in other states; residents in the home state then influence the decisions of elected officials. We find that both gubernatorial ACA announcements and grant activity increased support for the ACA in nearby states. Consistent with our expectations, however, only gubernatorial announcements respond to shifts in ACA support, presumably because it is a more salient policy than grant activity. Second, we test for the opinion learning mechanism, which suggests that shifts in public opinion in other states provide a signal to elected officials about the viability of decisions in their own state. We find evidence that states are more likely to emulate other states with similar ACA policy preferences when deciding about when to announce their decisions. Our results suggest that scholars and policy makers should consider how shifts in public support influence the spread of ideas across the American states.

Adolescent Determinants of Abortion Attitudes: Evidence from the Children of the National Longitudinal Survey of Youth.

The stability of abortion opinions suggests that pre-adult factors influence these attitudes more than contemporaneous political events. Surprisingly, however, we know little about the origins of abortion opinions, no doubt because the majority of research focuses on cross-sectional analyses of patterns across cohorts. We use a developmental model that links familial and contextual factors during adolescence to abortion attitudes years later when respondents are between 21 and 38 years old. Findings show that religious adherence and maternal gender role values are significant predictors of adult abortion opinions, even after controlling for contemporaneous religious adherence and the respondents' own views on gender roles. Adolescent religious adherence matters more than religious denomination for adult abortion attitudes. The results have important implications for future trends in abortion attitudes in light of declining religiosity among Americans.

Incorporating Health into Studies of Political Behavior: Evidence for Turnout and Partisanship.

We argue that research on political behavior, including political participation, public opinion, policy responsiveness, and political inequality will be strengthened by studying the role of health. We then provide evidence that health matters for voter turnout and partisanship. Using the General Social Survey (GSS) and The National Longitudinal Study of Adolescent Health (Add Health), we find that people who report poor health are less likely to vote and identify with the Republican Party. Moreover, the effects of health on voter turnout and partisanship appear to have both developmental and contemporaneous components. Taken together, our findings suggest that health inequalities may have significant political consequences.

Public health and agenda setting: determinants of state attention to tobacco and vaccines.

What determines government attention to emerging health issues? We draw on research in agenda setting and policy diffusion to explore the determinants of public health attention in the fifty American states. We find that intergovernmental influence has a strong and consistent influence over state attention to tobacco and vaccines from 1990 to 2010. While national attention to tobacco or vaccines also sparks attention in the states, this effect is smaller than the internal impact of gubernatorial attention and the horizontal influence of neighboring state attention. We find some support that problem severity matters; however, these results are highly dependent on the measures used. Finally, we find no evidence that interest groups influence the attention that states pay to tobacco or vaccines. Our results suggest that institutions play a critical role in explaining government attention to health policy.