The Healthy Democracy Kit: design, implementation, uptake, and impact of a novel voter registration toolkit for healthcare settings.

BACKGROUND: Access to voting is increasingly recognized as a social determinant of health. Health equity could be improved if healthcare workers (HCWs) routinely assessed the voter registration status of patients during clinical encounters and helped direct them towards appropriate resources. However, little consensus exists on how to achieve these tasks efficiently and effectively in healthcare settings. Intuitive and scalable tools that minimize workflow disruptions are needed. The Healthy Democracy Kit (HDK) is a novel voter registration toolkit for healthcare settings, featuring a wearable badge and posters that display quick response (QR) and text codes directing patients to an online hub for voter registration and mail-in ballot requests. The objective of this study was to assess national uptake and impact of the HDK prior to the 2020 United States (US) elections. METHODS: Between 19 May and 3 November 2020, HCWs and institutions could order and use HDKs to help direct patients to resources, free of cost. A descriptive analysis was conducted to summarize the characteristics of participating HCWs and institutions as well as the resultant total persons helped prepare to vote. RESULTS: During the study period, 13,192 HCWs (including 7,554 physicians, 2,209 medical students, and 983 nurses) from 2,407 affiliated institutions across the US ordered 24,031 individual HDKs. Representatives from 604 institutions (including 269 academic medical centers, 111 medical schools, and 141 Federally Qualified Health Centers) ordered 960 institutional HDKs. Collectively, HCWs and institutions from all 50 US states and the District of Columbia used HDKs to help initiate 27,317 voter registrations and 17,216 mail-in ballot requests. CONCLUSIONS: A novel voter registration toolkit had widespread organic uptake and enabled HCWs and institutions to successfully conduct point-of-care civic health advocacy during clinical encounters. This methodology holds promise for future implementation of other types of public health initiatives. Further study is needed to assess downstream voting behaviors from healthcare-based voter registration.

Addressing Health Disparities Through Voter Engagement.

Although the public's essential capacity for self-rule in the United States lies in the power of the ballot, there exist many barriers to voting, particularly for marginalized communities. These barriers cultivate less representative government and less inclusive public policy. Nonprofit and private health organizations, and in particular community health centers and safety-net hospitals, can help marginalized voting-eligible individuals overcome barriers to the ballot. With augmented, unbiased voter participation, elections would yield government that is more representative and public policy that is more equitable, while reducing costly and preventable health disparities. Health organizations can promote comprehensive, nonpartisan voter engagement through registration, mobilization, education, and protection of all voters.

Results of a voter registration project at 2 family medicine residency clinics in the Bronx, New York.

PURPOSE: Federally qualified health centers provide care to medically underserved populations, the same individuals often underrepresented in the electoral process. These centers are unique venues to access patients for voter registration services. METHODS: We undertook a clinician-led, nonpartisan voter registration drive within 2 university-affiliated federally qualified health centers in the Bronx, New York. Patients were approached by voter registration volunteers in clinic waiting areas during a 12-week period. RESULTS: Volunteers directly engaged with 304 patients. Of the 128 patients who were eligible and not currently registered, 114 (89%) registered to vote through this project. This number corresponded to 38% of all patients engaged. Sixty-five percent of new registrants were aged younger than 40 years. CONCLUSIONS: This project was successful in registering clinic patients to vote. Clinics are not only health centers, but also powerful vehicles for bringing a voice to civically disenfranchised communities.

Do political protests mobilize voters? Evidence from the Black Lives Matter protests.

In this article, we study the local political mobilization effects of political protests in the context of the Black Lives Matter (BLM) movement. We analyze monthly voter registration data from 2136 US counties across 32 states, leveraging variation in the exposure to BLM protests across counties in a two-way fixed-effects framework with a matched control group. In contrast to previous studies, which reported substantial mobilization effects of local protests in other contexts, we show that voter registrations in the aggregate were insensitive to the presence of local BLM protests. We further disentangle the effects along party lines and the degree to which protests were associated with violent behaviors and find similarly insignificant effects. We present some preliminary evidence that the large scale of the protests and their extensive news coverage might have reduced the importance of experiencing a protest firsthand.

What are the attitudes of medical students and housestaff towards health advocacy? A physician-led voter registration initiative and health advocacy survey.

Background: Compared to the general population, physicians have been shown to be less engaged in civic participation and less likely to vote. However, perspectives of current trainees on health advocacy remain under-explored. Objective: To investigate perspectives on a physician led voter registration initiative and identify current beliefs of physicians in training and medical students regarding physician health advocacy. Design: Cross sectional survey performed at a single urban academic center. Participants: A total of 366 medical students, residents, and fellows voluntarily participated in the survey out of a total of 1,719 available (21% response rate). Main Measures: We examined the current perceptions surrounding health advocacy among medical students and physicians in training and how this was impacted by the COVID-19 pandemic. Responses were analyzed using Chi-square analysis and logistic regression. Key Results: The voter registration code was scanned 131 times prior to the 2020 Presidential elections. Barriers to hospital-based voter registration included lack of time, lack of fit into the workflow and forgetting to ask. Over half of internal medicine-based residents and fellows (51%) and medical students (63%) agreed that physicians should be involved in helping patients register to vote compared to 34% of surgical-based trainees. A large majority (87%) indicated that the COVID-19 pandemic made it more necessary for physicians to be involved in politics. Conclusion: A high proportion of medical students and housestaff across specialties report an obligation to be involved in health advocacy, though there were differing views towards direct involvement in voter registration.

Voter Registration Among People With HIV in North Carolina.

Persons with HIV (PWH) represent a socially and medically vulnerable population who often depend on public resources. We examined voter registration among PWH in North Carolina. Sixty-four percent were registered to vote. Registration was lower among PWH who were young, Hispanic, publicly insured or uninsured, and who had poor HIV health status.

A cross-sectional national survey to explore the relationship between smoking and political abstention: Evidence of social mistrust as a mediator.

RATIONALE: Smoking prevalence is well known to vary socioeconomically but has been less studied in relation to political participation. Growing evidence suggests that health disparities and political nonparticipation are intertwined, but the underlying mechanism is unclear. OBJECTIVE: We investigated the relationship between smoking and voter registration, testing various forms of trust as possible mediators, in U.S. national survey data collected around the 2012 presidential election. METHODS: A random half (n = 9757) of adults who completed The Attitudes and Behaviors Survey on Health (TABS) in 2012 (response rate was 58.4% for landline and 24.3% for cell phone) also answered a section on voter registration, voting behavior, and trust in people and selected institutions. Multivariable logistic regression was used to examine the association between smoking and registering to vote and potential mediation by trust in people and various institutions, adjusted for covariates known to be associated with both. Analyses used design-based methods with weights to account for sampling probabilities, nonresponse, and calibration to the U.S. adult population in 2012. RESULTS: Compared with nonsmokers, daily smokers had significantly lower adjusted odds of being registered to vote (aOR: 0.33, 95% CI: 0.21-0.52) and higher adjusted odds of having low trust in people (aOR: 2.50, 95% CI: 1.29-4.83). Low trust in people predicted lower odds of registering to vote (aOR: 0.55, 95% CI: 0.36 to 0.84) and partially mediated the smoking-registration relationship. CONCLUSION: Lower electoral participation among daily smokers is partly attributable to lower trust in people, a factor that could also affect willingness to use cessation support resources such as quitlines. Low trust and low political participation among daily smokers may have important political and public health consequences.

Using Voter Registration to Increase Enrollment Into the Organ and Tissue Registry in New York State.

CONTEXT: In an effort to increase donation rates, interventions seek to increase the number of residents who are enrolled in the electronic organ and tissue registry. New York State includes an organ and tissue registration field on voter registration forms. OBJECTIVE: Report the results from voter enrollment drives in New York State seeking to increase voter registration and completed enrollments into the organ and tissue registry. SETTING: Cosponsored voter/donation drives taking place across in New York State at various public settings. PARTICIPANTS: New York State residents who completed and submitted voter registration forms at designated campaign sites from fall of 2014 through fall of 2018. INTERVENTION: Voter/donation drives cosponsored by League of Women Voters New York State with Organ Procurement Organizations and Eye & Tissue Banks in New York State. MAIN OUTCOME MEASURES: Number of enrollments to organ and tissue donation registry per drive over 4 project years. Calculation of yield as measured by percentage of enrollments to state organ and tissue registry divided by total number of voter registration forms completed. RESULTS: In all, 754 drives were undertaken over the project period with 6651 residents enrolling into the state organ and tissue registry. The average yield was 27% of completed voter forms resulting in organ and tissue registration; this estimate increased to 34% when prodonation representatives staffed the drives. CONCLUSION: Use of voter registration form to enroll organ and tissue donors is an effective method to supplement traditional methods to enroll donors.

Voter Registration and Engagement in an Adolescent and Young Adult Primary Care Clinic.

PURPOSE: Our aim was to bridge access to voter registration for youth by offering this service within a primary care setting and study the impact of this intervention on voter engagement and the barriers to voter turnout for registered youth voters. METHODS: A total of 120 eligible youth were presented with the opportunity to register to vote within their scheduled medical appointments. Participants were administered a follow-up survey via telephone or within scheduled visits after the 2018 midterm election. RESULTS: Eighteen of 41 participants (43.9%) who registered to vote in this clinic voted in the midterm elections, and 52 of 95 eligible participants (54.7%) voted overall. Those who did not vote cited multiple issues associated with social determinants of health, including economic stability and neighborhood and social environments, as top barriers. CONCLUSIONS: This study demonstrates that facilitating access to voter registration in an adolescent primary care setting is a feasible intervention and may improve voter engagement in youth.