We are thrilled to be in San Francisco today at YTH Live 2013. Hundreds of sparky, smart people have gathered to hear and share the latest on innovations connecting youth, tech, and sexual health. This morning, Martin Downs will give a talk about Sexual Health Rankings. He’ll present new research prepared especially for the YTH Live audience, so don’t miss it. If you can’t be here in person, you can watch a live Webcast starting at 8:30 a.m. PST: http://oneworld.org/ythlive
And since we are in California, we’ll take this opportunity to highlight a couple facets of the state’s sexual health.
Overall Rank: #26
INDICATOR: Percentage of women aged 15-44 living in a county without an abortion provider
California, rank: #2
California, value: 1%
Top state, value: 0%
Bottom state, value: 96%
These data are derived from a Guttmacher Institute analysis published in 2011. The researchers conducted a nationwide census of all facilities providing abortions. For many women, the need to travel long distances to a provider may be a barrier to obtaining an abortion.
INDICATOR: Percentage of women aged ≥25 years with high school diploma and higher education
California, rank: #50
California, value: 80.9%
Top state, value: 92.5%
Bottom state, value: 80.8%
For women, having a high school diploma or higher education is associated with:
- more intended births,
- increased use of reproductive health and contraceptive services,
- decreased likelihood of engaging in HIV risk-related behaviors in the past 12 months.
Data from a large representative study of American adults also show that men and women with a high school diploma or higher education are less likely to have problems related to sexual desire, orgasm, sexual pain, and sexual anxiety.
Join us at YTH Live 2013 in San Francisco, April 7-9, where we will be presenting about Sexual Health Rankings™. Now in it’s sixth year, YTH Live is the largest event of its kind, convening more than 600 attendees, including public health professionals, researchers, youth advocates, educators, government representatives, social entrepreneurs and technologists. Register or see the program at bit.ly/YTHreg
USING DATA TO MOVE FORWARD
Moderator: Chongyi Wei, PhD, UCSF
You’ll hear in Monday’s plenary about Big Data – national data sets that can be analyzed, presented and integrated into tech projects for our public health. These local projects use data too – The MPowerment project uses data from its in-person programs to inform its online practice; HANC talks about use of electronic behavioral data collection around sexual activity; and Sexual Health Rankings created an indicator to showcase the sexual health and wellness of communities in the U.S.
John Hamiga, Center for AIDS Prevention Studies CAPS – UCSF
Amy Ragsdale, Office of HIV/AIDS Network Coordination (HANC)
Martin Downs, MPH, Variance, LLC
Looking at the Sexual Health Rankings™ state map, it is easy to see its resemblance to a red-state, blue-state political map. Many of the lowest-ranked states, in red, are southern states that tend to be socially conservative and vote Republican. Most of the highest-ranked states, in blue, are the northern New England states that have a reputation for socially liberal politics and tend to vote Democratic.
Sexual Health Rankings™ is non-partisan, and is not designed to favor any state based on its politcal leanings. But we recognize that politics affects sexual health, and cannot be separated from our discussion of sexual health in the United States.
Appearances can be decieving, however, and we were not satisfied to merely observe the apparent coincidence. We undertook a new analysis of the Sexual Health Rankings™ data to investigate the relationship between voting patterns and states’ sexual health scores, to determine if the Rankings were biased to favor liberal politics.
We analyzed the relationship between state composite scores and votes cast for U.S. Representatives by major political party in 2008 and 2010 combined. We based this analysis on data available publicly from the U.S. Census Bureau. First we calculated the percentage of the total vote cast for Democratic candidates in each state during those election years. We converted the percentages to standard scores, and correlated them with the Sexual Health Rankings™ state composite scores.
The analysis showed that states’ Sexual Health Rankings™ scores are significantly, but only moderately correlated with voting behavior. Where correlation coefficient (r) of 1 represents a perfect positive correlation, -1 represents a perfect inverse correlation, and 0 means no correlation at all, our analysis produced a correlation coefficient of 0.61.
We went a step further with this analysis and calculated a new score for each state, controlling for voting behavior. Then we re-ranked the 50 states (ex D.C.) to see how they compare independent of voting behavior.
Here are the top and bottom 10 states according to this analysis (the original rankings are given in parentheses):
- 1 (17), Wyoming, 0.869
- 2 (23), Utah, 0.809
- 3 (3), New Hampshire, 0.747
- 4 (2), Connecticut, 0.582
- 5 (1), Vermont, 0.564
- 6 (7), Iowa, 0.521
- 7 (8), Minnesota, 0.495
- 8 (4), New Jersey, 0.485
- 9 (6), Maine, 0.446
- 10 (18), Montana, 0.420
- 41 (26), California, -0.388
- 42 (35), Nevada, -0.411
- 43 (43), Georgia, -0.424
- 44 (33), Michigan, -0.429
- 45 (45), Arizona, -0.465
- 46 (48), Arkansas, -0.500
- 47 (40), New Mexico, -0.576
- 48 (50), Louisiana, -0.642
- 49 (49), Texas, -0.650
- 50 (51), Mississippi, -0.984
Among the 10 highest-ranked states by composite score in the 2012 Sexual Health Rankings™, only three — Massachusetts, Hawaii, and Wisconsin — did not make it into the top 10 after controlling for their left-leaning tendencies, as measured by the proportion of the electorate voting for Democratic candidates in the congressional elections of 2008 and 2010. Wyoming replaced Vermont in the number-one spot, moving up from #17 in the original ranking. Utah jumped from #23 to #2, and Montana advanced from #18 to #10. Notably, New Hampshire’s number-three ranking was unchanged.
Even more notable is that the three lowest-ranked states in the original ranking — Texas, Louisiana, and Mississippi — remained the three lowest in this new analysis, with Mississippi again occupying the bottom spot.
We performed a separate analysis controlling for voting behavior in the 2008 and 2012 presidential elections. As in the prior analysis, we calculated standard scores based on votes for the Democratic candidate in all 50 states and the District of Columbia, and correlated these scores with our original composite scores. Again, we found a significant, but moderate correlation: r = 0.56.
Here are the top and bottom 10 states after controlling for voting behavior in the last two presidential elections (original rankings given in parentheses):
- 1 (3), New Hampshire, 0.790
- 2 (17), Wyoming, 0.740
- 3 (1), Vermont, 0.705
- 4 (2), Connecticut, 0.653
- 5 (4), New Jersey, 0.606
- 6 (23), Utah, 0.603
- 7 (7), Iowa, 0.567
- 8 (8), Minnesota, 0.551
- 9 (6), Maine, 0.522
- 10 (5), Massachusetts, 0.500
- 42 (33), Michigan, -0.389
- 43 (43), Georgia, -0.409
- 44 (47), Kentucky, -0.412
- 45 (45), Arizona, -0.443
- 46 (48), Arkansas, -0.541
- 47 (40), New Mexico, -0.552
- 48 (50), Louisiana, -0.627
- 49 (49), Texas, -0.670
- 50 (51), Mississippi, -0.949
- 51 (20), District of Columbia, -0.950
This time, eight of the original highest-ranked states, and seven of the original lowest-ranked states remain in the top 10 and bottom 10. What’s more, five of these states — six if you count the near-tie between Mississippi and D.C. — in this analysis keep their original places: Iowa (#7), Minnesota (#8), Georgia (#43), Arizona (#45), and Texas (#49).
D.C. is an outlier in this analysis, which likely accounts for its plunge from 20th to last place. In 2008 and 2012 combined, President Obama received over 91% of the votes cast in D.C. That is about 3.5 standard deviations above the national mean.
In the two analyses presented here, a few states moved into the top or bottom 10 from the middle of the rankings. More importantly, however, no states moved from top to bottom, or vice versa. If our composite measure of sexual health strongly reflected partisan politics — and by extension, liberal or conservative values — we would expect to see some of the highest- and lowest-ranked states switch places.
Taken all together, these results sugggest that Sexual Health Rankings™ may not be impervious to political bias, but it is at least resistant to it.
Sexual Health Rankings™ Director Martin Downs, MPH, talks about Maine’s #6 ranking with Pulse Morning Show host Don Cookson. The interview aired live, Monday, January 15, 2013, on radio station WZON The Pulse, AM 620, in Bangor, Maine. In the interview, Martin reveals what Maine’s ranking might have been if the state’s marriage equality law, passed in 2009, hadn’t been repealed; as well as how the same-sex marriage ballot measure that Maine voters approved in November 2012 might change Maine’s ranking in 2013.
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Martin Downs on WZON The Pulse, AM 620, Bangor, Maine – Jan. 15, 2013