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.
WPTZ News Channel 5 (Burlington, Vt., and Plattsburgh, N.Y.) covered Sexual Health Rankings™ on its evening news broadcast. Watch the interview with project director Martin Downs. The report also features insightful commentary by a Vermont Department of Health expert.
LEBANON, N.H. — A new report reveals, for the first time, a full picture of sexual health in the United States. Sexual Health Rankings™ is the most comprehensive measure of Americans’ sexual health ever developed, and the first state-by-state comparison of overall sexual health.
Sexual Health Rankings™ folds 26 different measures of sexual health into a single index, and rates the 50 states and District of Columbia according to their index scores.
The report finds that sexual health varies widely across state populations. In this first edition of Sexual Health Rankings™, which covers the year 2012, Vermont ranks highest (#1) in sexual health. Mississippi ranks as the least sexually healthy state (#51).
The main platform for Sexual Health Rankings™ is the Web site, www.sexualhealthrankings.com, which lets users explore the data, build community, and connect with additional resources to inform positive, evidence-based approaches to promoting sexual health.
Sexual Health Rankings™ is based on the World Health Organization’s definition of sexual health, which emphasizes wellness, and encompasses human rights, sexual expression and identity, and sexual pleasure. The World Health Organization defines sexual health as:
“… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”
“Sexual health is an essential part of health—each individual person’s health, and the health of society as a whole,” says Sexual Health Rankings™ Director Martin Downs, MPH. “Sexual health relates to many different parts of the body, aspects of life, and areas of society, in ways that aren’t always obvious.”
This positive, comprehensive way of thinking about sexual health is different from how sexual health was viewed historically. Until recently, medical and public health experts thought of sexual health mainly in terms of disease and reproduction. Leading health authorities in the United States now accept a broad, positively focused view of sexual health, which is informing changes in national health policy, medical education, and even the marketing of consumer products.
The Sexual Health Rankings™ index includes traditional sexual health indicators, such as rates of sexually transmitted infections, teen births, and sexual violence. It also includes indicators related to sexual satisfaction, and social factors that influence sexual health. Some, but not all, of these factors have to do with personal choices and behaviors. Laws and policies, culture, economic conditions, education, and health care systems also affect every person’s sexual health in some way.
“We need to be able to measure the sexual health of populations in order to know how all these factors relate to one another, to understand differences between populations, and to tell what’s working and what isn’t when we try to improve sexual health,” Downs says. “We use data that are currently available, but more and better measures of sexual health are needed. We want to spur the development of such measures.”
Sexual Health Rankings™ is a research project, but that is not all it is. It is meant to be a tool that people can use to identify needs and take positive action to improve sexual health across the United States.
Sexual Health Rankings™ is produced by Variance, LLC, in partnership with the Center for Sexual Pleasure and Health (CSPH), a nonprofit organization based in Pawtucket, R.I. Sexual Health Rankings™ is an independent initiative of Variance, LLC and the CSPH, and has no other sources of funding or support.