Health Promotion International, Vol. 30 No. 2
doi:10.1093/heapro/dau094
Advance Access published 4 November, 2014
# The Author 2014. Published by Oxford University Press. All rights reserved.
For Permissions, please email: [email protected]
Confidence in government and vaccination willingness
in the USA
GUSTAVO S. MESCH1* and KENT P. SCHWIRIAN2
1
Department of Sociology, The University of Haifa, Haifa, Israel and 2The Ohio State University,
Columbus, USA
*Corresponding author. E-mail: [email protected]
SUMMARY
The most recent internationally widespread disease outbreak occurred during the flu season of 2009 and 2010. On
April 2009, the first cases of influenza A (H1N1) (Popularly
called, Swine Flu) were confirmed in the USA and UK following a novel virus that was first identified in Mexico. As the
virus spread rapidly, the risk of morbidity and mortality
increased in several countries. In this paper, we rely on the
social cognitive theory of risk to assess the willingness of the
US public to comply with vaccination and reduce the risk of
sickness and death from the flu. We conduct a secondary
data analysis of the Pew Research for the People and Press
October 2009 and investigate the factors associated with
willingness to take the swine flu vaccine (n ¼ 1000). The findings indicate that the decision to take the swine flu vaccination was highly polarized across partisan lines. Controlling
for education, income and demographic factors, the likelihood of taking the vaccine was associated with party identification. Individuals that identified themselves as Democrats
were more likely to be willing to take the swine vaccine
than individuals that identify themselves as Republicans and
Independents. Confidence in the ability of the government to
deal with the swine flu crisis seems to explain party identification differences in the willingness to take the vaccine. The
implications of the findings are discussed.
Key words: H1N1; vaccination; sociology; health
INTRODUCTION
The most recent pandemic occurred during the
flu season of 2009 and 2010. On April 2009, the
first cases of influenza A (H1N1) (Swine Flu),
which was first identified in Mexico, were confirmed in both the USA and UK. On 11 June
2009, The World Health Organization (WHO)
declared the H1N1 outbreak to be the first worldwide pandemic in more than 40 years (Cohen and
Carter, 2010). By the year end, 203 000 people
had died worldwide from H1N1 (McNeil, 2013).
In the USA, the H1N1 virus had killed 12 500,
hospitalized 275 000 and sickened 61 million
(Mesch et al., 2013).
In spite of the fact that vaccination is one of
the greatest public health success stories and the
best defense medicine has against the risk of
acquiring infectious diseases (Stern and Markel,
2005), there was no vaccine available for protection against the H1N1. However, by August 2009
several US companies were underway in researching, manufacturing and field testing a vaccine with
a view to having it available for distribution early
fall 2009 (Ravnovich, 2009). During the winter of
2010, the vaccination program had become a
heated public issue, as an increasing segment of
the public became hesitant to take the vaccine.
Between May 2009 and January 2010, the percentage of unvaccinated adults intending to be vaccinated fell from 50 to 16% (Gidengil et al., 2012).
Public health practitioners as well as government
officials were surprised at both the widespread
and critical discussion of the advantages and
213
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G. S. Mesch and K. P. Schwirian
disadvantages of taking the vaccine. Emerging
from this public discourse was a significant resistance to taking the vaccine.
Why did so many people resist taking the
vaccine in the face of growing media reports of
H1N1 high rates of mortality and morbidity?
(Mesch et al., 2013). As the epidemic spread and
the call to vaccinate increased, it soon became
clear that the debates over the wisdom of taking
the H1N1 vaccination involve tensions among
political identification, trust and scientific knowledge (Gauchat, 2012). In this paper, we investigate the effect of these factors on the intent to
take the Swine Flu H1N1 vaccination. In doing
this, we rely on cultural cognition theory that
takes an agentic perspective on behavior that
views the individual actor as being embedded in
a complex sociocultural context that contains
numerous potential guides and motivators contributing to the decision to act in specific situations, such as the decision to take the flu
vaccination (Bandura, 2001, 2002).
VACCINATION, OPPOSITION
AND THE MEDIA
The reluctance of many to take the Swine Flu
vaccination in 2009– 2010 mirrored earlier
responses in the history of vaccination. Indeed,
some have argued that the anti-vaccionists of
today in the USA and UK are the direct intellectual descendants from those in the late 19th
century (Wolfe and Sharp, 2002). When seen
from the standpoint of cultural cognition theory,
there has been a long-run fundamental tension
over vaccination between the individual actor’s
agency and the collective agency of the state and
the public health authorities. These collective
actors have attempted to provide individual actors
with what they see as the means to safeguard or
improve individual actors’ health even when the
individual actors refuse or resist those means.
The history of the tension between vaccination
and opposition to it is rooted in the long-standing
war against smallpox as early as 1840 (Fitzpatrick,
2005; Gardner, 2011). Many believed that the
vaccine was dangerous and more risky than awaiting infection. The press at the time played on
these fears by publishing news articles, commentaries and cartoons in widely read sources such as
the London Times and more scholarly publications such as the Westminster Review and Lancet
(Maugh, 2009).
In England, opposition to vaccination sharpened when between 1840 and 1898 the British
government passed a series of laws requiring or
encouraging vaccinations (Wolfe and Sharp,
2002). In America, the Anti-Vaccination Society
of America was formed in New York in 1879,
and this was followed by the creation of similar
organizations in other cities (Wolfe and Sharp,
2002). These organizations fought the growing
number of city and state laws requiring vaccination that were often brutally enforced as in 1901,
when 250 New York City agents in the middle of
the night went through tenement houses in the
‘Little Italy’ section of the city and forcibly vaccinated everyone they found (Willrich, 2011). The
required vaccination issue came to a head in 1904
when the US Supreme Court ruled that the states
had a right to require vaccination during epidemics but they also had to make provision for
reasonable exclusions (Willrich, 2011).
The current opposition to vaccination is informed
by two major events carried widely by the media.
One was a television broadcast on 19 April 1982;
Washington DC television station WRC aired what
became a television award-winning special documentary, ‘Diphtheria, Pertussis and Tetanus (DPT):
Vaccine Roulette’ (Offit, 2011). The film caused a
major uproar by claiming that the standard DPT
vaccination routinely administered to children was
dangerous and caused brain damage (McNeil,
2008). Following the film and the extensive media
coverage of it, there was a decrease in vaccination
rates in the USA and a rise in the number of lawsuits against vaccine manufactures.
The second event occurred in 1998 when the
Lancet published a paper, suggesting that there was
a connection between the MMR (mumps, measles
and rubella) vaccine and ASD (the autism spectrum disorder) (Novella, 2010). Although the study
was eventually retracted, it still played a major role
in the development of further resistance to vaccination (Willrich, 2011). In 2008, a US national study
reported that 24% of the adult respondents said
that the vaccine may cause autism and that it was
safer not to have children vaccinated (Harvey,
2008). In recent years, the anti-vaccination movement relies on a greater distrust of government,
science and public health than in the past, and that
distrust becomes reflected in an increased opposition to vaccination (Gauchat, 2008; Tavernise,
2012). This accumulated distrust by many actors set
the stage for the general response to the vaccination
program developed in the fight against H1N1. This
outbreak became characterized by a high level of
Confidence in government and vaccination willingness in the USA
fear of infection in a significant segment of the
population (Mesch et al., 2013). Also, at this
time, many older adults already had a skeptical
acquaintance with Swine Flu. In 1976, there was
an outbreak of Swine Flu (H1N1) at Fort Dix
in New Jersey. President Jerry Ford quickly
ordered a nationwide vaccination program to
include 220 million Americans. The vaccination
campaign lasted only a few months when it
became clear that the epidemic did not materialize. Only one death resulted from Swine Flu
although some side effect illnesses were attributed to the injection. The politics accompanying the
failure of the campaign became known as the ‘Swine
Flu Fiasco’ and ‘the epidemic that never was.’
(Neustadt and Fineberg, 1983).
THEORY AND RESEARCH QUESTIONS
While the reasons for or against a specific vaccination in a specific circumstance may vary, we
suggest that there are common underlying
factors that shape attitudes and behaviors. These
factors are confidence in government, political
ideology and media influence. In this paper, we
examine the relative effect of each of these three
factors on intentions of American adults to take
the Swine Flu vaccination during the 2009 –2010
pandemic.
Confidence in government
At the heart of the vaccination issue is trust or
confidence in government and health authorities
(Hobson-West, 2007). For people to follow
public health admonitions, a degree of confidence in the supervising authority’s ability to
deal with the risk is required. The outbreak of
Swine Flu and the accompanying call for mass
vaccination represented a social risk, and there
was a great public concern over the production
of the Swine Flu vaccine. The public distrust
was further aggravated by media reports that
New York healthcare workers were complaining
about the regulation that they be required to be
vaccinated (Steinhauer, 2009). Confidence in
the government’s ability to deal with a public
health crisis is not universal. In the past, opposition to vaccination mandates has been part of
a more general resistance to government actions
(Nelson, 2010). Indeed, as Gordon Gauchat
[(Gauchat, 2012), p. 167] has argued, ‘Science
has always been politicized.’ However, the politicization of opposition today is more diffuse than
215
earlier in that the degree of opposition to vaccination programs varies by the disease, composition of vaccine and party identification. Mooney
(Mooney, 2005) has argued that over the last 40
years, the political ideology of conservatives has
become increasingly skeptical and disapproving
of the institution of science and of the nature of
the connections among science, government and
Big Pharma.
Political ideology
The cultural cognition theory of risk asserts that
individuals selectively attend to risk in a way that
reflects their membership in social groups such
as political party and religious affiliation (Kahan
and Braman, 2006). According to this view, individuals have a tendency to selectively credit and
dismiss information in a manner that confirms
previous beliefs and cultural dispositions shaped
by their membership or support of social and political groups (Kahan et al., 2010). In other words,
individuals have a tendency to fit their view to
those of others with whom they share some important, self-identifying commitments. Studies have
found that party identification was associated with
the perception of risk in issues such as global
warming, gun risk perception and HPV vaccination
(Kahan et al., 2010). The authors conclude that
party identification and worldview values affect
fact perceptions of risk and their actions.
In political science, the view that ideology
and party identity shape citizens positions on
issues has wide support. A longitudinal study that
investigated the effects of ideological identity
(conservative versus liberal), ideology and party
identification on the readiness to adopt attitudes
toward new political issues found that identification as conservative or liberal and party identity
influenced responses to new issues (Malka and
Lelkes, 2010). Pre-existing ideological and party
identities lead people to follow cues on what
stance they should adopt that is consistent with
their previous ideology and party identification.
In a similar vein, a study that investigated the
effects of ideology and party identification on the
2008 US election candidate choice found significant effects of party identification on voting
for candidates (Jacoby, 2010). A relevant issue is
whether party identification shapes ideology.
Studies show that party identification shapes the
positions citizens take on political and risk issues
(Goren et al., 2009). This position is consistent
with the cultural cognition theory.
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G. S. Mesch and K. P. Schwirian
Attention to the media
The cultural cognition theory of risk assumes that
the perception of risk is also shaped by social
groups to which individuals belong. Consequently,
the mass media are viewed as being an important
influence in people’s beliefs, opinions and attitudes. Attention, coverage and salience given to
an issue shape which issues people pay attention
to and regularly follow (Cobb and Elder, 1972,
1983; Dearing and Rogers, 1996). In highly
contested and politicized issues, alternative or
competing frames in news coverage attempt to
persuade the public to adopt one perspective over
another.
Recent health research has shown the influence of the media on (1) the perception of
disease—diseases that are covered more heavily
in the media are perceived by people as being
more severe (Young et al., 2008); (2) the flu vaccination rate—media attention leads to upward
spikes in vaccination rates (Yoo et al., 2010).
The Swine Flu pandemic was extensively
covered by the media. The WHO and the CDC
issued several alerts and warnings over 2009 –
2010 that were widely carried in the press, on
radio and on television. Research has shown that
the media coverage of the Swine Flu outbreak
was closely followed by a large segment of the
population, and the extent to which people followed the flu news was highly predictive of
people’s concern of possible infection (Mesch
et al., 2013).
RESEARCH QUESTIONS
Given confidence in government, political ideology and attention to the media, we ask:
When considered together, are the three—trust,
identification and attentiveness—associated with
willingness to take the vaccination?
Furthermore, does trust in government explain
the association between political identification
and willingness to take vaccine, should it exist?
There are two different expectations for answering
this question. One argument implies that the
news media environment is characterized more
by reinforcement seeking than by triangulation,
thereby forging and sustaining bipartisan consensus around even non-partisan issues such as flu
vaccination programs. Thus, the explanation of
the gap between Republicans and Democrats lies
in the different information streams to which
Republican and Democrats exposed themselves.
Following this argument, one can expect that the
effect of political identification will be reduced
or becomes non-statistically significant after controlling for exposure to the media (Baum, 2011).
An alternative argument implies that party identification effects are the result of differential confidence in the ability of the government to deal
with the pandemic crisis (Gauchat, 2012).
ADDITIONAL FACTORS
Previous studies have shown that influenza
vaccination rates differ according to ethnic/racial
status. From 1989 to 2004, Latino and AfricanAmerican older persons consistently experienced 10 and 20% lower vaccination coverage,
respectively, than did their White contemporaries. Reasons for the substantial racial/ethnic disparity involve many factors (Hutchins et al.,
2009). For this reason, we control for race and
ethnicity in our study.
Gender has been an important factor in health
behavior (Gabe et al., 2005). This had been reflected
recently in a research that has indicated that men
who report hegemonic masculinity attitudes feel
less vulnerable to illness and are therefore less
likely to receive preventive care, including vaccination than women (Springer and Mouzon, 2011).
The association between education and the
willingness to receive a vaccine is unclear. Some
studies had reported a direct effect, i.e. the propensity to vaccination increases with more education and household income (Linn et al., 2010).
Yet, more recent reviews have argued that the association is not direct but mediated by perceived
risks. A large review of studies found that the
most important reasons for taking the vaccine are
personal risk perceptions, including the perceived
risk of being infected by the virus, the perceived
risk of severe illness from being infected and the
perceived risk of negative vaccine side effects. As
education is positively associated with health
awareness and risk perception, it seems that education might have an effect on the willingness to
take the vaccine (Nguyen et al., 2011). In addition
to education, we have included two other status
measures: income and homeownership.
METHODS AND DATA
We conducted a secondary data analysis of the
Pew Research for the People and Press October
Confidence in government and vaccination willingness in the USA
2009. The institute conducts regular surveys of
public opinion, and the survey conducted in
October 2009 inquired on the willingness of US
residents to take the Swine Flu. The survey is
based on landline completed telephone interviews among a nationwide sample of 1000 adults,
18 years of age or older, conducted under the direction of ORC (Opinion Research Corporation).
Interviews were conducted from September 30
to 4 October 2009. As many as seven attempts
were made to contact every sampled telephone
number. Calls were staggered over times of day
and days of the week to maximize the chance of
making contact with potential respondents. At
least one daytime call was made to each phone
number in an attempt to find someone at home if
necessary. Interviewing was spread as evenly as
possible across the 5 days in field.
The response rate for the landline sample was
20.3%. Weighting was used to compensate for
sample designs and patterns of non-response that
might bias results. Weights were trimmed to
prevent individual interviews from having too
much influence on the final results. The use of
these weights in statistical analysis ensures that
the demographic characteristics of the sample
closely approximate the demographic characteristics of the national population.
The dependent variable, willingness to take
the Swine Flu vaccine was measured by the question: ‘Now thinking about the swine flu that’s
been in the news lately. . . . If the swine flu
vaccine was available to you, would you get it
or not?’ Answers were dichotomized, 1 ¼ yes,
0 ¼ no.
Independent variable, confidence in government, was measured by the answer to the question, ‘How confident are you in the government’s
ability to deal with the swine flu?’ Answers were
0 ¼ not at all to 4 ¼ very confident.
Independent variable political ideology, conservative, independent or liberal was measured
by the question, ‘In politics, as of today, do you
consider yourself a Republican, a Democrat, or
an Independent?’ The variables were introduced
as a series of dummy variables; that is, numerical
variables used to represent sample subgroups.
In order to measure exposure to the news on
swine flu, the survey provided a list of topics
covered by the media in the last month, and
respondents were asked to indicate which topic
they had followed more closely. Responses indicating following swine flu news were coded as 1
and responses to other topics were coded as 0.
217
DEMOGRAPHIC MEASURES
The demographic variables in the past have been
shown to be related to both health behaviors and
politics. Age was measured by 13 age categories
from 18 –20 years old to 75 and older. Gender is
a dummy variable indicating 1 for men and 0 for
women. Marital status was coded as a dummy
variable when 1 indicated married or cohabitation and 0 other. Education was a series of three
dummy variables coded as high school or less,
college education and graduate education. Income
was measured using 5 categories, from low to
higher income. Homeownership was a dummy
variable with 1 as owner and 0 for renter. Race/
Ethnicity was introduced as series of three dummy
variables: white/Caucasian, African-American and
Hispanic. The number of Asian-Americans was
too small and was excluded from the analysis.
FINDINGS
The results of the survey indicate that the US
public was divided in its willingness to take the
Swine flu vaccine. Only 50.4% indicated that
they would take the vaccine. (The table is available upon request.) A greater percentage of
African-Americans (60.4) and Hispanics (63.6)
were willing than Whites (47.6) to take the
vaccine. A larger percentage of renters (56.0) were
willing than owners (47.7). A larger percentage of
those with confidence in government (59.6) were
willing than were those with less confidence (32.2),
and a larger percentage of Democrats (63.7) were
willing than Republicans (43.0) and Independents
(43.1), and this party identification finding provides a measure of support for expectations of an
association between party identification and willingness to take the vaccine. Those who follow the
media (57.9) were more willing than those who did
not (30.9). No significant differences were found
for age, gender, education marital status.
Next, we conducted a logistic regression analysis predicting the willingness to take the vaccination. The model estimated includes endogenous
variables ( party identification, following the
news on the flu and confidence in the government). We used a two-step logistic regression
employing instrumental variables (Rassen et al.,
2009; Bollen, 2012). This approach helps to solve
the problem of correlated error terms among the
variables on the estimates of the relationships of
the key independent variables to the dependent
218
G. S. Mesch and K. P. Schwirian
variable. Accordingly, we created two sequential
logistic regressions. Using maximum likelihood
estimation, the first stage predicts the willingness
of vaccination as a function of instrumental variables and other covariates. The second stage
predicts the outcome as a function of the firststage predicted outcome and the hypothesized
endogenous variables (Rassen et al., 2009).
As given in Table 1, model 1, with other variables controlled, there are ethnic differences in
willingness to take the swine flu vaccination. For
ethnicity, white respondents indicated a smaller
likelihood of taking the vaccine than did Hispanics
and African-Americans. The effect of AfricanAmericans did not differ significantly from Hispanic
respondents in their willingness. Homeownership
has been indicated in the past as a potential measure
of conservative attitudes. In our study, we found that
homeowners reported a lower likelihood of being
vaccinated than renters. This finding is consistent
with the results regarding political affiliation.
The model 2 in Table 1 presents the results for
the second stage of the logistic regression. With
the other variables controlled, following the swine
flu news is significantly associated with willingness
to take the vaccine. Likewise, party identification
is statistically significant with Independents and
Republicans less willing than Democrats to take
the vaccine.
In our search for an explanation for the association of partisan identification and willingness
to take the vaccine, in Table 1, in model 3 we
introduce confidence in government into the
equation. It is statistically significant, thereby indicating that those confident in government are
more willing to take the vaccine than are those
lacking confidence in government. Interestingly,
the effect of identification with the Republican
Party is now no longer significant when the measure of confidence in the government was introduced. Also the effect of media reports remains
significant—those following the media are more
Table 1: Two-step logistic regression predicting the willingness to take the Swine Flu vaccine
Variable name
Step 1
Step 2
Model 1
Age
Hispanic
Black
White
Gender (1 ¼ male)
Marital Status (1 ¼ Married)
Number of Children
Education Less than college
College
Graduate
Income
Less than 30 K
From 30– 49 K
From 50– 74 K
More than 75 K
Homeowner
b
S.E.
Odds
0.01
---20.06
20.57
0.10
0.06
20.02
--20.27
20.19
0.02
---0.29
0.22
0.14
0.17
0.05
--1.74
1.74
1.01
----0.93
0.56**
1.11
1.06
0.97
--0.82
0.91
0.12
20.21
0.19
20.44
0.19
0.15
0.17
0.17
0.88
0.80
1.21
0.63**
Model 2
Predicted Step One Model 1
Following media reports
Republican
Democrat
Independent
Confidence in the Government
Constant
Neglerke Pseudo-R 2
0.69
0.035
0.33
2.07*
Model 3
b
S.E.
Odds
b
S.E.
Odds
4.11
1.31
20.48
--20.67
0.94
0.17
0.19
--0.17
61.15**
3.71**
0.61*
--0.51**
22.69
0.15
0.52
0.06**
3.92
1.26
20.31
--20.56
1.04
23.32
0.20
0.97
0.17
0.19
---0.17
0.16
0.55
50.54**
3.52**
0.73
---0.56*
2.82**
.03**
**p , 0.01, *p , 0.05, Contrast categories: Hispanic, Less than College, and Democrats, Less than 30 K
Confidence in government and vaccination willingness in the USA
willing to take the vaccine than those who do not
follow the media.
As we have seen, confidence in the government
is a strong predictor of the likelihood of taking the
vaccine, and with other variables controlled the
people who expressed confidence in government
are still more likely to take the vaccine. For this
reason, we turn now to investigate the factors associated with confidence in the government’s ability
to deal with the swine flu crisis (Table 2).
We conducted a two-step logistic regression
analysis to deal with the potential endogeneity of
party identification and confidence in the government. Using maximum likelihood estimation, the
first stage predicts confidence in government’s
ability to deal with the flu crisis as a function of
instrument variables and covariates. Age is now
statistically significant; that is, with the other variables statistically controlled, older people have
less confidence in the government’s ability to deal
with the Swine Flu outbreak. This in part might
reflect their direct experience with or knowledge
of the 1976 ‘Swine Flu Fiasco.’ In the second
stage, the predicted odds of the first stage are
introduced in the model together with party identification and exposure to the media. The findings
219
indicate that the confidence in the government’s
ability to deal with the flu crisis is predicted by
party identification and exposure to the news.
DISCUSSION
Influenza is a public health seasonal disease that
puts population members at risk of infection.
During the 2009 outbreak of the additional and
newly appearing swine flu, the press and the public
health officials were very active in making the
public aware of both the extent of spread of the
disease and of the potential negative consequences
of infection (Baum, 2011; Mesch et al., 2013).
What reasons accounted for the resistance to
taking the vaccine? The starting view of this
study was culture cognition theory from which
we derived the expectation that the willingness
of individuals to take the swine flu vaccine was
affected independently by three central factors:
exposure to the media, political party identification and confidence in the government. The findings both support this view and at the same time
clearly expand our understanding of the underlying process of hesitance and rejection to taking
the swine flu vaccine.
Table 2: Two-step logistic regression predicting confidence in the government’s ability to cope with the swine
crisis
Variable name
Age
Hispanic
Black
White
Gender (1 ¼ male)
Marital Status (1 ¼ Married)
Number of Children
Education Less than college
College
Graduate
Income
Less than 30 K
From 30–49 K
From 50–74 K
More than 75 K
Homeowner
Predicted Step One
Following media reports
Republican
Democrat
Independent
Constant
Neglerke Pseudo-R 2
Step 1
Step 2
b
SE
Odds
20.05
0.02
0.94*
0.06
20.17
0.03
0.02
20.02
--20.02
20.01
0.30
0.23
0.14
0.17
0.05
--0.02
0.01
1.06
0.84
1.03
1.02
0.97
--0.97
0.95
0.06
20.46
0.47
0.10
0.19
0.15
0.18
0.18
1.06
0.63**
1.60*
1.10
1.15
0.13
0.35
3.16**
b
SE
Odds
4.44
0.62
20.87
---20.51
22.30
0.10
0.88
0.16
0.18
--0.17
0.60
85.4**
1.86**
0.41**
---0.59**
1.86**
**p , 0.01, *p , 0.05, Contrast categories: Hispanic, Less than College, and Democrat, Less than 30 K.
220
G. S. Mesch and K. P. Schwirian
Consistent with the cultural cognition theory
of risk is our finding that individuals identifying
as Democrats are more willing to take the Swine
Flu vaccine than are individuals identifying with
the Republican Party. This finding is consistent
with the studies that had suggested that over time
the confidence of the political conservatives in
some areas of science has decreased (Gauchat,
2012). It is also consistent with the argument that
has suggested that due to media segmentation,
willingness to vaccinate has become a contested
political issue (Baum, 2011).
We also found that respondents expressing
more confidence in the ability of the government
are more likely to be willing to take the swine flu
vaccine than those expressing less confidence.
This finding, in addition to the finding on political affiliation, provides additional support for
the understanding of the extent of politicization
of public health issues. With the introduction of
confidence in the government in the equation,
the effect of identification with the Republican
Party was no longer statistically significant. This
finding expands the expectations of the culture
cognitive model and underscores the mechanism
of association of political identification and vaccination. It is not that Republicans reject vaccination because of their conservative views or
excessive exposure to the media, but mainly
because of their lack of confidence in the government’s ability, that at the time of the swine flu
outbreak was a Democratic administration.
In order to further increase the credibility of the
findings, we conducted a two-step logistic regression analysis of the correlates of confidence in the
government. Again consistent with the cultural
cognition of risk perspective, the results show that
party identification is a major explanation of the
extent of confidence in the government.
LIMITATIONS OF THE STUDY
Among the limitations of this study are: the
measurement of confidence in government, the
effect of the method of data collection, measurement of news exposure and vaccination status
verification. First, confidence in government was
measured by one question. It would have been
preferable to measure it with a several item
scale; however, it was not possible with this data
set. Second, the data were collected through
telephone interviews; the interaction situation
of face-to-face interviews may have elicited
different responses to the question of confidence
in government. Third, news exposure was measured by one question. Exposure may be a multiple dimensional phenomenon better measured
by a multiple item scale that gets at the nature of
the content of media exposure. Furthermore, no
distinction has been made here as to the actual
content of the media reports. This sampling was
underway before the vaccine was in wide distribution, so the assumption here has been that the
media content focused on the dangers of the
infection and the degree of spread rather than
response to possible dangers of the vaccine.
Fourth, the interview did not request a verification
of vaccination status, so the responses were taken
as an accurate depiction of the situation.
CONCLUDING REMARKS
Finally, overall our results provide support for a
moderate version of the politicization hypothesis. As we had shown, party identification is not
directly associated with vaccination, as previous
studies had argued (Baum, 2011). The link is dependent on the extent of the respondents’ confidence in the government; that is, the perception
of the public that the government is able to deal
with a public health crisis. Furthermore, it also
appears to depend on the segmentation of the
media along with a selective exposure or a worldview that rejects modern medicine and science,
and understates the government’s ability to deal
with major public health events. Future studies
need to move a step forward and test the simultaneous effect of political partisanship, confidence in
the government as well as other factors that had
been tested in various studies (such as concern with
risks of being infected and risks of the disease) and
not separately as is the current situation.
Health issues are complex and in this paper,
we deal with only one flu vaccination. It would
be interesting for future research to determine
which, if any, public health programs or health
issues conservatives and liberals are more similar
in program confidence.
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