Associations between county-level voter turnout, county-level felony voter disenfranchisement, and sexually transmitted infections among women in the Southern United States

Ann Epidemiol. 2019 Jan;29:67-73.e1. doi: 10.1016/j.annepidem.2018.10.006. Epub 2018 Oct 29.


Purpose: Voting may play a critical role in the allocation of social and structural resources to communities, which in turn shapes neighborhood environments, and ultimately, an individual's sexually transmitted infection (STI) risk. We assessed relationships among county-level voter turnout and felony voter disenfranchisement, and STIs.

Methods: This cross-sectional multilevel analysis included 666 women in Alabama, Florida, Georgia, Mississippi, and North Carolina enrolled in the Women's Interagency HIV Study between 2013 and 2015. Having a baseline bacterial STI (chlamydia, gonorrhea, trichomoniasis, or early syphilis) was determined by laboratory testing. We used generalized estimating equations to test relationships between county-level voter turnout in the 2012 general election, county-level percentage of felony disenfranchised voters, and STI prevalence.

Results: Eleven percent of participants had an STI. Higher voter turnout corresponded to lower STI prevalence (prevalence ratio = 0.84, 95% confidence interval = 0.73-0.96 per 4 percentage point higher turnout). Greater felony voter disenfranchisement corresponded to higher STI prevalence (prevalence ratio = 1.89, 95% confidence interval = 1.10-3.24 per 4 percentage point higher disenfranchisement).

Conclusions: STI prevalence was inversely associated with voter turnout and positively associated with felony voter disenfranchisement. Research should assess causality and mechanisms through which civic engagement shapes sexual health. Expanding political participation, including eliminating discriminatory voting laws, could influence sexual health.

Keywords: Felony voter disenfranchisement; Political participation; Sexually transmitted infections; Women.

MeSH terms

  • Adult
  • Civil Rights*
  • Criminals / psychology*
  • Criminals / statistics & numerical data
  • Cross-Sectional Studies
  • Female
  • Gonorrhea / epidemiology
  • Humans
  • Multilevel Analysis
  • Politics*
  • Prisoners / psychology*
  • Prisoners / statistics & numerical data
  • Residence Characteristics*
  • Sexually Transmitted Diseases / epidemiology*
  • Sexually Transmitted Diseases / psychology
  • Socioeconomic Factors
  • Syphilis / epidemiology
  • United States / epidemiology
  • Young Adult