{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:41:33Z","timestamp":1792428093933,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":88,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Childhood vaccination coverage in the United States has declined in recent years, raising concern about the reemergence of vaccine-preventable diseases. We examined whether state-level political partisanship was associated with routine childhood vaccination coverage after adjustment for socioeconomic factors from 2014 to 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional ecological study using publicly available state-level panel data from 50 states and the District of Columbia from 2014 to 2024. The analytic panel included 561 state-year observations. The primary outcome was measles-mumps-rubella coverage; secondary outcomes were diphtheria-tetanus-acellular pertussis, poliovirus, and hepatitis B coverage. Multivariable ordinary least squares regression with year fixed effects, Welch t tests, analysis of variance, and interaction models were used. Data were analyzed in March 2026. Sensitivity analyses included two-way (state and year) fixed-effects specifications, persistence-classification subset models (states with consistent presidential vote outcomes across multiple elections), and county-level analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Blue states had higher mean measles-mumps-rubella (MMR) vaccination coverage than red states (89.69% vs. 87.34%), a difference of 2.35% points (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001). In adjusted analyses with racial composition included as a covariate, higher Republican presidential vote share was associated with lower MMR vaccination coverage (b=-10.90; 95% CI=-16.69, -5.10;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009406 state-year observations). Every 10-percentage-point increase in Republican vote share corresponded to approximately 1.09%-point lower MMR vaccination coverage. Political-educational strata differed in coverage (analysis of variance\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001), and the political association did not strengthen over time (interaction\n                      <jats:italic>P<\/jats:italic>\n                      =.38). Persistence-based sensitivity analyses among states with consistent presidential vote outcomes across four elections (2012\u20132024) and three elections (2016\u20132024) yielded strengthened associations (b=-14.30,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009326; and b=-13.17,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009350, respectively). Within-state county-level analyses (county fixed effects and state-stratified specifications) were directionally consistent with the state-level finding (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009411 county-year observations from a 2023 cross-section across four states).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>State-level political context was associated with vaccination coverage after socioeconomic adjustment. Immunization surveillance, communication, and outreach strategies may benefit from accounting for undercoverage risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-026-27675-9","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:29:35Z","timestamp":1784802575000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Political polarization, educational attainment, and childhood vaccination coverage in the United States, 2014\u20132024: a cross-sectional study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2332-924X","authenticated-orcid":false,"given":"Wei","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed M.","family":"Mirsattari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"issue":"24","key":"27675_CR1","doi-asserted-by":"publisher","first-page":"2176","DOI":"10.1001\/jama.2025.6495","volume":"333","author":"MV Kiang","year":"2025","unstructured":"Kiang MV, Bubar KM, Maldonado Y, Hotez PJ, Lo NC. Modeling reemergence of vaccine-eliminated infectious diseases under declining vaccination in the US. JAMA. 2025;333(24):2176\u201387. https:\/\/doi.org\/10.1001\/jama.2025.6495.","journal-title":"JAMA"},{"issue":"41","key":"27675_CR2","doi-asserted-by":"publisher","first-page":"925","DOI":"10.15585\/mmwr.mm7341a3","volume":"73","author":"R Seither","year":"2024","unstructured":"Seither R, Yusuf OB, Dramann D, et al. Vaccination coverage with selected vaccines and exemption rates among children in kindergarten \u2014 United States, 2023-24 school year. MMWR Morb Mortal Wkly Rep. 2024;73(41):925\u201332. https:\/\/doi.org\/10.15585\/mmwr.mm7341a3.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"45","key":"27675_CR3","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.15585\/mmwr.mm7245a2","volume":"72","author":"R Seither","year":"2023","unstructured":"Seither R, Yusuf OB, Dramann D, Calhoun K, Mugerwa-Kasujja A, Knighton CL. Vaccination coverage with selected vaccines and exemption from school vaccine requirements among children in kindergarten \u2014 United States, 2022-23 school year. MMWR Morb Mortal Wkly Rep. 2023;72(45):1217\u201324. https:\/\/doi.org\/10.15585\/mmwr.mm7245a2.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"10","key":"27675_CR4","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.2105\/AJPH.2022.306964","volume":"112","author":"KA Estep","year":"2022","unstructured":"Estep KA, Muse A, Sweeney S, Goldstein ND. Partisan polarization of childhood vaccination policies, 1995\u20132020. Am J Public Health. 2022;112(10):1471\u20139. https:\/\/doi.org\/10.2105\/AJPH.2022.306964.","journal-title":"Am J Public Health"},{"issue":"1","key":"27675_CR5","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1093\/pubmed\/fdab401","volume":"44","author":"AJ Dolman","year":"2022","unstructured":"Dolman AJ, Fraser T, Panagopoulos C, Aldrich DP, Kim D. 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