Predictors of Canadian Legislators' Support for Public Health Policy Interventions
Cohen, Joanna E, Nicole A de Guia, Ashley, Mary Jane, Ferrence, Roberta, et al., Canadian Journal of Public Health
Healthy public policy is an important strategy for improving the health of individuals and populations.1-4 Because they can enact these policies, legislators should be a key focus for public health policy research. We have previously presented Canadian legislators' views on selected aspects of health promotion according to political party.5 In this report, we describe the relationships between Canadian legislators' support for public health policies and two groups of potentially important predictors: 1) political factors, and 2) personal characteristics.
The data were collected as part of the Canadian Legislator Study.6,7 All Canadian federal (n=291) and provincial/territorial (n=741) legislators, serving as of October 1996, were eligible to participate in a structured, computer-assisted telephone interview between July 1996 and June 1997. The overall response rate was 54% (n=553). Response rates did not vary by age, sex, educational attainment, or having an academic degree. However, current or former ministers or party leaders, longerserving legislators, and lawyers were less likely to respond (p<0.05).
Although the overall study focused on tobacco control,8 legislators were also asked to indicate their degree of support for four public health interventions: regulating violence on TV, requiring side-impact airbags in cars, requiring adult cyclists to wear helmets, and regulating stores selling alcohol. Confirmatory factor analysis of these four items using LISREL9 indicated acceptable fit of a one factor model. A unidimensional summative scale (the Public Health Support Scale or PHSS) was computed, using factor loadings as a weight for each item. The PHSS ranged from 0 to 1.85 (mean=1.03, standard deviation=0.51). The skew (-0.1) and kurtosis (2.3) indicated an approximately Gaussian distribution. The PHSS showed construct validity by varying with political party in the expected direction (i.e., decreased support from leftleaning to right-leaning parties).
Explanatory variables consisted of political and personal factors. Political factors included political party, governing status, minister status, and three measures of political ideology - the Health Promotion Ideology Scale (HPIS, measuring beliefs about the role of government in health promotion), the bipolar ideology scale (self-placement of political views on a 10point left-right scale), and views on government regulation of the private sector, fully described elsewhere.'O Personal characteristics included age, sex, educational attainment, and smoking status.
Bivariate relationships between the PHSS and explanatory variables were examined with linear regression, using Stata.11 Subsequently, multivariate relationships were determined using two multiple linear regressions. The first model included all variables found to have an association (p<0.10) with the PHSS in the bivariate analysis. The final model was identical to the first, but the bipolar ideology scale was omitted to increase the sample size.
New Democrats (p<0.001) and Liberals (p=0.003) were more supportive of public health interventions than were members of all other parties combined (Table I). Progressive Conservatives (p<0.001) and Reformers (p<0.001) were less supportive than all other respondents combined. Support was greater among those indicating that the government has a role in health promotion (higher scores on the HPIS, p<0.001). Support was lower among legislators who placed themselves toward the right of the bipolar ideology scale (p<0.001) and who thought there was too much government regulation of the private sector (p<0.001). Personal characteristics were not related to support.
In the final multivariate linear regression model, political party and political ideology were independently associated with support (Table II). Compared to Liberals, Progressive Conservatives and Reformers were less supportive of public health interventions (p<0. …