38. Your Health Your Voice: Identifying Disenfranchised Youth and Opportunities for Civic Engagement


      Studies have shown adolescent and young adult (AYA) participation in voting and other forms of civic engagement is associated with future optimism, increased life satisfaction and decreased health-related risk behaviors. Yet, AYA aged 18-24 are the least represented demographic at voting polls across the US. Recognizing voting and civic engagement may be an important health intervention for this population, we sought to determine factors associated with future voting intention (planning to vote in the next election) among AYA attending an urban adolescent clinic during the COVID-19 pandemic.


      We added four voting-related questions (Do you plan to vote in the next election? Did you vote in the last election? Are you registered to vote? Do you want to know how to register to vote?) to our pre-visit questionnaire distributed to all adolescent clinic patients ages 13-26 years. Both before and after the November 2020 election (i.e., July 2020 to March 2021), we collected 634 patient questionnaires; 77% (N=487) were from patients who were age eligible to vote on November 3, 2020. We limited the current analysis to questionnaires from age eligible patients with complete responses of yes or no to all four voting questions (N=258). Using bivariate and multivariable logistic regression we examined associations between voting intention and the following factors: age, gender, race, registration status, voting in last election, and weeks to/from November 2020 election. Age was dichotomized to 17-21 vs. 22-26 years based on Locally Weighted Scatterplot Smoothing and race to Black vs. non-Black. This project was approved by the Johns Hopkins IRB.


      Mean age was 20.7 years (SD=2.1); 63.2% were 17-21 years. Sixty-five percent were female, 88% were Black, 73% were registered to vote, 48% voted in last election, and 76% had future voting intention. Mean weeks to/from November election was -1.26 (SD=10.2). In the adjusted model, older patients were nearly 70% less likely to declare future voting intention than younger patients (aOR=0.32, 95% CI=0.14-0.76); males were half as likely as females (aOR=0.45, 95% CI=0.21-0.96). Voting in the last election (aOR=18.63, 95% CI=5.51-62.97) and being registered to vote (aOR=6.12, 95% CI=2.82-13.27) predicted future voting intention. Future voting intention was not associated with race or weeks to/from November election in either the unadjusted or adjusted models.


      Our findings from a clinic sample of urban AYA point to a subgroup of youth who may be more vulnerable to disenfranchisement. The COVID-19 pandemic introduced new challenges for AYA voting and this study highlighted how providers might harness the health care visit to promote AYA voting. Registration status, one of the variables most strongly associated with future voting intention, is modifiable and easily evaluated during a healthcare visit. Future qualitative investigation will explore the differences in future voting intention by age and gender to identify other factors that may also be modifiable or addressed by adolescent providers in clinical settings.

      Sources of Support

      Thomas Wilson Foundation (PI:Fields), NICHD T32HD052459 (PI:Trent).