Department of Society, Environment and Health Equity

Background and Aims: Healthcare workers (HCWs) were pivotal in delivering care during the COVID-19 pandemic, yet vaccination uptake in the United States was lower than anticipated. This study investigated whether economic incentives, paid time off (PTO), raffle entry, or a direct financial incentive could influence vaccine uptake among HCWs exhibiting greater vaccine hesitancy. Methods: We conducted a cross-sectional survey in a large integrated safety-net health system. Using an adapted Vaccine Hesitancy Scale (VHS), employees were classified as "more" vs "less" hesitant. For each incentive, respondents indicated whether it would influence their vaccination decision. Multivariable logistic regression estimated associations between demographic (age, gender, race/ethnicity, household income, education, marital status) and employment factors (job type, COVID-19 exposure, pandemic impact on income/employment) and reported influence. Results: Of 684 respondents with complete hesitancy data, 282 (41.2%) were classified as more hesitant. Within this group, 41.4% reported PTO would influence their decision, 28.5% a financial incentive, and 20.3% a raffle. Employees < 50 years had higher odds of reporting influence for a financial incentive (aOR = 3.52; 95% CI: 1.64-8.23), raffle (aOR = 2.34; 1.01-5.41), and PTO (aOR = 1.89; 1.00-3.62). Nonclinical staff were more likely to report influence from a financial incentive than clinical staff (aOR = 2.16; 1.07-4.46). Those reporting negative pandemic-related income/employment impact showed a borderline association with financial incentives (aOR = 2.12; 0.99-4.59). Conclusion: Economic incentives are an effective strategy for improving vaccine uptake among younger HCWs, nonclinical staff, and those negatively affected financially by the pandemic. A targeted application of financial incentives may help address vaccine hesitancy in healthcare settings.

In 1888, Brazil became the last country in the Americas to abolish slavery. Historians have outlined the racialized health disparities of people of African descent in the post-abolition period. Epidemiologists have shown that twenty-first-century health disparities continue to mirror patterns from over a century ago. This cross-sectional analysis quantifies health disparities in a post-abolition maternity hospital using infant birth weight. It relies on hospital records on infants delivered between 1922 and 1926 (n = 2845) at the Maternidade Laranjeiras in the city of Rio de Janeiro, Brazil to run linear models assessing differences in infant birth weight by maternal skin color, age, number of pregnancies (parity), and nationality. African ancestry was correlated with lower birth weights. Infants born to Afro-descendant women had birth weights estimated to be 84 g lighter (p-value = 0.002 [95% CI -137, -32]) than infants born to Euro-descendant women. Among Afro-descendant women, infants born to Black (preta) women had birth weights estimated to be 100 g lighter (p-value = 0.001 [95% CI -160, -39]) and infants born to mixed-race (parda) women had birth weights estimated to be 70 g lighter (p-value = 0.022 [95% CI -130, -10]) than infants born to White women. The findings were likely the consequence of slavery's legacy, particularly race-based socioeconomic inequality - including more strenuous work schedules, poorer nutrition, and less sanitary living environments for people of African descent. The findings are consistent with current-day research on racialized health disparities in Brazil and demonstrate the importance of historical findings to public health research.

Across scientific, medical, legal, political, popular, and religious discourses, the “mother” and the “fetus” are regarded as being separated by a physical boundary. Time and time again, feminist theorists have proposed ways to disband the mother/fetus division derived from Cartesian self/other binarism and individualism. The goal of this article is to introduce and explore an alternative ontology of the pregnant body I call the motherfetus. I follow material feminist Karen Barad (2007) in contending that the “fetus” does not preexist as an object with a distinct agency who interacts with the “mother,” but only materializes through what Barad calls intra-action. I argue that the pregnant body can be reconfigured in such a way that the material distinction between the “mother” and the “fetus” disappears. This endeavor entails re-interpreting material “evidences” provided by twenty-first century technosciences while mobilizing the motherfetus as an apparatus of bodily production. Through a lens that insists on rejecting the genetic, immunological, anatomical, and physiological separation of the “mother” and “fetus,” this article will borrow elements from immunology, microchimerism, and the human microbiome to generate multiple incarnations of the motherfetus as a material-discursive product. In the conclusion, I will examine how the motherfetus as a feminist theory can alter the ways in which the pregnant body is dealt with in feminist activisms as well as in scientific studies and medical practices.

Despite increasing awareness of the importance of political determinants of health, place-based research has not interrogated one of the most common political statuses: the impact of living in a community without municipal incorporation. In 2010 an estimated 37% of the U.S. population lived in an unincorporated area; despite their ubiquity, unincorporated communities are largely absent from the public health literature. Residents of unincorporated areas typically do not have their own local (e.g., city or municipal) government. This lack of representation leads to political exclusion and diminished access to resources, especially for low-income communities of color, Furthermore, by not disaggregating health data to unincorporated communities, residents are subsumed into county or census tract data that may not be reflective of their community's composition or context. Without jurisdictional distinction in research, there is no accountability for the manufacturing of health inequities in unincorporated communities . In the absence of empirical research on unincorporated communities, this paper uses the Commission on Social Determinants of Health (CSDH) Framework of the World Health Organization to argue that lack of municipal status is a structural determinant of health responsible for social conditions which generate cumulative health risks for residents. This includes using existing evidence on social conditions typical of unincorporated communities to describe patterns of residential segregation, neighborhood disadvantage, and environmental hazards that may increase residents' exposure to unhealthy environments in unincorporated communities. Finally, we provide an agenda for future public health research that can begin to address this health and racial equity gap for low-income unincorporated communities of color who have, until now, been absent in health equity discourse.

This article examines female sterilisation practices in early twentieth-century Rio de Janeiro, Brazil. It argues that the medical profession, particularly obstetricians and psychiatrists, used debates over the issue to solidify its moral and political standing during two political moments of Brazilian history: when the Brazilian government separated church and state in the 1890s and when Getúlio Vargas's authoritarian regime of the late 1930s renewed alliances with the Catholic church. Shifting notions of gender, race, and heredity further shaped these debates. In the late nineteenth century, a unified medical profession believed that female sterilisation caused psychiatric degeneration in women. By the 1930s, however, the arrival of eugenics caused a divergence amongst physicians. Psychiatrists began supporting eugenic sterilisation to prevent degeneration - both psychiatric and racial. Obstetricians, while arguing that sterilisation no longer caused mental disturbances in women, rejected it as a eugenic practice in regard to race. For obstetricians, the separation of sex from motherhood was more dangerous than any racial 'impurities', both phenotypical and psychiatric. At the same time, a revitalised Brazilian Catholic church rejected eugenics and sterilisation point blank, and its renewed ties with the Vargas regime blocked the medical implementation of any eugenic sterilisation laws. Brazilian women, nonetheless, continued to access the procedure, regardless of the surrounding legal and medical proscriptions.

We and others have suggested that vitamin D receptor gene (VDR) polymorphisms influence susceptibility for Parkinson's disease (PD), Alzheimer's disease (AD), mild cognitive impairment (MCI) or overall cognitive functioning. Here we examine VDR polymorphisms and cognitive decline in patients with PD. Non-Hispanic Caucasian PD patients (n=190) in the Parkinson Environment Gene (PEG) study were successfully genotyped for seven VDR polymorphisms. Cognitive function was assessed with the Mini-Mental State Exam (MMSE) at baseline and at a maximum of three follow-up exams. Using repeated-measures regression we assessed associations between VDR SNP genotypes and change in MMSE longitudinally. PD cases were on average 67.4years old at diagnosis and were followed for an average of 7.1years into disease. Each additional copy of the FokI A allele was associated with a 0.115 decrease in the total MMSE score per year of follow-up (β=-0.115, SE(β)=0.05, p=0.03) after adjusting for age, sex, education and PD duration. The effect on MMSE by the FokI A allele was comparable in absolute magnitude to the effect for disease duration in years prior to first interview (β=-0.129 per year, SE(β)=0.08, p=0.13), and years of education (β=0.118 per year, SE(β)=0.03, p<0.001). When LD/LED use and PD subtype were added to the model, the effect of the FokI A allele on total MMSE score was magnified (β=-0.141, SE(β)=0.05, p=0.005). Results point to Fokl, a functional VDR polymorphism, as being associated with cognitive decline in PD. Future studies examining the contributions of the vitamin D metabolic pathway to cognitive dysfunction in PD are needed.