International Journal of Environmental Research and Public Health

Preterm birth is a pressing public health issue, with short- and long-term implications for newborns, their families, and society. Although studies are increasingly examining the structural determinants of this birth outcome, few have considered the role of regional equity—residents’ access to resources, opportunity, and power within a region. This study merges U.S. birth certificate data (2023) with a metropolitan-level Racial Equity Index generated by the National Equity Atlas project to investigate the overall and race-specific associations between racial equity, including its constituent measures of prosperity and inclusion, and preterm birth. Multivariable logistic regression models were fit for the overall sample (N = 2,359,347) and stratified by race. Regional prosperity reduced the odds of preterm birth, but the effect of racial inclusion depended on whether it was measured as past or current performance. Combining past inclusion with current prosperity resulted in 4% lower odds of preterm birth. The results provide some support for proponents who emphasize the importance of historic legacies of exclusion, but they also suggest that attention should extend to regional growth and prosperity since those set the basis for the resources to distribute more equitably. Addressing preterm birth will require sustained commitment to both closing racial gaps and ensuring shared prosperity.

Background: Research demonstrates a strong relationship between healthcare professionals’ vaccine attitudes and behaviors and the vaccination behaviors of patients, family, and friends. Positive vaccine attitudes among healthcare professionals are associated with vaccine uptake among patients and non-patients. Relatedly, vaccine hesitancy among healthcare professionals is associated with decreases in vaccine uptake. Understanding and addressing vaccine hesitancy among healthcare professionals, such as nurses, is a critical public health issue. Purpose: This study examines social and political differences between COVID-19 fully vaccinated (FV) and not fully vaccinated (NFV) nursing students. Methods: An online survey was distributed to investigate the social (i.e., age, gender, race/ethnicity, and religious affiliation) and political (political affiliation) differences in COVID-19 vaccination among RN-to-BSN nursing students. Among the NFV, readiness for COVID-19 vaccination and reasons for vaccine hesitancy were also assessed. The final analytic sample included 192 respondents. Descriptive and bivariate analyses were conducted to identify whether socio-demographic and political differences existed between COVID-19 FV and NFV nursing students. Results: Political affiliation (p = 0.005) was the only statistically significant difference identified. Among the NFV, the majority (70.8%) were in the precontemplation stage, with no intention of becoming vaccinated in the foreseeable future. The top reason reported for vaccine hesitancy was concern about side effects (58.3%). Implications: Political affiliation is an important factor in understanding vaccine hesitancy. Strategies to build trust, engage in empathetic discussions about vaccine hesitancy, and enhance media literacy skills are crucial steps in addressing vaccine hesitancy and the influence of politics on public health issues.

Hookah (waterpipe) tobacco smoking remains common among young adults and is often perceived as less harmful than cigarettes, in part due to the misconception that water “filters” toxins. We examined the perceived short-term health effects of hookah versus cigarette smoking in a cross-sectional survey of 121 young adults (mean age 26 ± 5 years; 45% women) in Southern California, including 75 exclusive hookah smokers, 10 dual hookah and cigarette smokers, and 36 non-smokers. Participants rated perceived effects on general, cardiovascular, and respiratory health on a scale from −10 (extremely harmful) to +10 (extremely healthy). Multivariable linear regression adjusted for sex, ethnicity, and education assessed group differences. Compared with exclusive hookah smokers, non-smokers rated hookah as significantly more harmful to general (β = −2.49, p < 0.05), cardiovascular (β = −3.49, p < 0.01), and respiratory health (β = −2.52, p < 0.05). A pronounced perception difference was observed for cardiovascular health, where exclusive hookah smokers rated hookah’s cardiovascular impact near neutral (adjusted mean −1.70), whereas non-users rated it as substantially harmful (−4.91). Perceptions of cigarette harm were negative across groups. Hookah smokers reported relatively low perceived harm from hookah smoking, including cardiovascular harm, highlighting cardiovascular risk perceptions as a potential target for public health communication.