Jodian Pinkney, MBBS, DM, MPH is an Infectious Diseases (ID) physician at the Massachusetts General Hospital and an Instructor in Medicine at Harvard Medical School. Her research focuses on promoting the equitable distribution and uptake of preventive health measures for ID-related conditions, including vaccination and HIV pre-exposure prophylaxis for reproductive-aged women, both domestically and in the Caribbean. For this work, she received an NIH T32 training grant and was recently awarded the prestigious Maxwell Finland Award for excellence in research by the Massachusetts Infectious Diseases Society. She earned her MBBS and DM from the University of the West Indies in Jamaica and subsequently served as the Clinical Coordinator for the Center for HIV/AIDS, Research and Education Services (CHARES)—an urban specialized clinic catering to the third-largest cohort of People Living with HIV in Jamaica. Dr. Pinkney furthered her training with an Internal Medicine residency at the University of South Carolina, serving as Chief Resident, before starting her ID training in the Massachusetts General Brigham ID fellowship program in 2020. Most recently, she completed her Master of Public Health in Health Policy with a concentration in Maternal and Child Health at the Harvard School of Public Health, and the Commonwealth Fund Fellowship in Minority Health Policy at Harvard University in 2024. She currently sits on the community linkages arm of the Massachusetts Maternal Health Task Force and is a member of the Diversity, Equity, and Inclusion Committee of the Infectious Diseases Society for Obstetrics and Gynecology.
Jodian Pinkney, MBBS, DM, MPH
Instructor in Medicine, Harvard Medical School
Assistant in Medicine, Division of Infectious Diseases, Massachusetts General Hospital
The relationship between transportation insecurity and influenza vaccination among pregnant individuals in the US: an opportunity for a bundled intervention
Objective:
To examine the relationship between transportation insecurity and influenza vaccination among pregnant individuals in the US.
Background:
In the United States (US), influenza (flu) vaccination is recommended for all pregnant individuals in all trimesters to safeguard both mothers and infants from the severe impacts of influenza. Despite these recommendations, maternal flu vaccine uptake remains significantly below the national goal of 70%, and has been declining over the last three years, leveling off at 47% in the 2022-23 flu season. Racial and ethnic disparities in maternal flu vaccine uptake have also been observed with non-Hispanic Black pregnant individuals consistently having the lowest uptake among all racial and ethnic groups. This trend is alarming, given the significant health benefits that maternal flu vaccination provides for pregnant people and their infants throughout their life course. Therefore, understanding the various factors that deter maternal flu vaccination is necessary to improve health outcomes.
To date, research has focused primarily on vaccine hesitancy as a deterrent to maternal flu vaccination; however, the impact of health-related social needs on maternal flu vaccine uptake remains unclear. Specifically, the role that transportation insecurity (TI) – a lack of access to safe and reliable transportation – plays in maternal flu vaccination is unknown.
The Massachusetts General Hospital (MGH) Infectious Diseases Division as a part of their Vaccine Equity for Adult Vaccines Initiative, aimed to understand the relationship between TI and flu vaccination rates in the pregnant population. This information is crucial for developing interventions and policies that optimize flu vaccine uptake in this priority group.
Methods:
- Performed a literature review to determine if TI was associated with flu vaccine uptake in the general US population and to identify predictors of TI in the US.
- Conducted key informant interviews to understand the relevance of TI in maternal flu vaccine decision-making and to review the current protocols for addressing TI at MGH.
- Secondary analysis of the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional US-based telephone survey which included a Social Determinants and Health Equity Module in 2022, to examine the relationship between TI and flu vaccination among pregnant respondents.
Results:
Flu vaccination was lower among pregnant individuals with TI (16.3%) versus those without TI (40.7%) [crude Odds Ratio = 0.28, 95%CI = 0.15 – 0.56; p = <0.001]. This association was attenuated by adjusting for race, income, and health insurance [adjusted Odds Ratio = 0.48, 95%CI = 0.21 – 1.12; p = 0.089]. Income was the most influential covariate, resulting in a 40% change in the beta coefficient.
Recommendations:
- These findings present an opportunity to examine the impact of comprehensive multi-pronged interventions and policies that mitigate TI on maternal flu vaccine uptake. Examples include examining the impact of mobile prenatal clinics, home visiting programs, rideshare vouchers, and state-based maternal cash benefits on maternal flu vaccine uptake.
Preceptor:
Ruanne Barnabas, Chief, Division of Infectious Diseases, MGH
