Factors Associated with Underimmunization at 3 Months of Age in Four Medically Underserved Areas

Abstract

Objective. Risk factors for underimmunization at 3 months of age are not well described. This study examines coverage rates and factors associated with underimmunization at 3 months of age in four medically underserved areas.Methods. During 1997-1998, cross-sectional household surveys using a two-stage cluster sample design were conducted in four federally designated Health Professional Shortage Areas. Respondents were parents or caregivers of children ages 12-35 months: 847 from northern Manhattan, 843 from Detroit, 771 from San Diego, and 1,091 from rural Colorado. A child was considered up-to-date (UTD) with vaccinations at 3 months of age if documentation of receipt of diphtheria-tetanuspertussis, polio, haemophilus influenzae type B, and hepatitis B vaccines was obtained from a provider or a hand-held vaccination card, or both.Results. Household response rates ranged from 79% to 88% across sites. Vaccination coverage levels at 3 months of age varied across sites: 82.4% in northern Manhattan, 70.5% in Detroit, 82.3% in San Diego, and 75.8% in rural Colorado. Among children who were not UTD, the majority (65.7% to 71.5% per site) had missed vaccines due to missed opportunities. Factors associated with not being UTD varied by site and included having public or no insurance, Ն2 children living in the household, and the adult respondent being unmarried. At all sites, vaccination coverage among WIC enrollees was higher than coverage among children eligible for but not enrolled in WIC, but the association between UTD status and WIC enrollment was statistically significant for only one site and marginally significant for two other sites.Conclusions. Missed opportunities were a significant barrier to vaccinations, even at this early age. Practice-based strategies to reduce missed opportunities and prenatal WIC enrollment should be focused especially toward those at highest risk of underimmunization.

Determinants of Influenza Vaccination Among Young Children in an Inner-City Community

“…Additional factors previously noted in the literature to be associated with vaccination coverage were also entered into the models due to their potential theoretical importance. Such factors included child age, maternal age, maternal education, presence of a personal doctor or nurse, accessibility of services and discontinuous insurance coverage [15,[30][31][32][33]. All analyses were performed using SPSS version 17.0 (SPSS Inc. Chicago, Ill).…”

Pertussis: Microbiology, Disease, Treatment, and Prevention

“…In the United States, despite great success of public health programs and availability of vaccines for disadvantaged children through the federally funded Vaccines for Children Program, many children in medically underserved areas as well as in minority groups remain partially immunized or nonimmunized (520). Recent (2015) data from Detroit, MI, show that only 40% of children have completed the primary vaccination series and suggest that rates of underimmunization may exceed 50% in some populations (Michigan Care Improvement Registry, unpublished data).…”

Do changes in socio-demographic characteristics impact up-to-date immunization status between 3 and 24 months of age? A prospective study among an inner-city birth cohort in the United States

“…We included the following potentially immunization-related characteristics in the survey: maternal race, marital status, maternal age, education level, employment status, monthly income, receipt of prenatal care, WIC participation, infant birth order, and usual clinical care site (i.e., hospital-affiliated site, private office or community clinic/health center, or none). 7,8,[27][28][29][30][31] We administered the short version of the Test of Functional Health Literacy in Adults (S-TOFHLA) to each mother. The S-TOFHLA is a wellvalidated measure of functional health literacy that uses specific health-related examples to assess reading comprehension.…”