ABSTRACT. Background. Pediatric immunization rates have increased in the United States since 1990. Nevertheless, national survey data indicate that up to one third of 2-year-old children in some states and urban areas lack at least one recommended dose of diphtheria-tetanus-pertussis (DTP)-, polio-, or measles-containing vaccines. Immunization has become a key measure of preventive pediatric health care in the United States. To achieve and maintain the national immunization goal that 90% of children receive all recommended immunizations by 2 years of age, the role of the health care system in immunization delivery must be examined. Urban eastern Virginia has a diverse population that obtains immunization services from public, private, and military providers and insurers. At the time of this survey, immunization services in Virginia were available free to all children through public health clinics and to military families when using a military facility.Objective. To examine access to pediatric immunization services and health system factors associated with underimmunization in a representative sample of children at 12 and 24 months of age.Methods. We conducted a household survey in urban eastern Virginia from April through September 1993. A total of 12 770 households in Norfolk and Newport News, VA, were selected for inclusion in the study using probability-proportionate-to-size cluster sampling. Use of probability-proportionate-to-size sampling ensured that children within each city had equal probability of being included in the survey. Selected households were visited by trained interviewers to determine their eligibility, defined as having at least one child 12 to 30 months of age residing in the household. In eligible households, parents were asked to participate in a standardized, 15-minute interview. Survey respondents were asked about household demographics, and for each eligible child, the immunization history, health insurance, the name and location of all immunization providers, the usual immunization provider, and any problems the parent had experienced accessing immunization services with that child. Up-to-date (UTD) immunization status was defined as having all recommended doses of DTP, polio, and measles-mumps-rubella at 12 months (three DTP and two polio immunizations) and 24 months (four DTP, three polio, and one measles-mumps-rubella immunizations). The child's immunization history was assessed from parent and provider records only. Data analysis accounted for the survey's cluster sampling design (ie, within-cluster correlation). Because the immunization rates of the two cities did not differ significantly, unweighted analyses were used for ease of computation. Significance was determined for contingency tables by Wald's 2 test. Results. A total of 749 children (91% of eligible households) participated in the survey. Study children were born between October, 1990, and July, 1992. Immunization records were obtained for 705 children (94%). Eighty-seven percent of respondents were mothers, 44% were ...
The authors discuss the attitudes, knowledge, and skills needed for counselors to work effectively with men who are facing common health‐related concerns, specifically erectile dysfunction, sexually transmitted diseases, benign hypertrophy of the prostate and prostatitis, cardiovascular disease, diabetes, prostate cancer, testicular cancer, lung cancer, and accidental trauma and injuries. The authors present suggestions for ways of attracting men with health‐related concerns to counseling and methods of ensuring low attrition rates from counseling.
Public-private partnerships are integral to our public health paradigm. The Coalition Training Institute (1995-1998) trained 283 participants from 29 U.S. cities, 49 states, and 7 U.S. territories to foster and sustain partnerships that improve immunization rates. Evaluation consisted of on-site and follow-up surveys, effectiveness inventories, and focus groups. The Institute met participants' expectations. Four months later, participants reported training was applicable (93%) and helpful in overcoming organizational barriers. Most built or improved coalitions (81%), helped organizations apply new ideas (86%), and obtained training/support (60%). Participants requested more on-site and distance-learning opportunities to network, train coalition leaders and members, and learn new skills.
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