Causes of Low Preschool Immunization Coverage in the United States

Cutts, Felicity; Orenstein, W. A.; Bernier, Roger H.

doi:10.1146/annurev.pu.13.050192.002125

Cited by 76 publications

(31 citation statements)

References 39 publications

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“…6,7 In our study, we found that children with mothers who had 12 or fewer years of education and children in households with Ͻ$50 000 annual incomes were more likely to have received hepatitis A vaccine than children of mothers with higher education level or in families with greater income, respectively. The hepatitis A vaccination program in Butte County was not specifically targeted toward children of low SES.…”

Section: Discussionmentioning

confidence: 53%

“…In addition, provider knowledge, attitudes, and practices play a key role in vaccination of children. 6,7,23 However, in this study, we did not account for the potential influence of provider knowledge, attitudes, and practices on receipt of hepatitis A vaccine by children in our study and, therefore, possibly on results of our study.…”

Section: Discussionmentioning

confidence: 88%

“…Of the 59 classrooms, the average estimated class size was 18.32 (range: 1-30). The average number of surveys returned per classroom was 11.0 (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Response Ratesmentioning

confidence: 99%

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Parental Knowledge, Attitudes, and Practices Associated With Not Receiving Hepatitis A Vaccine in a Demonstration Project in Butte County, California

et al. 2003

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ABSTRACT. Objective. To determine hepatitis A vaccination coverage and factors associated with not receiving hepatitis A vaccine among children.Methods. A random cluster sample survey was conducted of parents of children who attended kindergarten in Butte County, California, in 2000. Because of a history of recurrent epidemics, an aggressive hepatitis A vaccination program was ongoing during the time this study was conducted. Receipt of 1 or 2 doses of hepatitis A vaccine was studied.Results. Of 896 surveys sent, 648 (72%) were completed. The vaccination coverage for at least 1 dose of hepatitis A vaccine was 398 (62%) and for 2 doses was 272 (42%). Factors associated with not receiving the vaccine included lack of provider recommendation (vs having recommendation; odds ratio [OR]: 7.8; 95% confidence interval [CI]: 4.9 -12.2), not having heard of the vaccine (OR: 2.4; 95% CI: 1.2-4.9), and parent's not perceiving child is likely to get hepatitis A (vs perceiving child might get disease; OR: 2.1; CI: 1.6 -2.9).Conclusions. Vaccination coverage among kindergartners did not reach high levels (ie, >90%), despite aggressive vaccination efforts in this community. Lack of provider recommendation and lack of parental awareness of hepatitis A vaccine were the 2 most significant factors associated with failure to receive vaccine. These findings will facilitate the development of vaccination strategies for communities in which hepatitis A vaccination is recommended. unpublished data, 2002). Because of clinically unrecognized or asymptomatic infections, especially among children, the number of infections may be up to 10 times higher. 1 Because children account for at least one third of cases and also are a potential source of infection for others, routine vaccination of children is likely to be an effective way to reduce hepatitis A incidence. 2 In October 1999, the Advisory Committee on Immunization Practices (ACIP) updated recommendations for hepatitis A vaccination to include routine vaccination of children age Ն2 years in states, counties, and communities with hepatitis A incidence rates that were at least twice the 1987-1997 national average (Ն20 cases per 100 000 population). 2 Over time, this strategy has the potential to substantially lower disease incidence and possibly eliminate indigenous transmission of hepatitis A virus. 3 Butte County is located in the Sacramento Valley of northern California and had an estimated population in 2000 of 207 000. The county has had recurrent outbreaks since hepatitis A became reportable in 1966 and meets the ACIP's criteria for routine childhood hepatitis A vaccination. 4 During 1987-1997, the average annual hepatitis A incidence rate was 45.3 per 100 000 (CDC, unpublished data, 2001).From January 1995 through December 2000, a demonstration project was implemented in Butte County to assess the impact of routine vaccination of children on disease incidence over time. Hepatitis A vaccine was made widely available free of charge to children aged 2 to 12 years in 1995 and to succes...

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 88%

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Parental Knowledge, Attitudes, and Practices Associated With Not Receiving Hepatitis A Vaccine in a Demonstration Project in Butte County, California

et al. 2003

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“…Interven tions need to be targeted at infrastructural improvement and greater account ability (21,66). Children who receive inadequate preventive services or who have multiple providers of care are more frequently under-immunized (39).…”

Section: Childhood Immunizationsmentioning

confidence: 99%

Nonfinancial Barriers to Care for Children and Youth

Halfon¹,

Inkelas²,

Wood³

1995

Annu. Rev. Public Health

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Public health and medical care interventions have produced dramatic changes in the health of children in the United States. Emerging new morbidities such as behavioral and learning disorders, and child abuse and neglect, highlight the lack of an integrated system of health. Children's developmental vulnera bility, dependency, and unique morbidities have been underemphasized in the organization and delivery of health care. The Andersen and Aday model of health care utilization is used to describe financial and nonfinancial barriers to care for children that include family characteristics and organizational characteristics of the health system. Case studies of immunization delivery, children with chronic illness, and mobile popUlations of children reveal the mismatch between the health care system and children's basic health needs.Integrated service models for high-risk populations of children represent an essential mechanism for coordinating the delivery of medical, developmental, educational, and social services needed by children and families. Universal, coordinated public health and medical services of adequate scope and quality should be assured for children through market and health system reform.

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“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Population risk factors found to be associated with underimmunization include inner-city residence, African-American ethnicity, multiplechild household, single parenthood, teenage mother, low educational level of the mother, and having Medicaid as the source of health care coverage. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Although some studies have reported that access barriers to primary care and immunization services, such as lack of transportation, inconvenient clinic locations and hours, long waiting times, restrictive appointment systems, and/or cost of immunization services, contribute to reduced immunization rates, 5,6,9 -14,22 others have suggested that access barriers do not explain the low immunization rates found in many populations. [23][24][25] There is a lack of population-based research that examines the extent to which parents perceive health system access barriers to various types of immunization services and the extent to which health system factors are associated with immunization coverage within a defined geographic area.…”

mentioning

confidence: 99%

A Population-based Study of Access to Immunization Among Urban Virginia Children Served By Public, Private, and Military Health Care Systems

et al. 1998

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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 ...

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Causes of Low Preschool Immunization Coverage in the United States

Cited by 76 publications

References 39 publications

Parental Knowledge, Attitudes, and Practices Associated With Not Receiving Hepatitis A Vaccine in a Demonstration Project in Butte County, California

Parental Knowledge, Attitudes, and Practices Associated With Not Receiving Hepatitis A Vaccine in a Demonstration Project in Butte County, California

Nonfinancial Barriers to Care for Children and Youth

A Population-based Study of Access to Immunization Among Urban Virginia Children Served By Public, Private, and Military Health Care Systems

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