Factors Related to Immunization Status Among Inner-City Latino and African-American Preschoolers

Abstract

Objective. To identify factors associated with undervaccination at 3 months and 24 months among low-income, inner-city Latino and African-American preschool children. Design. Interviews with a representative sample of inner-city families using a cross-sectional, multi-stage, cluster-sample design combined with a replicated quota sampling approach. Setting. South Central and East Los Angeles areas in inner-city Los Angeles. Population. Eight hundred seventeen Latino and 387 African-American families with children between 12 and 36 months of age. Main Outcome Variables. Being fully immunized or up-to-date (UTD) at 3 months (1 diphtheria-tetanus-pertussis vaccine and 1 oral polio vaccine) and 24 months of age (4 diphtheria-tetanus-pertussis vaccines, 3 oral polio vaccines, and 1 measles-mumps-rubella vaccine). Methods. Logistic regressions of UTD immunization status at 3 and 24 months by population and health care system factors. Results. Seventy percent of Latino children and 53% of African-American children were UTD at 3 months of age. At 24 months of age, 42% of Latino children and 26% of African-American children were UTD on their immunizations. Receipt of the first immunizations by 3 months was associated with smaller family size, and evidence of connection to prenatal care. Latino children were less likely to be UTD at 24 months if they obtained well child care from private providers versus public clinics (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.26, 0.79). There was also a trend for Latino children to be less well immunized if they were in health maintenance organizations versus public clinics (0.31, .0.05 < P < .1). African-American children were more likely to be UTD at 24 months if they were UTD at 3 months (OR = 5.56, 95% CI = 1.43, 21.6), had more health visits (OR = 1.13, 95% CI = 1.01, 1.27), and were less likely to be UTD at 24 months if they were on Medicaid versus private insurance (OR = 0.26, 95% CI = 0.08, 0.90). Implications. Both African-American and Latino children in inner-city Los Angeles have low immunization rates at 3 and 24 months. Prenatal care and family size are strongly associated with being UTD by 3 months; however, family and child characteristics are relatively unimportant predictors of being UTD at 24 months of age. Important risk factors for underimmunization at 2 years of age in the inner-city, low-income communities studied include type of health insurance and source of well child care, with the public sector having higher rates than private doctors' offices or health maintenance organization/managed care plans.

Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy

“…Finally, the generational shift in vaccine-hesitancy patterns through the years may explain the differential impact of education and socioeconomic status on vaccine hesitancy. Prior to the measles elimination period, vaccine hesitancy patterns in the 1980s and 1990s were largely unintentional and was associated with poverty and lack of vaccine access [ 155 ], particularly among immigrant families with limited education [ 156 ]. On the other hand, articles in this review were published between 2000 and 2022 and highlighted the positive correlation between vaccine hesitancy, income, education, and NMEs—the timing of which corresponded with greater information availability and access through the internet and social media, which can influence mothers’ decisions on their children’s vaccination status.…”

Incomplete immunization uptake and associated factors among children aged 12–23 months in sub-Saharan African countries; multilevel analysis evidenced from latest demography and health survey data, 2023

“…This indicated that through the integrated program of family planning and immunization services, the woman who visited the health facility for family planning services may be able to vaccinate her kid [ 24 ]. According to a study done on African-American and Latino children in inner-city Los Angeles, health insurance was another factor that determined incomplete immunization [ 25 ]. Furthermore, the finding of this study revealed that the availability of health insurance was the determinant of incomplete immunization this was in line with a study conducted in African-American and Latino children in inner-city Los Angeles [ 25 ].…”

“…According to a study done on African-American and Latino children in inner-city Los Angeles, health insurance was another factor that determined incomplete immunization [ 25 ]. Furthermore, the finding of this study revealed that the availability of health insurance was the determinant of incomplete immunization this was in line with a study conducted in African-American and Latino children in inner-city Los Angeles [ 25 ]. Health insurance coverage makes preventive services like vaccinations and screening programs more accessible [ 26 ].…”