This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (98)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Ann S. Bates, MD, MPH; John F. Fitzgerald, MD, MBA; Robert S. Dittus, MD, MPH; Fredric D. Wolinsky, PhD

JAMA. 1994;272(14):1105-1110.

Abstract
Objective.
—To assess risk factors for underimmunization in poor urban infants.

Design.
—Prospective cohort study.

Setting.
—A large municipal teaching hospital in the Midwest.

Participants.
—A total of 464 healthy, full-term newborn infants delivered at a large municipal teaching hospital who were to be discharged to the care of their mothers. Mothers were interviewed 24 to 72 hours post partum regarding personal and financial characteristics and 9 to 12 months later to determine where immunizations had been received.

Main Outcome Measures.
—Immunization status at 3 and 7 months of age.

Results.
—Despite availability of free vaccine to most patients, only 67% had received their first set of immunizations by 3 months of age, and only 29% were up-to-date by 7 months of age. Marital status, coresidence with the infant's grandmother, adequacy of prenatal care, and perceived barriers to care were significant independent predictors of initiation of immunizations by 3 months and completion of immunization by 7 months. Poverty was also an independent predictor of immunization status at 7 months. Perceived susceptibility to common symptoms and perceived benefit of medical care to prevent disease were inversely related to immunization status at 7 months.

Conclusions.
— These data suggest that poor urban infants of single mothers and of mothers who received inadequate prenatal care, and those not living with their grandmother should be targeted for tracking and follow-up to ensure adequate immunization. The provision of free vaccine alone will not guarantee adequate immunization coverage of poor urban children.

(JAMA. 1994;272:1105-1110)

Author Affiliations
From the Departments of Pediatrics (Dr Bates) and Medicine (Drs Fitzgerald, Dittus, and Wolinsky), Indiana University School of Medicine, Regenstrief Institute for Health Care (Drs Bates, Fitzgerald, Dittus, and Wolinsky), Richard L. Roudebush Veterans Administration Medical Center (Drs Fitzgerald and Dittus), and Bowen Research Center (Dr Dittus), Indianapolis, Ind.

Footnotes
The contents of this article reflect the opinions of the authors and not the official opinion of any funding agency.

Reprint requests to Regenstrief Institute, 1001 W 10th St, Floor 5, Indianapolis, IN 46202 (Dr Bates).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Spatial Accessibility to Providers and Vaccination Compliance Among Children With Medicaid
Fu et al.
Pediatrics 2009;124:1579-1586.
ABSTRACT | FULL TEXT  

A hierarchical analysis of social determinants of measles vaccination coverage in Austrian schoolchildren
Stronegger and Freidl
Eur J Public Health 2009;0:ckp188v1-ckp188.
ABSTRACT | FULL TEXT  

Maternal employment and indicators of child health: a systematic review in pre-school children in OECD countries
Mindlin et al.
J. Epidemiol. Community Health 2009;63:340-350.
ABSTRACT | FULL TEXT  

Linking Mother and Child Access to Dental Care
Grembowski et al.
Pediatrics 2008;122:e805-e814.
ABSTRACT | FULL TEXT  

Media Coverage of the Measles-Mumps-Rubella Vaccine and Autism Controversy and Its Relationship to MMR Immunization Rates in the United States
Smith et al.
Pediatrics 2008;121:e836-e843.
ABSTRACT | FULL TEXT  

Parental Satisfaction With Early Pediatric Care and Immunization of Young Children: The Mediating Role of Age-Appropriate Well-Child Care Utilization
Schempf et al.
Arch Pediatr Adolesc Med 2007;161:50-56.
ABSTRACT | FULL TEXT  

Identifying Factors Predicting Immunization Delay for Children Followed in an Urban Primary Care Network Using an Electronic Health Record
Fiks et al.
Pediatrics 2006;118:e1680-e1686.
ABSTRACT | FULL TEXT  

Impact of State Vaccine Financing Policy on Uptake of Heptavalent Pneumococcal Conjugate Vaccine
Stokley et al.
AJPH 2006;96:1308-1313.
ABSTRACT | FULL TEXT  

Parental Attitudes About Sexually Transmitted Infection Vaccination for Their Adolescent Children
Zimet et al.
Arch Pediatr Adolesc Med 2005;159:132-137.
ABSTRACT | FULL TEXT  

Are Parental Vaccine Safety Concerns Associated With Receipt of Measles-Mumps-Rubella, Diphtheria and Tetanus Toxoids With Acellular Pertussis, or Hepatitis B Vaccines by Children?
Bardenheier et al.
Arch Pediatr Adolesc Med 2004;158:569-575.
ABSTRACT | FULL TEXT  

Effectiveness of Individually Tailored Calendars in Promoting Childhood Immunization in Urban Public Health Centers
Kreuter et al.
AJPH 2004;94:122-127.
ABSTRACT | FULL TEXT  

Association Between Parents' Preferences and Perceptions of Barriers to Vaccination and the Immunization Status of Their Children: A Study From Pediatric Research in Office Settings and the National Medical Association
Taylor et al.
Pediatrics 2002;110:1110-1116.
ABSTRACT | FULL TEXT  

Reducing Geographic, Racial, and Ethnic Disparities in Childhood Immunization Rates by Using Reminder/Recall Interventions in Urban Primary Care Practices
Szilagyi et al.
Pediatrics 2002;110:e58-58.
ABSTRACT | FULL TEXT  

Visiting Multiple Sites for Immunization and Vaccine Coverage Levels of Preschool Children in 3 Urban Clinics: Potential Indicator of Record Scatter?
Joseph et al.
CLIN PEDIATR 2002;41:249-256.
ABSTRACT  

The Influence of Grandmothers and Other Senior Caregivers on Sleep Position Used by African American Infants
Flick et al.
Arch Pediatr Adolesc Med 2001;155:1231-1237.
ABSTRACT | FULL TEXT  

Prevalence and Predictors of Immunization Among Inner-City Infants: A Birth Cohort Study
Brenner et al.
Pediatrics 2001;108:661-670.
ABSTRACT | FULL TEXT  

A Simple Provider-Based Educational Intervention to Boost Infant Immunization Rates: A Controlled Trial
Stille et al.
CLIN PEDIATR 2001;40:365-373.
ABSTRACT  

Effects of Medicaid Managed Care on Quality: Childhood Immunizations
Alessandrini et al.
Pediatrics 2001;107:1335-1342.
ABSTRACT | FULL TEXT  

Delays in Receipt of Immunizations in Low-Birth-Weight Children: A Nationally Representative Sample
Langkamp et al.
Arch Pediatr Adolesc Med 2001;155:167-172.
ABSTRACT | FULL TEXT  

Patterns Of Insurance Coverage Within Families With Children
Hanson
Health Aff (Millwood) 2001;20:240-246.
ABSTRACT | FULL TEXT  

Effect of Different Types of Medicaid Managed Care on Childhood Immunization Rates
Cotter et al.
Eval Health Prof 2000;23:397-408.
ABSTRACT  

Association Between Administration of Hepatitis B Vaccine at Birth and Completion of the Hepatitis B and 4:3:1:3 Vaccine Series
Yusuf et al.
JAMA 2000;284:978-983.
ABSTRACT | FULL TEXT  

Effect of a Monetary Sanction on Immunization Rates of Recipients of Aid to Families With Dependent Children
Kerpelman et al.
JAMA 2000;284:53-59.
ABSTRACT | FULL TEXT  

Low immunisation uptake: Is the process the problem?
Harrington et al.
J. Epidemiol. Community Health 2000;54:394-394.
ABSTRACT | FULL TEXT  

Strategies to Sustain Success in Childhood Immunizations
The National Vaccine Advisory Committee
JAMA 1999;282:363-370.
ABSTRACT | FULL TEXT  

Characteristics of Families Who Attend Free Vaccine Fairs
Hambidge et al.
Pediatrics 1999;104:158-163.
ABSTRACT | FULL TEXT  

Reconfiguring Child Health Services in the Inner City
Wood and Halfon
JAMA 1998;280:1182-1183.
FULL TEXT  

Prevalence and Predictors of the Prone Sleep Position Among Inner-city Infants
Brenner et al.
JAMA 1998;280:341-346.
ABSTRACT | FULL TEXT  

Personal, Financial, and Structural Barriers to Immunization in Socioeconomically Disadvantaged Urban Children
Bates and Wolinsky
Pediatrics 1998;101:591-596.
ABSTRACT | FULL TEXT  

Reducing Missed Opportunities to Vaccinate During Child Health Visits: How Effective Are Parent Education and Case Management?
Wood et al.
Arch Pediatr Adolesc Med 1998;152:238-243.
ABSTRACT | FULL TEXT  

Health Care and Hospitalizations of Young Children Born to Cocaine-Using Women
Forsyth et al.
Arch Pediatr Adolesc Med 1998;152:177-184.
ABSTRACT | FULL TEXT  

A Population-based Study of Access to Immunization Among Urban Virginia Children Served By Public, Private, and Military Health Care Systems
Morrow et al.
Pediatrics 1998;101 :e5-e5.
ABSTRACT | FULL TEXT  

Increasing Immunization Rates Among Inner-City, African American Children: A Randomized Trial of Case Management
Wood et al.
JAMA 1998;279:29-34.
ABSTRACT | FULL TEXT  

Vapocoolant Spray Is Equally Effective as EMLA Cream in Reducing Immunization Pain in School-aged Children
Cohen Reis and Holubkov
Pediatrics 1997;100:e5-e5.
ABSTRACT | FULL TEXT  

Welfare Reform and the Obstetrical Care of Immigrants and Their Newborns
Minkoff et al.
NEJM 1997;337:705-707.
FULL TEXT  

The Effect of Epidemic Measles on Immunization Rates
Goldstein et al.
JAMA 1996;276:56-58.
ABSTRACT  

The Impact of the Vaccine for Children's Program on Child Immunization Delivery: A Policy Analysis
Wood and Halfon
Arch Pediatr Adolesc Med 1996;150:577-581.
ABSTRACT  

SERIOUS GAPS IN CHILDHOOD IMMUNIZATION
JWatch General 1994;1994:1-1.
FULL TEXT  

Crossing the Divide From Vaccine Technology to Vaccine Delivery: The Critical Role of Providers
Orenstein and Bernier
JAMA 1994;272:1138-1139.
ABSTRACT