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  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Henry D. Mustin, MD, MPH; Victoria L. Holt, PhD; Frederick A. Connell, MD, MPH

JAMA. 1994;272(14):1111-1115.

Abstract
Objective.
—To determine adequacy of preventive care for US infants, including both well-child care visits and immunizations, and to identify risk factors for inadequate receipt of care.

Design.
—Analysis of the 1988 National Maternal and Infant Health Survey of the National Center for Health Statistics.

Sample.
—Nationally representative sample of all US children born in 1988.

Participants.
—A total of 7035 infants from a live-birth subsample who were at least 8 months of age and living with their mothers at the time of the survey.

Main Outcome Measures.
—Percentage of children receiving both adequate well-child visits and adequate immunizations by 8 months of age.

Results.
—Adequate visits were received by 82% of white infants and 75% of black infants; adequate immunizations were received by 46% and 34%, respectively. Forty-two percent of white infants and 29% of black infants received both. Sixty percent of infants who did not have adequate immunizations by 8 months of age had at least three well-baby visits. With adjustment for maternal education level, poor white children had a relative risk of 1.5 of receiving inadequate care compared with infants in families with income greater than 185% of the federal poverty level. Infants with Medicaid or other government assistance had significantly lower levels of adequate care than did infants with private insurance.

Conclusions.
—This study demonstrates a wide gap between actual immunization coverage levels and recommended levels among US infants born in 1988. Public health agencies, Medicaid programs, and primary care providers should explore ways to take better advantage of well-child visits that are already occurring to achieve appropriate levels of immunization coverage.

(JAMA. 1994;272:1111-1115)

Author Affiliations
From the Departments of Health Services (Drs Mustin, Holt, and Connell) and Epidemiology (Dr Holt), School of Public Health and Community Medicine, University of Washington, Seattle.

Footnotes
Reprint requests to Department of Health Services, School of Public Health and Community Medicine, University of Washington, SC-37, Seattle, WA 98195 (Dr Mustin).

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

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Association Between Having a Medical Home and Vaccination Coverage Among Children Eligible for the Vaccines for Children Program
Smith et al.
Pediatrics 2005;116:130-139.
ABSTRACT | FULL TEXT  

Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population: A Cluster Randomized Controlled Trial
Hambidge et al.
Arch Pediatr Adolesc Med 2004;158:162-169.
ABSTRACT | FULL TEXT  

Well-Child Care: Effectiveness of Current Recommendations
Dinkevich and Ozuah
CLIN PEDIATR 2002;41:211-217.
ABSTRACT  

Parental Perceptions of Well-Child Care Visits in an Inner-city Clinic
Busey et al.
Arch Pediatr Adolesc Med 2002;156:62-66.
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  

Vaccination Coverage and Physician Distribution in the United States, 1997
LeBaron et al.
Pediatrics 2001;107:31e-31.
ABSTRACT | FULL TEXT  

Determination of Up-to-Date Vaccination Status for Preschool-Aged Children: How Accurate Is Manual Assessment Conducted by Paraprofessional Staff?
Shefer et al.
Pediatrics 2000;106:493-496.
ABSTRACT | FULL TEXT  

Parental Prevention Practices for Young Children in the Context of Maternal Depression
McLennan and Kotelchuck
Pediatrics 2000;105:1090-1095.
ABSTRACT | FULL TEXT  

The Impact of a Pediatric Medical Home on Immunization Coverage
Ortega et al.
CLIN PEDIATR 2000;39:89-96.
ABSTRACT  

How Much Time Is Spent on Well-Child Care and Vaccinations?
LeBaron et al.
Arch Pediatr Adolesc Med 1999;153:1154-1159.
ABSTRACT | FULL TEXT  

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

Impact of North Carolina's Universal Vaccine Purchase Program by Children's Insurance Status
Freed et al.
Arch Pediatr Adolesc Med 1999;153:748-754.
ABSTRACT | FULL TEXT  

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

Impact of Community Volunteers on Immunization Rates of Children Younger Than 2 Years
Barnes et al.
Arch Pediatr Adolesc Med 1999;153:518-524.
ABSTRACT | FULL TEXT  

Association Between Licensing Examination Scores and Resource Use and Quality of Care in Primary Care Practice
Tamblyn et al.
JAMA 1998;280:989-996.
ABSTRACT | FULL TEXT  

Comparing Generalist and Specialty Care: Discrepancies, Deficiencies, and Excesses
Donohoe
Arch Intern Med 1998;158:1596-1608.
ABSTRACT | FULL TEXT  

Use of Public Immunization Services After Initiation of a Universal Vaccine Purchase Program
Clark and Freed
Arch Pediatr Adolesc Med 1998;152:642-645.
ABSTRACT | FULL TEXT  

The Association Between Adequacy of Prenatal Care Utilization and Subsequent Pediatric Care Utilization in the United States
Kogan et al.
Pediatrics 1998;102:25-30.
ABSTRACT | FULL TEXT  

The Impact of Interventions by a Community-Based Organization on Inner-city Vaccination Coverage: Fulton County, Georgia, 1992-1993
LeBaron et al.
Arch Pediatr Adolesc Med 1998;152:327-332.
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  

Anemia and Elevated Lead Levels in Underimmunized Inner-city Children
Adams et al.
Pediatrics 1998;101 :e6-e6.
ABSTRACT | FULL TEXT  

Health Insurance and Access to Primary Care for Children
Newacheck et al.
NEJM 1998;338:513-519.
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  

Transition to a Computer-Based Record Using Scannable, Structured Encounter Forms
Shiffman et al.
Arch Pediatr Adolesc Med 1997;151:1247-1253.
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  

Physician Beliefs and Knowledge About Vaccinations: Are Cincinnati Doctors Giving Their Best Shot?
Siegel and Schubert
CLIN PEDIATR 1996;35:79-83.
ABSTRACT  

Adequacy of Well-Child Care and Immunization
Marcuse et al.
JAMA 1995;273:1580-1580.
ABSTRACT  

Adequacy of Well-Child Care and Immunization
Fragoso
JAMA 1995;273:1580-1580.
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