KEYWORDS:
Immunization Assessment, Undervaccinated Populations, Childhood Immunization Rates

BACKGROUND:
Results of the 2000 Vaccination Coverage Survey showed for the first time since 1994 that the coverage level among minority children was significantly lower than the coverage level among caucasian children. Analyses were conducted to investigate this apparent difference.

OBJECTIVE(S):
To assess differences in the effect of the educational status of the mother, the type(s) of providers seen for immunization, Medicaid participation, and WIC participation on immunization status in two race groups (white, and black and other).

METHOD(S):
A retrospective, birth registry-based survey of 600 randomly selected children was conducted to assess the immunization status of two-year-old children. Multiple variables were evaluated using both univariate and multivariate analyses.

RESULT(S):
In the black and other race group the coverage rate was 83.7% and in the white race group it was 90.2%. In univariate analysis Medicaid participation, seeing multiple provider types, and lower educational status of the mother were also significantly associated with under-immunization. After controlling for Medicaid participation, provider type, educational status of the mother, WIC participation, and the interaction between provider type and Medicaid participation race was no longer a significant predictor of under-immunization. In the final regression model, seeing multiple provider types was the single strongest predictor of under-immunization (OR=10.73, 95% CI 3.44-33.45), followed by Medicaid participation (OR=2.86, 95% CI 1.21-6.75). WIC participation showed a protective effect (OR=0.90 95% CI 0.16-0.65). The effect of the interaction between multiple provider types and Medicaid participation will be further evaluated.

CONCLUSIONS(S):
Evaluating the multiple factors associated with under-immunization will allow programs to appropriately identify under-immunized populations and target efforts to improve immunization rates. The current research demonstrates the importance of immunization registries in improving the immunization status of children seeing multiple provider types

LEARNING OBJECTIVES:
Investigate multiple factors associated with under-immunization.