BACKGROUND:
Little information exists regarding immunization coverage levels of African American (AA) children in Los Angeles County (LAC). 2001 California Kindergarten Retrospective Survey data show that 4:3:1 series completion at 24 months of age was lowest among LAC AA toddlers (52%), compared to Whites (71%), Hispanics (72%) and Asians (80%). “Cluster survey” methodology was used to estimate current immunization coverage levels.

OBJECTIVE:
Estimate immunization coverage levels for LAC AA children 2-3 years old; identify factors influencing immunization completion; and assess guardian’s immunization knowledge, attitudes, and practices.

METHOD:
Five LAC zip codes with a high percentage of AA residents (identified using Census 2000 data) were divided into 51 clusters (groups of randomly selected blocks). From July to December 2002 staff identified all AA children 2-3 years old in each cluster through door-to-door visits. Ten children were randomly selected from each cluster. Each child’s immunization record was reviewed while each guardian completed a survey.

RESULT:
Out of 533 guardians, 68% participated, 14% refused, 7% moved, and 11% were “other.” Most children (98.9%) were immunized, 88.8% by a pediatrician. 4:3:1 coverage level was 73.5%. Having the immunization record and being immunized by a pediatrician were associated with higher completion rates. Lack of transportation was a common barrier. Forty-three percent of guardians identified four or more vaccine preventable diseases, 82.6% identified doctors as their source of immunization information, and 55.6% relied on doctors to tell them when their child’s next immunization was due.

CONCLUSION:
Immunization rates were better than expected. Guardians had positive attitudes towards immunizations. Immunization interventions should focus on reducing access barriers and educating parents about immunization timing. Data also supports enhancing provider education, especially with non-pediatricians.

LEARNING OBJECTIVES:
To understand application of cluster survey methodology. To identify factors influencing immunization coverage levels in the LAC AA community.