BACKGROUND:
Population seeking primary care in emergency departments are underinsured and underinsured patients are at increase risk for being unimmunized.

OBJECTIVE:
To determine if differences in vaccine acceptance are related to a language barrier.

METHOD:
Design: cross-sectional. Setting: Emergency Department and Urgent Care Center (ED) of University of New Mexico Hospital, an urban tertiary care teaching hospital and regional Level 1 trauma center. Subjects: All patients presenting to the ED were asked if they were interested in speaking with someone about being immunized. Patients who agreed were interviewed by bilingual medical students to determine if they were at high risk for influenza or pneumococcal disease. Those consenting to be vaccinated and did not have a contraindication, they were vaccinated. Observations: Data elements in the risk assessment tool include language preference, age, gender, perceived need for immunization, and insurance status

RESULT:
From December 1-21, 2003, 685 patients were assessed, of whom 83.4% spoke English, and 16.6% preferred Spanish. Differences were observed in patient characteristics: patients who preferred Spanish were older (45.5 vs. 40.0 years, p<.0001), female (64% vs. 51%, P =.02) and less likely to be insured (13.4% vs. 20.8%, p= .01). Patient perception of their need for either vaccine and their likelihood to accept vaccination was not influenced by language preference or insurance. Lack of insurance predicted high risk patients not already vaccinated for influenza (OR 2.8, 95%CI 1.7-4.7) or pneumococcal disease (OR 4.3, 95% CI 2.2-8.8). Patients’ insurance status did not affect their willingness to be vaccinated.

CONCLUSION:
Latinos, whether or not they prefer to speak Spanish, have equal vaccine coverage. Only insurance status affected prior vaccination in high risk groups. Insurance status and patient preference seem to be the barrier to immunization rather than language in the Spanish-speaking community.

LEARNING OBJECTIVES:
Latinos, whether or not they prefer to speak Spanish, have equal vaccine coverage. Only insurance status affected prior vaccination in high risk groups. Insurance status and patient preference seem to be the barrier to immunization rather than language in the Spanish-speaking community.