Learning Objectives for this Presentation:
By the end of the presentation participants will be able to outline steps needed to develop a community-based immunization promotion program.

Background:
Immunization disparities for children in communities of color widened during the 1996-2001 period. Evidence shows that the most effective strategies for the reduction of immunization disparities have been comprehensive and multi-faceted, with a mixture of provider strategies with community outreach. Little research has been reported on the effectiveness of community-owned and community-based strategies for promoting immunizations.

Objectives:
Demonstrate how community-based immunization promotion reduced childhood immunization disparities.

Methods:
A community-wide coalition integrated immunization promotion into existing services. In 2002-2004, 3,748 children <5 were enrolled, of whom 1502 were 19-35 months old in April 2004. Disparity reduction was assessed by comparing coalition immunization coverage rates (4:3:1:3:3 series) with those of the National Immunization Survey 2003. Logistic regression was used to assess factors contributing to up-to-date immunizations.

Results:
Coverage increased from 46% at enrollment to 80.5%, not significantly different from nationwide rates for all (t=0.87) or white (t=1.99) children. African Americans in the Start Right program (n=281) achieved 78% coverage, significantly higher than 73% for US African American children (t=2.90); Latinos (n=1221) had a 84% rate, significantly higher than 77% for US Latinos (t=2.32). Being current with age-appropriate immunizations at enrollment (OR = 9.8), Latino ethnicity (OR = 1.6), participation through facilitated child health insurance enrollment (OR =4.9), WIC (OR = 3.1) and child care or parenting (OR = 1.9) programs increased immunization coverage.

Conclusions:
A community-based program which embedded immunization promotion into existing programs was successful in eliminating immunization disparities. The most effective programs were those with a direct linkage to health care systems or targeting young children.