Failure to Return: Parental, Practice and Community Factors Affecting Missed Immunization Visits for Young, Urban Children

Background: Multiple factors are associated with underimmunization at sentinel end points. Yet, it may be more useful to know what keeps young children from getting immunized between the start of the immunization process at 2 months of age and the end at 19 months. 

Objectives:To assess parental, practice and community factors influencing missed immunization visits by young, urban children.

Methods:Parents of children ≤36 months (N= 705) were surveyed at community health centers, hospital clinics, private practices and community-based organizations in New York City using open and close ended questions.  Key parent, practice and community factors having significant bivariate associations (p<0.10) with parental reported missed immunization visits were included in a hierarchical logistical regression using forward stepwise selection.

Results: Families were predominately Latino and publicly insured.  One-fifth of parents missed an immunization visit.  The most commonly reported reason (62.5%) was other competing needs such as work.  On multivariable analysis, parents who rescheduled appointments (AOR 3.27, 95%CI 1.76,6.09) and had problems scheduling appointments (AOR 4.00, 95%CI 1.49,10.75) were more likely to miss a visit.  As were those who delayed giving their child a vaccine due to safety fears (AOR 3.76 95%CI 1.23,11.5) and who could not tell their provider anything (AOR 2.38 95%CI 1.05,5.36). Having friends and families with positive immunization views was protective (AOR.030  95%CI .002,.41). The final model had a predictive value of 84.4%, R² of .60 and a satisfactory Hosmer-Lemeshow Chi square statistic(.39).   Children whose parents reported missing a visit were more likely to have been underimmunized (OR 2.52 95%CI 1.42, 4.47). 

Conclusions: This study highlighted factors that can be targeted to help families keep immunization visits, thereby increasing immunization coverage: open lines of communication between family and provider, flexibility in scheduling appointments, and individual and community education regarding importance of immunizations and their safety. CDC/NCIRD U01 IP000086