Personal, Financial, and Structural Barriers to Immunization in Socioeconomically Disadvantaged Urban Children

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Abstract

Design

Prospective cohort study.

Setting

A large municipal teaching hospital in the Midwest.

Participants

Healthy term newborns discharged to the care of their mothers. Mothers were interviewed 24 to 72 hours postpartum regarding personal and financial barriers, and 2 years later regarding personal, financial, and structural barriers to care.

Main Outcome Measure

Vaccination status at age 2 years.

Results

Of 399 children with documented vaccination status, 47% had not received all recommended vaccinations by 2 years of age. After adjusting for mother's age, race, and education, mothers who were unmarried (adjusted odds ratio [AOR] 1.74; 95% confidence interval [CI]: 1.05, 2.90), multiparous (AOR 2.10; 95% CI: 1.26, 3.52), not coresident with the child's grandmother (AOR 1.75; 95% CI: 1.01, 3.03), had not received adequate prenatal care (AOR 1.78; 95% CI: 1.12, 2.84), or lived in poverty (AOR 2.62; 95% CI: 1.44, 4.75) were more likely to have undervaccinated children, as were mothers who perceived less satisfaction with their child's health care (AOR 1.63; 95% CI: 1.01, 2.61), less control over their lives (AOR 2.01; 95% CI: 1.03, 3.94), or more benefit of medical care to prevent vaccine-related diseases (AOR 1.76; 95% CI: 1.25, 2.48).

Conclusions

Family environment, a mother's history of prenatal care use, and financial barriers are important factors related to vaccination receipt among socioeconomically disadvantaged children at age 2 years. These factors, however, do not fully explain the variation in vaccination status. Pediatrics 1998;101:591-596.

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