Skip to main content

Advertisement

Log in

Determinants of Influenza Vaccination Among Young Children in an Inner-City Community

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Few studies have examined potential factors that contribute to low influenza vaccination rates among minority children. This study aimed to assess the prevalence of early childhood influenza vaccination among young black and Latino children, living in inner-city neighborhoods, and examine the effects of child, caregiver and health system factors. Secondary data analysis was performed using a survey about medical home experiences conducted from May 2007–June 2008. The study sample was limited to children ≥6 months in any influenza season prior to the 2006–2007 influenza season. Bivariate analyses and multivariable logistic regression tested associations between influenza vaccination receipt and socio-demographic and health system characteristics. One-third of children received an influenza vaccination by the end of 2006–2007 season, while only 11% received a vaccination within their first season of eligibility. Black children were more likely than Latino children to have been vaccinated (50% vs. 31%, P < 0.01) during their first few eligible seasons. Children whose mothers were older, proficient in English, and frequent users of healthcare were more likely to obtain vaccination. Child attendance at healthcare settings with immunization reminder systems was also positively correlated with influenza vaccination. Our findings suggest that initial vaccination receipt among minority children from inner-city communities might be improved by expanded influenza promotion activities targeting younger mothers or those with limited English proficiency. Strategies to increase the frequency of child’s actual contact with the medical home, such as reminder systems, may be useful in improving uptake of influenza vaccination among inner-city, minority children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Neuzil, K. M., Mellen, B. G., Wright, P. F., Mitchel, E. F., Jr., & Griffin, M. R. (2000). The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. New England Journal of Medicine, 342(4), 225–231.

    Article  PubMed  CAS  Google Scholar 

  2. Thompson, W. W., Shay, D. K., Weintraub, E., Brammer, L., Bridges, C. B., Cox, N. J., et al. (2004). Influenza-associated hospitalizations in the United States. JAMA, 292(11), 1333–1340.

    Article  PubMed  CAS  Google Scholar 

  3. Fiore, A. E., Shay, D. K., Broder, K., Iskander, J. K., Uyeki, T. M., Mootrey, G., et al. (2008). Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recommendations and Reports, 57(RR-7), 1–60.

    Google Scholar 

  4. Poehling, K. A., Edwards, K. M., Weinberg, G. A., Szilagyi, P., Staat, M. A., Iwane, M. K., et al. (2006). The underrecognized burden of influenza in young children. New England Journal of Medicine, 355(1), 31–40.

    Article  PubMed  CAS  Google Scholar 

  5. Harper, S. A., Fukuda, K., Uyeki, T. M., Cox, N. J., & Bridges, C. B. (2004). Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and Reports, 53(RR-6), 1–40.

    Google Scholar 

  6. Ampofo, K., Gesteland, P. H., Bender, J., Mills, M., Daly, J., Samore, M., et al. (2006). Epidemiology, complications, and cost of hospitalization in children with laboratory-confirmed influenza infection. Pediatrics, 118(6), 2409–2417.

    Article  PubMed  Google Scholar 

  7. Interim results: state-specific influenza vaccination coverage–United States, August 2010-February 2011. (2011). MMWR Morb Mortal Wkly Rep, 60(22), 737–743.

  8. Results from the March 2011 National Flu Survey–United States, 2010-11 Influenza Season. (2011). Retrieved August 18, 2011, from http://www.cdc.gov/flu/pdf/vaccination/fluvacsurvey.pdf.

  9. Guyer, B., Hughart, N., Holt, E., Ross, A., Stanton, B., Keane, V., et al. (1994). Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore. Pediatrics, 94(1), 53–58.

    PubMed  CAS  Google Scholar 

  10. Ryan, S., Riley, A., Kang, M., & Starfield, B. (2001). The effects of regular source of care and health need on medical care use among rural adolescents. Archives of Pediatrics and Adolescent Medicine, 155, 184–190.

    PubMed  CAS  Google Scholar 

  11. Lieu, T. A., Black, S. B., Ray, P., Chellino, M., Shinefield, H. R., & Adler, N. E. (1994). Risk factors for delayed immunization among children in an HMO. American Journal of Public Health, 84(10), 1621–1625.

    Article  PubMed  CAS  Google Scholar 

  12. Smith, P. J., Santoli, J. M., Chu, S. Y., Ochoa, D. Q., & Rodewald, L. E. (2005). The association between having a medical home and vaccination coverage among children eligible for the vaccines for children program. Pediatrics, 116(1), 130–139.

    Article  PubMed  Google Scholar 

  13. Allred, N. J., Wooten, K. G., & Kong, Y. (2007). The association of health insurance and continuous primary care in the medical home on vaccination coverage for 19- to 35-month-old children. Pediatrics, 119(Suppl 1), S4–S11.

    Article  PubMed  Google Scholar 

  14. Bundt, T. S., & Hu, H. M. (2004). National examination of compliance predictors and the immunization status of children: Precursor to a developmental model for health systems. Military Medicine, 169(10), 795–803.

    PubMed  Google Scholar 

  15. Gore, P., Madhavan, S., Curry, D., McClung, G., Castiglia, M., Rosenbluth, S. A., et al. (1999). Predictors of childhood immunization completion in a rural population. Social Science and Medicine, 48(8), 1011–1027.

    Article  PubMed  CAS  Google Scholar 

  16. Stokely, S., Philip, S. J., Klevens, M., & Battaglia, M. P. (2001). Vaccination status of children living in rural areas in the United States: Are they protected? American Journal of Preventive Medicine, 20, 55–60.

    Article  Google Scholar 

  17. Daniels, D., Jiles, R. B., Klevens, R. M., & Herrera, G. A. (2001). Under vaccinated African-American preschoolers: A case of missed opportunities. American Journal of Preventative Medicine, 20(4 Suppl), 61–68.

    Article  CAS  Google Scholar 

  18. Luman, E. T., & Chu, S. Y. (2009). When and why children fall behind with vaccinations: Missed visits and missed opportunities at milestone ages. American Journal of Preventative Medicine, 36(2), 105–111.

    Article  Google Scholar 

  19. Rosenthal, J., Rodewald, L., McCauley, M., Berman, S., Irigoyen, M., Sawyer, M., et al. (2004). Immunization coverage levels among 19- to 35-month-old children in 4 diverse, medically underserved areas of the United States. Pediatrics, 113(4), e296–e302.

    Article  PubMed  Google Scholar 

  20. Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208–220.

    PubMed  CAS  Google Scholar 

  21. Stockwell, M. S., Irigoyen, M., Martinez, R. A., & Findley, S. (2011). How parents’ negative experiences at immunization visits affect child immunization status in a community in New York City. Public Health Reports, 126(Suppl 2), 24–32.

    PubMed  Google Scholar 

  22. Olson, E. C., Van Wye, G., Kerker, B., Thorpe, L., & Frieden, T. R. (2006). Take care central Harlem. New York City Department of Health and Mental Hygeine. Retrieved from http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-302.pdf.

  23. Olson, E. C., Van Wye, G., Kerker, B., Thorpe, L., & Frieden, T. R. (2006). Take Care Inwood and Washington Heights. New York City Department of Health and Mental Hygeine. Retrieved from http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-301.pdf.

  24. Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health: Data resource center [cited 2011 Aug 26]. Available from: URL: http://www.nschdata.org.

  25. Flores, G., Abreu, M., & Tomany-Korman, S. C. (2005). Limited English proficiency, primary language at home, and disparities in children’s health care: How language barriers are measured matters. Public Health Reports, 120(4), 418–430.

    PubMed  Google Scholar 

  26. Flores, G., & Tomany-Korman, S. C. (2008). The language spoken at home and disparities in medical and dental health, access to care, and use of services in US children. Pediatrics, 121(6), e1703–e1714.

    Article  PubMed  Google Scholar 

  27. Weathers, A. C., Novak, S. P., Sastry, N., & Norton, E. C. (2008). Parental nativity affects children’s health and access to care. Journal of Immigrant and Minority Health, 10(2), 155–165.

    Article  PubMed  Google Scholar 

  28. Policy statement: Organizational principles to guide and define the child health care system and/or improve the health of all children. (2004). Pediatrics, 113(5 Suppl), 1545–1547.

  29. Starfield, B., & Shi, L. (2004). The medical home, access to care and insurance: A review of the evidence. Pediatrics, 113(5), 1493–1498.

    PubMed  Google Scholar 

  30. Bardenheier, B. H., Yusuf, H. R., Rosenthal, J., Santoli, J. M., Shefer, A. M., Rickert, D. L., et al. (2004). Factors associated with under immunization at 3 months of age in four medically underserved areas. Public Health Reports, 119(5), 479–485.

    Article  PubMed  Google Scholar 

  31. Poehling, K. A., Fairbrother, G., Zhu, Y., Donauer, S., Ambrose, S., Edwards, K. M., et al. (2010). Practice and child characteristics associated with influenza vaccine uptake in young children. Pediatrics, 126(4), 665–673.

    Article  PubMed  Google Scholar 

  32. Chen, M. F., Wang, R. H., Schneider, J. K., Tsai, C. T., Jiang, D. D., Hung, M. N., et al. (2011). Using the Health Belief Model to understand caregiver factors influencing childhood influenza vaccinations. Journal of Community Health Nursing, 28(1), 29–40.

    Article  PubMed  CAS  Google Scholar 

  33. Characteristics associated with seasonal influenza vaccination of preschool children—Oregon, 2006–2008. (2011). MMWR Morb Mortal Wkly Rep, 60, 981–984.

    Google Scholar 

  34. Kim, S. S., Frimpong, J. A., Rivers, P. A., & Kronenfeld, J. J. (2007). Effects of maternal and provider characteristics on up-to-date immunization status of children aged 19–35 months. American Journal of Public Health, 97(2), 259–266.

    Article  PubMed  Google Scholar 

  35. Ku, L., & Waidmann, T. (2003). How race/ethnicity, immigration status, and language affect health insurance coverage, access to and quality of care among the low-income population. Kaiser Family Foundation.

  36. Brugge, D., Edgar, T., George, K., Heung, J., & Laws, M. B. (2009). Beyond literacy and numeracy in patient provider communication: Focus groups suggest roles for empowerment, provider attitude and language. BMC Public Health, 9, 354.

    Article  PubMed  Google Scholar 

  37. Nowalk, M. P., Zimmerman, R. K., Lin, C. J., Ko, F. S., Raymund, M., Hoberman, A., et al. (2005). Parental perspectives on influenza immunization of children aged 6–23 months. American Journal of Preventative Medicine, 29(3), 210–214.

    Article  Google Scholar 

  38. Sanders, L. M., Thompson, V. T., & Wilkinson, J. D. (2007). Caregiver health literacy and the use of child health services. Pediatrics, 119(1), e86–e92.

    Article  PubMed  Google Scholar 

  39. Smith, P., Chu, S., & Barker, L. (2004). Children who have received no vaccines: Who are they and where do they live? Pediatrics, 114(1), 187–195.

    Article  PubMed  Google Scholar 

  40. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.

    Article  PubMed  CAS  Google Scholar 

  41. Fitch, P., & Racine, A. (2004). Parental beliefs about vaccination among an ethnically diverse inner-city population. Journal of the National Medical Association, 96(8), 1047–1050.

    PubMed  Google Scholar 

  42. Taylor, J. A., Darden, P. M., Slora, E., Hasemeier, C. M., Asmussen, L., & Wasserman, R. (1997). The influence of provider behavior, parental characteristics, and a public policy initiative on the immunization status of children followed by private pediatricians: A study from pediatric research in office settings. Pediatrics, 99(2), 209–215.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Omolara T. Uwemedimo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uwemedimo, O.T., Findley, S.E., Andres, R. et al. Determinants of Influenza Vaccination Among Young Children in an Inner-City Community. J Community Health 37, 663–672 (2012). https://doi.org/10.1007/s10900-011-9497-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-011-9497-9

Keywords

Navigation