Susmita Pati1, Jiayu Huang1, Angie Wong1, Zeinab Baba2, Svetlana Ostapenko2, Alexander G Fiks2,3,4, Avital Cnaan5. 1. a Division of Primary Care Pediatrics , State University of New York at Stony Brook , Stony Brook , NY , USA. 2. b Division of General Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , PA , USA. 3. c Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania , Philadelphia , PA , USA. 4. d Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia , PA , USA. 5. e Center for Clinical and Translational Science, Children's National Health System , Washington , DC , USA.
Abstract
INTRODUCTION: Low-income child populations remain under-vaccinated. Our objective was to determine differences in the relative importance of maternal health literacy and socio-demographic characteristics that often change during early childhood on up-to-date (UTD) immunization status among a low-income population. METHODS: We performed secondary data analysis of a longitudinal prospective cohort study of 744 Medicaid-eligible mother-infant dyads recruited at the time of the infant's birth from an inner-city hospital in the United States and surveyed every 6 months for 24 months. Our primary outcome was infant UTD status at 24 months abstracted from a citywide registry. We assessed maternal health literacy with the Test of Functional Health Literacy in Adults (short version). We collected socio-demographic information via surveys at birth and every 6 months. We compared predictors of UTD status at 3, 7, and 24 months. RESULTS: The cohort consisted of primarily African-American (81.5%) mothers with adequate health literacy (73.9%). Immunizations were UTD among 56.7% of infants at 24 months of age. Maternal health literacy was not a significant predictor of UTD immunization status. Instead, adjusted results showed that significant predictors of not-UTD status at 24 months were lack of a consistent health care location or "medical home" (OR 0.17, 95%CI 0.18-0.37), inadequate prenatal care (OR 0.48, 95%CI 0.25-0.95), and prior not-UTD status (OR 0.31, 95%CI 0.20-0.47). Notably, all upper confidence limits are less than 1.0 for these variables. Health care location type (e.g., hospital-affiliate, community-based, none) was a significant predictor of vaccine status at age 3 months, 7 months, and 24 months. CONCLUSIONS: Investing in efforts to support early establishment of a medical home to obtain comprehensive coordinated preventive care, including providing recommended vaccines on schedule, is a prudent strategy to improve vaccination status at the population level.
INTRODUCTION: Low-income child populations remain under-vaccinated. Our objective was to determine differences in the relative importance of maternal health literacy and socio-demographic characteristics that often change during early childhood on up-to-date (UTD) immunization status among a low-income population. METHODS: We performed secondary data analysis of a longitudinal prospective cohort study of 744 Medicaid-eligible mother-infant dyads recruited at the time of the infant's birth from an inner-city hospital in the United States and surveyed every 6 months for 24 months. Our primary outcome was infant UTD status at 24 months abstracted from a citywide registry. We assessed maternal health literacy with the Test of Functional Health Literacy in Adults (short version). We collected socio-demographic information via surveys at birth and every 6 months. We compared predictors of UTD status at 3, 7, and 24 months. RESULTS: The cohort consisted of primarily African-American (81.5%) mothers with adequate health literacy (73.9%). Immunizations were UTD among 56.7% of infants at 24 months of age. Maternal health literacy was not a significant predictor of UTD immunization status. Instead, adjusted results showed that significant predictors of not-UTD status at 24 months were lack of a consistent health care location or "medical home" (OR 0.17, 95%CI 0.18-0.37), inadequate prenatal care (OR 0.48, 95%CI 0.25-0.95), and prior not-UTD status (OR 0.31, 95%CI 0.20-0.47). Notably, all upper confidence limits are less than 1.0 for these variables. Health care location type (e.g., hospital-affiliate, community-based, none) was a significant predictor of vaccine status at age 3 months, 7 months, and 24 months. CONCLUSIONS: Investing in efforts to support early establishment of a medical home to obtain comprehensive coordinated preventive care, including providing recommended vaccines on schedule, is a prudent strategy to improve vaccination status at the population level.
Authors: Alexander G Fiks; Evaline A Alessandrini; Anthony A Luberti; Svetlana Ostapenko; Xuemei Zhang; Jeffrey H Silber Journal: Pediatrics Date: 2006-11-06 Impact factor: 7.124
Authors: Barbara H Bardenheier; Hussain R Yusuf; Jorge Rosenthal; Jeanne M Santoli; Abigail M Shefer; Donna L Rickert; Susan Y Chu Journal: Public Health Rep Date: 2004 Sep-Oct Impact factor: 2.792