title: Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore.
abstract: OBJECTIVE
  To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization.
  
  
  METHODS
  We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers.
  
  
  METHODS
  Age-appropriate immunizations and preventive health care visits.
  
  
  RESULTS
  By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age.
  
  
  CONCLUSIONS
  Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.
authors.affiliation: Department of Maternal and Child Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
authors.forename: B
authors.initials: B
authors.lastname: Guyer
authors.forename: N
authors.initials: N
authors.lastname: Hughart
authors.forename: E
authors.initials: E
authors.lastname: Holt
authors.forename: A
authors.initials: A
authors.lastname: Ross
authors.forename: B
authors.initials: B
authors.lastname: Stanton
authors.forename: V
authors.initials: V
authors.lastname: Keane
authors.forename: N
authors.initials: N
authors.lastname: Bonner
authors.forename: D M
authors.initials: DM
authors.lastname: Dwyer
authors.forename: J S
authors.initials: JS
authors.lastname: Cwi
mesh_terms: D015142:Baltimore; D002675:Child, Preschool; D015331:Cohort Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D007115:Immunization Schedule; D008458:Measles Vaccine / Q000627:therapeutic use; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine / Q000627:therapeutic use; D011054:Poliovirus Vaccine, Inactivated / Q000627:therapeutic use; D011204:Poverty Areas; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012411:Rubella Vaccine / Q000627:therapeutic use; D015983:Selection Bias; D014504:Urban Health; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D004338:Drug Combinations; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D011054:Poliovirus Vaccine, Inactivated; D012411:Rubella Vaccine