Well child care in the United States: racial differences in compliance with guidelines.
OBJECTIVE
This study sought to estimate the rate of compliance with American Academy of Pediatrics guidelines for well child care in the first 6 months of life and to determine risks for inadequate care.


METHODS
The study included 7776 infants whose mothers participated in both the 1988 National Maternal and Infant Health Survey and its 1991 longitudinal follow-up and whose mothers or pediatric providers supplied information about their medical care. Regression analysis was used to determine the probability of incomplete compliance with guidelines for well child care in relation to several socioeconomic risks.


RESULTS
Fifty-eight percent of White infants, 35% of African American infants, and 37% of Hispanic infants obtained all recommended well child care. African American race was the biggest risk for inadequate care (odds ratio = 1.7, 95% confidence interval = 1.5, 1.9), followed by low levels of maternal education, low income, and poor prenatal care. The risk for African American infants persisted across socioeconomic levels.


CONCLUSIONS
The racial disparities identified suggest that cultural barriers to seeking preventive care need further study and that programs aimed at reducing these barriers need to be developed.
Ronsaville
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Health Care Financing Administration, Baltimore, Md. 21244, USA. rhakim@hcfa.gov
Hakim
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D000328:Adult; D001741:Black or African American / Q000193:education / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000592:standards*; D004522:Educational Status; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006630:Hispanic or Latino / Q000193:education / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D044465:White People / Q000193:education / Q000706:statistics & numerical data*