title: Can opportunities be enhanced for vaccinating children in home visiting programs? A population-based cohort study.
abstract: BACKGROUND
  Home visiting programs focused on improving early childhood environments are commonplace in North America. A goal of many of these programs is to improve the overall health of children, including promotion of age appropriate vaccination. In this study, population-based data are used to examine the effect of a home visiting program on vaccination rates in children.
  
  
  METHODS
  Home visiting program data from Manitoba, Canada were linked to several databases, including a provincial vaccination registry to examine vaccination rates in a cohort of children born between 2003 and 2009. Propensity score weights were used to balance potential confounders between a group of children enrolled in the program (n = 4,562) and those who were eligible but not enrolled (n = 5,184). Complete and partial vaccination rates for one and two year old children were compared between groups, including stratification into area-level income quintiles.
  
  
  RESULTS
  Complete vaccination rates from birth to age 1 and 2 were higher for those enrolled in the Families First program [Average Treatment Effect Risk Ratio (ATE RR) 1.06 (95 % CI 1.03-1.08) and 1.10 (95 % CI 1.05-1.15) respectively]. No significant differences were found between groups having at least one vaccination at age 1 or 2 [ATE RR 1.01 (95 % CI 1.00-1.02) and 1.00 (95 % CI 1.00-1.01) respectively). The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile.
  
  
  CONCLUSIONS
  Home visiting programs have the potential to increase vaccination rates for children enrolled, despite limited program content directed towards this end. Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness.
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Michael.Isaac@gov.mb.ca.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Isaac
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Mariette_Chartier@cpe.umanitoba.ca.
authors.forename: Mariette
authors.initials: M
authors.lastname: Chartier
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Marni_Brownell@cpe.umanitoba.ca.
authors.forename: Marni
authors.initials: M
authors.lastname: Brownell
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Dan_Chateau@cpe.umanitoba.ca.
authors.forename: Dan
authors.initials: D
authors.lastname: Chateau
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Nathan_Nickel@cpe.umanitoba.ca.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Nickel
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Pat_Martens@cpe.umanitoba.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: Martens
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Akatz@cpe.umanitoba.ca.
authors.forename: Alan
authors.initials: A
authors.lastname: Katz
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Joykrishna_Sarkar@cpe.umanitoba.ca.
authors.forename: Joykrishna
authors.initials: J
authors.lastname: Sarkar
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Milton_Hu@cpe.umanitoba.ca.
authors.forename: Milton
authors.initials: M
authors.lastname: Hu
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Elaine_Burland@cpe.umanitoba.ca.
authors.forename: Elaine
authors.initials: E
authors.lastname: Burland
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. ChunYan_Goh@cpe.umanitoba.ca.
authors.forename: ChunYan
authors.initials: C
authors.lastname: Goh
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. Carole_Taylor@cpe.umanitoba.ca.
authors.forename: Carole
authors.initials: C
authors.lastname: Taylor
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006301:Health Services Needs and Demand; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008350:Manitoba; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*