Influence of family functioning and income on vaccination in inner-city health centers

R. K. Zimmerman, E. R. Ahwesh, T. A. Mieczkowski, B. Block, J. E. Janosky and D. W. Barker
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh (Pa), USA.

OBJECTIVES: To assess family functioning and consumer decision-making about vaccinations and to compare the results with age at vaccination. DESIGN: Self-administered survey that was mailed to parents with comparison to vaccination records from chart audits. SETTINGS: Two inner-city health centers in Pittsburgh, Pa, that receive free vaccine supplies. PARTICIPANTS: Systematic sample from the billing computer records of parents whose children were aged 2 to 4 years as of July 2, 1993. INTERVENTIONS: The survey used simplified versions of the Family Profile and the Triandis model of consumer decision-making that includes perceived consequences of vaccinations, attitude about vaccinations, social influences, and facilitating conditions (eg, ease of obtaining an appointment). MAIN OUTCOME MEASURES: Variables associated with age at vaccination for third diphtheria and tetanus toxoids and pertussis vaccine immunization and first measles-mumps-rubella immunization. RESULTS: Of 395 families, 167 responded. Higher family dysfunction scores and lower family concordance scores each were associated with receiving first measles-mumps-rubella vaccination (P < or = .02) and third diphtheria and tetanus toxoids and pertussis vaccination (P < = .02) at later ages. Many (30%-54%) of the respondents reported that they knew little about the risks and benefits of vaccination. However, knowledge about vaccines was not associated with vaccination status. Those respondents with an annual income of less than $10000 received the first measles-mumps-rubella vaccination later than those with an annual income $10000 or greater (P < .02) when the data were analyzed by age at vaccination but not when the data were analyzed as on-time vs late vaccinations. CONCLUSIONS: To increase vaccination rates in innercity clinics, strategies need to consider family dysfunction and income and not merely focus on education. The use of age at vaccination as a continuous variable offers advantages over the dichotomy of immunized vs not immunized.

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