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The Effectiveness of Assessment and Referral on Immunization Coverage in the Special Supplemental Nutrition Program for Women, Infants, and Children
Susan H. Ashkar, MA;
Loring G. Dales, MD;
Francisco Averhoff, MD, MPH;
Abigail Shefer, MD;
Jeffrey Higa, MPH;
Lisa Thompson, MPH;
Judy Gomez, MPH, RD;
Denise C. Gee, MPH, RD;
Eric L. Hurwitz, DC, PhD
Arch Pediatr Adolesc Med. 2003;157:456-462.
Background The use of immunization assessment and referral (A/R) in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to produce dramatic improvements in vaccination coverage when coupled with parental incentive; however, data are lacking to support the use of A/R alone.
Objective To determine the effectiveness of A/R in increasing immunization coverage among WIC participants.
Design Participating WIC centers were assigned to1 of 3 interventions that delivered A/R of varying frequency or a control group.
Setting Twenty of the largest Public Health Foundation Enterprises–WIC centers in Los Angeles County.
Participants Children continuously enrolled in participating WIC centers from 6 to 24 months of age.
Intervention Assessment of child's vaccination status followed by referral to a health care provider for those lacking indicated vaccinations.
Main Outcome Measure Up-to-date (UTD) status at 24 months of age for all recommended vaccines.
Results Baseline coverage rates were similar among all study sites (overall, 77% UTD). After the study period, compared with the controls (88% UTD), we found no differences in immunization coverage among WIC centers that administered A/R at every visit (every 2 months) to all children (90% UTD; adjusted odds ratio [OR], 1.02; 95% confidence interval [CI], 0.54-1.94), every 6 months to all children (89% UTD; OR, 0.98; 95% CI, 0.62-1.56), or every visit to children found to be behind at 8 months of age (89% UTD; OR, 0.89; 95% CI, 0.48-1.68).
Conclusion In this urban population of WIC children with high baseline immunization coverage, A/R was not effective in increasing immunization coverage.
From the Department of Health Services, Public Health, Immunization Program, County of Los Angeles, Los Angeles, Calif (Mss Ashkar and Thompson and Mr Higa); the Department of Health Services, Immunization Branch, State of California, Berkeley (Dr Dales); the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Averhoff and Shefer); Public Health Foundation Enterprises, Special Supplemental Nutrition Program for Women, Infants, and Children, Irwindale, Calif (Mss Gomez and Gee); and the Department of Epidemiology, School of Public Health, University of California, Los Angeles (Dr Hurwitz). Mr Higa is now with the Department of Health Services, Infectious Diseases Branch, State of California, Gardena; Ms Thompson, the Center for Healthier Children, Families and Communities, University of California, Los Angeles.
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