Article2003

The Effectiveness of Assessment and Referral on Immunization Coverage in the Special Supplemental Nutrition Program for Women, Infants, and Children

Susan H. Ashkar · Loring G. Dales · Francisco M. Averhoff · Abigail M. Shefer · Jeffrey I. Higa · LISA A. THOMPSON +3 more

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Vaccine Coverage and Hesitancy Child and Adolescent Health Food Security and Health in Diverse Populations

Abstract

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.

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2000Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults11The names and affiliations of the Task Force members are listed on page v of this supplement and at http://www.thecommunityguide.org22Some of this material was published previously in: Shefer A, Briss P, Rodewald L, et al. Improving immunization coverage rates: an evidence-based review of the literature. Epidemiol Rev 1999;20:96–142.1999Improving Immunization Coverage Rates: An Evidence-based Review of the Literature 1990Barriers to Vaccinating Preschool Children 1998Increasing Immunization Rates Among Inner-City, African American Children 1997Maternal acculturation and childhood immunization levels among children in Latino families in Los Angeles.1998Persistent Low Immunization Coverage Among Inner-city Preschool Children Despite Access to Free Vaccine 1998Impact of a Large-Scale Immunization Initiative in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)1995The immunization of children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC). The impact of different strategies

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2013Face to face interventions for informing or educating parents about early childhood vaccination 2007Assessment of Missing Immunizations and Immunization-Related Barriers among WIC Populations at the Local Level

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