A MODEL IMMUNIZATION DEMONSTRATION FOR PRESCHOOLERS IN AN INNER-CITY BARRIO, SAN-DIEGO, CALIFORNIA, 1992-1994

An immunization demonstration project was conducted in an inner-city L atino neighborhood in San Diego to address underimmunization of childr en of preschool age. The project attempted interventions on consumer, provider, and system levels to reduce barriers to immunization and rai se immunization rates. Free walk-in immunization clinics with emphasis on cultural sensitivity and that incorporated computerized reminder/r ecall were established. An educational series was offered to community health center (CHC) providers, and extensive community-based outreach and education took place in schools, churches, a WIC site, etc. Evalu ation activities included preintervention and postintervention provide r knowledge, attitudes, and practice surveys, CHC chart audits, and ho usehold surveys in the intervention ZIP code area and a control ZIP co de area. Immunization coverage for 4DPT, 3OPV, and 1MMR (4:3:1) among two-year-olds increased significantly from 37% to 50% overall, and to 59% in the 1991 birth cohort in the intervention area compared to a on e percentage point overall increase in the control area. Coverage impr oved significantly and missed opportunities decreased in one intervent ion CHC that participated most actively in educational inservices. Whi le the Year 2000 U.S. Public Health Service objective of 90% 4:3:1 cov erage for two-year-olds was not achieved over the 21-month course of t he project, the results approached the 1996 single-antigen objectives. This demonstration underscores the importance of multilevel intervent ions including low cost, no appointment, and culturally appropriate im munization services for the indigent; the use of computerized reminder systems; and provider assessment, education, and feedback in the effo rt to raise preschool immunization levels. Medical Subject Headings (M eSH):immunization, preschool-age children, health promotion, provider education, immunization monitoring and follow-up systems, pediatric im munization standards, household surveys.