INFLUENCE OF FAMILY FUNCTIONING AND INCOME ON VACCINATION IN INNER-CITY HEALTH CENTERS

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 comp arison to vaccination records from chart audits. Settings: Two inner-c ity health centers in Pittsburgh, Pa, that receive free vaccine suppli es. Participants: Systematic sample from the billing computer records of parents whose children were aged 2 to 4 years as of July 2, 1993. I nterventions: The survey used simplified versions of the Family Profil e and the Triandis model of consumer decision-making that includes per ceived consequences of vaccinations, attitude about vaccinations, soci al influences, and facilitating conditions (eg, ease of obtaining an a ppointment). Main Outcome Measures: Variables associated with age at v accination for third diphtheria and tetanus toxoids and pertussis vacc ine 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 f irst measles-mumps-rubella vaccination (P less than or equal to.02) an d third diphtheria and tetanus toxoids and pertussis vaccination (P le ss than or equal to.02) at later ages. Many (30%-54%) of the responden ts reported that they knew little about the risks and benefits of vacc ination. However, knowledge about vaccines was not associated with vac cination status. Those respondents with an annual income of less than $10 000 received the first measles-mumps-rubella vaccination later tha n those with an annual income $10 000 or greater (P<.02) when the data were analyzed by age at vaccination but not when the data were analyz ed as on-time vs late vaccinations. Conclusions: To increase vaccinati on rates in inner-city clinics, strategies need to consider family dys function and income and not merely focus on education. The use of age at vaccination as a continuous variable offers advantages over the dic hotomy of immunized vs not immunized.