IMMUNIZATION COVERAGE AND ITS RELATIONSHIP TO PREVENTIVE HEALTH-CARE VISITS AMONG INNER-CITY CHILDREN IN BALTIMORE

Objective. To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization. Design and methods. We surveyed a rand om sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their prev entive health care visits and immunization status was obtained from me dical record audits of their health care providers. Main outcome measu res. Age-appropriate immunizations and preventive health care visits. Results. By 3 months of age, nearly 80% made an age-appropriate preven tive health visit, but by 7 months of age, less than 40% had a prevent ive visit that was age-appropriate. In the second year of life, 75% ma de a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DT P1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants w ho received their DTP1 on-time were twice as likely to be up-to-date b y 24 months of age. Conclusions. Our analyses focus attention on the p erformance of the primary health care system, especially during the fi rst 6 months of life. Many young infants are underimmunized despite ha ving age-appropriate preventive visits, health insurance coverage thro ugh Medicaid, and providers who receive free vaccine from public agenc ies. Measles vaccination coverage could be improved by initiating meas les-mumps-rubella vaccine vaccination, routinely, at 12 months among h igh risk populations.