The role of state policies and programs in buffering the effects of poverty on children's immunization receipt

Objectives. This study assessed the influence of public policies on the imm unization status of 2-year-old children in the United States. Methods. Up-to-dateness for the primary immunization series was assessed il l a national sample of 8100 children from the 1988 National Maternal and In fant Health Survey and its 1991 Longitudinal Follow-Up. Results. Documented immunization rates of this sample were 33% for poor chi ldren and 44% for others. More widespread Medicaid coverage was associated with greater likelihood of up-to-dateness among poor children. Up-to-datene ss was more likely for poor children with public rather than private source s of routine pediatric care, bur all children living in states where most i mmunizations were delivered in the public sector were less likely to be up to date. Poor children in states with partial vaccine replacement programs were less likely to be up to date than those II free-market purchase states . Conclusions. While state policies can enhance immunization delivery for poo l children, heavy reliance on public sector immunization does not ensure ti mely receipt of vaccines. Public- and private-sector collaboration is neces sary to protect children from vaccine-preventable diseases.