IMPACT OF A LARGE-SCALE IMMUNIZATION INITIATIVE IN THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC)

Context.-Inner-city immunization rates have lagged behind those in oth er areas of the country. Objective.-To evaluate the impact of an initi ative linking immunization with distribution of food vouchers in the i nner city, Design.-Retrospective analysis of immunization data gathere d in 1996 and 1997,Setting.-Nineteen Special Supplemental Nutrition Pr ogram for Women, Infants, and Children (WIC) sites serving 30% of the Chicago, III, birth cohort, Participants.-A total of 16581 children 24 months old or younger. Interventions.-voucher incentives (varying fre quency of food voucher issuance based on immunization status) and asse ssment of immunization status and referral to immunization provider. M ain Outcome Measures.-Age-appropriate immunization rates and WIC enrol lment rates. Results.-During the 15-month period of evaluation, immuni zation rates increased from 56% to 89% at sites performing voucher inc entives. The proportion of children needing voucher incentives decline d from 51% to 12%, Sites performing assessment and referral, but not p roviding voucher incentives, showed no evidence of improvement in immu nization coverage. No difference was observed in enrollment rates betw een sites performing voucher incentives and those that did not, Conclu sion.-Applied in a large-scale, programmatic fashion, voucher incentiv es in WIC can rapidly increase and sustain high childhood immunization rates in an inner-city population.