The effect of parental monetary sanctions on the vaccination status of young children - An evaluation of welfare reform in Maryland

Objective: To determine whether financial sanctions to Aid to Families With Dependent Children (AFDC) recipients can be used to improve vaccination co verage of young children. Design: Randomized controlled trial. Setting: Six AFDC jurisdictions in Maryland. Intervention: Recipients of AFDC were randomized to the experimental or con trol group of the Primary Prevention Initiative. Families in the experiment al group were penalized financially for failing to verify that their childr en received preventive health care, including vaccinations; control familie s were not. Participants: Children aged 3 to 24 months from assigned families were rand omly selected for the evaluation (911 in the experimental, 864 in the contr ol, and 471 in the baseline groups). Main Outcome Measures: Up-to-date for age for diphtheria and tetanus toxoid s and pertussis (DTP),polio, and measles-mumps-rubella (MMR) vaccines; miss ed opportunities to vaccinate; and number of visits per year. Analysis: Comparisons among baseline and postimplementation years 1 and 2. Results: Vaccination coverage of children was low. Less than 70% of childre n were up-to-date for age for polio and MMR vaccines; slightly more than 50 % were up-to-date for DTP vaccine. Up-to-date rates differed little among b aseline, experimental, and control groups. Over time, there was a decrease in missed opportunities, and more children made at least 1 well-child visit ; however, neither improvement resulted in a change in vaccination status. Conclusions: The Primary Prevention Initiative did not contribute to an inc rease in vaccination coverage among these children. Minimal economic sancti ons alone levied against parents should not be expected substantially to af fect vaccination rates.