Characteristics of families who attend free vaccine fairs.

OBJECTIVE: To determine the health care resources and perceived barriers to care of families attending free vaccine fairs. DESIGN: A cross-sectional survey. SETTING: Twelve free vaccine fairs in Denver, Colorado, in 1994. PARTICIPANTS: A total of 533 consecutive parents or guardians of children receiving vaccine at the fairs. Interventions. None. MEASUREMENTS/RESULTS: Survey respondents reported that their children received regular health care through a private physician or health maintenance organization (HMO) (47%), a public clinic (20%), or a hospital-based clinic (14%); 18% had no regular site for health care. Twenty-seven percent of the families carried private insurance, although less than half of these plans covered children's vaccines: 9% were enrolled in an HMO or a preferred provider organization and 13% had Medicaid, whereas 50% had no health insurance. Families who received primary care at a private physician's office (OR: 1.7; 95% CI: 1.01-2.7) and those with no regular site for health care (OR: 2.0; 95% CI: 1.01-4.0) were more likely than those who went to a public clinic or hospital clinic to report free vaccine as the most important reason for attending a vaccine fair. Conversely, families who received well-child care at a hospital clinic were more likely to identify no appointment needed as the most important reason (OR: 2.7; 95% CI: 1. 4-5.1). Families with private health insurance (OR: 2.3; 95% CI: 1. 05-4.0) or no health insurance (OR: 2.3; 95% CI: 1.1-4.6) were more likely to identify free vaccine as the most important reason for attending a vaccine fair, whereas those enrolled in an HMO or preferred provider organization identified convenient time as the most important reason (OR: 3.2; 95% CI: 1.2-8.3). Families with Medicaid (OR: 3.2; 95% CI: 1.3-8.3) or with no insurance (OR: 2.1; 95% CI: 1.02-4.6) were more likely than were those with private insurance to identify no appointment needed as the most important reason for attending a vaccine fair. CONCLUSIONS: Most families attending free vaccine fairs have a regular source of health care. For families with private health insurance or with no health insurance, the availability of free vaccine is the major reason to bring their children to a vaccine fair, whereas for families whose insurance routinely covers the cost of childhood vaccine (HMO, Medicaid), convenience is the major determinant.

Rural childhood immunization. Rates and demographic characteristics.

BACKGROUND: Childhood immunization rates are suboptimal, especially in high-risk populations. Rural residents could constitute a population at high risk for childhood underimmunization; little is known about demographic factors associated with childhood underimmunization. This study compared the immunization rates of urban and rural 2-year-olds and examined the association between demographic factors and underimmunization for rural 2-year-olds. METHODS: We analyzed two nationally representative surveys: the 1991 National Maternal and Infant Health Survey (NMIHS) and the 1993 National Health Interview Survey (NHIS). The study population consisted of children in non-metropolitan statistical areas who were 24 to 36 months of age in the NMIHS and 19 months to 5 years of age in the NHIS. The NMIHS sample contained 4425 children (966 in rural areas) and the NHIS sample contained 2505 children (566 in rural areas). RESULTS: There were no significant differences in immunization rates between rural and urban children. In urban areas, immunization rates were 63.3% (NMIHS) and 65.5% (NHIS) compared with 63.0% (NMIHS) and 67.8% (NHIS) in rural areas. Low income, low family education, nonwhite race, unemployment, and being a female child were associated with underimmunization in one or both data sets. These relationships were not modified by residence in a universal purchase state, where the state purchases and distributes vaccine for all children to reduce the cost and thereby improve access to immunization services. CONCLUSIONS: Approximately one third of children in urban and rural areas were underimmunized. The demographic characteristics of underimmunized children were similar in urban and rural areas; however, the special characteristics of rural areas may require that interventions be tailored to rural needs.

Mortality from intentional and unintentional injury among infants of young mothers in Colorado, 1986 to 1992.

OBJECTIVES: To investigate the association between maternal age and other risk factors and infant injury deaths in the state of Colorado from 1986 to 1992. DESIGN: A retrospective cohort design was used to compare rates of unintentional and intentional infant injury mortality by maternal age group. A case-control design explored the importance of various risk factors, particularly maternal age, using multivariate logistic regression. PARTICIPANTS: The 2 case groups comprised all unintentional and intentional injury deaths in the first year of life. The control group was a random sample of both survivors and noninjury deaths selected from the entire birth cohort. RESULTS: The infant injury mortality rate for the 322766 live births in Colorado from 1986 to 1992 was 3.1 per 10000. Intentional injury death rates were highest for infants of teenaged mothers, peaking at 10.5 per 10000 live births for mothers aged 16 years. Unintentional injury death rates were highest for infants of mothers aged 20 to 24 years, peaking at 3.7 per 10000 live births for 22-year-old mothers. For intentional injury death, maternal marital status had a significant impact on maternal age; compared with the baseline group of married mothers older than 24 years, significantly higher risks were observed for infants of teenagers who were married (odds ratio [OR] = 32.0; 95% confidence interval[CI], 9.9-104.0) but also in infants of older mothers who were unmarried (OR = 3.6; 95% CI, 1.0-13.0 for unmarried mothers aged 20-24 years and (OR = 7.7; 95% CI, 2.4-25.0 for those > 24 years). Black race (OR = 3.5; 95% CI, 1.4-9.4) was also associated with intentional injury death. For unintentional injury death, the highest risk was for infants of mothers aged 20 to 24 years and unmarried (OR = 3.9; 95% CI, 1.7-9.3). Risk was also elevated for infants of married teenaged mothers (OR = 3.5; 95% CI, 0.7-17.8) but was not significantly different from the baseline group for unmarried teenagers, married 20- to 24-year-old mothers, or unmarried mothers aged 25 years or older. Risk was increased by the presence of older siblings (OR = 1.5 per sibling; 95% CI, 1.2-2.0). CONCLUSIONS: Maternal age and marital status significantly affect the rate of both unintentional and intentional infant injury mortality. These results suggest that child abuse prevention strategies should be targeted to teenaged mothers, and that strategies designed to prevent unintentional injuries should focus particularly on parents or caretakers of infants born to unmarried mothers in their early 20s as well as married teenagers.

Patterns of serum glucose and galactose concentrations in term newborn infants after milk feeding.

Galactose and glucose concentrations were measured in peripheral blood in relation to ad libitum milk feeding in 11 healthy near-term infants. Galactose and glucose concentrations before feeding averaged 1.06 +/- 0.21 and 60.3 +/- 3.2 mg/dl, respectively. After feedings containing 0.76-2.68 g lactose/kg body weight, both galactose and glucose rose by approximately 35% Galactose concentrations rose by 0.72 +/- 0.10 mg/dl at 30 min after feeding, while glucose concentration rose by 23.3 +/- 2.5 mg/dl at 30 min after feeding. The 25-fold greater absolute increase in the concentration of glucose than galactose is consistent with efficient first-pass clearance of galactose by the neonatal liver.

Response to influenza A vaccine among high-risk patients.

In recent years, it has been recommended that "high-risk" patients receive influenza immunizations annually. During the 1976 National Influenza Immunization Program, a higher priority was given to these patients than to the general population. The present study was undertaken to compare the antibody response of high-risk patients with that of a group of individuals with no underlying disease after immunization with 0.5 ml of bivalent, split-virus vaccine containing 200 CCA units each of influenza A/New Jersey/76 and A/Victoria/75. Sera were obtained before and after immunization from 41 "healthy" volunteers and from 57 cariology, 31 hematology, 13 hemodialysis, and 16 renal transplant patients. The control, cardiology, and hemodialysis groups responded equally well to A/Victoria/75 antigen, but the hematology and renal transplant groups did not respond as well (P less than .05). Only the hematology patients responded at a significantly lower level (P less than .05) than the control group to A/New Jersey/76. The control and renal transplant groups had a significantly greater response to A/New Jersey/76 antigen than to A/Victoria/75 antigen (P less than .002). Although the same pattern was demonstrated by the other patient groups, the differences were not significant. Because hematology and renal transplant patients responded relatively poorly to influenza immunization, prophylactic administration of amantadine during influenza outbreaks should be considered in patients with renal function adequate to excrete this drug.