Immunization Among African American Children: Implications for Social Work

Health care services for poor children have historically been inadequate. Over the past decade the percentages of children living in poverty, children with no health insurance, and children who lacked access to medical care services increased (Harvey, 1991; National Center for Children in Poverty [NCCP], 1990). Although childhood immunizations are one of the most effective ways to prevent and control infectious and communicable diseases, thousands of preschool children are not being adequately immunized (Centers for Disease Control and Prevention [CDC], 1994a; National Commission on Children [NCC], 1991; National Vaccine Advisory Committee [NVAC], 1991; Orenstein, Atkinson, Mason, & Bernier 1990; U.S. Department of Health and Human Services [DHHS], 1991). Immunization of preschool children is a function of the interrelationship among the health-seeking behaviors of parents of young children, financial and nonfinancial barriers to health care, and provider practices that inhibit appropriate immunization. Low rates of immunization are an especially critical problem for inner-city African American preschool children from economically disadvantaged families. BACKGROUND Because immunizations provide both individual and group immunity, the goal is to have the greatest possible proportion of the entire population immunized. If a high percentage of the population is immunized, the likelihood that the disease will be introduced into the community and infect unimmunized individuals is minimized. Immunization is incomplete when an insufficient percentage of the total population is immunized or when significant numbers of critical segments of the population, such as children, lack partial or complete immunization protection (Interagency Committee to Improve Access to Immunization Services [ICI], 1992). Childhood immunizations are one of two well-child care services (newborn screening is the other) that have been unequivocally demonstrated as an effective method of intervention, and the cost-effectiveness of childhood immunizations has been demonstrated repeatedly (Kotch, Blakely, Brown, & Wong, 1992). A child is fully immunized when the recommended schedules for active immunizations have been met (Miller, Fine, & Adams-Taylor, 1989). Current recommendations suggest that children receive between 11 and 15 vaccines, many in combination form and all requiring more than one dose, for a total of five immunizations by age two (CDC, 1995b; DHHS, 1991, 1994; ICI, 1992). A child who begins receiving immunizations by 10 months of age should be able to complete the full series of individual immunizations by his or her second birthday (DHHS, 1994; Klein, 1991). By school entry, state legislation usually requires the immunization of children against polio, diphtheria, pertussis (whooping cough), tetanus, measles, rubella, mumps, hepatitis B, and Haemophilus B conjugate. This accounts for the higher rates of immunization among kindergarten and first-grade children than among younger children (Hinman, 1990; ICI, 1992; Novello, 1991; Orenstein et al., 1990). Compulsory immunization for school entry is widely supported by health and welfare officials because immunization rates are a good predictor of long-term changes in the incidence of disease (Miller et al., 1989). However, there is no universal approach to immunizing all children, and the current childhood immunization system lacks national coordination. Although the actual vaccine delivery system is the responsibility of state and local governments (Orenstein et al., 1990), the past success of childhood immunization programs has been a direct result of the partnership among local, state, and federal governments. About half of U.S. children receive their immunizations from private pediatricians, and the other half receive their immunizations in the public sector through public health departments and community health centers (DHHS, 1994; Hinman, 1990; NVAC, 1991; Testimony of Mark V. …