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The Effectiveness of
Assessment and Referral on Immunization Coverage in the
Special Supplemental Nutrition Program for Women,
Infants, and Children
Susan H. Ashkar, MA; Loring
G. Dales, MD; Francisco Averhoff, MD, MPH;
Abigail Shefer, MD; Jeffrey Higa, MPH;
Lisa Thompson, MPH; Judy Gomez, MPH,
RD; Denise C. Gee, MPH, RD;
Eric L. Hurwitz, DC, PhD
Arch Pediatr Adolesc Med. 2003;157:456-462.
Background The use of immunization
assessment and referral (A/R) in the Special
Supplemental Nutrition Program for Women,
Infants, and Children (WIC) has been shown to produce
dramatic improvements in vaccination coverage
when coupled with parental incentive;
however, data are lacking to support the use of A/R
alone.
Objective To determine the effectiveness of
A/R in increasing immunization coverage among
WIC participants.
Design Participating WIC centers were
assigned to1 of 3 interventions that
delivered A/R of varying frequency or a
control group.
Setting Twenty of the largest Public Health
Foundation Enterprises–WIC centers in Los
Angeles County.
Participants Children continuously enrolled
in participating WIC centers from 6 to 24
months of age.
Intervention Assessment of child's
vaccination status followed by referral to a
health care provider for those lacking
indicated vaccinations.
Main Outcome Measure Up-to-date (UTD) status
at 24 months of age for all recommended
vaccines.
Results Baseline coverage rates were similar
among all study sites (overall, 77% UTD).
After the study period, compared with the
controls (88% UTD), we found no differences in
immunization coverage among WIC centers that
administered A/R at every visit (every 2
months) to all children (90% UTD; adjusted odds ratio
[OR], 1.02; 95% confidence interval [CI],
0.54-1.94), every 6 months to all children
(89% UTD; OR, 0.98; 95% CI, 0.62-1.56), or
every visit to children found to be behind at 8 months
of age (89% UTD; OR, 0.89; 95% CI,
0.48-1.68).
Conclusion In this urban population of WIC
children with high baseline immunization
coverage, A/R was not effective in increasing
immunization coverage.
From the Department of Health Services, Public
Health, Immunization Program, County of Los Angeles, Los
Angeles, Calif (Mss Ashkar and Thompson and Mr Higa);
the Department of Health Services, Immunization Branch,
State of California, Berkeley (Dr Dales); the National
Immunization Program, Centers for Disease Control and
Prevention, Atlanta, Ga (Drs Averhoff and Shefer);
Public Health Foundation Enterprises, Special
Supplemental Nutrition Program for Women, Infants, and
Children, Irwindale, Calif (Mss Gomez and Gee); and the
Department of Epidemiology, School of Public Health,
University of California, Los Angeles (Dr Hurwitz). Mr
Higa is now with the Department of Health Services,
Infectious Diseases Branch, State of California,
Gardena; Ms Thompson, the Center for Healthier Children,
Families and Communities, University of California, Los
Angeles.
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