African-American children in Harlem and Hispanic children in Washington Heights caught up with other U.S. children and surpassed their peers nationwide in achieving up-to-date vaccination status following an immunization promotion in these New York City neighborhoods.

The multifaceted intervention, which was embedded within existing social service programs, improved up-to-date vaccination status among children ages 19 to 35 months by 33.5 percent over a two-year period.

“This shows that immunizations are winnable,” said lead researcher Sally Findley, Ph.D., of Columbia University’s Mailman School of Public Health. “It’s a question of harnessing the resources that are there in the community to keep children on target.”

The study will be published in the July issue of Health Promotion Practice.

For years, African-American and Hispanic children in the U.S. have lagged behind non-Hispanic white children in immunization coverage, a disparity that widened between 1996 and 2001. To improve vaccine coverage among local minority children, a coalition of 23 community organizations in Harlem and Washington Heights developed the Start Right immunization promotion program.

Program strategies included parent education, reminders of upcoming vaccinations and follow-up to ensure that children received their required immunizations. These strategies were implemented by trained peer health educators on staff at the participating social service organizations.

“This is a good example of applying best practices,” said Maureen Kolasa, R.N., of the Centers for Disease Control and Prevention’s National Immunization Program. “Since the coalition used multiple strategies that have been shown effective in increasing childhood immunization coverage, the finding of an increase in coverage in this study was not unexpected.”

A key aspect of the Start Right intervention was integrated tracking of immunization records from providers, community groups and parents to ensure that each child’s vaccination status was monitored until all vaccinations were complete.

The CDC recommends an immunization series involving 14 doses of vaccine for nine different diseases, spread out over at least six doctor visits. “Although the schedule of vaccinations for children under age five is complicated, receiving these vaccinations is critical to protecting children from disease,” Kolasa said.

Of the 1,502 study participants enrolled between 2002 and 2004, only 46 percent of were up-to-date on their vaccinations. By April 2004, the up-to-date status of these children had improved to 80.5 percent, virtually the same as the most recently reported (2003) national immunization rate of 79.4 percent and just over the Healthy People 2010 goal of 80 percent.

Not all community programs were equally effective. Children participating through health-related programs such as facilitated enrollment in child health insurance were almost five times as likely to have completed all vaccinations as children enrolled through housing-assistance or faith-based programs.

Children enrolled through child care and parenting programs and Women, Infants, and Children (WIC) and income maintenance programs were also more likely to be up-to-date with vaccinations compared to children enrolled through housing and faith-based programs.

The study was funded by the Reach 2010 program of the CDC.

Findley SE, et al. Community-based strategies to reduce childhood immunization disparities. Health Promotion Practice 7 (3S), 2006