Effect of health determinants on immunization rates of two-year-old children in Denton county, Texas

Children in America do not receive the recommended vaccinations before age two when they are most vulnerable to disease. America's immunization rate for children under two lags behind most of the developed world. Moreover, Texas immunization rate for two-year-old children falls between 50 th and 42nd for all states.

The purpose of this descriptive study was to identify factors that affect young children's timely immunization. Health determinant's effect on immunization rates of two-year-old children was the focus of the hypotheses. Hypotheses reflected the individual-level and neighbor-hood factors: (1) mother's perceived stress, (2) neighborhood support, (3) neighborhood collective efficacy, (4) intergenerational closure, (5) residential stability, (6) economic advantage/disadvantage, and their effect on immunization of the child. The establishment of a medical home for the child also factored in the study.

Collaboration with the County Health Department was reflected in the identification of the birth cohort, children born in 2000 (n = 7,437), as well as survey receipt and processing. Questionnaires in English and Spanish were mailed to 1,500 mothers of children born in 2000. Mothers whose children had died or who were minors at the time of the child's birth were excluded. Response rate was 4% with 543 surveys returned for mothers who no longer lived at the birth address. The completed forty surveys, therefore, were analyzed as a pilot study of the instrument.

It was determined that the respondents who were white, 25–35 years of age, educated, had family income of over $50,000 and worked in managerial-professional jobs or were full-time mothers. Only nine of the forty children were up-to-date at two and timely in their immunizations from birth to two years.

The declining awareness of the impact of a population of children who do not meet timely immunization standards creates an opportunity for education about infectious diseases and vaccines. A mailed-response method proved inadequate for this mobile population. This may indicate the use of focus groups for replication of the study. Maintaining vigilance for infectious disease and the herd immunity of the community through immunization should be the vision for public health educators.