AJPH
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (7)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Strine, T. W.
Right arrow Articles by Chu, S. Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Strine, T. W.
Right arrow Articles by Chu, S. Y.
Related Collections
Right arrow Other Health Service Delivery
Right arrow Immunization/Vaccines
Right arrow Prevention
Right arrow Native Americans
Right arrow Surveys
Right arrow Minority Children
December 2003, Vol 93, No. 12 | American Journal of Public Health 2046-2049
© 2003 American Public Health Association

RESEARCH AND PRACTICE

Vaccination Coverage of American Indian/Alaska Native Children Aged 19 to 35 Months: Findings From the National Immunization Survey, 1998–2000

Tara W. Strine, MPH, Ali H. Mokdad, PhD, Lawrence E. Barker, PhD, Amy V. Groom, MPH, Rosalyn Singleton, MD, Craig S. Wilkins, MPH and Susan Y. Chu, PhD

Tara W. Strine, Ali H. Mokdad, Lawrence E. Barker, Amy V. Groom, Craig S. Wilkins, and Susan Y. Chu are with the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga. Amy V. Groom is also with Indian Health Service, Albuquerque, NM. Rosalyn Singleton is with the National Center for Infectious Diseases, Centers for Disease Control and Prevention, and the Alaska Native Tribal Health Consortium, Anchorage.

Correspondence: Requests for reprints should be sent to Tara W. Strine, MPH, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, Koger/Rhodes Bldg, Mail Stop K-66, 3005 Chamblee-Tucker Rd, Atlanta, GA 30341 (e-mail: tstrine{at}cdc.gov).


   INTRODUCTION
TOP
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
The federal government has placed a priority on eliminating racial and ethnic health disparities, such as disparities in vaccination coverage, by 2010.1 This study was conducted to examine recent vaccine coverage rates for American Indian/Alaska Native (AIAN) children aged 19 to 35 months and to compare these rates with those of non-AIAN children.


   METHODS
TOP
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
The National Immunization Survey is a multistage, random-digit-dialed survey that estimates US national vaccination coverage. In households with children aged 19 to 35 months, a parent or guardian is interviewed to collect demographic information, the child’s immunization history, and consent to contact the child’s immunization provider. Providers are surveyed by mail, and only provider-verified vaccinations are included in the analysis. National Immunization Survey methods, including the weighting procedure designed to compensate for nontelephone coverage, response propensity, and other characteristics of the respondents and sampling plan, have been described elsewhere.2,3

National AIAN and non-AIAN coverage estimates and confidence intervals were calculated with SUDAAN, Version 7.5.3.4 In addition, coverage rates for the 10 states with the highest percentage of AIAN children, as determined by the Census Bureau (Alaska, Arizona, Montana, Nevada, New Mexico, North Dakota, Oklahoma, South Dakota, Washington, and Wyoming), were examined to maximize the chance of surveying American Indians/Alaska Natives. These states have Indian Health Service and tribal programs that provide integrated primary health care specifically targeted toward American Indians/Alaska Natives.


   RESULTS
TOP
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
AIAN children aged 19 to 35 months had a higher prevalence of several risk factors for underimmunization (e.g., larger family size and lower socioeconomic status) than did non-AIAN children (Table 1Go).5


View this table:
[in this window]
[in a new window]
  		TABLE 1—— Characteristics of American Indian/Alaska Native (AIAN) Children Aged 19–35 Months: National Immunization Survey, 1998–2000a
 
Nationally, American AIAN children aged 19 to 35 months had a slightly lower, although not statistically significant, 4:3:1:3 series (4 or more doses of diphtheria and tetanus toxoids and pertussis vaccine, 3 or more doses of poliovirus vaccine, 1 or more doses of measles-containing vaccine, and 3 or more doses of Haemophilus influenzae type b vaccine) vaccination coverage compared with non-AIAN children (Table 2Go). All other vaccines showed the same pattern, with coverage for all AIAN children slightly lower than coverage for non-AIAN Native children.


View this table:
[in this window]
[in a new window]
  		TABLE 2—— Vaccine Coverage Levels Among American Indian/Alaska Native (AIAN) Children Aged 19–35 Months, by Selected Vaccines: National Immunization Survey, 1998–2000a
 
In contrast, in the 10 states with the highest population percentages of American Indians/Alaska Natives, 4:3:1:3 series coverage was slightly higher, although not statistically significant, for AIAN children than for non-AIAN children (Table 2Go). With the exception of varicella and Haemophilus influenzae type b, all other vaccine coverage rates in the 10 states showed the same pattern, with coverage for AIAN children slightly higher than coverage for non-AIAN children.


   DISCUSSION
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
Despite increased risk factors for underimmunization, immunization coverage for American Indians/Alaska Natives is comparable to that for other races/ethnicities. One potential reason for high AIAN coverage rates in the ten states with the highest American Indian/Alaska Native population percentage is the provision of comprehensive health services through the US Department of Health and Human Services’s Indian Health Service and, increasingly, tribal health programs established under Public Law 93 638 (Indian Self Determination and Education Assistance Act).6

In 1998 and 1999, 60% of all US American Indians/Alaska Natives lived in an Indian Health Service area, which, in many areas, is the only source of health care.6 The Indian Health Service and tribal organizations provide integrated, primary care that includes several different services. For example, public health nurses make home visits; track underimmunized children; and hold field clinics at tribal community centers, clinics, schools, or other locations on reservations. In addition, many Indian Health Service and tribally operated clinics collaborate with other programs such as Special Supplemental Nutrition Program for Women, Infants, and Children; Community Health Representative Program; and, in Alaska, the Community Health Aide Program. The Special Supplemental Nutrition Program for Women, Infants, and Children provides food, nutrition counseling, and access to health services to low-income women, infants, and children.7 Community Health Representative Programs provide community outreach and education, and the Community Health Aide Programs provide primary and emergency care in remote Alaska villages.8

Another program that may be responsible for high AIAN coverage is the Vaccines for Children Program, which provides free vaccines to providers who care for children in 4 risk groups, one of which is AIAN children.9

Several caveats apply to our results. First, our data are from the National Immunization Survey, a random-digit-dialed survey. Although adjustments are made for nonresponse and nontelephone households by race/ethnicity (White, Black, Hispanic, other) on a national level, it was not possible to make this adjustment to the relatively small AIAN population. Given that many American Indians/Alaska Natives live in a nontelephone household, a positive bias likely exists. Second, because National Immunization Survey nontelephone adjustments are not state specific, it is unknown whether adjustments would have had more or less effect on coverage estimates in the selected 10 states. Third, the study combined multiple years of National Immunization Survey data, which implicitly assumes no strong secular trend. Despite these limitations, our coverage estimates were remarkably similar to estimates from several smaller Indian Health Service surveys of AIAN populations (R. Singleton, MD, Alaska Native Tribal Health Consortium, unpublished data, October 12, 2001; R. Singleton, MD, oral communication).

A precept of public health is the equitable distribution of preventive services benefits to all regardless of poverty, race/ethnicity, limited access, and so forth. The high immunization coverage estimates in a minority population with higher prevalence of several "traditional" risk factors for underimmunization suggest that sufficiently targeted, community-based, culturally appropriate programs can affect racial/ethnic and other health disparities.


   Footnotes
 
Note. The opinions expressed are those of the authors and do not necessarily reflect the views of the Indian Health Service.

Contributors
T. W. Strine developed the research idea, analyzed the data, and wrote the brief. A. H. Mokdad suggested revisions to the analysis and provided editorial assistance. L. E. Barker provided statistical guidance and editorial assistance. A. V. Groom produced the Indian Health Service analysis and co-wrote the Discussion section. R. Singleton produced the Alaska analysis and commented on the Discussion section. C. S. Wilkins co-wrote the Discussion section and communicated with Indian Health Service partners. S. Y. Chu provided editorial assistance and assisted in developing collaborative relationships with Indian Health Service partners.

Human Participant Protection
No protocol approval was needed for this study.

Peer Reviewed

Accepted for publication September 24, 2002.


   References
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Healthy People 2010: Understanding and Improving Health. Washington, DC: US Dept of Health and Human Services; 2001.

2. Smith PJ, Battaglia MP, Huggins VJ, et al. Overview of the sampling design and statistical methods used in the National Immunization Survey. Am J Prev Med. 2001;20(suppl 4):17–24.[Medline]

3. Zell ER, Ezzati-Rice TM, Battaglia MP, Wright RA. National Immunization Survey: the methodology of a vaccination surveillance system. Public Health Rep.2000;115:65–77.[ISI][Medline]

4. Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual, Release 7.5. Vol 1. Research Triangle Park, NC: Research Triangle Institute; 1997.

5. Marks JS, Halpin TJ, Irvin JJ, Johnson DA, Keller JR. Risk factors associated with failure to receive vaccinations. Pediatrics.1979;64:304–309.[Abstract/Free Full Text]

6. Trends in Indian Health 1998–1999. Washington, DC: US Dept of Health and Human Services, Indian Health Service, Office of Public Health, Program Statistics Team; 2001.

7. Shefer AM, Luman ET, Lyons BH, et al. Vaccination status of children in the Women, Infants, and Children (WIC) Program: are we doing enough to improve coverage? Am J Prev Med. 2001;20(suppl 4):47–54.[ISI][Medline]

8. Indian Health Service. Comprehensive health care program for American Indians and Alaska Natives: paraprofessional training opportunities. Available at: http://www.ihs.gov/nonmedicalprograms/profiles/profiletraining.asp. Accessed October 28, 2002.

9. Wood DL, Halfon N. The impact of the Vaccine for Children’s Program on child immunization delivery: a policy analysis. Arch Pediatr Adolesc Med.1996;150:577–581.[Abstract]




This article has been cited by other articles:


Home page
 Am. J. Public HealthHome page
M. C. Lindley, A. V. Groom, P. M. Wortley, and G. L. Euler
Status of Influenza and Pneumococcal Vaccination Among Older American Indians and Alaska Natives
Am J Public Health, May 1, 2008; 98(5): 932 - 938.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
A. V. Groom, M. L. Washington, P. J. Smith, and R. T. Bryan
Underimmunization of American Indian and Alaska Native Children
Pediatrics, May 1, 2008; 121(5): 938 - 944.
[Abstract] [Full Text] [PDF]

Home page
 Epidemiol RevHome page
D. A. Salmon, P. J. Smith, A. M. Navar, W. K. Y. Pan, S. B. Omer, J. A. Singleton, and N. A. Halsey
Measuring Immunization Coverage among Preschool Children: Past, Present, and Future Opportunities
Epidemiol. Rev., August 1, 2006; 28(1): 27 - 40.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Public HealthHome page
D. Bramley, P. Hebert, L. Tuzzio, and M. Chassin
Disparities in Indigenous Health: A Cross-Country Comparison Between New Zealand and the United States
Am J Public Health, May 1, 2005; 95(5): 844 - 850.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (7)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Strine, T. W.
Right arrow Articles by Chu, S. Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Strine, T. W.
Right arrow Articles by Chu, S. Y.
Related Collections
Right arrow Other Health Service Delivery
Right arrow Immunization/Vaccines
Right arrow Prevention
Right arrow Native Americans
Right arrow Surveys
Right arrow Minority Children

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2003 by the American Public Health Association