RESUMEN
CONTEXT: Inner-city immunization rates have lagged behind those in other areas of the country. OBJECTIVE: To evaluate the impact of an initiative linking immunization with distribution of food vouchers in the inner city. DESIGN: Retrospective analysis of immunization data gathered in 1996 and 1997. SETTING: Nineteen Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites serving 30% of the Chicago, III, birth cohort. PARTICIPANTS: A total of 16581 children 24 months old or younger. INTERVENTIONS: Voucher incentives (varying frequency of food voucher issuance based on immunization status) and assessment of immunization status and referral to immunization provider. MAIN OUTCOME MEASURES: Age-appropriate immunization rates and WIC enrollment rates. RESULTS: During the 15-month period of evaluation, immunization rates increased from 56% to 89% at sites performing voucher incentives. The proportion of children needing voucher incentives declined from 51% to 12%. Sites performing assessment and referral, but not providing voucher incentives, showed no evidence of improvement in immunization coverage. No difference was observed in enrollment rates between sites performing voucher incentives and those that did not. CONCLUSION: Applied in a large-scale, programmatic fashion, voucher incentives in WIC can rapidly increase and sustain high childhood immunization rates in an inner-city population.
Asunto(s)
Servicios de Salud del Niño/organización & administración , Planificación en Salud Comunitaria/organización & administración , Programas de Gobierno/organización & administración , Programas de Inmunización/organización & administración , Fenómenos Fisiológicos de la Nutrición , Vacunación/estadística & datos numéricos , Chicago , Preescolar , Femenino , Servicios de Alimentación , Humanos , Programas de Inmunización/estadística & datos numéricos , Lactante , Estudios Retrospectivos , Población UrbanaRESUMEN
A protocol was developed in 1984 by the Missouri Department of Health to provide a systematic method for responding to citizen reports of cancer clusters. This protocol integrates public health and environmental expertise and includes two stages: the preliminary review and the investigation. The preliminary review is focused on problem definition and hypothesis generation. Cancer mortality and incidence data are reviewed. Information is gathered and verified through the efforts of citizens, local health officials, environmental staff, and the cancer program staff. Epidemiologic factors evaluated include type of cancer, temporal and spatial relations, population at risk, community profile, and possible environmental and occupational factors. The investigation is an expanded analytic study. Resources are focused on cancer inquiries that appear most likely to involve manageable common exposures. Program experience and protocol development highlights, including surveillance system improvement and educational programming, are described.