RESUMO
OBJECTIVES: To examine parental beliefs and logistical challenges to early childhood vaccination completion as well as opportunities to support improved vaccine uptake among families experiencing homelessness. STUDY DESIGN: A cross-sectional survey was conducted between February 2018 and October 2019 with parents of children ages 19-35 months old experiencing homelessness. Participants were recruited from 10 locations that serve families experiencing homelessness in Washington, DC and by referral from other participants. Vaccination records were obtained from health care providers to determine the child's up-to-date (UTD) status with a combined 7-vaccine series. RESULTS: Of 135 children of participants, only 69 (51.1%) were UTD. Most participants had at least 1 concern about childhood vaccines and at least 1 logistical barrier to completing vaccination (57% and 85.9%, respectively). The most frequent barriers were getting a convenient appointment time (46.3%), remembering appointments (44.8%), and commuting to appointments (44.4%). Although only 53.3% of the participants' children attended a licensed daycare center and only 43.7% received benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), use of either of these programs that routinely assess vaccination status was associated with over 3 times higher adjusted odds of being UTD (aOR 3.4, 95% CI 1.6-7.3, and aOR 3.1, 95% CI 1.4-6.5, respectively). CONCLUSIONS: Logistical barriers to accessing primary care services are common among children experiencing homelessness, underscoring the importance of health care providers offering vaccines at every opportunity. Government-regulated programs are useful for promoting vaccination, and enrollment should be encouraged because many children experiencing homelessness may not access them.
Assuntos
Pessoas Mal Alojadas , Esquemas de Imunização , Pais , Vacinação/estatística & dados numéricos , Adulto , Pré-Escolar , Estudos Transversais , District of Columbia , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Masculino , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To describe the structure of networks in a cohort of mothers and to analyze associations of social network characteristics and norms with infant sleep practices. STUDY DESIGN: We recruited a prospective cohort of mothers with infants <6 months of age from January 2015 to December 2016. Mothers completed a survey about their personal social networks and infant care practices. Latent class analysis identified unobserved network types. Binary statistics and path analysis were performed. RESULTS: Overall, 402 mothers were surveyed. Latent class analysis identified 2 a priori unknown social network types: "exclusive" (restricted) and "expansive." Mothers who were black, younger, unmarried, less educated, and of lower socioeconomic status were more likely to have exclusive networks than expansive networks. Mothers with exclusive networks were more likely to be exposed to the norm of soft bedding (P = .002). Exposure to norms of non-supine infant placement, bedsharing, and soft bedding use within one's network was associated with engaging in these practices (P < .0001 for each). First-time mothers were more likely to pay attention to a non-supine norm and place infants in a non-supine position. Black mothers and first-time mothers were more likely to pay attention to the norm and use soft bedding. CONCLUSIONS: Both the type of networks mothers have and the norms regarding infant sleep practices that circulate within these networks differed by race. Network norms were strongly associated with infant sleep practices and may partially explain the racial disparity therein.
Assuntos
Cuidado do Lactente , Comportamento Materno , Mães , Assunção de Riscos , Sono , Rede Social , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Estudos ProspectivosRESUMO
OBJECTIVE: To examine missed opportunities to administer an eligible vaccination (MOs) and their contribution to underimmunization in contemporary pediatric practices. STUDY DESIGN: This study was a retrospective analysis from 42 diverse pediatric practices located throughout the US. Medical records of 50 randomly selected children 3-18 months of age per practice were reviewed in Spring 2013. Immunization status for age and MOs were assessed as of each encounter and as of March 1, 2013. RESULTS: Of 2076 eligible patients, 72.7% (95% CI 67.6-77.9) were up-to-date with receipt of standard vaccines. Most children (82.4%; 95% CI 78.3-85.9) had at least 1 MO, and 37.8% (95% CI 30.0-46.2) had at least one MO to administer an overdue vaccination. After adjustment, risk of underimmunization was 3.5 times greater for patients who had ever experienced an MO for an overdue vaccination compared with those who had not (adjusted relative risk = 3.5; 95% CI 2.8-4.3). If all age-appropriate vaccinations had been administered at the last recorded encounter, 45.5% (95% CI 36.8-54.5) of the underimmunized patients would have been up to date at the time of assessment. CONCLUSION: MOs were common and contributed substantially to underimmunization in this contemporary sample of diverse primary care practice settings.
Assuntos
Atenção Primária à Saúde , Vacinação/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: To identify factors associated with infant sleep location. STUDY DESIGN: Demographic information and infant care practices were assessed for 708 mothers of infants ages 0 to 8 months at Women, Infants and Children centers. Generalized linear latent mixed models were constructed for the outcome, sleeping arrangement last night (room-sharing without bed-sharing versus bed-sharing, and room-sharing without bed-sharing versus sleeping in separate rooms). RESULTS: Two-thirds of the mothers were African-American. A total of 48.6% mothers room-shared without bed-sharing, 32.5% bed-shared, and 18.9% slept in separate rooms. Compared with infants who slept in separate rooms, infants who room-shared without bed-sharing were more likely to be Hispanic (odds ratio [OR], 2.58, 95% CI 1.11-5.98) and younger (3.66- and 1.74-times more likely for infants 0-1 month old and 2-3 months old, respectively, as compared with older infants). Compared with infants who bed-shared, infants who room-shared without bed-sharing were more likely to be 0 to 1 month old (OR, 1.57; 95% CI, 1.05-2.35) and less likely to be African-American (OR, 0.43; 95% CI, 0.26-0.70) or have a teenage mother (OR, 0.37; 95% CI, 0.23-0.58). CONCLUSIONS: Approximately one-third of mothers and infants bed-share, despite increased risk of sudden infant death syndrome (SIDS). The factors associated with bed-sharing are also associated with SIDS, likely rendering infants with these characteristics at high risk for SIDS.