{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:05:44Z","timestamp":1765728344845,"version":"3.40.5"},"reference-count":26,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,9,1]]},"abstract":"<jats:p>OBJECTIVE. Obtaining childhood immunization coverage data for small geographic areas is difficult and resource-intensive, especially in the absence of comprehensive immunization registries. To identify factors that are associated with delayed immunization, we collected school-entry immunization records statewide and used geocoding to link to publicly available census tract sociodemographic data.<\/jats:p><jats:p>METHODS. Immunization records were reviewed for children who were enrolled in all public and private school kindergarten programs in Hawaii in the 2002\u20132003 school year; immunization status at the time of the second birthday was determined. The main outcome variable was up-to-date status for the 4:3:1:3:3 vaccination series (4 doses of diphtheria-tetanus-pertussis, 3 doses of polio, 1 dose of measles-mumps-rubella, 3 doses of Haemophilus influenzae type b, and 3 doses of hepatitis B vaccines). Children's home addresses were geocoded to census tracts; coverage rates by tract were mapped, and sociodemographic data from Census 2000 files were used to identify factors that were associated with delays in immunization.<\/jats:p><jats:p>RESULTS. Records were obtained for 15275 of 15594 children registered in Hawaii kindergartens. Overall, 78% had completed their 4:3:1:3:3 series by their second birthday. Risk factors for delayed immunization included delayed immunization at 3 months of age, living in Maui County, living in a neighborhood where a low proportion of adults had postsecondary education, and living in a neighborhood where a high proportion of households spoke a language other than English at home. The majority (80%) of underimmunized children would have required only 1 additional visit to bring them up-to-date.<\/jats:p><jats:p>CONCLUSIONS. Retrospective review of kindergarten-entry immunization data revealed geographic areas with lower immunization coverage, and geocoding to census tracts identified associated sociodemographic risk factors. This is a practical method for state or city health departments to identify pockets of need and to direct resources appropriately.<\/jats:p>","DOI":"10.1542\/peds.2006-3296","type":"journal-article","created":{"date-parts":[[2007,8,7]],"date-time":"2007-08-07T00:54:03Z","timestamp":1186448043000},"page":"e535-e542","source":"Crossref","is-referenced-by-count":17,"title":["Identifying Risk Factors for Underimmunization by Using Geocoding Matched to Census Tracts: A Statewide Assessment of Children in Hawaii"],"prefix":"10.1542","volume":"120","author":[{"given":"Sara J.","family":"Whitehead","sequence":"first","affiliation":[{"name":"Preventive Medicine Residency Program, Career Development Division, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia"},{"name":"Disease Outbreak and Control Division, Hawaii State Department of Health, Honolulu, Hawaii"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate X.","family":"Cui","sequence":"additional","affiliation":[{"name":"Disease Outbreak and Control Division, Hawaii State Department of Health, Honolulu, Hawaii"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anindya K.","family":"De","sequence":"additional","affiliation":[{"name":"Preventive Medicine Residency Program, Career Development Division, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy","family":"Ayers","sequence":"additional","affiliation":[{"name":"Disease Outbreak and Control Division, Hawaii State Department of Health, Honolulu, Hawaii"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul V.","family":"Effler","sequence":"additional","affiliation":[{"name":"Disease Outbreak and Control Division, Hawaii State Department of Health, Honolulu, Hawaii"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2007,9,1]]},"reference":[{"key":"2021120902243148900_R1","unstructured":"Centers for Disease Control and Prevention. 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