Response Rate

According to clinic records, 1316 households had children in the selected age range. See Figure 1 for a disposition of the sample. Twenty-five households were excluded because the respondent was ineligible due to one of the following reasons: either the respondent was not the parent or legal guardian of the child in question or the respondent was unable to complete the survey due to illness, hearing impairment, or language /comprehension barriers. An examination of the immunization data for all 507 participants indicates that there was no statistically significant difference between those who completed the telephone survey (n= 483) and those who did not (n = 24) in terms of lateness for immunization.

Demographics of Respondents

The majority of those surveyed were African American, had 12 or fewer years of education and, had an annual household income of less than $10,000. See Table 1 for a summary of the demographic characteristics of the total population. The demographic characteristics of the study participants reflect the characteristics of the population who receive care at the four study sites rather than the population of the region. The four study sites are representative of the typical settings where children of low-income households in urban areas receive their primary care.
Table 1. Demooraphic Description of Sample

Number Percer
Total

483

100

Race
African American

365

75.9

White/Other

116

24.1

Missing CM

Number of Children
One

142

29.4

Two

167

34.6

Three or more

174

36.0

Age
16 to 21

51

10.6

22 to 30

225

46.6

31 and over

207

42.9

Education
12 or Fewer Years of School

338

70.0

Some Post Secondary Education

145

30.0

Income below $10,000
No

141

29.4

Yes

338

70.6

Missing

4

Employed
No

334

69.2

Yes

149

30.8

Enrolled in School
No

377

78.1

Yes

106

21.9

Clinic
Children’s Hospital Primary Care Clinic

347

71.8

East Liberty Family Health Care Center

53

11.0

Matilda H. Theiss Health Center

54

11.2

Allegheny County Northside Child Clinic

29

6.0

Immunization Status

Using the definitions of lateness described above, only 15% of children were late for the first DTP immunization at 3 months of age. However, at 7 months, a little over half of the children – 52% were late for the third DTP vaccination. By 19 months of age, 40% of children had not received at least four DTP, three polio and one MMR.
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Parental Awareness and Experience with Childhood Diseases

Parents were asked about their awareness of and experience with measles and whooping cough. Fifty-seven percent (n = 275) of parents said that they had heard of whooping cough. When they were read a list of symptoms (see Table 2) and asked which ones a child with the disease would have, the vast majority of parents who had heard of whooping cough, knew one or more of the correct symptoms. For instance, 96% (n = 264) said a painful cough, 95% (n = 261) said difficulty breathing and 91% (n = 250) said a fever were symptoms of whooping cough. Twenty-one percent (n = 101) of respondents said that they knew someone who has had whooping cough. Seventy-two percent (n = 347) of parents had heard of measles. Among those who had heard of measles, almost everyone knew the obvious symptoms of red rash all over the body and high fever. Twenty-seven percent (n = 130) of respondents reported knowing someone who has had measles.

Table 2. Parental Beliefs Regarding Symptoms of Whooping Cough and Measles

Whooping Cough Symptoms
1.  Mucous in the lungs2.  Swelling in arms and legs

3.  Painful Cough

4.  Infection

5.  Nose bleeds

6.  Red rash all over the body

7.  Difficulty breathing

8.  Fever

Measles Symptoms
1.  Red rash all over body2.  Mucous in the lungs

3.  Red eyes

4.  A virus

5.  Nose bleeds

6.  High fever

7.  Swelling in arms and legs

8.  Cough

Based on the results of the bivariate analysis, parental awareness regarding the symptoms of these two diseases had no significant impact on the timing of their child’s immunization at 3,7 or 19 months.

Parental Beliefs Regarding Susceptibility

Parents were asked whether they thought their child could get whooping cough. The majority of parents (65%) said yes. Among parents who believed that their child is susceptible to whooping cough, 43% were late at 19 months for completing four DTP, three polio and one MMR vaccines. Regardless of whether the parent was on-time or late at 19 months, parents gave three main reasons for why they considered their child to be susceptible. The most frequently mentioned reasons for both groups were that “anyone can get whooping cough,” followed by “being exposed to the disease” and, “being around a lot of kids.” Only four parents said, “not getting shots” was a reason why their child could be susceptible to whoopingcough. (See Table 3 for a complete list of reasons cited by parents.)
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Table 3. Parental Beliefs Regarding Reasons for their Child’s Susceptibility to Whooping Cough & Measles

1.   Being around a lot of kids2.   Being exposed to the disease

3.   Not getting shots

4.   Weaker immune system

5.   Born with the disease /heredity

6.   Not healthy

7.   Parental neglect (no check-up, not dressing child properly)

8.   Child’s age (young children are more vulnerable)

9.   Shots are not effective for some children

10.  Having a bad cold

11.  Anyone can get whooping cough/ measles

12.  Other reason

13.  No Answer

14.  Don’t know

Among the 35% of parents who said their child was not susceptible to whooping cough, 35% were late at 19 months for completing four DTP, three polio and one MMR vaccines. The main reason that both on-time and late parents gave for why their children were not susceptible was that: they were “up-to-date with their shots.”

Parental Beliefs Regarding Disease Transmission

Parents were asked how they thought whooping cough and measles are transmitted. Two underlying dimensions of parental beliefs regarding transmission were identified from the factor analyses (Table 4). The first factor was labeled the “poor parenting factor” based on participants’ wording, and included the following reasons why children got whooping cough: “not dressing child properly in cold weather,” “child is sickly” “child is not kept clean” and, “child has a poor diet.” Parents who gave one of these responses were very likely to give all of these responses. The second underlying dimension of parental beliefs regarding disease transmission was labeled the “contagion factor.” This belief is characterized by parents who state that the reasons children get whooping cough are that they: “do not have shots ” “have a weak immune system,” “are in contact with a person who has whooping cough” and, “are exposed to germs or viruses in the air.”
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Table 4. Parental Beliefs Regarding Disease Transmission and Prevention: Factor Analysis Results *

Factor Factor Loadina
A. Parental Beliefs Regarding Disease
Transmission (Whooping cough only)
“Poor Parenting” Factor
Not dressing child properly in cold weather 0.706
Being sickly 0.694
Not keeping child clean 0.659
Poor diet 0.626
“Contagion” Factor
Not having shots 0.675
Weak immune system 0.663
Being close to a person w/ whooping cough 0.603
Exposure to germs or viruses in air 0.569
B. Parental Beliefs Regarding Disease
Prevention (Whooping cough only)
“Good Parenting” Factor
Get regular checkups 0.724
Dress child warmly in cold weather 0.653
Make sure child has a healthy diet 0.522
“General Prevention” Factor
Don’t allow child around a lot of children 0.831
Prevent colds 0.586
“Specific Prevention” Factor
Keep child away from someone
w/ whooping cough 0.758
Get shots for child 0.751
Note: Only items with factor loadings > .500 (a common con-
vention) are included.
* Factor analysis is a technique that is used to identify the
underlying dimensions of responses to survey items by examin-
ing their inter-correlations. Factor loadings are coefficients
which represent the strength of the association of each item
with the underlying dimension. The higher the factor loading
the more closely related the item is to the underlying dimension.

Parental Beliefs Regarding Disease Prevention

Parents were asked what they might do to protect their children from getting whooping cough. Three underlying dimensions of parental beliefs regarding prevention of childhood diseases were identified (Table 4). One set of responses was labeled as, the “good parenting factor” and included, “getting regular checkups,” “dressing a childincluded, such things as “not allowing your child to be around a lot of other children” and “preventing colds.” The third factor was labeled “specific prevention” and included such strategies as “keeping a child away from people who have whooping cough” and, “get¬ting shots for a child.” Parents who gave one of the responses under each factor were very likely to give all of the responses.

Parental Beliefs Regarding Immunization Effectiveness

Parents were asked if they agreed or disagreed with a series of statements regarding their understand¬ing of how shots work and their effectiveness. Three factors were identified which describe how parents think about shots for childhood diseases (Table 5). The first factor was labeled “shots as treatment” and summarizes the following parental responses: “shots contain medicine to treat diseases,” “shots can cure diseases” such as whooping cough and measles, “it doesn’t matter at what age a child gets shots” and, “shots wear off after several months.” The second factor was labeled “shots as prevention” and included: “shots prevent children from getting diseases” and “children who have shots won’t get whooping cough and measles.” A final factor was designated as “shot maintenance” and this factor summarized the following two parental responses: “a series of several shots is needed for full protection” and “shots build up a child’s immune system.”
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Table 5. Parental Beliefs Regarding Immunization Effectiveness and Side Effects: Factor Analysis Results*

Factor Factor Loadina
A. Parental Beliefs Regarding
Immunization Effectiveness
“Shots as Treatment” Factor
Shots contain medicine to treat disease 0.696
Whooping cough & measles
can be cured by shots 0.694
It doesn’t matter at what age
child gets shots 0.522
Shots wear off after several months 0.509
“Shots as Prevention” Factor
Shots prevent children from
getting disease 0.779
Children with shots won’t get
whooping cough & measles 0.722
“Shot Maintenance” Factor
A series of several shots is needed
for full protection 0.798
Shots build up child’s immune system 0.606
B. Parental Beliefs Regarding
Side Effects of Immunizations
“Severe Side Effects” Factor
Brain damage 0.769
Severe allergic reactions 0.739
High fever 0.688
Getting the disease from the shot 0.673
“Minor Side Effects” Factor
Fussy and crabby 0.818
Low grade fever 0.725
Soreness where shot was given 0.691
Note: Only items with factor loadings > .500 (a common con
vention) are included.
* Factor analysis is a technique that is used to identify the
underlying dimensions of responses to survey items by examin
ing their inter-correlations. Factor loadings are coefficients
which represent the strength of the association of each item
with the underlying dimension. The higher the factor loading
the more closely related the item is to the underlying dimension.

Parental Beliefs Regarding Adverse Effects

Parents were also asked about the likelihood of certain problems occurring as a result of their child getting shots for measles and whooping cough. They were asked to rate seven possible outcomes as: very likely, somewhat likely, or not at all likely to occur. Two factors were identified which describe how parents think about the possible side effects of immunizations for childhood diseases (Table 5). The first factor, “severe side effects” included the following responses regarding possible outcomes: “brain damage,” “severe allergic reactions,” “high fever” and, “getting the disease from the shot”. The second factor was labeled, “minor side effects” and included: “fussiness and crabbiness,” “low grade fever” and, “soreness where the shot was given” as possible outcomes after receipt of childhood immunizations. eriacta 100 mg