Date of Award

Fall 1994

Document Type


Degree Name

Doctor of Philosophy (PhD)


Urban Services--Health Services

Committee Director

Clare Houseman

Committee Member

Brenda Nichols

Committee Member

Lindsay Rettie

Committee Member

Ardythe Morrow


This study represents an investigation of psychosocial factors affecting age-appropriate immunizations of infants in Norfolk, Virginia. A household survey was conducted in Norfolk, Virginia, from 4/93-8/93, to assess immunization coverage of children 12-30 months of age. This survey included a total of 389 children in the target age range. A subset of 201 mothers were randomly selected and reinterviewed to assess their knowledge and attitudes and the relationships of these factors to age-appropriate immunizations at 12 months of age. Sixty-two percent of children were not age-appropriately immunized at 12 months of age. Almost all mothers (99%) considered vaccines to be safe and effective, and these attitudes did not predict age-appropriate immunizations. However, not being age-appropriately immunized was significantly (p<. 05) associated with lack of knowledge of vaccines and vaccine-preventable diseases (odds ratio (OR) 2.6, 95% confidence interval (CI) 1.5-4.5); of when to start immunizations (OR 2.2; CI 1.2-4.1); and believing that a child with minor illness should not be immunized (OR 1.9; CI 1.1-3.2). After controlling for education and other demographic variables in multiple logistic regression analysis, knowledge variables continued to predict immunization status. Maternal knowledge about vaccines and diseases were stronger predictors of age-appropriate immunizations among children receiving their immunization from a private provider than among those receiving immunizations from a public or a military provider.

Overall the results showed that Norfolk mothers believe that vaccines are safe, and effective. The data suggest that parent education should emphasize specific vaccines and the diseases they prevent; when to begin immunizations; and that immunizations can be given during minor illness.