Date of Award

Summer 2001

Document Type


Degree Name

Doctor of Philosophy (PhD)


Urban Services--Health Services

Committee Director

Clare Houseman

Committee Member

Ardythe L. Morrow

Committee Member

Katharine C. Kersey


This is a retrospective longitudinal study of health service utilization using the Immunization Practice Data Set obtained from the Center for Pediatric Research, Norfolk, Virginia. Cluster sampling was used to identify a cohort of children (n = 271), aged 0 to 24 months, from the city of Norfolk, Virginia. A two-year abstraction of medical records was used to determine utilization practice patterns for three categories of health: well-baby, acute and chronic care. The purpose of this study was to identify socio-demographic, need, and health system factors associated with under-utilization of primary care services using Aday's model. The proportion of children who met the American Academy of Pediatrics guidelines for the number of preventive care visits was identified.

As a group, half of the children in the first year-of-life failed to meet the AAP guidelines of 5 well-baby visits (mean = 4.64, SD 2.72) while most of those in the second year-of-life slightly exceeded the 3 well-baby visit standard (mean = 4.04, SD 2.47). Compliance in the latter group was 76.60 of the cohort (n = 82) and those that did not meet the AAP specification were 23.4% (n = 25). The mean age of the child at first visit was 8.1 months and represents a highly significant lack of well baby/preventive care visits during the first year of life in the study cohort.

Results of this study concur with prior research in identifying risk factors/variables associated with access to healthcare providers and under utilization of primary care providers. Respondents who tended to under-utilize primary care services and over utilize emergency care providers were Black, single unsupported parents, from low-income families, with low education and those who lacked insurance. The major barriers reported by parents were location, lack of transportation, and cost.