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December 14, 1999

Reducing Welfare Payments Has No Impact on Vaccination Rates For Young Children in Maryland

Penalizing welfare recipients if they fail to have their children vaccinated does not increase vaccination coverage for young children, according to a team of researchers. Their findings were published in the December issue of Archives of Pediatrics and Adolescent Medicine.

Welfare sanctions are being promoted across the country as an effective tool to increase vaccination coverage for young children. Using a behavior-based approach, the State of Maryland conducted a welfare reform demonstration project, the Primary Prevention Initiative (PPI). The PPI relied on monetary reductions to welfare payments to motivate families to seek preventive health care and thereby improve the health of their children. Parents who failed to verify that their preschool children received preventive health care services, including vaccinations, were subject to a $25 monthly penalty.

Lead author Cynthia Minkovitz, MD, MPP, assistant professor, Population and Family Health Sciences, Johns Hopkins School of Public Health, said, "Neither the theory behind such programs nor the available evidence suggests they will increase vaccination coverage."

The Maryland Department of Human Resources designed and directed the implementation of PPI. In six selected metropolitan and rural areas of Maryland, 17,524 families receiving Aid to Families with Dependent Children (AFDC) were randomly assigned to either experimental or control groups. Families in the control groups were not subject to the penalty.

Vaccination rates among the children were determined at the beginning of the study, then at one year and at two years after the intervention was in place. Five comparison groups (each with 650 children) were studied -- baseline (at the start of the study); experimental and control groups one year after the intervention; and experimental and control groups two years after the intervention. For each child, researchers measured the number of health care visits and determined whether all vaccinations recommended for that child's particular age group had been given. Data were collected from medical records obtained from primary care providers.

Overall, vaccination coverage was low. Among families receiving AFDC, PPI did not contribute to a meaningful increase in health care visits or vaccination coverage for children between ages 3 and 24 months. Up-to-date vaccination rates differed little between experimental and control groups at baseline and at each follow-up year. Fewer than 70 percent of children were up-to-date for polio and measles-mumps-rubella, while slightly more than 50 percent were up-to-date for diphtheria-tetanus toxoid-pertussis.

This study was done in conjunction with the Maryland Department of Human Resources and Department of Health and Mental Hygiene, with funding from the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention.

Public Affairs Media Contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Brigham @ 410-955-6878 or paffairs@jhsph.edu.  

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