Effect of a monetary sanction on immunization rates of recipients of aid to families with dependent children.

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Abstract
Although immunization rates have increased in general over the last decade,1,2 the rates for poor and minority children have not kept pace.3,4 Robinson and colleagues5 have identified several risk factors that highly correlate with failure to immunize children on schedule, including having low parental education level, large family size, low socioeconomic status, or ethnic or minority group membership; receiving services through public health clinics; being a single parent; starting the immunization series late; and having inadequate insurance coverage for immunizations. Others have indicated that the difficulties poor families have in keeping their children's immunizations up-to-date result from deficiencies in the health care system,6,7 and a lack of transportation, social support, and understanding of immunization schedules.8,9 These factors strongly suggest that families receiving welfare assistance are at risk of not having their children immunized in a timely fashion.

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