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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2009.175935v1 100/5/839    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Baker, D. L. Articles by Diaz, R. PubMed PubMed Citation Articles by Baker, D. L. Articles by Diaz, R. Related Collections Access to Care Immunization/Vaccines Asians Socioeconomic Factors Surveys Refugees

Dian L. Baker, PhD, APRN-BC, PNP, Michelle T. Dang, RN, MSN, May Ying Ly, MSW and Rafael Diaz, PhD

At the time of the study, Dian L. Baker was a doctoral candidate at the University of Hawai‘i at Manoa. Michelle T. Dang is with the Division of Nursing and Rafael Diaz is with the Department of Mathematics and Statistics, California State University, Sacramento. Michelle T. Dang is also a doctoral student in the Human and Community Development Department, University of California, Davis. May Ying Ly is with the Sacramento City Unified School District, Sacramento, and the Sacramento Asian American Network for Cancer Awareness, Research, and Training, Sacramento.

Correspondence: Correspondence should be sent to Dian L. Baker, California State University, Sacramento, Division of Nursing, 6000 J St, Sacramento, CA 95819 (e-mail: dibaker{at}csus.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.

Objectives. We explored factors associated with perception of barriers to immunization among parents of Hmong origin in California, whose children experience persistent immunization inequities even with health insurance.

Methods. A partnership of academic researchers and members of the Hmong community conducted a community-based participatory research project. We collected data in naturalistic settings with a standardized instrument. We analyzed responses from 417 parents and caregivers and created a structural equation model to determine factors that contributed to perceived barriers.

Results. Of 3 potential contributing factors to perceived barriers—nativity, socioeconomic position, and use of traditional Hmong health care (i.e., consulting shamans and herbalists)—the latter 2 significantly predicted higher perceived barriers to immunization. Nativity, indicated by years in the United States, age of arrival in the United States, and English language fluency, did not predict perceived barriers.

Conclusions. Interventions aimed at reducing immunization inequities should consider distinct sociocultural factors that affect immunization rates among different refugee and immigrant groups.