American Journal of Public Health, Vol 90, Issue 9 1436-1443, Copyright © 2000 by American Public Health Association

JOURNAL ARTICLE

Well child care in the United States: racial differences in compliance with guidelines

DS Ronsaville and RB Hakim
Health Care Financing Administration, Baltimore, Md. 21244, USA. rhakim@hcfa.gov

OBJECTIVES: This study sought to estimate the rate of compliance with American Academy of Pediatrics guidelines for well child care in the first 6 months of life and to determine risks for inadequate care. METHODS: The study included 7776 infants whose mothers participated in both the 1988 National Maternal and Infant Health Survey and its 1991 longitudinal follow-up and whose mothers or pediatric providers supplied information about their medical care. Regression analysis was used to determine the probability of incomplete compliance with guidelines for well child care in relation to several socioeconomic risks. RESULTS: Fifty-eight percent of White infants, 35% of African American infants, and 37% of Hispanic infants obtained all recommended well child care. African American race was the biggest risk for inadequate care (odds ratio = 1.7, 95% confidence interval = 1.5, 1.9), followed by low levels of maternal education, low income, and poor prenatal care. The risk for African American infants persisted across socioeconomic levels. CONCLUSIONS: The racial disparities identified suggest that cultural barriers to seeking preventive care need further study and that programs aimed at reducing these barriers need to be developed.

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