The sampling of states and localities is far too small to be statistically representative, and the findings of the case studies cannot be used by themselves to make national generalizations, at least as regards state-level program models and policy choices. Nevertheless, the case studies and site visits allowed the committee to pursue questions about the implementation of national program and funding policies across an array of states. They also gave committee members, staff, and consultants the opportunity to communicate directly with state and local immunization and health program managers in a sustained fashion on several occasions, which provided much insight into the impact and importance of federal policies.

The sites chosen were Maine; New Jersey; North Carolina; Alabama; Michigan; Texas; Washington; and, in California, Los Angeles and San Diego Counties. These states and counties were selected because they vary demographically, and because their immunization policies and program structures reflect distinctive choices that convey a sense of the variety among all the states in immunization strategies, challenges, and achievements. Table E-1 displays notable demographic statistics for these states (California data are used for Los Angeles and San Diego Counties), Table E-2 shows immunization-related public policies and programmatic features; and Table E-3 displays Section 317, VFC, and state-source immunization spending for 1995 and 1998.

The framework for developing profiles of individual states and the data elements to be collected for all cases were designed by staff and reviewed by the committee. A subcommittee to oversee the conduct of the case studies was formed, and members of this subcommittee, as well as members of the committee at large, participated in site visits and were involved in both the written and oral presentation of findings to the rest of the committee.

Four site visits were conducted to large metropolitan areas known to have pockets of need and/or overall low immunization coverage rates:

  • Detroit, Michigan;

  • Newark, New Jersey;

  • Houston, Texas; and

  • Los Angeles and San Diego, California (a combined visit).

Interviews with and visits to operating programs included the following in each of the sites:

  • county and municipal immunization program and health directors,

  • managed care organizations serving Medicaid and SCHIP clients,

  • persons using or developing immunization registries,



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