From 1976, in addition to the above, newborns and children aged between 6 and 12 years were vaccinated with BCG if they were: (1) Inuits or Amerindians; (2) immigrants originating from a country with high TB incidence; and (3) tuberculin-negative individuals who lived at poverty threshold, especially in larger towns (Ministère des Affaires sociales, 1976). Our study revealed an important contribution of the subject’s ethnocultural background in determining the likelihood of BCG vaccination, both the parents’ and grandparents’ origin. Individuals born to immigrant parents were much less likely

to be vaccinated than those whose parents were born in Québec. As well, the subject’s grandparents’ ethnocultural origin was the sole and strong predictor of vaccination after the period of the provincial program. These observations are in agreement with a study selleck conducted among

immigrant children in Ontario (Canada), in which subject’s region of origin was the most influential determinant of immunization compliance, after adjusting for individual, maternal, familial, and health service characteristics (Guttmann et al., 2008). Vaccination compliance was also higher in Australian-born than among immigrant children (Jones et al., 1992). Residential area was an important predictor of vaccination within the BCG program. In the 1950s, tuberculin reactivity test and vaccination rates in Québec were estimated 17-AAG research buy to be 80% in rural areas and less than 60% in large cities (Frappier et al., 1971). We also observed a higher vaccination coverage among rural inhabitants, as reported elsewhere (Bundt and Hu, 2004, Faustini et al., 2001, Harmanci et al., 2003 and Haynes and Stone,

through 2004). Faustini suggested that this tendency might be explained by the relative scarcity of healthcare resources per capita in urban settings. In large cities where a vast susceptible population is targeted in a vaccination campaign, the per capita availability could be inadequate despite a greater number of clinics (Faustini et al., 2001). Our results on parents’ birthplace and grandparents’ ancestry, in the context of the province of Québec, may relate to the minority English-speaking community which was generally not in favor of BCG vaccination, similarly to most other provinces in Canada and the USA (Malissard, 1998). Vaccination after the program was only related to grandparents’ ethnocultural origin, and was much more likely among those of French ancestry. Among Stage 2 participants, almost all mothers and fathers of those who were vaccinated after the program were born in Québec, preventing us from considering parents’ birthplace in the final model. The association with grandparents’ ancestry may again reflect the greater acceptance of this vaccine in the French-speaking community.