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Abstract Immunization rates of preschool children in the United States are well below recommended levels. Whereas low-income and minority groups have been targeted as at risk for inadequate immunization, the assumption is generally made that middle/upper-income children are adequately immunized through the private sector. We conducted a community-based survey that refutes this assumption. Only 31% of the 302 parents surveyed reported full immunization of their 2-year-olds. No significant differences were found in the immunization rates for middle upper-income (34% immunized) versus lower-income children (28% immunized). Failure to receive the 18-month doses of DTP and polio was the most frequent cause of inadequate coverage for both groups. Barriers to immunization reported by middle/upper- and lower-income parents were similar, with over one-third of the parents identifying cost and lack of insurance coverage as problems. Additional barriers related to methods of operations of providers. Findings have immediate implications for public health nurses in terms of assessing coverage of their own preschool populations and introducing corrective actions to improve levels of immunization.