Objective. To assess the extent of immunization coverage against hepatitis B among children in Eastern VA. Method. A household survey was conducted in Newport News and Norfolk VA from 6/96-12/96. A total of 22,579 households were selected for inclusion using probability-proportionate-to-size (PPS) cluster sampling. To be eligible for interview, households had to have at least one child 12 to 30 months of age. A standardized questionnaire was administered in the home to parents of an age-eligible child. Data gathered included demographics, immunization history, provider and insurance factors, and problems obtaining immunizations. Immunization history was based on parent and provider records. Up-to-date(UTD) immunization status for hepatitis B vaccine was defined as having the first dose by 3 mo, the second dose by 5 mo, and the third dose by 19 mo and at 24 mo. Differences among groups in UTD status at 3 mo and 19 mo were tested by chi-square. Results. A total of 935 children (75% of eligible)were included in the survey. Half of mothers were white, 42% were black, 17% had not completed high school, 48% were in WIC, and 19% did not have operative telephones. Parents reported that their child's usual immunization provider was: private doctor (43%); public health clinic or community health center (18%); or military clinic (37%). 84% of infants were UTD for hepatitis B vaccine at 3 mo, 69% at 5 mo, 62% at 19 mo, and 71% at 24 mo. Of 843 infants who received the first dose of hepatitis B vaccine, 66% were immunized by 7 days and 76% were immunized by one mo of age. The percent UTD at 3 mo differed by provider (military-79%, public health-87%, private-89%, P=.002); and by insurance (CHAMPUS-80%, Medicaid-83%, private-92%, P=.001). At 19 mo, the percent UTD differed by ethnicity(white-68%, black-58%, P=.004)and by insurance type (CHAMPUS or Medicaid-61%, private-74%, P=.007). Among those ever immunized against hepatitis B, the earlier they received the first dose, the more likely they were to be UTD at 19 mo (P<0.001). UTD rates did not differ by WIC status or income level. Conclusions. While hepatitis B immunization has been well adopted in urban eastern VA, more than one-third of children do not receive the third dose of hepatitis B on schedule in the second year of life. In this population, privately-insured children have better hepatitis B immunization coverage than the Medicaid- and CHAMPUS-insured. Early initiation of hepatitis B immunization increases the chances of being UTD in the second year of life.