School and daycare entry requirements have been credited with increasing immunization rates among school-age children, but no prior study has assessed the nationwide effects of entry requirements while controlling for individual, family, and household characteristics. The 2002 National Immunization Survey (NIS) is a nationally representative annual survey that includes provider record-verified immunization dates for 20,546 children aged 19-35 months without prior history of varicella. In weighted bivariate and multivariate logistic regression models, we examined the association of state entry mandate implementation with children's up-to-date (UTD) status for varicella vaccine, adjusted for sociodemographic characteristics of children, mothers, and household income and for children's UTD status for other recommended vaccines. In this national sample representative of 5.6 million children, 83.2% (95% CI: 82.3%-84.1%) were UTD for varicella vaccine. Between 1997 and 2002 inclusive, 33 states and the District of Columbia had implemented school and/or daycare entry immunization mandates for varicella. In bivariate analyses, 84.9% (83.9%-85.9%) of children in states with varicella entry mandates were UTD, compared to 76.8% (75.3%-78.4%) of children in states without such mandates. In multivariate analyses controlling for child and family characteristics, children living in states with varicella entry mandates remained significantly more likely to be UTD for varicella than children in states without mandates. These findings indicate that immunization entry requirements are associated with higher immunization rates among preschool-age children, and suggest that the effects of entry requirements are independent of other individual and household factors associated with childhood immunization.
[Show abstract][Hide abstract] ABSTRACT: This paper provides an analytical framework for evaluating the effects of individual health insurance mandates on coverage. That framework draws from three literatures — health economics, tax compliance, and behavioral economics — to identify the factors that affect people's responses to health insurance mandates. The health economics literature explains how people value health insurance and how changes in its costs affect coverage. The tax compliance literature indicates that the probability of detection and peoples attitudes toward risk affect perceptions of those costs. The salience of the mandate and social norms — factors from the behavioral economics literature — also may affect coverage decisions.
National tax journal 12/2010; 63(4):659-679. DOI:10.2307/41791073 · 0.37 Impact Factor
"Ethical analyses of compulsory vaccination have focused on tensions between maximizing public health benefits and respecting parental autonomy with regards to medical decision-making for their daughters (Colgrove 2006; Zimmerman 2006; Charo 2007; Balog 2009). Prior experience with varicella and Hepatitis B vaccination indicates that requiring vaccination for school entry leads to greater public uptake of vaccine recommendations (Davis and Gaglia 2005; Morita, Ramirez et al. 2008). Mandating vaccinations has also been shown to reduce racial disparities in both vaccination rates (Morita, Ramirez et al. 2008) and rates of vaccinepreventable disease (Flannery, Schrag et al. 2004). "
[Show abstract][Hide abstract] ABSTRACT: To explore parents' opinions of school-entry requirements for human papillomavirus (HPV) vaccination.
We interviewed parents of vaccine-eligible girls attending medical appointments in an urban academic medical center and an affiliated community health center. We used qualitative methods to explore parents' opinions about mandating routine childhood vaccines and HPV vaccine, as well as their feelings about vaccinating their own daughters against HPV.
We included 19 Caucasian, 18 African-American, 12 Afro-Caribbean, 3 African, and 21 Latino parents. Nearly all parents had allowed their children to receive routine vaccinations and expressed support for mandating these vaccines. Most parents also vaccinated their daughters against HPV: 100% of Caucasian parents, 90% of African-American parents, 73% of Afro-Caribbean/African parents, and 90% of Latino parents. Only 11% of Caucasian parents supported HPV vaccine mandates, however, compared with 78% of African-American, 60% of Afro-Caribbean/African, and 90% of Latino parents. Immigrants supported mandates more frequently than U.S.-born parents. Most Caucasian parents opposed mandatory HPV vaccination because they believed the HPV vaccine should be an individual decision because the virus can only be spread by sexual contact. African-American, Afro-Caribbean, African, and Latino parents generally viewed mandates as the most effective way to protect their daughters from cervical cancer. Latino parents gave special importance to protecting their daughters from sexually transmitted infections.
Parents from different racial and ethnic backgrounds expressed unique perspectives about mandatory HPV vaccination. Caucasians were less likely than parents of other races/ethnicities to support vaccine mandates.
Women s Health Issues 11/2010; 20(6):420-6. DOI:10.1016/j.whi.2010.07.001 · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In 1995, the first hepatitis A vaccines became available for use. At that time, Arizona had the highest hepatitis A incidence of all 50 states. During that same time period, the Arizona State Immunization Information System (ASIIS) was created to collect information on all immunizations given in the state. Four state-level hepatitis A vaccination policies were enacted according to Centers for Disease Control and Prevention recommendations and local initiatives from 1996 to 2005. Our primary objective was to assess the impact of these policies on vaccine uptake in children.
Immunization records from ASIIS were used to calculate yearly coverage of children with at least one reported hepatitis A vaccination between 1995 and 2008. Proportions vaccinated were calculated by age group (12-23 months, 24-59 months, 5-9 years, 10-14 years, and 15-19 years) for three regions: Maricopa County; Apache and Navajo counties; and the remaining 12 Arizona counties, which were grouped as one to reflect different target groups for the four policies examined. We calculated percent changes from before and after each policy implementation.
Significantly different percent changes were detected among the three regions that related to the four policies implemented. Percent change in uptake was consistently higher in the regions that were targeted for that specific policy.
Analysis of ASIIS data revealed a major effect of hepatitis A policy recommendations on vaccine uptake in Arizona. Targeting high-risk populations through vaccine recommendations and child care entry requirements was highly successful in achieving higher vaccination coverage.
Public Health Reports 01/2011; 126 Suppl 2:87-96. DOI:10.2307/41639289 · 1.55 Impact Factor
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