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ABSTRACT: INTRODUCTION: One of two overarching goals of the Healthy People 2010 initiative was to eliminate health disparities. We evaluate trends in children vaccination coverage disparities by socio-demographic characteristics in the United States from 2001 through 2010. METHODS: Disparities in vaccination coverage for the 4:3:1:3:3:1 vaccine series was assessed with National Immunization Survey (NIS) 2001-2010 data. The disparities between two categories of population were independently evaluated yearly from 2001 through 2010. RESULTS: In 2001, 10 out of 12 disparities were significant (P-value <0.05). Six disparities were reduced from statistically significant in 2001 to not significant in 2010. Across 2001-2010, 8 disparities narrowed significantly; the average change in disparities per year were negative and ranged from -0.30% to -0.64% (P-value <0.05). CONCLUSIONS: Significant success has been achieved in reducing disparities in vaccination coverage for young children among most of the major socio-demographic subpopulations in the United States by 2010.
Vaccine 03/2013; · 3.77 Impact Factor
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ABSTRACT: Estimated trends in county-level vaccination coverage compared with national health objectives and associated with other variables (e.g., access to care, economic conditions, and demographic characteristics) have not been reported previously.
1995-2008.
The National Immunization Survey (NIS) is an ongoing, random-digit-dialed telephone survey that gathers vaccination coverage data from households with children aged 19-35 months in 50 states and selected urban areas and territories.
During 1995-2008, 185,336 children aged 19-35 months sampled by NIS had adequate provider data and lived in one of the 257 counties where the combined sample size for at least one of the seven biennial periods during 1995-2008 was ≥35. Statistically significant increases in estimated vaccination coverage occurred in 27 of 233 counties (12%) with ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP); for 38 of 233 counties (16%) with ≥3 doses of polio vaccine; eight of 233 counties (3%) with ≥1 dose of measles, mumps, and rubella (MMR); nine of 233 counties (4%) with ≥3 doses of Haemophilus influenzae type B (Hib) vaccine; 193 of 233 counties (83%) with ≥3 doses of hepatitis B vaccine; 228 of 232 counties (98%) with ≥1 dose of varicella vaccine; and 187 of 192 counties (97%) with ≥4 doses of 7-valent pneumococcal conjugate vaccine (PCV7). Six of 233 (2%) counties had significant decreases in vaccination coverage for Hib. During the 2007-2008 biennial period, the percentage of 193 counties with estimated vaccine coverage that achieved the Healthy People 2010 objective of 90% vaccination coverage was 8% for DTaP/DTP vaccines, 93% for polio vaccine, 86% for MMR vaccine, 71% Hib vaccine, 94% for hepatitis B vaccine, 50% for varicella vaccine, and <1% for PCV7. Among 104 counties, the estimated percentage of children aged 6-23 months who were administered ≥1 dose of the seasonal influenza vaccine during the 2007-2008 influenza vaccination season was 39.0% (range: 22.2%-68.8%). For most vaccines and vaccine series, higher levels of county-level vaccination coverage correlated with a higher number of pediatricians per capita, a higher number of people living in group quarters (e.g., college residence halls, residential treatment centers, skilled nursing facilities, group homes, military barracks, correctional facilities, workers' dormitories, and facilities for persons experiencing homelessness) per capita, higher per capita income, a higher number of Hispanics per capita, and having a service-dependent economy. Lower levels of county-level vaccination coverage correlated with higher number of persons in poverty per capita, a higher percentage of black children among children aged <5 years, higher levels of housing stress (i.e., ≥30% income for rent or mortgage and certain inadequate housing characteristics), a higher number of pediatric intensive care beds per capita, and designation as a nonmetropolitan county with an economy dependent on recreation activities.
During 1995-2008, significant increases in vaccination coverage for individual vaccines occurred in many counties for the newly recommended vaccines, varicella and PCV7.
In counties that did not meet the Healthy People 2010 vaccination coverage objectives, states should evaluate strategies to achieve these objectives. The Guide to Community Preventive Services provides a summary of interventions that increase community vaccination coverage, including provider reminder-recall systems that remind parents to return to clinics to administer missed doses to children and assessment and feedback on the performance of vaccination providers. In counties where significant decreases in Hib vaccination coverage occurred, additional research is warranted to determine whether the recent shortage in the Hib vaccine was the sole cause of these decreases. In counties with a high proportion of children living in poverty, interventions to increase vaccination coverage among these children are needed. Additional research is required to understand potential barriers to increased coverage with these vaccines, the role of vaccination providers and their resource constraints, and factors associated with access to health care among children.
MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries / CDC 04/2011; 60(4):1-86.
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ABSTRACT: Random-digit-dial telephone surveys are experiencing both declining response rates and increasing under-coverage due to the prevalence of households that substitute a wireless telephone for their residential landline telephone. These changes increase the potential for bias in survey estimates and heighten the need for survey researchers to evaluate the sources and magnitudes of potential bias. We apply a Monte Carlo simulation-based approach to assess bias in the NIS, a land-line telephone survey of 19-35 month-old children used to obtain national vaccination coverage estimates. We develop a model describing the survey stages at which component nonsampling error may be introduced due to nonresponse and under-coverage. We use that model and components of error estimated in special studies to quantify the extent to which noncoverage and nonresponse may bias the vaccination coverage estimates obtained from the NIS and present a distribution of the total survey error. Results indicated that the total error followed a normal distribution with mean of 1.72 per cent(95 per cent CI: 1.71, 1.74 per cent) and final adjusted survey weights corrected for this error. Although small, the largest contributor to error in terms of magnitude was nonresponse of immunization providers. The total error was most sensitive to declines in coverage due to cell phone only households. These results indicate that, while response rates and coverage may be declining, total survey error is quite small. Since response rates have historically been used to proxy for total survey error, the finding that these rates do not accurately reflect bias is important for evaluation of survey data. Published in 2011 by John Wiley & Sons, Ltd.
Statistics in Medicine 02/2011; 30(5):505-14. · 1.88 Impact Factor
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ABSTRACT: The goal was to explore the association of being underinsured and receiving doses at a health department clinic (HDC) with not receiving all recommended adolescent vaccine doses.
A total of 5657 adolescents, 13 to 17 years of age, were sampled in the National Immunization Survey-Teen in 2006-2007.
A total of 63.9% of all adolescents were covered by private health insurance. Among privately insured adolescents, approximately 31.3% were underinsured. Compared with fully insured adolescents, underinsured adolescents were more likely to receive doses at an HDC for tetanus-diphtheria toxoids/tetanus toxoids-reduced diphtheria toxoids-acellular pertussis vaccine (25.1% vs 6.2%; P < .05), tetravalent meningococcal conjugate vaccine (11.5% vs 2.5%; P < .05), and quadrivalent human papillomavirus vaccine (16.2% vs 3.4%; P < .05). Also, compared with fully insured adolescents, underinsured adolescents who received doses at an HDC had lower estimated rates of vaccination coverage for tetanus-diphtheria toxoids/tetanus toxoids-reduced diphtheria toxoids-acellular pertussis vaccine (58.5% vs 70.9%; P < .05), tetravalent meningococcal conjugate vaccine (10.8% vs 25.8%; P < .05), and quadrivalent human papillomavirus vaccine (7.8% vs 14.3%; P < .05).
Underinsured adolescents who receive doses at an HDC have lower rates of vaccination coverage than do fully insured adolescents.
PEDIATRICS 12/2009; 124 Suppl 5:S515-21. · 4.47 Impact Factor
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ABSTRACT: Underinsured children are covered by private health insurance that does not cover the cost of vaccines, are not entitled to receive publicly purchased vaccines at no cost through the Vaccines for Children (VFC) Program unless they receive doses at a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC), may be referred by their primary care providers to health department clinics (HDCs) for vaccinations, and may have lower vaccination coverage for new and more expensive vaccines.
To describe the estimated percentage of children in the U.S. who are underinsured, receive vaccine doses at HDCs, and are not VFC-entitled; and to evaluate the association between being underinsured, receiving vaccine doses at an HDC, and timely vaccination coverage.
Subjects were 16,621 19-35 month-old children sampled by the National Immunization Survey in 2007.
Of all 19-35 month-old children, an estimated 10.5% were underinsured; and an estimated 1.4% were underinsured, received doses at an HDC, and were not VFC-entitled. Compared to fully insured children, children who were underinsured and received doses at an HDC had significantly lower vaccination coverage for the varicella (81.5% vs. 87.7%, p < 0.05) and PCV7 (55.1% vs. 75.9%, p < 0.05) vaccines.
Children who were underinsured and received doses at HDCs were found to have lower estimated timely vaccination coverage for recently recommended vaccines and more expensive varicella and PCV7 vaccines. To adequately vaccinate these children at HDCs, states require stable funding to pay for vaccines as the number of new and more expensive vaccines grows.
PEDIATRICS 12/2009; 124 Suppl 5:S507-14. · 4.47 Impact Factor
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ABSTRACT: To evaluate trends in national vaccination coverage from 2000 to 2007 among children aged 19-35 months for at least four doses of diphtheria-tetanus-pertussis vaccine (4+DTaP), three doses of poliovirus vaccine (3+Polio), one dose of measles-mumps-rubella vaccine (1+MMR), three doses of Haemophilus influenzae type b vaccine (3+Hib), three doses of hepatitis B vaccine (3+HepB), one dose of Varicella vaccine (1+Var), and the standard vaccine series of these six vaccines (4:3:1:3:3:1). To predict vaccination coverage levels in 2008-2010 for those vaccines that have not yet reached the Healthy People 2010 coverage targets of 90% for individual vaccines and 80% for the vaccine series.
Data were analyzed for 167,086 children aged 19-35 months in the 2000-2007 National Immunization Survey. Vaccination coverage trends were analyzed with weighted least squares linear regression models. Nonlinear Weibull and logarithmic regression models were fitted to these past results, and extrapolation was used to predict vaccination coverage levels for 4+DTaP, 1+Var, and the 4:3:1:3:3:1 series from 2008 to 2010.
From 2000 to 2007, observed vaccination coverage increased significantly for four of the six vaccines and the standard vaccine series, and reached the 90% target for 3+Polio, 1+MMR, 3+Hib, and 3+HepB. Increases in coverage were not significant for 1+MMR and 3+Hib; however, coverage for these vaccines was consistently>90% throughout the study period. Both Weibull and logarithmic regression models predicted that coverage with 1+Var and the 4:3:1:3:3:1 series will surpass the 2010 target by 2008, while coverage with 4+DTaP will fall short of the target at 86% in 2010.
The United States is well on the way toward reaching most of the Healthy People 2010 objectives for early childhood vaccination coverage. Enhanced efforts are needed to ensure that these trends continue, and to increase coverage with 4+DTaP.
Vaccine 07/2009; 27(36):5008-12. · 3.77 Impact Factor
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ABSTRACT: To evaluate progress in timely vaccination coverage associated with low-income households.
The US National Immunization Survey.
Children aged 19 to 35 months living in low-income households who were sampled between 1995 and 2007 (N = 232 318). Low-income households had an annual income that was 133% or less of the federal poverty level, and high-income households had an annual income of 400% or more of the federal poverty level.
Administration of 4 or more doses of diphtheria, tetanus, pertussis (DTaP-DTP) vaccine; 3 or more doses of polio; 1 or more doses of measles, mumps, rubella (MMR); 3 or more doses of Haemophilus influenzae type b (Hib); 3 or more doses of hepatitis B; and 1 or more doses of varicella vaccines by age 19 months as reported by the children's vaccination providers. Progress in timely coverage was evaluated by tracking changes between consecutive annual birth cohorts born between 1994 and 2004.
Among low-income children, timely vaccination coverage increased significantly between consecutive birth cohorts by an estimated 0.5% for DTaP-DTP, 0.3% for polio, 0.6% for MMR, 1.2% for hepatitis B, and 5.3% for varicella vaccines but did not change significantly for the Hib vaccine. Disparities in timely coverage for low- vs high-income children declined significantly between consecutive birth cohorts by an estimated -0.3% for MMR, -0.3% for hepatitis B, and -0.5% for varicella vaccines, did not change significantly for the polio vaccine, and increased significantly by 0.4% for the DTaP-DTP vaccine.
Disparities in vaccination coverage associated with low household income persist. Further progress in timely vaccination may be achieved by improving health care providers' reminder/recall systems, implementing educational interventions that address barriers to vaccination, and increasing parents' awareness of the Vaccines for Children Program.
Archives of pediatrics & adolescent medicine 06/2009; 163(5):462-8. · 3.73 Impact Factor
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ABSTRACT: The purpose of the study was to identify and understand associations between characteristics of medical practices where immunization services are delivered and vaccination status among white, black, and Hispanic children aged less than 19 months.
Eighty pediatric and family physicians participated in a physician-patient encounters survey that included 684 children aged less than 19 months who received at least 1 vaccination during a randomly selected week in 2003.
According to physicians' responses to survey questions, white children who used large medical practices, and black and Hispanic children who used practices, all enrolled in the Vaccine for Children (VFC) program, were more likely to receive vaccines at the recommended age, but Hispanic children who used large Medicaid practices were less likely to receive them at the recommended age. White children who used medical practices that had a large minority patient population were more likely to have completely missed whole series of vaccines.
Medical practice characteristics varied in importance as determinants of childhood vaccination among white, black, and Hispanic children. Understanding how type of medical practice and other medical practice characteristics may impact the receipt of timely preventive health services is vital to improving health care access in underserved populations.
Journal of the National Medical Association 04/2009; 101(3):229-35. · 1.16 Impact Factor
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ABSTRACT: In survey sampling, information about the prevalence of a health outcome Y for a defined target population is frequently obtained using a two-stage data collection process. In the first stage, households that have members of the target population are identified and socio-demographic data that are believed to be associated with Y are collected. At the end of the first stage of data collection, permission is requested to contact the member's health providers so that accurate information about Y can be obtained. When permission is obtained, a second phase of data collection is conducted in which those health providers are contacted and Y is obtained. A 'complete response' results when data are obtained from both the first and the second phases of the survey. A 'partial response' results when data are collected from the first phase, but Y is not obtained in the second phase. To adjust for selection bias in estimating the prevalence of Y caused by partial responders' missing Y values, potential differences between complete and partial responders are typically taken into account by using weighting class methods. These methods assume that missing Y values are missing at random (MAR). This paper describes statistical tests for evaluating whether missing data are missing completely at random or MAR.
Statistics in Medicine 07/2008; 27(22):4569-80. · 1.88 Impact Factor
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ABSTRACT: The goal was to determine whether disparities in childhood immunization coverage exist between American Indian/Alaska Native children and non-Hispanic white children.
We compared immunization coverage with the 4 diphtheria-tetanus-pertussis, 3 poliovirus, 1 measles-mumps-rubella, 3 Haemophilus influenza type b, and 3 hepatitis B(4:3:1:3:3) series and its individual vaccine components (> or = 4 doses of diphtheria, tetanus, and pertussis vaccine; > or = 3 doses of oral or inactivated polio vaccine; > or = 1 dose of measles, mumps, and rubella vaccine; > or = 3 doses of Haemophilus influenzae type b vaccine; and > or = 3 doses of hepatitis B vaccine) between American Indian/Alaska Native children and non-Hispanic white children from 2000 to 2005, using data from the National Immunization Survey.
Although immunization coverage increased for both populations from 2001 to 2004, American Indian/Alaska Native children had significantly lower immunization coverage, compared with non-Hispanic white children, over that time period. In 2005, coverage continued to increase for American Indian/Alaska Native children but decreased for non-Hispanic white children, and no statistically significant disparity in 4:3:1:3:3 coverage was evident in that year.
Disparities in immunization coverage for American Indian/Alaska Native children have been present, but unrecognized, since 2001. The absence of a disparity in coverage in 2005 is encouraging but is tempered by the fact that coverage for non-Hispanic white children decreased in that year.
PEDIATRICS 05/2008; 121(5):938-44. · 4.47 Impact Factor
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ABSTRACT: We describe how trends in the vaccination coverage at 19 months of age vary by race/ethnicity; explore the extent to which data required to evaluate a child's up-to-date vaccination status is missing as a result of the scattering of vaccination records among many vaccination providers; evaluate how the prevalence of that missing data varies by race/ethnicity; and evaluate the impact that the missing data has on estimated race/ethnic disparities in vaccination coverage. We analyzed data from 255,043 children sampled between 1995 and 2006 by the National Immunization Survey (NIS). Among children who had 2+ vaccination providers reporting, estimated vaccination coverage was significantly lower by approximately 15 per cent among children who did not have all of their providers reporting to the NIS compared with children who had all of their vaccination providers reporting to the NIS. By comparing coverage estimates that were adjusted for missing data to unadjusted estimates, we found that unadjusted estimates consistently underestimated vaccination coverage by as much as 4.9 per cent for Asians, 4.8 per cent for Hispanics, 4.1 per cent for American Indian/Alaska Natives, 3.3 per cent for non-Hispanic blacks, and 2.8 per cent for non-Hispanic white children. Estimates of disparities in estimated vaccination coverage did not depend on whether coverage estimates were adjusted for missing data. Hispanic and non-Hispanic black children had estimated coverage rates that were significantly less than that of non-Hispanic white children, with median disparities of 4 and 9 per cent, respectively. Regardless of whether estimates are adjusted, data from the NIS show that disparities in vaccination coverage that existed in the early 1990s persist.
Statistics in Medicine 03/2008; 27(20):4107-18. · 1.88 Impact Factor
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ABSTRACT: Routine childhood immunization with pneumococcal conjugate vaccines (PCV7s) began in 2000 in the United States. Despite vaccine shortages, reductions in invasive pneumococcal disease occurred rapidly during 2000-2002. Age-appropriate PCV7 coverage was estimated and characteristics associated with undervaccination were identified for children in the 1998-2002 birth cohorts.
Data were analyzed for 85,135 children aged 19-35 months in the 2001-2004 National Immunization Surveys. To obtain PCV7 coverage estimates by birth cohorts, a pooled analysis was conducted by combining individual survey years that sampled children with appropriate birth dates. Logistic regression models were used to identify factors associated with age-appropriate vaccination.
The proportion of children receiving the primary 3-dose PCV7 series by age 12 months increased from 45.5% (+/-0.6) among children born in 2000 to 62.1% (+/-0.7) among those born in 2002. By age 24 months, an estimated 30.7% (+/-0.6), 38.0% (+/-0.6), and 49.0% (+/-1.1) of children born in 2000, 2001 and 2002, respectively, had received all four PCV7 doses; however, only 15.0% (+/-0.4), 16.1% (+/-0.4) and 24.4% (+/-0.6) of children were age-appropriately immunized. Among children born in 1998 and 1999, 10.1% +/-0.5) and 37.6% (+/-0.7), respectively, received one or more catch-up doses during their second year of life. Lower age-appropriate PCV7 coverage was independently associated with black race, Hispanic ethnicity, receiving vaccinations from public health providers, and low household income.
The dramatic reductions in pneumococcal-related diseases from direct and indirect vaccine effects occurred when few children had received the recommended complete vaccine schedule, and there were substantial racial and socioeconomic disparities in coverage.
American Journal of Preventive Medicine 02/2008; 34(1):46-53. · 4.04 Impact Factor
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ABSTRACT: In September 2001 and again in February 2004, the Centers for Disease Control and Prevention announced shortages in the supply of the pneumococcal conjugate vaccine. We describe the effects of the pneumococcal conjugate vaccine shortages in 2001-2003 and 2004 on the timeliness of vaccination uptake for quarterly birth cohorts affected by the shortages.
A total of 102,478 19- to 35-month-old children were sampled by the National Immunization Survey between 2001 and 2005. Provider-reported vaccination histories were used to evaluate whether children had been administered > or = 4 doses of pneumococcal conjugate vaccine by 16 months of age.
Among successive birth cohorts affected by the first shortage, estimated coverage of > or = 4 doses of pneumococcal conjugate vaccine by 16 months declined significantly from 28.8% to 18.2%. As the first shortage ended, estimated coverage of > or = 4 doses of pneumococcal conjugate vaccine by 16 months increased steadily with each successive birth cohort to 40.2%. From the onset of the second shortage, estimated coverage of > or = 4 doses of pneumococcal conjugate vaccine by 16 months declined steadily and significantly to 13.7%. As many as 27% of parents whose child was affected by the first shortage reported that their child's vaccination provider had delayed the administration of pneumococcal conjugate vaccine doses. Of those parents who said that a pneumococcal conjugate vaccine dose was delayed and whose child was not administered > or = 4 doses, 2.9% received a reminder notice from the provider to schedule administration of those delayed doses, and 0.2% had an appointment to receive those delayed or missed doses.
Vaccine shortages can result in delayed or missed doses and can have a dramatic impact on the vaccine coverage of children. Vaccination providers need to communicate effectively with parents so that doses that are delayed or missed during a vaccine shortage are administered when the shortage is resolved.
PEDIATRICS 11/2007; 120(5):e1165-73. · 4.47 Impact Factor
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ABSTRACT: Parents who have concerns about vaccine safety may be reluctant to have their children vaccinated. The purpose of this study was to explore how vaccination coverage among children 19 to 35 months of age is associated with health care providers' influence on parents' decision to vaccinate their children, and with parents' beliefs about vaccine safety.
Parents of 7695 children 19 to 35 months of age sampled by the National Immunization Survey were administered the National Immunization Survey Parental Knowledge Module between the third quarter of 2001 and the fourth quarter of 2002. Health care providers were defined as a physician, nurse, or any other type of health care professional. Parents provided responses that summarized the degree to which they believed vaccines were safe, and the influence providers had on their decisions to vaccinate their children. Children were determined to be up-to-date if their vaccination providers reported administering > or = 4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, > or = 3 doses of polio vaccine, > or = 1 dose of measles-mumps-rubella vaccine, > or = 3 doses of Haemophilus influenzae type b vaccine, and > or = 3 doses of hepatitis B vaccine.
Of all of the parents, 5.7% thought that vaccines were not safe, and 21.5% said that their decision to vaccinate their children was not influenced by a health care provider. Compared with parents who responded that providers were not influential in their decision to vaccinate their children, parents who responded that providers were influential were twice as likely to respond that vaccines were safe for children. Among children whose parents believed that vaccines were not safe, those whose parents' decision to vaccinate was influenced by a health care provider had an estimated vaccination coverage rate that was significantly higher than the estimated coverage rate among children whose parents' decision was not influenced by a health care provider (74.4% vs 50.3%; estimated difference: 24.1%).
Health care providers have a positive influence on parents to vaccinate their children, including parents who believe that vaccinations are unsafe. Physicians, nurses, and other health care professionals should increase their efforts to build honest and respectful relationships with parents, especially when parents express concerns about vaccine safety or have misconceptions about the benefits and risks of vaccinations.
PEDIATRICS 11/2006; 118(5):e1287-92. · 4.47 Impact Factor
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ABSTRACT: This study explored how vaccination coverage is associated with not being insured and with insurance type among children who are insured and to show how these associations are modified by race/ethnicity.
We determined whether 8324 children sampled in the National Immunization Survey in 2001 and 2002 were covered by private insurance only, Medicaid/State Children's Health Insurance Program, or another insurance type or were uninsured at the time of the National Immunization Survey interview or were uninsured at some time before the interview. Children were up to date if, by the date of the interview, their vaccination providers had administered > or =4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, > or =3 doses of polio vaccine, > or =1 dose of measles-mumps-rubella vaccine, > or =3 doses of Haemophilus influenzae type b vaccine, and > or =3 doses of hepatitis B vaccine. To evaluate the association between insurance type and breaks in insurance with timely completion of the recommended vaccination schedule soon after 19 months of age, we restricted our analyses to children 19 to 24 months of age.
Nationally, 12.6 +/- 1.6% of all children 19 to 24 months of age were uninsured at some time. Children who were uninsured at the time of the National Immunization Survey interview had significantly lower vaccination coverage than did children with Medicaid/State Children's Health Insurance Program coverage or children with private insurance only (52.6% vs 70.0% and 75.6%). Children who had never been insured and children who were insured but had a break in insurance coverage in the 12 months immediately preceding the National Immunization Survey interview had significantly lower vaccination coverage than did children who had been insured continuously (47.4% and 64.8% vs 73.5%).
Approximately 1 of 8 children were uninsured at some time, and those children were at greater risk of not being vaccinated on time as recommended.
PEDIATRICS 07/2006; 117(6):1972-8. · 4.47 Impact Factor
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ABSTRACT: Control of vaccine-preventable diseases depends on maintaining high levels of immunization coverage. Immunization coverage among preschool children remains suboptimal in some areas and sociodemographic subgroups, as well as for more recently introduced vaccines, leaving susceptible young children vulnerable to complications from vaccine-preventable diseases. This paper reviews approaches historically used to measure immunization coverage among preschool children in the United States. The strengths and weaknesses of various approaches to measuring immunization coverage among preschool children are explored, with emphasis on the current means to measure national immunization coverage-the National Immunization Survey. Methods for measuring immunization coverage among preschool children at local and state levels are also evaluated. Future opportunities and challenges for measuring immunization coverage at the local, state, and national levels are explored.
Epidemiologic Reviews 02/2006; 28:27-40. · 7.58 Impact Factor
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ABSTRACT: Lack of information has been associated with patient anxiety or concern in a number of healthcare areas.
(1) Identify the proportion of parents who agreed, were neutral, and disagreed that they had access to enough information to make a decision about immunizing their child; (2) examine how parents who agreed and disagreed differed with respect to sociodemographic characteristics, and their attitudes about immunizations, their child's healthcare provider, immunization requirements/exemptions, and immunization policymakers; and (3) identify if differences exist in specific immunization concerns.
A sample of parents with at least one child aged < or =6 years (n=642) was analyzed using data from the HealthStyles survey conducted during July and August 2003. Odds ratios and the Mantel-Haenszel chi-square test were used for analysis.
Response rate for HealthStyles was 69% (4035/5845). The largest proportion of parents agreed they had access to enough information (67%) compared to parents who were neutral (20%) or who disagreed (13%). Compared to parents who agreed, parents who disagreed were more likely to be less confident in the safety of childhood vaccines (odds ratio [OR]=5.4, 95% confidence interval [CI]=3.3-8.9), and to disagree that their child's main healthcare provider is easy to talk to (OR=10.3, 95% CI=3.7-28.1). There was a significant linear trend in the percentage of parents expressing immunization concerns among those who agreed, were neutral, and who disagreed they had access to enough information (p<0.05; df=1).
While most parents agreed that they had access to enough immunization information, approximately a third did not. Perceived lack of information was associated with negative attitudes about immunizations and toward healthcare providers. Basic information about the benefits and risks of vaccines presented by a trusted provider could go a long way toward maintaining and/or improving confidence in the immunization process.
American Journal of Preventive Medicine 09/2005; 29(2):105-12. · 4.04 Impact Factor
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ABSTRACT: Methods for estimating the size of a closed population from a capture-recapture study require the availability of unique identifiers on each of two lists. These identifiers are used to identify the number of individuals appearing on both lists. When the number of individuals appearing on both lists cannot be determined with certainty from the data, matching between the lists is problematic. In this paper, we develop a weighted estimator to account for all possible matches between two lists. A bootstrap procedure is proposed for estimation. To illustrate the methods, we used two lists that recorded New York State (NYS) hospitalizations due to pertussis in 1996 to estimate the number of persons hospitalized for pertussis in NYS that year.
Statistics in Medicine 08/2005; 24(13):2041-51. · 1.88 Impact Factor
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ABSTRACT: The Vaccines for Children (VFC) program is designed to reduce the cost of vaccines for vulnerable children, including Medicaid-eligible children, American Indian/Alaska Native children, uninsured children, and underinsured children whose health insurance does not cover the cost of vaccinations. A desired consequence of the program is to promote comprehensive continuous medical care within a medical home for these children.
To explore how having a medical home is associated with vaccination coverage among children eligible for the program.
A total of 24514 children 19 to 35 months of age sampled by the National Immunization Survey.
VFC eligibility was evaluated for 24514 children 19 to 35 months of age who were sampled by the National Immunization Survey. Children were considered to have a medical home if they had a doctor, nurse, or physician's assistant who provided them with ongoing routine care, including well-child care, preventive care, and sick care, according to their parents. Sampled children were determined to be 4:3:1:3:3 up-to-date (UTD) if their vaccination providers reported administering >or=4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, >or=3 doses of polio vaccine, >or=1 dose of measles-mumps-rubella vaccine, >or=3 doses of Haemophilus influenzae type b vaccine, and >or=3 doses of hepatitis B vaccine.
Nationally, 44.9% of all children were VFC eligible and 93.0% of the VFC-eligible children received all vaccine doses at a provider enrolled in the VFC program. Compared with children who were not VFC eligible, VFC-eligible children were less likely to be UTD (70.8% vs 77.7%) and less likely to have a medical home (82.1% vs 95.0%). However, among VFC-eligible children, children who had a medical home were significantly more likely to be UTD, compared with children who did not have a medical home (72.3% vs 63.5%). Also, among VFC-eligible children who had a medical home, children who used their medical home consistently to receive all of their vaccination doses were significantly more likely to be UTD, compared with children who did not receive all of their doses from their medical home (75.3% vs 65.7%). Finally, the 4:3:1:3:3 vaccination coverage rate among VFC-eligible children who received all of their vaccination doses from their medical home was not significantly different from that among non-VFC-eligible children, after controlling for significant differences in sociodemographic factors between these groups (adjusted difference: 2.8%; 95% confidence interval: -0.1% to 5.7%).
Although the vaccination coverage rate among VFC-eligible children who had a medical home and received all vaccine doses from their medical home was essentially equivalent to that of non-VFC-eligible children, substantial percentages of VFC-eligible children either did not have a medical home or did not use their medical home to receive all of their recommended vaccinations. The vaccination coverage rate among these children was significantly lower. This suggests that there may be opportunities to increase vaccination coverage by removing barriers that prevent the adoption and consistent use of a medical home among these children.
PEDIATRICS 07/2005; 116(1):130-9. · 4.47 Impact Factor
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ABSTRACT: Since 1994 the National Immunization Survey (NIS) has monitored progress toward the Healthy People 2000 and 2010 vaccination goals. The NIS collects data in two phases: first, a random-digit-dialing (RDD) telephone survey to identify households with children 19-35 months old and, second, a mail survey to vaccination providers to obtain vaccination histories used to estimate vaccination coverage rates. This report reviews the methodologies used in the 1994-2002 NIS to obtain official estimates of vaccination coverage and describes the methodology used for the first three topical modules of the NIS.
From 1994 to 1997 the NIS used a variation of a two-phase estimator to compensate for missing provider-reported vaccination histories. Between 1998 and 2001 a weighting-class estimator was used. In 2002 and thereafter the weighting-class approach was refined to account for households that do not have telephones and for unvaccinated children. To collect data on immunization-related topics, the NIS sample was randomized among three topical modules: health insurance and ability to pay for vaccinations (HIM); parental knowledge and experiences about vaccinations (PKM); and daycare attendance, breastfeeding practices, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (DCM).
In 2001 among children with completed RDD interviews, 0.3 percent were entirely unvaccinated. Together, the new nontelephone adjustment and the refinement for unvaccinated children yielded revised estimates that were within 1.5 percentage points of the original estimates obtained using the 1998-2001 methodology. Over the six quarters during which the first three topical modules were fielded (from mid-2001 through 2002), 21,163 children were randomized to the HIM, 3576 to the PKM, and 3511 to the DCM.
Vital and health statistics. Series 2, Data evaluation and methods research 04/2005;
