Association of Health Insurance Status and Vaccination Coverage among Adolescents 13-17 Years of Age

Lu, Peng–jun; Yankey, David; Jeyarajah, Jenny; Fredua, Benjamin; Elam–Evans, Laurie D.; Reagan‐Steiner, Sarah

doi:10.1016/j.jpeds.2017.12.024

Cited by 22 publications

(12 citation statements)

References 24 publications

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“…Similarly, the presence of public or organizational policies providing women with paid maternity leave has been found to increase breastfeeding initiation and duration (44)(45)(46). Policies that ensure access to health insurance that covers immunization have also been found to determine access to immunization services, therefore, playing a signi cant role in immunization decision-making (42,47,48).…”

Section: Policy-level Factorsmentioning

confidence: 99%

“…Policies play a fundamental role in access to healthcare services, utilization of healthcare services, and the adoption of healthy behaviors (41). For example, there is ample evidence that universal healthcare coverage increases access to healthcare services, including immunization (41)(42)(43). Similarly, the presence of public or organizational policies providing women with paid maternity leave has been found to increase breastfeeding initiation and duration (44)(45)(46).…”

Section: Policy-level Factorsmentioning

confidence: 99%

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The Socioecological Model as a Framework for Exploring Factors Influencing Childhood Immunization Uptake in Lagos State, Nigeria

Olaniyan

Isiguzo

Hawk

2021

Preprint

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Background Nigeria is one of the ten countries globally that accounts for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies' interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders' perspectives using the Socioecological Model (SEM). Methods Using the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods. Results The study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 18 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at the each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers’ immunization knowledge, caregivers’ welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards) that influence childhood immunization uptake. Several factors were intertwined, such as healthcare workers’ education of caregivers on immunization and caregivers' knowledge of vaccination. Conclusions The reciprocity of the findings from the different Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria's suboptimal immunization coverage.

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Section: Policy-level Factorsmentioning

confidence: 99%

Section: Policy-level Factorsmentioning

confidence: 99%

The Socioecological Model as a Framework for Exploring Factors Influencing Childhood Immunization Uptake in Lagos State, Nigeria

Olaniyan

Isiguzo

Hawk

2021

Preprint

View full text Add to dashboard Cite

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“…Our data only included commercially insured children, accounting for ∼54% of the US population ,18 years of age (39% are insured through Medicaid, 2% are insured through other public insurance, and 5% are uninsured). 41 In the 2015 NIS-Teen, 3-dose HPV vaccine coverages among commercially insured, Medicaid-insured, and uninsured children were 42%, 44%, and 25% for girls and 27%, 31%, and 23% for boys, 42 suggesting that compared with commercially insured children, Medicaid-insured children had slightly higher coverage and uninsured children had a lower coverage.…”

Section: Discussionmentioning

confidence: 99%

Trends in Human Papillomavirus Vaccination in Commercially Insured Children in the United States

et al. 2020

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OBJECTIVES: The human papillomavirus (HPV) vaccine was recommended in 2006 for girls and in 2011 for boys. The Healthy People 2020 goal for 2-dose HPV vaccination coverage is 80% by age 15 for girls and boys. We used nationwide population-based data to describe trends in HPV vaccination in children. METHODS: We conducted a cohort study nested within the MarketScan health care database between January 2003 and December 2017. Children were followed from the year they turned 9 until HPV vaccination, insurance disenrollment, or the end of the year when they turned 17, whichever came first. We estimated the cumulative incidence of at least 1-and 2-dose HPV vaccination, stratified by birth year, sex, and state. In secondary analyses, we evaluated the association between state-level vaccination policies and HPV vaccination coverage. RESULTS: This study included 7 837 480 children and 19.8 million person-years. The proportion of 15-year-old girls and boys with at least a 1-dose HPV vaccination increased from 38% and 5% in 2011 to 57% and 51% in 2017, respectively; the proportion with at least a 2-dose vaccination went from 30% and 2% in 2011 to 46% and 39% in 2017, respectively. By 2017, 2-dose HPV vaccination coverage varied from 80% in Washington, District of Columbia, among girls to 15% in Mississippi among boys and was positively correlated with legislation for HPV vaccine education and pediatrician availability. CONCLUSIONS: Despite the increasing trends in uptake, HPV vaccine coverage among commercially insured children in the United States remains behind target levels, with substantial disparities by state.

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“…5 Studies of adolescent vaccination, many focused on the HPV vaccine and conducted among urban and suburban populations, have identified a lack of a provider recommendation, financial and insurance concerns, questions about the need for vaccination and vaccine safety, and decreased access to care or low health care-seeking behavior as barriers to vaccination. [6][7][8][9][10][11] Less is known about barriers to vaccination for rural adolescents. Studies of rural adolescent HPV vaccination have identified the influence of race, religion, parental education, and lack of collaborative provider communication as barriers, along with some of the same issues noted across geographic settings.…”

Section: Introductionmentioning

confidence: 99%

Rural Adolescent Immunization: Delivery Practices and Barriers to Uptake

et al. 2021

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Background: Rural adolescent vaccination rates lag behind urban. We sought to assess rural-urban differences in barriers to adolescent vaccination, perceived parental vaccine attitudes, and immunization delivery practices among public health nursing (PHN), pediatric (Peds), and family medicine (FM) clinicians.Methods: Internet and mail survey of Colorado PHN, Peds, and FM clinicians from June-August 2019. Study population was recruited from local health plans and the American Medical Association Physician Masterfile. Rural and urban responses were compared using Cochran Armitage trend, Fisher's exact, and chi-square tests.Results: Response rate was 38% (163/433; 91 rural, 72 urban). Rural respondents were less likely than urban to agree most patients have insurance that covers vaccination (86% vs 97%; P = .02). Rural respondents were less likely than urban to indicate most parents in their practice would agree with statements about vaccine benefits (P = .02) and trust in medical providers (P = .05). Rural respondents were more likely than urban to report adolescents were somewhat/very likely to receive vaccines at public health departments (65% vs 28%; P < .0001) and less likely to report adolescents were somewhat/very likely to receive vaccines at pharmacies (26% vs 45%; P = .02). Fewer providers strongly recommended HPV vaccine (81% for females, 80% for males 11 to 12 years) than other adolescent immunizations (Tdap: 97%, MenACWY at 11 to 12 years: 87%; influenza at 11 to 17 years: 87%; each P < .005, rural-urban responses did not differ).Conclusions: Rural barriers to adolescent vaccination include logistic issues and parental vaccine attitudes. Efforts to improve rural adolescent vaccination should include public health departments and address vaccine confidence and access barriers.

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Association of Health Insurance Status and Vaccination Coverage among Adolescents 13-17 Years of Age

Cited by 22 publications

References 24 publications

The Socioecological Model as a Framework for Exploring Factors Influencing Childhood Immunization Uptake in Lagos State, Nigeria

The Socioecological Model as a Framework for Exploring Factors Influencing Childhood Immunization Uptake in Lagos State, Nigeria

Trends in Human Papillomavirus Vaccination in Commercially Insured Children in the United States

Rural Adolescent Immunization: Delivery Practices and Barriers to Uptake

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