Published online November 30, 2009
PEDIATRICS Vol. 124 Supplement December 2009, pp. S515-S521 (doi:10.1542/peds.2009-1542K)

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SUPPLEMENT ARTICLE

Underinsurance and Adolescent Immunization Delivery in the United States

Philip J. Smith, PhD, Megan C. Lindley, MPH, Abby Shefer, MD, FACP, Lance E. Rodewald, MD

Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVE: 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.

METHODS: A total of 5657 adolescents, 13 to 17 years of age, were sampled in the National Immunization Survey-Teen in 2006–2007.

RESULTS: A total of 63.9% of all adolescents were covered by private health insurance. Among privately insured adolescents, 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).

CONCLUSION: Underinsured adolescents who receive doses at an HDC have lower rates of vaccination coverage than do fully insured adolescents.

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Key Words: immunization • financing

Abbreviations: HDC—health department clinic • VFC—Vaccines for Children • ACIP—Advisory Committee on Immunization Practices • Td—tetanus-diphtheria toxoids • TdaP—tetanus toxoids-reduced diphtheria toxoids-acellular pertussis • MCV4—tetravalent meningococcal conjugate vaccine • HPV4—quadrivalent human papillomavirus vaccine • RHC—rural health center • FQHC—federally qualified health center • CI—confidence interval • NIS—National Immunization Survey • MSA—metropolitan statistical area

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Accepted Aug 25, 2009.

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