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Kempe A, O’Leary ST, Shoup JA, Stokley S, Lockhart S, Furniss A, Dickinson LM, Barnard J, Daley MF. Parental Choice of Recall Method for HPV Vaccination: A Pragmatic Trial. Pediatrics 2016; 137:e20152857. [PMID: 26921286 PMCID: PMC5884084 DOI: 10.1542/peds.2015-2857] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Completion rates for the human papillomavirus vaccine (HPV) series among adolescents remain low. Effectiveness of recall with parents choosing the method (preference-based recall) for increasing HPV series completion is unstudied. Within a cluster-randomized trial, we examined effectiveness of preference-based recall compared with usual care for increasing series completion and the association of recall choices with completion. METHODS All Kaiser Permanente Colorado pediatric practices (n = 7) were randomized to intervention (n = 4) or control (n = 3) by using covariate-constrained randomization. From January to June 2013, parents at intervention practices whose adolescents received HPV 1 were asked the recall method they preferred for subsequent doses and if they also wanted their child reminded. Completion rates were assessed 1 year after HPV 1. RESULTS At intervention practices, 374 (43%) of 867 patients were enrolled; 39% preferred text, 18% e-mail, 9% auto-dialer, and 34% 2-methods; 19% chose to have adolescent also recalled. Intervention adolescents were more likely to complete (63% vs 38%) than were controls (adjusted risk ratio 1.47 [1.38-1.57]) and less likely to be late in completing the series (45% vs 57%, P = .02). Rates of completion were similar between different recall methods, but significantly higher for those preferring e-mail and phone compared withother methods (90% vs 60%. P = .008). Completion rates were similar for adolescents who also received recalls (62%) versus those who did not (63%). CONCLUSIONS Preference-based recall was effective in increasing HPV series completion rates, with point estimates substantially higher than for most published studies of reminder/recall.
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Affiliation(s)
- Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Departments of Pediatrics, and
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Shannon Stokley
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Lockhart
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Anna Furniss
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - L. Miriam Dickinson
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Juliana Barnard
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew F. Daley
- Department of Pediatrics, University of Colorado, Aurora, Colorado,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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Angier H, Gregg J, Gold R, Crawford C, Davis M, DeVoe JE. Understanding how low-income families prioritize elements of health care access for their children via the optimal care model. BMC Health Serv Res 2014; 14:585. [PMID: 25406509 PMCID: PMC4240836 DOI: 10.1186/s12913-014-0585-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022] Open
Abstract
Background Insurance coverage alone does not guarantee access to needed health care. Few studies have explored what “access” means to low-income families, nor have they examined how elements of access are prioritized when availability, affordability, and acceptability are not all achievable. Therefore, we explored low-income parents’ perspectives on accessing health care. Methods In-depth interviews with a purposeful sample of 29 Oregon parents who responded to a previously administered statewide survey about health insurance. Transcribed interviews were analyzed by a multidisciplinary team using a standard iterative process. Results Parents highlighted affordability and limited availability as barriers to care; a continuous relationship with a health care provider helped them overcome these barriers. Parents also described the difficult decisions they made between affordability and acceptability in order to get the best care they could for their children. We present a new conceptual model to explain these experiences accessing care with health insurance: the Optimal Care Model. The model shows a transition from optimal care to a breaking point where affordability becomes the driving factor, but the care is perceived as unacceptable because it is with an unknown provider. Conclusions Even when covered by health insurance, low-income parents face barriers to accessing health care for their children. As the Affordable Care Act and other policies increase coverage options across the United States, many Americans may experience similar barriers and facilitators to health care access. The Optimal Care Model provides a useful construct for better understanding experiences that may be encountered when the newly insured attempt to access available, acceptable, and affordable health care services.
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Angier H, DeVoe JE, Tillotson C, Wallace L, Gold R. Trends in health insurance status of US children and their parents, 1998-2008. Matern Child Health J 2014; 17:1550-8. [PMID: 23014890 DOI: 10.1007/s10995-012-1142-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the United States (US), a parent's health insurance status affects their children's access to health care making it critically important to examine trends in coverage for both children and parents. To gain a better understanding of these health insurance trends, we assessed the coverage status for both children and their parents over an 11-year time period (1998-2008). We conducted secondary analysis of data from the nationally-representative Medical Expenditure Panel Survey. We examined frequency distributions for full-year child/parent insurance coverage status by family income, conducted Chi-square tests of association to assess significant differences over time, and explored factors associated with full-year insurance coverage status in 1998 and in 2008 using logistic regression. When considering all income groups together, the group with both child and parent insured decreased from 72.4 % in 1998 to 67.2 % in 2008. When stratified by income, the percentage of families with an insured child, but an uninsured parent increased for low-income families from 12.4 to 25.1 % and from 3.8 to 7.1 % for middle-income families when comparing 1998-2008. In regression analyses, family income remained the strongest characteristic associated with a lack of full-year health insurance. As future policy reforms take shape, it will be important to look beyond children's coverage patterns to assess whether gains have been made in overall family coverage.
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Affiliation(s)
- Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Rd, Mail Code FM, Portland, OR, 97239, USA,
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Lu PJ, Williams WW, Li J, Dorell C, Yankey D, Kepka D, Dunne EF. Human papillomavirus vaccine initiation and awareness: U.S. young men in the 2010 National Health Interview Survey. Am J Prev Med 2013; 44:330-338. [PMID: 23498097 PMCID: PMC5822442 DOI: 10.1016/j.amepre.2012.11.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/04/2012] [Accepted: 11/21/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2009, the quadrivalent human papillomavirus (HPV) vaccine was licensed by the U.S. Food and Drug Administration for use in men/boys aged 9-26 years. In 2009, the Advisory Committee on Immunization Practices (ACIP) provided a permissive recommendation allowing HPV vaccine administration to this group. PURPOSE To assess HPV vaccination initiation and coverage, evaluate awareness of HPV and HPV vaccine, and identify factors independently associated with such awareness among men aged 18-26 years. METHODS Data from the 2010 National Health Interview Survey were analyzed in 2011. RESULTS In 2010, HPV vaccination initiation among men aged 18-26 years was 1.1%. Among the 1741 men interviewed in this age group, nearly half had heard of HPV (51.8%). Overall, about one third of these men had heard of the HPV vaccine (34.8%). Factors independently associated with a higher likelihood of awareness of both HPV and HPV vaccine among men aged 18-26 years included having non-Hispanic white race/ethnicity; a higher education level; a U.S. birthplace; more physician contacts; private health insurance; received other vaccines; and reported risk behaviors related to sexually transmitted diseases, including HIV. CONCLUSIONS HPV vaccination initiation among men aged 18-26 years in 2010 was low. HPV and HPV vaccine awareness were also low, and messages in this area directed to men are needed. Since ACIP published a recommendation for routine use of HPV4 among men/boys in December 2011, continued monitoring of HPV vaccination uptake among men aged 18-26 years is useful for evaluating the vaccination campaigns, and planning and implementing strategies to increase coverage.
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Affiliation(s)
- Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Jun Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Christina Dorell
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - David Yankey
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Deanna Kepka
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Eileen F Dunne
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
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Robison SG. Incomplete Early Childhood Immunization Series and Missing Fourth DTaP Immunizations; Missed Opportunities or Missed Visits? ISRN PREVENTIVE MEDICINE 2012; 2013:351540. [PMID: 24967133 PMCID: PMC4062864 DOI: 10.5402/2013/351540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 05/31/2012] [Indexed: 11/23/2022]
Abstract
The successful completion of early childhood immunizations is a proxy for overall quality of early care. Immunization statuses are usually assessed by up-to-date (UTD) rates covering combined series of different immunizations. However, series UTD rates often only bear on which single immunization is missing, rather than the success of all immunizations. In the US, most series UTD rates are limited by missing fourth DTaP-containing immunizations (diphtheria/tetanus/pertussis) due at 15 to 18 months of age. Missing 4th DTaP immunizations are associated either with a lack of visits at 15 to 18 months of age, or to visits without immunizations. Typical immunization data however cannot distinguish between these two reasons. This study compared immunization records from the Oregon ALERT IIS with medical encounter records for two-year olds in the Oregon Health Plan. Among those with 3 valid DTaPs by 9 months of age, 31.6% failed to receive a timely 4th DTaP; of those without a 4th DTaP, 42.1% did not have any provider visits from 15 through 18 months of age, while 57.9% had at least one provider visit. Those with a 4th DTaP averaged 2.45 encounters, while those with encounters but without 4th DTaPs averaged 2.23 encounters.
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Affiliation(s)
- Steve G. Robison
- Immunization Program, State of Oregon, Oregon Health Authority, 800 NE Oregon Street, Suite 370, Portland, OR 97232, USA
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Dorell CG, Stokley S, Yankey D, Markowitz LE. Compliance with recommended dosing intervals for HPV vaccination among females, 13–17 years, National Immunization Survey-Teen, 2008–2009. Vaccine 2012; 30:503-5. [DOI: 10.1016/j.vaccine.2011.11.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 11/07/2011] [Accepted: 11/11/2011] [Indexed: 10/15/2022]
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Dorell CG, Yankey D, Santibanez TA, Markowitz LE. Human papillomavirus vaccination series initiation and completion, 2008-2009. Pediatrics 2011; 128:830-9. [PMID: 22007006 DOI: 10.1542/peds.2011-0950] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to describe factors associated with human papillomavirus (HPV) vaccination series initiation (≥1 dose) and completion (≥3 doses) and parents' intent to have their daughters vaccinated. METHODS Data from the 2008 and 2009 National Immunization Survey-Teen were analyzed to estimate HPV vaccination coverage among girls 13 to 17 years of age (N = 18,228) and to examine associations of vaccination coverage with demographic characteristics. RESULTS Overall, 40.5% of girls had received ≥1 HPV vaccine dose, and 53.3% of those girls completed the series. Factors independently associated with vaccination initiation included older age, having an 11- to 12-year preventive visit, insurance status, mother's age and marital status, not receiving all vaccines at public facilities, and provider recommendation, which was the factor most strongly associated with initiation (prevalence ratio: 2.6 [95% confidence interval: 2.4-2.9]). Compared with white girls (60.4%), black (46.0%) and Hispanic (40.3%) girls were less likely to complete the series. Lack of knowledge of the vaccine (19.4%), vaccination was not needed (18.8%), the daughter was not sexually active (18.3%), and a provider did not recommend (13.1%) were the most common reasons for parents' nonintent to have their daughters vaccinated. CONCLUSIONS Although HPV vaccine coverage rates are increasing, they are still below target levels. Recommendations by providers to adolescent patients and parents likely would improve vaccine uptake. Parental education regarding disease risks and benefits of HPV vaccination before exposure is needed to promote vaccine uptake.
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Affiliation(s)
- Christina G Dorell
- Division of Immunization Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Conway JH, Green T. Childhood immunization policies and the prevention of communicable disease. Pediatr Ann 2011; 40:136-43. [PMID: 21417204 PMCID: PMC6267946 DOI: 10.3928/00904481-20110217-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CME Educational Objectives
1.
Review the process through which vaccines are licensed and recommendations are developed for routine use.
2.
Discuss immunization coverage rates.
3.
Review possible strategies to improve immunization coverage rates.
The drastic reduction in the incidence of vaccine-preventable diseases through childhood immunization represents one of public health’s greatest achievements. The social and economic benefits gained through the prevention of mortality and morbidity caused by infectious diseases have dramatically improved the lives of people around the world. The most impressive gains have been in developed countries, where abundant economic resources and extensive healthcare systems have supported the development and implementation of increasingly sophisticated and expensive vaccines.
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Affiliation(s)
- James H Conway
- University of Wisconsin School of Medicine and Public Health, Department of Population Health Sciences, Madison, WI 53792, USA.
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Kim EY, Lee MS. Related factors of age-appropriate immunization among urban-rural children aged 24-35 months in a 2005 population-based survey in Nonsan, Korea. Yonsei Med J 2011; 52:104-12. [PMID: 21155042 PMCID: PMC3017684 DOI: 10.3349/ymj.2011.52.1.104] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study was aimed to determine the status and related factors of age-appropriate immunization among urban-rural children aged 24-35 months in a 2005 population-based survey in Nonsan, Korea. MATERIALS AND METHODS We conducted household survey and provider check using questionnaire and checklist to obtain data on immunization status for children, aged 24-35 months. Age-appropriate immunization was defined as status of receiving the fourth diphtheria-tetanus-pertussis (4 DTP), 3 Polio, the first measles-mumps-rubella (1 MMR) doses, and the 4 : 3 : 1 series. RESULTS Age-appropriate immunization rates were 51.7% for 4 DPT, 88.0% for 3 Polio, 87.9% for 1 MMR, and 50.3% for the 4 : 3 : 1 series. First-born children, lower perceived barrier scores, and higher perception of immunization data were significantly related to age-appropriate immunization. CONCLUSION The findings indicated that age-appropriate immunization rate could be improved by implementing reminder/recall service and providing the knowledge about immunization. Identification and consideration related factors would improve immunization rate and age-appropriate immunization.
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Affiliation(s)
- Eun-Young Kim
- Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - Moo-Sik Lee
- Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, Korea
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DeVoe JE, Ray M, Krois L, Carlson MJ. Uncertain health insurance coverage and unmet children's health care needs. Fam Med 2010; 42:121-132. [PMID: 20135570 PMCID: PMC4918751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVES The State Children's Health Insurance Program (SCHIP) has improved insurance coverage rates. However, children's enrollment status in SCHIP frequently changes, which can leave families with uncertainty about their children's coverage status. We examined whether insurance uncertainty was associated with unmet health care needs. METHODS We compared self-reported survey data from 2,681 low-income Oregon families to state administrative data and identified children with uncertain coverage. We conducted cross-sectional multivariate analyses using a series of logistic regression models to test the association between uncertain coverage and unmet health care needs. RESULTS The health insurance status for 13.2% of children was uncertain. After adjustments, children in this uncertain "gray zone" had higher odds of reporting unmet medical (odds ratio [OR] =1.73; 95% confidence interval [CI]=1.07, 2.79), dental (OR=2.41; 95% CI=1.63, 3.56), prescription (OR=1.64, 95% CI=1.08, 2,48), and counseling needs (OR=3.52; 95% CI=1.56, 7.98), when compared with publicly insured children whose parents were certain about their enrollment status. CONCLUSIONS Uncertain children's insurance coverage was associated with higher rates of unmet health care needs. Clinicians and educators can play a role in keeping patients out of insurance gray zones by (1) developing practice interventions to assist families in confirming enrollment and maintaining coverage and (2) advocating for policy changes that minimize insurance enrollment and retention barriers.
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Affiliation(s)
- Jennifer E DeVoe
- Oregon Health and Science University, Department of Family Medicine, 3181 Sam Jackson Park Road, Mailcode: FM, Portland, OR 97239, USA.
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Immunization status and risk factors of migrant children in densely populated areas of Beijing, China. Vaccine 2009; 28:1264-74. [PMID: 19941996 DOI: 10.1016/j.vaccine.2009.11.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 11/06/2009] [Accepted: 11/08/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To properly evaluate the immunization status and determine risk factors of migrant children in 23 densely populated towns and townships in Beijing. METHODS A household cluster sampling survey was implemented and standard face-to-face interviews were conducted with 1820 migrant children aged 12-35 months. Demographic characteristics of the child and primary caregiver, the child's migrant characteristics, the primary caregiver's knowledge and attitude toward immunization, information about immunization services provided by the local clinic, and the child's immunization history were obtained. Weighted up-to-date (UTD) and age-appropriate immunization rates for the following four vaccines were assessed: three doses of diphtheria, tetanus and pertussis combined vaccine (DTP); three doses of oral poliomyelitis vaccine (OPV); three doses of hepatitis B vaccine (HepB); and one dose of Measles-containing vaccine (MCV). Weighted UTD and age-appropriate immunization rates for the overall series of these four vaccines (the 3:3:3:1 immunization series) were also estimated. Risk factors for not being UTD, being invalid and being delayed for the 3:3:3:1 immunization series were explored using both single-level and multi-level multinomial logistic regression models. RESULTS For each antigen, the weighted UTD immunization rate was above 83%, but the age-appropriate immunization coverages for HepB, OPV, DPT, and MCV were only 45.6%, 49.6%, 50.8% and 54.7%, respectively. The 1st dose was most likely to be invalid or delayed within HepB, OPV and DPT series. For the 3:3:3:1 immunization series, the weighted UTD and age-appropriate immunization rates were 78.1% and 20.5%, respectively. Immunization status of migrant children tended to be homogenous within a village and therefore, multi-level model was more appropriate for assessing risk factors. Besides demographic characteristics, several other factors were significantly associated with age-appropriate immunization coverage. These factors included: the child's migrant characteristics; the primary caregiver's awareness of the importance of vaccination, and outreach services provided by immunization clinics including notification services and supplementary immunization activities (SIAs). The frequency and duration of clinical immunization sessions significantly influenced the UTD immunization rate but not the age-appropriate immunization rate. The degree of the primary caregiver's satisfaction with clinic services and convenience to vaccination clinic had no impact on the child's immunization status. CONCLUSION Alarmingly low age-appropriate immunization coverage of migrant children in densely populated areas demanded immediate intervention. Community context was an important factor to a migrant child's vaccination status and should be considered when taking measures. Strategies to strengthen outreach immunization service need to be developed to effectively improve the age-appropriate immunization coverage of migrant children.
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A usual source of care: supplement or substitute for health insurance among low-income children? Med Care 2008; 46:1041-8. [PMID: 18815525 DOI: 10.1097/mlr.0b013e3181866443] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the separate and combined effects of having health insurance and a usual source of care (USC) on access to healthcare for low-income children and to determine if one or the other is superior in ensuring better access to necessary services. METHODS We conducted cross-sectional, multivariable analyses of data from a mail-return survey of Oregon's food stamp program. Results from 2681 completed surveys were weighted back to a population of 84,087 families with adjustments for oversampling techniques and nonresponse. RESULTS Among low-income Oregon children, those with health insurance and a USC reported the best access to healthcare. In multivariable comparisons to this reference group, insured children without a USC had higher rates of unmet medical need [odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.27-3.73]; no doctor visits in 12 months (OR = 6.77; 95% CI: 3.80-12.06); and problems obtaining specialty care (OR = 4.12; 95% CI: 1.59-10.68). Similarly, having a USC but not health insurance was associated with an even higher likelihood of unmet medical needs (OR = 4.33; 95% CI: 2.85-6.57); as well as unmet prescription needs (OR = 2.64, 95% CI: 1.77-3.94), and problems obtaining dental care (OR = 4.83; 95% CI: 3.31-7.06). CONCLUSIONS Incremental policy solutions are being proposed that focus on either health insurance coverage for children or expanded access to primary care. However, neither approach displaces the need for the other. The effects of a USC and health insurance, together, are additive predictors of the likelihood that children have optimal access to necessary healthcare services.
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Kim SS, Frimpong JA, Rivers PA, Kronenfeld JJ. Effects of maternal and provider characteristics on up-to-date immunization status of children aged 19 to 35 months. Am J Public Health 2007; 97:259-66. [PMID: 17194865 PMCID: PMC1781415 DOI: 10.2105/ajph.2005.076661] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2004] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the effects of maternal and provider characteristics on the up-to-date immunization status of children. METHODS We used data from the 2003 National Immunization Survey to determine variations in children's up-to-date status in the 4:3:1:3 immunization series. RESULTS Low maternal educational levels and low socioeconomic status were associated with high 4:3:1:3 series completion rates. Also, completion rates were high in Hispanic and non-Hispanic Black families with low income-to-poverty ratios. CONCLUSIONS We found that children of less educated mothers and children in Hispanic and non-Hispanic Black families with low income-to-poverty ratios were more likely to have completed the 4:3:1:3 series. Although the reasons for these results need further exploration in other data sets, possible factors are Hispanics' positive cultural attitudes regarding the needs and importance of young children and provision of information on immunizations to low-income minority mothers who access government-subsidized health care programs.
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Affiliation(s)
- Sam S Kim
- Department of Sociology, Arizona State University, Tempe, AZ 85287-3701, USA
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Brousseau DC, Hoffmann RG, Yauck J, Nattinger AB, Flores G. Disparities for Latino Children in the Timely Receipt of Medical Care. ACTA ACUST UNITED AC 2005; 5:319-25. [PMID: 16302832 DOI: 10.1367/a04-203r1.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE It is not known whether Latino children, the largest minority population in the United States, experience disparities in the timeliness of their access to health care. We compared timeliness of care among Latino, white, and African American children. METHODS DESIGN cross-sectional cohort from the 2000 Medical Expenditure Panel Survey. PATIENTS children with a usual source of care. OUTCOME MEASURE timeliness of care was assessed using parent reports of their child's 1) routine care, 2) illness care, 3) phone help, and 4) experiencing of a brief wait time. ANALYSIS multiple logistic regression was used to determine the adjusted odds of not always receiving timely medical care. RESULTS Four-thousand one-hundred twenty children were included. Latino children were less likely to always (P < .05) receive timely care compared with whites and African Americans, respectively, in 3 areas: routine care, phone help, and brief wait time. Multiple regression revealed decreased relative risks (RR, 95% CI) of always receiving timely medical care for Latinos in the same areas: routine care, compared with whites (0.88, 0.79-0.98) and African Americans (0.81, 0.70-0.93); phone help, compared with whites (0.84, 0.76-0.92) and African Americans (0.86, 0.76-0.960); and brief wait time, compared with whites (0.71, 0.65-0.80) and African Americans (0.81, 0.70-0.92). With parental survey language in the model, Latinos experienced decreased timeliness of care for routine care compared with African Americans (0.85, 0.72-0.98); phone help compared with whites (0.87, 0.77-0.96); and brief wait times compared with whites (0.79, 0.71-0.87). CONCLUSIONS Latino children experience marked disparities in obtaining timely medical care, only some of which is associated with language differences.
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Affiliation(s)
- David C Brousseau
- Department of Pediatrics/Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Shi L, Stevens GD. Disparities in access to care and satisfaction among U.S. children: the roles of race/ethnicity and poverty status. Public Health Rep 2005; 120:431-41. [PMID: 16025723 PMCID: PMC1497738 DOI: 10.1177/003335490512000410] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. METHODS Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. RESULTS Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. CONCLUSIONS Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.
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Affiliation(s)
- Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205-1996, USA.
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