title: Vaccination status of children living in rural areas in the United States: are they protected?
abstract: OBJECTIVE
  To estimate the vaccination coverage levels of children living in rural areas and identify statistically significant differences in coverage between children living in rural areas and their suburban and urban counterparts.
  
  
  METHODS
  Children aged 19 to 35 months participating in the 1999 National Immunization Survey (NIS) were included in the study. Children were classified as living in a rural, urban, or suburban area based on their telephone exchange (area code plus the first three digits of the telephone number). Statistically significant differences in vaccination coverage levels between the rural population and their urban counterparts were determined for individual vaccines and vaccine series.
  
  
  RESULTS
  Overall, 18% of the children included in the 1999 NIS lived in a rural area, 46% lived in a suburban area, and 36% lived in an urban area. The characteristics of the rural population were: 72% were white, non-Hispanic; 24% were below the poverty level; 16% had a mother with <12 years of education; and 30% received vaccinations from a public provider. Eighty percent of rural children, 79% of suburban children, and 77% of urban children completed the 4:3:1:3 series. The rural population had statistically significantly lower (p<0.01) varicella coverage levels than their suburban and urban counterparts.
  
  
  CONCLUSIONS
  Results of this study suggest that children living in rural areas are just as likely to receive the basic 4:3:1:3 vaccination series as their suburban and urban counterparts. Uptake of the varicella vaccine appears to be slower in rural areas than urban areas. Further studies are recommended to identify the risk factors for not receiving the varicella vaccine in rural areas.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. sstokley@cdc.gov
authors.forename: S
authors.initials: S
authors.lastname: Stokley
authors.forename: P J
authors.initials: PJ
authors.lastname: Smith
authors.forename: R M
authors.initials: RM
authors.lastname: Klevens
authors.forename: M P
authors.initials: MP
authors.lastname: Battaglia
mesh_terms: D019433:Chickenpox Vaccine; D002675:Child, Preschool; D019538:Health Care Surveys; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data*; D007223:Infant; D009313:National Health Programs; D010349:Patient Compliance / Q000706:statistics & numerical data; D011203:Poverty; D012424:Rural Population / Q000145:classification / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013383:Suburban Population / Q000706:statistics & numerical data; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D019433:Chickenpox Vaccine