title: Underinsurance and adolescent immunization delivery in the United States.
abstract: 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, 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).
  
  
  CONCLUSIONS
  Underinsured adolescents who receive doses at an HDC have lower rates of vaccination coverage than do fully insured adolescents.
authors: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA 30333, USA. pzs6@cdc.gov
authors: Philip J
authors: PJ
authors: Smith
authors: Megan C
authors: MC
authors: Lindley
authors: Abby
authors: A
authors: Shefer
authors: Lance E
authors: LE
authors: Rodewald
mesh_terms: D000293:Adolescent; D002648:Child; D003153:Community Health Services / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007115:Immunization Schedule; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D012423:Rural Health; D014481:United States; D014611:Vaccination / Q000191:economics*