title: System factors to explain 2009 pandemic H1N1 state vaccination rates for children and high-risk adults in US emergency response to pandemic.
abstract: BACKGROUND
  During the 2009-2010 H1N1 pandemic, children and high-risk adults had priority for vaccination. Vaccine in short supply was allocated to states pro-rata by population, but vaccination rates as of January 2010 varied among states from 21.3% to 84.7% for children and 10.4% to 47.2% for high-risk adults. States had different campaign processes and decisions.
  
  
  OBJECTIVE
  To determine program and system factors associated with higher state pandemic vaccination coverage for children and high-risk adults during an emergency response with short supply of vaccine.
  
  
  METHODS
  Regression analysis of factors predicting state-specific H1N1 vaccination coverage in children and high-risk adults, including state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and surveillance data.
  
  
  RESULTS
  Our modeling explained variation in state-specific vaccination coverage with an adjusted R-squared of 0.82 for children and 0.78 for high-risk adults. We found that coverage of children was positively associated with programs focusing on school clinics and with a larger proportion of doses administered in public sites; negatively with the proportion of children in the population, and the proportion not visiting a doctor because of cost. The coverage for high-risk adults was positively associated with shipments of vaccine to "general access" locations, including pharmacy and retail, with the percentage of women with a Pap smear within the past 3 years and with past seasonal influenza vaccination. It was negatively associated with the expansion of vaccination to the general public by December 4, 2009. For children and high-risk adults, coverage was positively associated with the maximum number of ship-to-sites and negatively associated with the proportion of medically underserved population.
  
  
  CONCLUSIONS
  Findings suggest that distribution and system decisions such as vaccination venues and providers targeted can positively impact vaccination rates for children and high-risk adults. Additionally, existing health infrastructure, health-seeking behaviors, and access affected coverage.
authors.affiliation: School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Drive, NW, Atlanta, GA 30332-0205, USA. Electronic address: carlo.davila@gatech.edu.
authors.forename: Carlo
authors.initials: C
authors.lastname: Davila-Payan
authors.affiliation: School of Industrial and Systems Engineering, Georgia Institute of Technology and School of Public Policy (by Courtesy), Georgia Institute of Technology, 755 Ferst Drive, NW, Atlanta, GA 30332-0205, USA. Electronic address: jswann@isye.gatech.edu.
authors.forename: Julie
authors.initials: J
authors.lastname: Swann
authors.affiliation: Immunization Services Division, Centers for Disease Control and Prevention, CDC Corporate Square Building 8, Corporate Boulevard NE, Atlanta, GA 30329, USA. Electronic address: pmw1@cdc.gov.
authors.forename: Pascale M
authors.initials: PM
authors.lastname: Wortley
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: Children and high-risk adults; Coverage; Estimates; Factors; Pandemic; State-specific