title: Preexisting Chronic Health Conditions and Health Insurance Status Associated With Vaccine Receipt Among Adolescents.
abstract: OBJECTIVE
  Four vaccines are routinely recommended for adolescents: tetanus, diphtheria, and acellular pertussis (Tdap); human papillomavirus (HPV); meningococcal-conjugate (MCV4); and a yearly seasonal influenza vaccine. Vaccination promotion and outreach approaches may need to be tailored to certain populations, such as those with chronic health conditions or without health insurance.
  
  
  METHODS
  In a controlled trial among middle and high school students in Georgia, 11 schools were randomized to one of three arms: no intervention, parent education brochure, or parent education brochure plus a student curriculum on the four recommended vaccines. Parents in all arms were surveyed regarding their adolescent's vaccine receipt, chronic health conditions, and health insurance status.
  
  
  RESULTS
  Of the 686 parents, most (91%) reported their adolescent had received at least one of the four vaccines: Tdap (82%), MCV4 (59%), current influenza vaccine (53%) and HPV (48%). Twenty-three percent of parents reported that their adolescent had asthma. Most parents reported that their adolescent's insurance was Medicaid (60%) or private insurance (34%), and 6% reported no insurance. More adolescents with a chronic health condition received any adolescent vaccine than adolescents without a chronic health condition (p < .0001). Among those with no insurance, fewer had received any adolescent vaccine than those with Medicaid or private insurance (p < .0001).
  
  
  CONCLUSIONS
  The federal Vaccines for Children program offers recommended vaccines free to eligible children (including those without health insurance). Our findings suggest that parents may not be aware of this program or eligibility for it, thus revealing a need for education or other fixes.
authors.affiliation: Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia. Electronic address: kseib@emory.edu.
authors.forename: Katherine
authors.initials: K
authors.lastname: Seib
authors.affiliation: Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Natasha L
authors.initials: NL
authors.lastname: Underwood
authors.affiliation: Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Gargano
authors.affiliation: Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Sales
authors.affiliation: East Central Health District, Georgia Department of Public Health, Augusta, Georgia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Morfaw
authors.affiliation: Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
authors.forename: Paul
authors.initials: P
authors.lastname: Weiss
authors.affiliation: Department of Pediatrics, School of Medicine, Georgia Regents University, Augusta, Georgia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Murray
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Vogt
authors.affiliation: Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: DiClemente
authors.affiliation: Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: James M
authors.initials: JM
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D005260:Female; D005380:Financing, Government; D005845:Georgia; D006266:Health Education; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D010290:Parents / Q000193:education; D014481:United States; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*
keywords: Adolescent immunization; Chronic disease; HPV vaccine; Influenza vaccine; Insurance; MCV4 vaccine; Tdap vaccine; Vaccines for Children