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health services, immunization, vaccination



  1. Groom, Holly MPH
  2. Kolasa, Maureen MPH
  3. Wooten, Karen MA
  4. Ching, Pamela SD
  5. Shefer, Abigail MD


Objective: To determine how child characteristics and immunization coverage levels differ among children using public and private providers.


Methods: Immunization coverage rates between 1996 and 2004 were compared among children aged 19-35 months, using data from the National Immunization Survey. Coverage was based on the 4:3:1:3:3 vaccine series: four or more doses of diphtheria, tetanus toxoids, acellular pertussis vaccine; three or more doses of poliovirus vaccine; one or more doses of measles-mumps-rubella vaccine; three or more doses of Haemophilus influenzae type b vaccine; and three or more doses of hepatitis B vaccine. Coverage differences were examined by provider types (child vaccinated by private, public, or a mix of providers), and stratified by child's race/ethnicity, area of residence, and household income level.


Results: Between 1996 and 2004, the proportion of children seeing exclusively private providers increased (58%-61%; P < .05); the proportion seeing only public providers decreased (19%-15%; P < .01). Coverage levels increased among children seeing all provider types. Coverage levels were higher for children using private providers than those using public providers in 2004 (83% vs 79%; P <.05). Except for White race (coverage was higher among those using private providers vs public providers), coverage levels by demographic variables did not significantly differ between children using only public or only private providers in 2004.


Conclusions: Equal emphasis should be placed on the efforts of public providers and private providers to increase coverage among children of all race/ethnicity, income, and residential groups.