The impact of state policies on vaccine coverage by age 13 in an insured population

J Adolesc Health. 2007 May;40(5):405-11. doi: 10.1016/j.jadohealth.2006.12.013. Epub 2007 Mar 9.


Purpose: To determine the impact of state policies on vaccine coverage among adolescents with managed care insurance.

Methods: We used the 2003 Health Plan Employer Data and Information Set to determine state-specific hepatitis B and varicella vaccine coverage among children with managed care insurance who turned 13 years in 2002. Our outcomes of interest were receipt of hepatitis B and varicella vaccines by age 13. Utilizing weighted least-squares methods, multiple linear regression models were developed to evaluate the relationship between hepatitis B and varicella vaccine coverage and state policies, while controlling for state sociodemographic variables.

Results: Across 28 states, adolescent hepatitis B vaccine coverage ranged from 35.3% to 80.5% (mean = 55.3%) and varicella vaccine coverage ranged from 22.9% to 7.6% (mean = 42.3%). In separate multiple regression models, after adjusting for potentially confounding sociodemographic variables, middle school mandates were significantly associated with hepatitis B vaccine coverage (p = .002) and varicella vaccine coverage (p = .024). Other policies, including universal purchase of vaccines and availability of philosophic exemptions, were not associated with vaccine coverage in this insured population.

Conclusions: In this population of insured adolescents, middle school vaccine mandates were the only state policy associated with improved hepatitis B and varicella vaccine coverage. Mandates are an effective method for promoting adolescent immunization.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Chickenpox / epidemiology
  • Chickenpox / prevention & control*
  • Chickenpox Vaccine / administration & dosage*
  • Child
  • Cross-Sectional Studies
  • Female
  • Health Policy
  • Hepatitis B / epidemiology
  • Hepatitis B / prevention & control*
  • Hepatitis B Vaccines / administration & dosage*
  • Humans
  • Immunization Programs / economics
  • Immunization Programs / organization & administration*
  • Immunization Schedule
  • Insurance Coverage / organization & administration*
  • Male
  • Managed Care Programs / organization & administration
  • Program Evaluation
  • Registries
  • State Health Plans / organization & administration*
  • United States / epidemiology
  • Vaccination / statistics & numerical data


  • Chickenpox Vaccine
  • Hepatitis B Vaccines