Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Public Health (DPH)


Epidemiology and Biostatistics


Heidi Jones

Committee Members

Glen Johnson

Vassiliki Papadouka

Jennifer Dowd

Subject Categories

Public Health


Vaccines For Children Program, VFC, Citywide Immunization Registry CIR, vaccine series completeness, HPV


A Multilevel Analysis to Understand the Role of the Federal Vaccine Financing Program in Socioeconomic Disparities in Vaccination Coverage among Children and Adolescents in New York City

Objectives: The purpose of this study was to examine the role of the federal vaccine financing program, the Vaccines For Children (VFC) program, in vaccine series completeness among children and adolescents in New York City. In addition, we aimed to investigate possible effect measure modification by selected neighborhood variables to explain socioeconomic disparities in vaccination coverage.

Methods: We used data from the New York City (NYC) Citywide Immunization Registry (CIR) and the American Community Survey (ACS) to examine vaccine series completeness among children 19-35 months and adolescents 13-17 years of age, with VFC status as the main exposure controlling for selected individual- and neighborhood-level factors. Neighborhood poverty and VFC-facility concentration were explored as confounders and effect measure modifiers in the relationship between VFC status and vaccine series completeness. Data were analyzed using Poisson and multilevel log-binomial models. A separate spatial analysis was conducted using spatial scan statistics to identify clusters of undervaccination and ArcGIS to examine intersections between neighborhood vaccination coverage and neighborhood poverty.

Results: The effect of VFC status was minimal among children (prevalence ratio, PR=1.06, p

Conclusion: Efforts to reduce vaccination coverage disparities based on VFC status should target primarily adolescents. Improving overall adolescent coverage must consider the barriers to HPV vaccination. For both children and adolescents, identifying the root causes of neighborhood coverage variations can help reduce disparities overall.

Included in

Public Health Commons



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