Maternal education, child immunizations, and public policy: evidence from the US National Immunization Survey

This article measures the independent association of maternal education level and childhood immunization rates in the USA and compares the associations in states that provide free vaccines to all residents (Universal) and those that do not (non-Universal). To do this, the US-based National Immunization Survey data from 1995 to 2003 for children 19-35 months of age were analyzed. Unadjusted estimates of up-to-date status for the 4:3:1:3:3 series and the pneumococcal conjugate vaccine were estimated by the level of maternal education. Linear probability regressions produced adjusted estimates of maternal education effects controlling for covariates. Adjusting for race/ethnicity, income, and other covariates, children of mothers with less than high school education were found to be 7.8% (p<0.05) less likely than children of mothers with college education to be up-to-date for the 4:3:1:3:3 vaccine series. For the newer pneumococcal conjugate vaccine, these children were 4.5% (p<0.05) less likely to be up-to-date. Residence in a Universal state was found to significantly attenuate these effects. As such, higher maternal education, independent of income and race/ethnicity is associated with improved child immunization rates, but subsidizing immunization choices diminishes the disadvantage associated with lower maternal educational achievement.