Date of Award

January 2021

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Linda M. Niccolai


Background: Adolescent vaccination coverage varies considerably between Tdap, meningococcal, and HPV vaccines. While evidence suggests that health care access affects vaccination coverage, evidence does not explain whether access drives delayed or no vaccination. This study evaluates whether measures of health care access are associated with delayed vaccination or not being vaccinated by age 17 years for Tdap, meningococcal, and HPV vaccines when controlling for sociodemographic factors as proxies for vaccine hesitancy. The secondary objective assesses whether health care access measures had consistent associations across the different vaccines. Methods: Using current ACIP recommendations, ‘on-time’, ‘delayed’, and ‘missed’ status by age 17 were defined for Tdap, meningococcal, and HPV vaccinations. Vaccination coverage disparities among 17-year-olds by access and sociodemographic variables were assessed using data from NIS-Teen 2018. Associations between measures of health access and delayed or missed vaccination by age 17 were evaluated using multivariable logistic regression analysis. Results: For adolescents age 17 years, missing the 11–12 years well-child check-up was the strongest predictor for delayed or missed vaccination for Tdap, ≥1 dose MenACWY, and HPV. Other measures of health care access, such as continuity of insurance and number of health provider visits in the past 12 months, were not significantly associated with delayed or missed vaccination for any of the vaccines. Conclusions: For the small proportion of the adolescent population that does not have an 11–12-year-old check-up, the detrimental effect on vaccination follows them through adolescence with a higher likelihood of no recommended vaccinations by age 17. The findings support a need to improve efforts for catch-up vaccination throughout adolescence.


This is an Open Access Thesis.

Open Access

This Article is Open Access