Statistical Methodology of the National Immunization Survey: 1994-2002

1. Statistical Methodology of the National Immunization Survey: 1994-2002 Michael P. Battaglia, M.A., Abt Associates Inc.; Philip J. Smith, Ph.D., Centers for Disease Control and Prevention; David C. Hoaglin, Ph.D. Abt Associates Inc.; Meena Khare, M.S.., Centers for Disease Control and Prevention; Lawrence E. Barker, Ph.D., Centers for Disease Control and Prevention

2. National Immunization Survey • Large ongoing RDD survey, conducted by CDC since 1994 • Measures vaccination coverage among children aged 19-35 months at National, State, and urban area levels • Monitors Healthy People 2000 and 2010 goals of immunization coverage: >90% Coverage: 4 DTP, 3 Polio, 1 MMR, 3 Hep B, 3 Hib, and 4:3:1:3 series • Monitors introduction of new vaccines • <4% of households in the U.S. contain child aged 19-35 months

3. Seattle NYC Detroit Boston Milwaukee Cleveland Newark Chicago SantaClara Philadelphia Indianapolis Columbus Memphis Baltimore LosAngeles DC Nashville Phoenix San Diego Atlanta Dallas Birmingham El Paso Jacksonville Houston NewOrleans Miami SanAntonio NIS Sampling DesignIndependent samples in each of 78 Immunization Action Plan (IAP) areas. These areas will begin to “rotate” soon

4. Target Pop: 5.8M children 19-35 months of age NIS Sampling Plan RDD PRC 3.4 million telephone numbers sampled 31,693 kids 19-35 m.o.a completing the RDD survey 21,410 kids with sufficient provider-reported data to know their UTD status

5. 3 Important Advances: NIS Survey Weights National Adjustment Percentage Children who Received No Vacc. Doses 0.3% Nontelephone Households 4.5% Vaccination Provider Nonresponse 32.7%

6. Rates per 100,000: Zero Dose Children 19-35 moa

7. Characteristics of Zero Dose Children Child Characteristics Non-Hispanic White2-5x more likely than Hisp. or Non-Hisp Black Maternal Characteristics College education2-3x more likely than ≤ 12 years > 30 years of age2-3x more likely than moms 20-29 years Households Characteristics Income >$75k/yr2-6x more likely than ≤ $75K/year 4+ children in HH2-10x more likely than 1 child

8. Variation in Telephone Coverage

9. How the “Nontelephone” Adjustment Works Research by Frankel et al. has shown that HHs that experienced an interruption in telephone service are very much like nontelephone households. Determine which HHs have had an interruption Increase the survey weights of children living in HHs with a recent interruption to represent both interruption and nontelephone HHs.

10. Characteristics of HHs with an Interruption Child Characteristics Hispanics 2x more likely than Non-Hisp. Whites Blacks 2x more likely than Non-Hisp.Whites Native Americans 3x more likely than Non-Hisp. Whites Foreign Born 2x more likely than US born Maternal Characteristics Divorced or Never Married > 2x more likely than married < 12 years of education > 2x more likely than w/ some college Preferred language: Spanish 2x more likely than English Maternal age ≤ 29 years > 2x more likely than ≥ 30 years Households Characteristics Income below poverty10x more likely than >$75K/year 4+ children in HH ~2x more likely than 1 child

11. Provider Nonresponse Rates

12. How the Provider Nonresponse Adjustment Works Identify characteristics associated with provider nonresponse Within each IAP area, group children into adjustment classes: with similar propensities of having provider data Within each adjustment class: Increase the survey weights of children with adequate provider reported vaccination histories to represent all of the children in the class

13. Children w/out Adequate Provider Report Child Characteristics Non-Hispanic Black and Hispanics ~1.2x more likely than Non-Hisp. Whites Foreign Born1.4x more likely than US born Maternal Characteristics No Shot Card1.1 x more likely than shot card moms Households Characteristics Unknown HH income1.4x more likely than >$75K/year

14. Summary Progress Adjusting NIS vaccination coverage estimates for nonsampling errors