RESUMO
Vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine is recommended for all pregnant women to protect infants who are too young for vaccination from severe pertussis-related outcomes (1-3). However, Tdap vaccine coverage among pregnant women remains suboptimal in California (4). California mothers whose infants developed pertussis in 2016 and their prenatal care providers were interviewed to ascertain possible reasons for low Tdap vaccine coverage. Mothers who were offered Tdap vaccination on-site during a routine prenatal visit were more likely to be vaccinated than were mothers who were referred off-site for vaccination. Mothers insured by Medicaid were less likely to receive Tdap vaccine than were mothers with private insurance, even when the vaccine was stocked on-site. Nearly all vaccinated mothers received Tdap vaccine in their prenatal clinic. Incorporating Tdap vaccination into routine prenatal care visits is an effective means to increase prenatal Tdap vaccination coverage.
Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Acessibilidade aos Serviços de Saúde , Gestantes/psicologia , Cuidado Pré-Natal , Vacinação/estatística & dados numéricos , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , California/epidemiologia , Vacinas contra Difteria, Tétano e Coqueluche Acelular/provisão & distribuição , Feminino , Humanos , Lactente , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Gravidez , Setor Privado , Pesquisa Qualitativa , Encaminhamento e Consulta/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Estados UnidosRESUMO
This systematic review examines the relationship between neighborhood characteristics and adolescent pregnancy, contraceptive use, sexual initiation, and birthrate. Several studies found a significant association between higher poverty and increased adolescent birthrate, pregnancy, and earlier age at sexual initiation. Unsafe neighborhoods were associated with earlier sexual initiation and increased adolescent pregnancy. Mixed results were found for neighborhood racial or ethnic composition. Lower collective efficacy and social support were associated with increased rates of adolescent pregnancy and earlier age at sexual initiation. Improved definitions of neighborhoods, as well as research on interactions between structural factors and social processes during adolescence is needed.