This study is the first to formally estimate the causal effects of
state-level vaccination mandates upon immunization rates within
the United States. Using longitudinal immunization data and the
differential timing of state-mandate introduction, we establish that
state-level mandates were indeed successful at increasing varicella
immunization rates, above and beyond the aggregate upward
trends in immunization rates observed throughout the country
after introduction of the varicella vaccine in 1995. The mandate
effects are, however, somewhat short-lived with the peak effectiveness
occurring roughly two years post-mandate; after about
six years, the causal impact of mandates dies out.
It is worthwhile to compare our causal mandate-effect
estimates with the results in Davis and Gaglia (2005). For crosssectional
NIS data in 2002, Davis and Gaglia (2005, Table 4) report
roughly a 7–9 percentage-point higher immunization probability
for children in mandate states than children in non-mandate
states. This “raw” difference can be compared to the individuallevel
mandate effects reported in Table 4, in which we find that the
short-run causal effects of the mandates are on the order of 2–4 percentage
points. The mandates themselves, therefore, account for a
little under half of the observed difference in 2002 immunization
rates.
There are a few limitations to the current study. First, the results
are specific to the varicella vaccine. Although we would expect the
pattern of the mandate effects to be similar for other childhood vaccines,
the magnitude of mandate effects for a specific vaccine will
depend on several factors, including parents’ perceptions of the
relative costs and benefits of the vaccine for their child. Whereas
many parents viewed varicella as a relatively mild affliction and
may have been hesitant to vaccinate their child without a mandate,
more serious diseases like the recent H1N1 influenza virus might
not require mandates. Second, although we have identified significant
effects from state mandates, we do not know the channels
This study is the first to formally estimate the causal effects ofstate-level vaccination mandates upon immunization rates withinthe United States. Using longitudinal immunization data and thedifferential timing of state-mandate introduction, we establish thatstate-level mandates were indeed successful at increasing varicellaimmunization rates, above and beyond the aggregate upwardtrends in immunization rates observed throughout the countryafter introduction of the varicella vaccine in 1995. The mandateeffects are, however, somewhat short-lived with the peak effectivenessoccurring roughly two years post-mandate; after aboutsix years, the causal impact of mandates dies out.It is worthwhile to compare our causal mandate-effectestimates with the results in Davis and Gaglia (2005). For crosssectionalNIS data in 2002, Davis and Gaglia (2005, Table 4) reportroughly a 7–9 percentage-point higher immunization probabilityfor children in mandate states than children in non-mandatestates. This “raw” difference can be compared to the individuallevelmandate effects reported in Table 4, in which we find that theshort-run causal effects of the mandates are on the order of 2–4 percentagepoints. The mandates themselves, therefore, account for alittle under half of the observed difference in 2002 immunizationrates.There are a few limitations to the current study. First, the resultsare specific to the varicella vaccine. Although we would expect theรูปแบบลักษณะพิเศษอาณัติจะเหมือนกันสำหรับค่าวัคซีนเด็กอื่น ๆขนาดของผลอาณัติสำหรับวัคซีนเฉพาะจะขึ้นอยู่กับปัจจัยหลาย รวมทั้งภาพลักษณ์ของผู้ปกครองของการต้นทุนที่เกี่ยวข้องและประโยชน์ของวัคซีนสำหรับเด็กของพวกเขา ในขณะที่ผู้ปกครองหลายคนดู varicella เป็นเนตรที่ค่อนข้างอ่อน และเคยลังเลที่จะปลูกฝีลูกโดยไม่มอบอำนาจโรคที่ร้ายแรงมากเช่นไวรัสไข้หวัดใหญ่ H1N1 ล่าอาจไม่ต้องใช้เอกสาร ที่สอง แม้ว่าเราได้ระบุความสำคัญผลจากสถานะเอกสาร เราไม่รู้ว่าช่อง
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