The association between Adverse Childhood Experiences and HPV vaccination coverage in US young adults: a cross-sectional study

Introduction: Adverse childhood experiences (ACEs) affect more than half of all children in the United States, and people with ACEs are more prone to various unhealthy situations in adulthood. Access to preventive healthcare services, including HPV vaccinations, may help reduce the impact of ACEs on adverse health outcomes. Our objective was to assess the prevalence of ACEs and self-reported HPV vaccination coverage among young adults. MethodsWe included 18–29-year-old respondents to the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) ACE and HPV vaccination modules. ACEs were defined as a history of emotional abuse, physical abuse, sexual abuse, intimate partner violence, substance abuse, mental illness, parental separation or divorce, or incarcerated household member. Self-reported HPV vaccination initiation was defined as having ever been vaccinated and completion was defined as reporting at least 3 doses. Data on the timing of vaccination are not available in BRFSS. We used log-binomial regression models to calculate prevalence ratios (PRs) with 95% confidence intervals for the associations between ACEs and HPV vaccination. We evaluated race and ethnicity, urban/rural status, education level, income level, health insurance status, and smoking status as potential confounders. We also evaluated influenza vaccination uptake and the length of time since the last routine checkup as secondary outcomes, and ever having had an HIV test and recent HIV-related risk behaviors as outcomes in post-hoc analyses. ResultsAmong 3450 participants, 2441 (71%) reported at least 1 ACE. 1030 (30%) reported that they had ever been vaccinated, and 489 (14%) completed the HPV vaccination series. We identified several ACEs that were positively associated with HPV vaccine initiation in early adulthood, including emotional abuse (PR for initiation: 1.29, 95% CI:1.17-1.43, PR for completion: 1.20, 95% CI:1.01-1.41), intimate partner violence (PR for initiation: 1.14, 95% CI:1.01-1.30), substance abuse (PR for initiation: 1.20, 95% CI:1.08-1.33, PR for completion: 1.19, 95% CI:1.00-1.41), and mental illness (PR for initiation: 1.35, 95% CI:1.22-1.50, PR for completion: 1.41, 95% CI:1.19-1.68). Conversely, reporting physical abuse, intimate partner violence, substance abuse, parental separation or divorce, and incarcerated household member were each negatively associated with receipt of influenza vaccination in the past year (PRs ranging from 0.72-1.00). Most ACEs were negatively associated with reporting a routine checkup within the past 1-2 years (PRs ranging from 0.92-1.00). There were positive associations between each ACE and report of having ever had an HIV test (PRs ranging from 1.19-1.56) and HIV-related risk behavior (PRs ranging from 1.57-2.07). ConclusionsUnexpected positive associations between ACEs and HPV vaccination coverage were observed. A possible explanation is that accessing STI/HIV prevention or treatment services provided additional opportunities to receive HPV vaccination in late adolescence or early adulthood. Future studies evaluating associations between ACEs and timely HPV vaccination in early adolescence will be important for informing HPV and HPV-related cancer prevention strategies in individuals with ACEs.