The Association Between Adverse Childhood Experiences and Human Papillomavirus Vaccination Coverage in US Young Adults: A Cross-Sectional Study

Abstract

Background Adverse childhood experiences (ACEs) contribute to adverse health outcomes in adulthood. Access to preventive health care services, including genital human papillomavirus (HPV) vaccinations, may mitigate the impact of ACEs on adverse health outcomes. Our objective was to assess associations between ACEs and HPV vaccination coverage among young adults. Methods We included 3415 respondents aged 18 to 29 years to the 2019–2020 Behavioral Risk Factor Surveillance System ACE and HPV vaccination modules. Adverse childhood experiences included emotional, physical, and sexual abuse; household intimate partner violence, substance abuse, and mental illness; and parental separation/divorce and incarcerated household member. We used log-binomial regression models to calculate prevalence ratios (PRs) with 95% confidence intervals (CI) for associations between ACEs and self-reported HPV vaccination and completion. Secondary outcomes included influenza vaccination uptake, time since routine checkup, HIV testing history, and HIV-related risk behavior. Results Several ACEs were positively associated with HPV vaccination initiation, including emotional abuse (PR, 1.29; 95% CI, 1.17–1.43), intimate partner violence (PR, 1.14; 95% CI, 1.00–1.30), substance abuse (PR, 1.20; 95% CI, 1.08–1.33), and mental illness (PR, 1.35; 95% CI, 1.22–1.50). Similar associations were observed for completion. Conversely, most ACEs were negatively associated with influenza vaccination (PRs from 0.72 to 1.00) and with recent checkup (PRs from 0.92 to 1.00). Adverse childhood experiences were positively associated with having had an HIV test (PRs from 1.19 to 1.56) and HIV-related risk behavior (PRs from 1.19 to 2.07). Conclusions The unexpected positive associations between ACEs and HPV vaccination coverage could be due to opportunities to receive HPV vaccination in late adolescence or early adulthood while accessing STI/HIV prevention or treatment services. Future studies should evaluate associations between ACEs and timely HPV vaccination in early adolescence.