High caregiver adverse childhood experiences are associated with pediatric influenza and COVID-19 vaccination uptake.

Abstract

Factors surrounding vaccine uptake are complex. Although anxiety, which could influence vaccination decisions, has been associated with adverse childhood experiences (ACEs), little is known about links between caregiver ACEs and pediatric vaccine uptake. We evaluated associations between caregivers' ACEs and decisions to vaccinate their children with influenza and COVID-19 vaccines. A cross-sectional study of caregivers of patients ≥6 months at one pediatric primary care center was performed. Caregivers completed a 19-question survey examining caregiver ACEs, influenza vaccine acceptance and beliefs, and intention to vaccinate their child with the COVID-19 vaccine. Demographic characteristics, social risks (e.g., housing and food insecurity), and vaccination data for children present with each caregiver were extracted from the electronic health record. Statistical analyses included chi-square tests for categorical and t-tests for continuous variables. A total of 240 caregivers participated, representing 283 children (mean age of 5.9 years, 47% male). Twenty-four percent (n=58) had high ACEs (≥4). Of those with high ACEs, 55% accepted pediatric influenza vaccination compared to 38% with low ACEs (p=0.02). Those with high ACEs had more positive attitudes toward influenza vaccine safety and efficacy (p≤0.02). Those with high, compared to low, ACEs were also more likely to accept COVID-19 vaccination (38% vs. 24%; p=0.04). Pediatric influenza vaccination rates and intention to vaccinate children against COVID-19 differed between caregivers with high and low ACEs: those with more ACEs were more likely to vaccinate. Further studies assessing the role of caregiver ACEs on vaccine decision-making are warranted.