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

Abstract

Adverse childhood experiences (ACEs) contribute to adverse health outcomes in adulthood. Access to preventive healthcare services, including 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. We included 3415 18-29-year-old respondents to the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) ACE and HPV vaccination modules. ACEs included emotional, physical and sexual abuse; household intimate partner violence, substance abuse, 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 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. Several ACEs were positively associated with HPV vaccine 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 0.72-1.00), and with recent checkup (PRs from 0.92-1.00). ACEs were positively associated with having had an HIV test (PRs from 1.19-1.56) and HIV-related risk behavior (PRs from 1.19-2.07). 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.