From the Departments of Epidemiology.
Sex Transm Dis. 2023 Oct 1;50(10):656-663. doi: 10.1097/OLQ.0000000000001846. Epub 2023 Jul 4.
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.
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.
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).
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.
不良的童年经历（ACEs）会导致成年后出现不良健康后果。获得预防保健服务，包括生殖器人乳头瘤病毒（HPV）疫苗接种，可能会减轻 ACEs 对不良健康结果的影响。我们的目的是评估 ACEs 与年轻人 HPV 疫苗接种率之间的关系。
我们纳入了 2019-2020 年行为风险因素监测系统 ACE 和 HPV 疫苗接种模块中 18 至 29 岁的 3415 名受访者。不良的童年经历包括情感、身体和性虐待；家庭内部亲密伴侣暴力、药物滥用和精神疾病；以及父母分居/离婚和被监禁的家庭成员。我们使用对数二项式回归模型计算 ACEs 与自我报告的 HPV 疫苗接种和完成情况之间的关联的患病率比（PR）及其 95%置信区间（CI）。次要结局包括流感疫苗接种率、上次常规检查时间、HIV 检测史和与 HIV 相关的风险行为。
一些 ACEs 与 HPV 疫苗接种的启动呈正相关，包括情感虐待（PR，1.29；95%CI，1.17-1.43）、亲密伴侣暴力（PR，1.14；95%CI，1.00-1.30）、药物滥用（PR，1.20；95%CI，1.08-1.33）和精神疾病（PR，1.35；95%CI，1.22-1.50）。完成情况也存在类似的关联。相反，大多数 ACEs 与流感疫苗接种（PR 从 0.72 到 1.00）和最近的检查（PR 从 0.92 到 1.00）呈负相关。不良的童年经历与 HIV 检测（PR 从 1.19 到 1.56）和与 HIV 相关的风险行为（PR 从 1.19 到 2.07）呈正相关。
ACEs 与 HPV 疫苗接种覆盖率之间出乎意料的正相关可能是由于在青少年后期或成年早期获得性传播感染/艾滋病毒预防或治疗服务时，有机会接受 HPV 疫苗接种。未来的研究应该评估 ACEs 与青少年早期及时 HPV 疫苗接种之间的关系。
