Associations between childhood adversity and human papillomavirus vaccination in Australian women: a cross-sectional study

BACKGROUND: Adversity in childhood can lead to greater adoption of risky health behaviours, but less use of preventive health care. The impact of childhood adversity on the uptake of the human papillomavirus (HPV) vaccination in a country with a schools-based vaccination program has not been explored. Our aim was to investigate the associations between adverse childhood factors and HPV vaccination in a cohort of Australian women born in 1989-95 from the Australian Longitudinal Study on Women's Health (aged 12-18 years in 2007 when the Australian schools-based program began). METHODS: Survey and linked vaccination data from the Australian Immunisation Register for 7964 women were used. We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between adverse childhood factors and none versus any HPV vaccination (reflecting the recommended dosing schedule introduced in Australia in 2023 of a single dose for immunocompetent people aged 9-25 years). RESULTS: Women were more likely not to have an HPV vaccination if they experienced ≥4 adverse childhood experiences compared to no experiences (OR 1.70; 95% CI 1.35, 2.15), had school absences ≥1 month for illness or injury (OR 1.38; 95% CI 1.13, 1.69 versus no absences of this duration), or if their parents divorced when they were < 14 years (OR 1.21; 95% CI 1.03, 1.42 versus no divorce). Women who reported they had not finished high school (versus finishing high school) were also more likely to be unvaccinated (OR 1.85; 95% CI 1.45, 2.37). CONCLUSIONS: Our results highlight the importance of providing opportunities for HPV vaccination outside school and for young adults. In non-school health settings, proactively checking vaccination status and recommending vaccination if missed in school is also worthwhile.