Child sexual abuse and adult vaccination: Opposing patterns between routine and pandemic vaccines in a Nationwide survey.

BACKGROUND

Child sexual abuse (CSA) is common and has long-term health consequences. Evidence remains limited regarding the association between CSA and adult vaccination, as well as potential effect modification by social capital and vaccine attitudes. We aimed to examine the association between childhood CSA and adult influenza and COVID 19 vaccination.

METHODS

Participants were adults aged 18-79 years in the 2023 Japan COVID-19 and Society Internet Survey (JACSIS). Cases with unnatural responses and existing conditions were excluded. We defined CSA as an exposure. The primary outcome was vaccination status for influenza and COVID-19 in the past year. We examined the association between CSA and outcomes using inverse probability of treatment weighting (IPTW) based on a propensity score derived from socioeconomic factors. We also assessed effect modification by individual behaviors, social capital and institutional trust, and vaccine attitudes.

RESULTS

CSA was significantly associated with lower influenza vaccination (adjusted odds ratio [aOR] 0.80; 95% confidence interval [CI] 0.74-0.86, p < 0.001), and was not with COVID-19 vaccination (aOR 1.05, 95%CI 0.97-1.14, p = 0.23). In stratified analyses, significant interactions were observed for COVID-19 vaccination with neighborhood networks (p for interaction 0.02) and vaccine attitudes (trust in vaccine efficacy p for interaction <0.001, anxiety about side effects p for interaction <0.001). In subgroups with weak neighborhood networks or low trust in vaccine efficacy, CSA was associated with higher COVID-19 vaccination than no CSA.No such interactions were observed for influenza vaccination.

CONCLUSION

CSA was associated with lower influenza vaccination rates, while COVID-19 vaccination did not differ overall by CSA status but showed heterogeneity by neighborhood network and vaccine attitudes. These findings highlight the need for trauma-informed vaccination strategies tailored to vaccine type, though further research is needed to evaluate their effectiveness.