#21 High Caregiver Adverse Childhood Experiences are Associated with Influenza and COVID-19 Vaccination Acceptance in One Pediatric Primary Care Site

BACKGROUND: Vaccine hesitancy is complex, ranging from safety concerns to decisions built atop disinformation and medical mistrust.

Though distrust towards healthcare providers has been described in those with adverse childhood experiences (ACEs), studies have not assessed for links between caregiver ACEs and pediatric vaccine refusal.

We sought to determine the association between caregiver ACEs and caregiver decisions to immunize their child with influenza and COVID-19 vaccines.

METHOD: This was a cross-sectional study of caregivers of patients >6 months at one pediatric primary care center.

Caregivers completed a 19-question survey to determine ACE score, influenza vaccine acceptance and beliefs (adapted from a CDC-validated survey), and intention to accept the COVID-19 vaccine for their children.

Demographic characteristics, social risk factors (e.g. housing and food insecurity), social work notes or medical legal partnership referrals within 3 days of a clinic visit, and vaccination data of the children present with each caregiver were extracted from the electronic medical record.

Statistical analyses included chi-square tests for categorical variables and t-tests for age.

The chi-square test was used to determine the association between caregiver ACEs (high versus low) and demographic, social risk factors and vaccination acceptance, and the two-sample t-test was used to test for differences in child age.

RESULTS: A total of 234 caregivers participated, representing 276 patients (mean age of 5.9 years, 52% male).

Of participating caregivers, 24% (n = 56) had high ACEs (score ≥ 4) and 38% (n = 88) accepted influenza vaccination for their child in 2021.

Of those with high ACEs, 51% accepted influenza vaccination for their child compared to 34% with low ACEs (p = 0.03).

Those with high ACEs also had more positive attitudes toward influenza vaccine safety and efficacy (p=0.01).

Intention to vaccinate children with COVID-19 vaccine also varied by caregiver ACE score (high ACEs: 40%; low ACEs: 24%; p=0.03).

Insurance type, a positive social risk screen, and social work consult were not associated with ACEs (Table 1).

CONCLUSION: Influenza vaccination rates and intention to vaccinate children with the COVID-19 vaccine 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 is warranted.