Adverse childhood experiences (ACEs) were associated with vaccine hesitancy and distrust in government COVID-19 restrictions, U.K. researchers found.
Vaccine hesitancy was three times higher among adults who reported at least four ACEs, and higher overall among younger people, reported Mark Bellis, DSc, of Bangor University in Wales, and colleagues.
Likewise, ACEs were associated with lack of trust in COVID information, feeling unfairly restricted by government, and opposition to mask mandates, the authors noted in BMJ Open.
Controlling a pandemic is largely dependent on individuals both believing and complying with health messaging, so it is critical “to understand what factors differentiate individuals who may or may not trust health information, adhere to behavioral advice or accept offers of vaccination,” they wrote.
ACEs, such as maltreatment, domestic violence, substance use, and other criminal justice problems in the household have been linked to “substantive increases in poor mental health,” they explained.
“Moreover, more limited research suggests maltreatment during childhood may leave individuals with lower levels of trust including in health and other public services,” they added, noting that about half of adults in Europe and North America have experienced at least one ACE, and a quarter may have experienced multiple ACEs.
Bellis and team set out to address the effect of ACEs on adherence to COVID-19 control measures by conducting a cross-sectional telephone survey of Welsh adults during national restrictions from December 2020 to March 2021. The questionnaire included self-reported demographic information, ACEs, health conditions, trust in information on COVID-19 from the National Health Service (NHS), and attitudes towards COVID restrictions and vaccination.
Overall, 2,285 participants responded; 52% reported no ACEs, 21% reported one ACE, 16% reported two to three ACEs, and 10% reported four or more ACEs.
About a quarter of participants said they “at least occasionally” broke COVID restrictions, the authors noted.
Adjusted analyses showed at least four ACEs were associated with at least three times higher odds of the following beliefs:
- Mandatory face coverings should go (adjusted OR 3.57, 95% CI 2.14-5.94)
- Low trust in NHS COVID-19 information (aOR 3.22, 95% CI 1.94-5.36)
- Vaccine hesitancy (aOR 3.11, 95% CI 2.00-4.82)
Younger age was also associated with vaccine hesitancy and opposition to mask mandates, while low socioeconomic status was associated with vaccine hesitancy and low trust in NHS COVID information.
Estimates of vaccine hesitancy in adults ages 18 to 29 more than doubled among those with four or more ACEs versus those with none (38% vs 17%).
Limitations to the study included the low response rate (36.4% of all surveyed) and the use of self-reported data. In addition, women were overrepresented in the final sample, and the sample was not powered to detect differences between ethnicities.
This work was supported by Public Health Wales.
Bellis disclosed no conflicts of interest.
Other co-authors were funded by Health and Care Research Wales through the National Centre for Population Health and Well-being Research.