{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:17:41Z","timestamp":1787768261454,"version":"build-2784847793"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Childhood abuse is associated with long-term health consequences and may influence uptake of preventive healthcare. We evaluated whether adult socioeconomic experiences and healthcare access modify the association between childhood abuse and adherence to U.S. Preventive Services Task Force (USPSTF) cancer screening guidelines. We analyzed 2020 Behavioral Risk Factor Surveillance System (BRFSS) data among respondents who answered the childhood abuse item and were eligible for colorectal (CRC; 50\u201374years), cervical (women 25\u201364years, excluding hysterectomy), and\/or breast screening (women 40\u201374years), adapted to BRFSS 5-year age categories. Screening adherence was compared by abuse history. Survey-weighted Poisson regression estimated multivar incidence rate ratios (aIRRs), and stratified models assessed heterogeneity across adult socioeconomic factors and healthcare access. Among 123,169 respondents (weighted U.S. adult population: 68.08 million), 43.7% reported childhood abuse. Eligible cohorts included 27,368 for cervical screening and 39,986 women for breast screening (ages 40\u201374). In fully adjusted survey-weighted models, childhood abuse was associated with modestly lower adherence to cervical (aIRR\u2009=\u20090.97, 95%CI 0.94\u20130.99) and breast screening (aIRR\u2009=\u20090.96, 95%CI 0.93\u20130.99). In stratified analyses, inverse associations for cervical screening persisted across multiple socioeconomic strata, including college graduates (aIRR\u2009=\u20090.96, 95%CI 0.94\u20130.98), employed respondents (aIRR\u2009=\u20090.97, 95%CI 0.95\u20130.98), and married respondents (aIRR\u2009=\u20090.97, 95%CI 0.96\u20130.99). For breast screening, childhood abuse was consistently associated with lower adherence across most strata, with stronger associations among divorced\/widowed\/separated respondents (aIRR\u2009=\u20090.92, 95%CI 0.90\u20130.95) and lower-income respondents (aIRR\u2009=\u20090.95, 95%CI 0.93\u20130.96), and a pronounced deficit among uninsured women (aIRR\u2009=\u20090.86, 95%CI 0.78\u20130.95). Childhood abuse was associated with modestly lower adherence to cervical and breast cancer screening (with smaller, less consistent differences for CRC), and these associations varied across socioeconomic and healthcare-access strata. These findings support targeted, trauma-informed strategies to improve screening uptake among survivors of childhood abuse, particularly in settings where structural barriers to preventive care persist.<\/jats:p>","DOI":"10.1371\/journal.pgph.0007073","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:22:36Z","timestamp":1787764956000},"page":"e0007073","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Past hurts, present hurdles: Analyzing the impact of adult socioeconomic status and healthcare access on cancer screening among childhood abuse survivors"],"prefix":"10.1371","volume":"6","author":[{"given":"Qaidar","family":"Alizai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azza","family":"Sarfraz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4490-4453","authenticated-orcid":true,"given":"Meher","family":"Angez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areesh","family":"Mevawalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odysseas P.","family":"Chatzipanagiotou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Elemosho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rida","family":"Ejaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2899-4030","authenticated-orcid":true,"given":"Kizuki","family":"Yuza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Ekenze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7994-9870","authenticated-orcid":true,"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"issue":"2","key":"pgph.0007073.ref001","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s10578-021-01258-8","article-title":"Child maltreatment and long-term physical and mental health outcomes: an exploration of biopsychosocial determinants and implications for prevention","volume":"54","author":"D Mehta","year":"2023","journal-title":"Child Psychiatry Hum Dev"},{"issue":"6","key":"pgph.0007073.ref002","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1111\/cch.13104","article-title":"Adverse childhood experiences and association with poorer health and health-harming behaviours in adulthood among the Americans","volume":"49","author":"MM Islam","year":"2023","journal-title":"Child Care Health Dev"},{"key":"pgph.0007073.ref003","doi-asserted-by":"crossref","first-page":"105181","DOI":"10.1016\/j.chiabu.2021.105181","article-title":"The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life","volume":"120","author":"NR Downing","year":"2021","journal-title":"Child Abuse Negl"},{"key":"pgph.0007073.ref004","doi-asserted-by":"crossref","first-page":"105088","DOI":"10.1016\/j.chiabu.2021.105088","article-title":"Adverse childhood experiences and risk of cancer during adulthood: a systematic review and meta-analysis","volume":"117","author":"Z Hu","year":"2021","journal-title":"Child Abuse Negl"},{"issue":"19","key":"pgph.0007073.ref005","doi-asserted-by":"crossref","first-page":"12615","DOI":"10.3390\/ijerph191912615","article-title":"A comprehensive review on multifaceted mechanisms involved in the development of breast cancer following adverse childhood experiences (ACEs)","volume":"19","author":"O Pino","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pgph.0007073.ref006","doi-asserted-by":"crossref","first-page":"108326","DOI":"10.1016\/j.ypmed.2025.108326","article-title":"The association of childhood experiences of abuse on timely cervical cancer screening utilization among women in the United States","volume":"197","author":"KA Prather","year":"2025","journal-title":"Prev Med"},{"key":"pgph.0007073.ref007","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.chiabu.2017.04.026","article-title":"Colorectal cancer screening and adverse childhood experiences: which adversities matter?","volume":"69","author":"HE Alcal\u00e1","year":"2017","journal-title":"Child Abuse Negl"},{"issue":"3","key":"pgph.0007073.ref008","first-page":"343","article-title":"Heterogeneous impacts: adverse childhood experiences and cancer screening","volume":"29","author":"HE Alcal\u00e1","year":"2018","journal-title":"Cancer Causes Control"},{"issue":"10007","key":"pgph.0007073.ref009","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1016\/S0140-6736(15)00757-6","article-title":"HPV vaccination for victims of childhood sexual abuse","volume":"386","author":"SM Garland","year":"2015","journal-title":"Lancet"},{"key":"pgph.0007073.ref010","doi-asserted-by":"crossref","first-page":"104356","DOI":"10.1016\/j.chiabu.2020.104356","article-title":"It\u2019s not \u201cJust poverty\u201d: educational, social, and economic functioning among young adults exposed to childhood neglect, abuse, and poverty","volume":"101","author":"SA Font","year":"2020","journal-title":"Child Abuse Negl"},{"issue":"5","key":"pgph.0007073.ref011","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1177\/15248380221122816","article-title":"The impact of childhood psychological maltreatment on mental health outcomes in adulthood: a systematic review and meta-analysis","volume":"24","author":"Z Xiao","year":"2023","journal-title":"Trauma Violence Abuse"},{"key":"pgph.0007073.ref012","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-0873","article-title":"Early physical abuse and adult outcomes","volume":"147","author":"JE Lansford","year":"2021","journal-title":"Pediatrics"},{"key":"pgph.0007073.ref013","year":"2022"},{"key":"pgph.0007073.ref014","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-4268L","article-title":"The association between adverse childhood experiences and risk of cancer in adulthood: a systematic review of the literature","volume":"138","author":"DM Holman","year":"2016","journal-title":"Pediatrics"},{"issue":"23","key":"pgph.0007073.ref015","doi-asserted-by":"crossref","first-page":"2564","DOI":"10.1001\/jama.2016.5989","article-title":"Screening for colorectal cancer: us preventive services task force recommendation statement","volume":"315","author":"US Preventive Services Task Force","year":"2016","journal-title":"JAMA"},{"issue":"7","key":"pgph.0007073.ref016","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1001\/jama.2018.10897","article-title":"Screening for cervical cancer: US preventive services task force recommendation statement","volume":"320","author":"US Preventive Services Task Force","year":"2018","journal-title":"JAMA"},{"key":"pgph.0007073.ref017"},{"key":"pgph.0007073.ref018","doi-asserted-by":"crossref","first-page":"106627","DOI":"10.1016\/j.ypmed.2021.106627","article-title":"Combined patterns of participation in cervical, breast, and colorectal cancer screenings and factors for non-participation in each screening among women in Japan","volume":"150","author":"K Ishii","year":"2021","journal-title":"Prev Med"},{"key":"pgph.0007073.ref019","article-title":"Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis","year":"2021","journal-title":"BMJ Open"},{"issue":"9","key":"pgph.0007073.ref020","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1002\/cncr.34098","article-title":"Lung cancer screening use and implications of varying eligibility criteria by race and ethnicity: 2019 behavioral risk factor surveillance system data","volume":"128","author":"RM Williams","year":"2022","journal-title":"Cancer"},{"issue":"9","key":"pgph.0007073.ref021","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1089\/jwh.2020.8807","article-title":"Perceived financial barriers to cervical cancer screening and associated cost burden among low-income, under-screened women","volume":"30","author":"CB Biddell","year":"2021","journal-title":"J Womens Health (Larchmt)"},{"key":"pgph.0007073.ref022","doi-asserted-by":"crossref","first-page":"118567","DOI":"10.1016\/j.socscimed.2025.118567","article-title":"The role of stress proliferation in linking childhood stressors to accelerated biological aging","volume":"384","author":"M Fekete","year":"2025","journal-title":"Soc Sci Med"},{"key":"pgph.0007073.ref023","author":"M Kraft","year":"2023"},{"issue":"4","key":"pgph.0007073.ref024","first-page":"299","article-title":"Racial and socioeconomic disparities in lung cancer screening in the United States: a systematic review","volume":"71","author":"E Sosa","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"pgph.0007073.ref025","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1093\/occmed\/kqaf015","article-title":"The impact of employment stability on all-cause mortality among young workers","volume":"75","author":"B Yun","year":"2025","journal-title":"Occup Med (Lond)"},{"key":"pgph.0007073.ref026","article-title":"Does marriage protect mental health? Evidence from the COVID-19 pandemic","author":"CE Jace","year":"2021","journal-title":"Soc Sci Q"},{"key":"pgph.0007073.ref027","doi-asserted-by":"crossref","first-page":"100328","DOI":"10.1016\/j.bbih.2021.100328","article-title":"The health consequences of stress in couples: a review and new integrated dyadic biobehavioral stress model","volume":"16","author":"MR Shrout","year":"2021","journal-title":"Brain Behav Immun Health"},{"key":"pgph.0007073.ref028","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ypmed.2016.05.017","article-title":"The influence of marital status on the use of breast, cervical, and colorectal cancer screening","volume":"89","author":"J Hanske","year":"2016","journal-title":"Prev Med"},{"issue":"1","key":"pgph.0007073.ref029","doi-asserted-by":"crossref","DOI":"10.1016\/j.amepre.2017.08.024","article-title":"Health insurance status and clinical cancer screenings among U.S. adults","volume":"54","author":"G Zhao","year":"2018","journal-title":"Am J Prev Med"},{"key":"pgph.0007073.ref030","doi-asserted-by":"crossref","first-page":"10732748211072983","DOI":"10.1177\/10732748211072983","article-title":"Preventative cancer screening rates among uninsured patients in free clinics: a retrospective cohort study of cancer survivors and non-cancer survivors","volume":"29","author":"M MacDonald","year":"2022","journal-title":"Cancer Control"},{"issue":"10279","key":"pgph.0007073.ref031","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/S0140-6736(21)00397-4","article-title":"Insurance coverage and financing landscape for HIV treatment and prevention in the USA","volume":"397","author":"J Kates","year":"2021","journal-title":"Lancet"},{"key":"pgph.0007073.ref032","doi-asserted-by":"crossref","first-page":"104802","DOI":"10.1016\/j.chiabu.2020.104802","article-title":"Child sexual abuse and pregnancy: a systematic review of the literature","volume":"111","author":"R Brunton","year":"2021","journal-title":"Child Abuse Negl"},{"issue":"8","key":"pgph.0007073.ref033","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1038\/s41415-022-5103-z","article-title":"Avoiding psychological (re)traumatisation in dentistry when working with patients who are adult survivors of child sex abuse","volume":"233","author":"S Alyce","year":"2022","journal-title":"Br Dent J"},{"issue":"6","key":"pgph.0007073.ref034","article-title":"Screening for childhood trauma in adult primary care patients: a cross-sectional survey","volume":"12","author":"L Weinreb","year":"2010","journal-title":"Prim Care Companion J Clin Psychiatry"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0007073","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:22:42Z","timestamp":1787764962000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0007073"}},"subtitle":[],"editor":[{"given":"Jose Ignacio","family":"Nazif-Munoz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0007073","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]}}}