{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T22:01:51Z","timestamp":1771020111090,"version":"3.50.1"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adverse childhood experiences (ACEs) have been linked to negative health outcomes and behaviors in adulthood. Despite widespread research on ACEs, their relationship with COVID-19 vaccination uptake, particularly heterogeneity across demographic groups, remains underexplored. This study examined the association between ACEs and COVID-19 vaccination status, with a focus on how this relationship varies by sex and urban-rural residence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), including respondents who participated in the ACEs and COVID-19 vaccination optional state modules (N\u2009=\u200912,085 adults). COVID-19 vaccination status (yes\/no) served as the dependent variable, while ACEs were categorized into four levels: 0, 1, 2\u20133, and 4\u2009+\u2009ACEs. Multivariable logistic regression analyses, stratified by sex and urban-rural residence, were conducted to assess the association between ACEs and vaccination status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the sample, 76.2% reported receiving at least one dose of the COVID-19 vaccine. Multivariable analysis revealed no statistically significant association between ACEs and vaccination status for the full sample. Stratified analyses indicated that male respondents living in rural counties with 4\u2009+\u2009ACEs had significantly lower odds of vaccination (adjusted odds ratio [aOR] = 0.57, 95% CI\u2009=\u20090.34\u20130.96). No significant associations were observed for other demographic groups (e.g., females in urban or rural areas; males in urban areas).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings suggest that males in rural areas with high ACE exposure may be vulnerable to low COVID-19 vaccination uptake. Targeted trauma-informed public health interventions warrant consideration to address vaccination uptake among this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336390","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T18:40:42Z","timestamp":1762540842000},"page":"e0336390","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adverse childhood experiences and COVID-19 vaccination uptake: Examining the intersection of sex and urban-rural residence"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9102-2390","authenticated-orcid":true,"given":"Karyn","family":"Fu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dylan B.","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Testa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"pone.0336390.ref001","unstructured":"1918 pandemic (H1N1 virus) | pandemic influenza (flu) | CDC. https:\/\/archive.cdc.gov\/www_cdc_gov\/flu\/pandemic-resources\/1918-pandemic-h1n1.html. 2023. Accessed 2024 August 8."},{"key":"pone.0336390.ref002","unstructured":"COVID-19 cases | WHO COVID-19 dashboard. https:\/\/data.who.int\/dashboards\/covid19\/cases. Accessed 2024 July 29."},{"key":"pone.0336390.ref003","doi-asserted-by":"crossref","first-page":"106147","DOI":"10.1016\/j.econmod.2022.106147","article-title":"Macroeconomic consequences of the COVID-19 pandemic","volume":"120","author":"T Walmsley","year":"2023","journal-title":"Econ Model"},{"issue":"4","key":"pone.0336390.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0275699","article-title":"The impact of COVID-19 vaccination in the US: Averted burden of SARS-COV-2-related cases, hospitalizations and deaths","volume":"18","author":"TK Yamana","year":"2023","journal-title":"PLoS One"},{"key":"pone.0336390.ref005","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-069317","article-title":"Public health impact of covid-19 vaccines in the US: observational study","volume":"377","author":"AB Suthar","year":"2022","journal-title":"BMJ"},{"key":"pone.0336390.ref006","article-title":"The benefits of large scale covid-19 vaccination","volume":"377","author":"C Dye","year":"2022","journal-title":"BMJ"},{"issue":"1","key":"pone.0336390.ref007","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3390\/vaccines11010074","article-title":"Higher COVID-19 vaccination rates are associated with lower COVID-19 mortality: a global analysis","volume":"11","author":"I Hoxha","year":"2023","journal-title":"Vaccines"},{"issue":"5","key":"pone.0336390.ref008","first-page":"1770","article-title":"Vaccination to reduce severe COVID-19 and mortality in COVID-19 patients: a systematic review and meta-analysis","volume":"26","author":"Y-Z Huang","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"pone.0336390.ref009","unstructured":"COVID-19 Vaccination Coverage and Vaccine Confidence Among Adults. CDC. https:\/\/www.cdc.gov\/vaccines\/imz-managers\/coverage\/covidvaxview\/interactive\/adults.html. 2024. Accessed 2024 July 29."},{"issue":"34","key":"pone.0336390.ref010","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","article-title":"Vaccine hesitancy: definition, scope and determinants","volume":"33","author":"NE MacDonald","year":"2015","journal-title":"Vaccine"},{"key":"pone.0336390.ref011","doi-asserted-by":"crossref","first-page":"101673","DOI":"10.1016\/j.pmedr.2021.101673","article-title":"Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review","volume":"25","author":"Y Wang","year":"2021","journal-title":"Prev Med Rep"},{"key":"pone.0336390.ref012","unstructured":"CDC. About Adverse Childhood Experiences. https:\/\/www.cdc.gov\/aces\/about\/index.html. 2024. Accessed 2024 July 29."},{"issue":"4","key":"pone.0336390.ref013","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0749-3797(98)00017-8","article-title":"Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study","volume":"14","author":"VJ Felitti","year":"1998","journal-title":"Am J Prev Med"},{"key":"pone.0336390.ref014","doi-asserted-by":"crossref","first-page":"104127","DOI":"10.1016\/j.chiabu.2019.104127","article-title":"Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis","volume":"97","author":"K Petruccelli","year":"2019","journal-title":"Child Abuse Negl"},{"issue":"10","key":"pone.0336390.ref015","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(19)30145-8","article-title":"Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis","volume":"4","author":"MA Bellis","year":"2019","journal-title":"Lancet Public Health"},{"issue":"8","key":"pone.0336390.ref016","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(17)30118-4","article-title":"The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis","volume":"2","author":"K Hughes","year":"2017","journal-title":"Lancet Public Health"},{"issue":"3","key":"pone.0336390.ref017","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.amepre.2015.07.022","article-title":"Associations Between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood","volume":"50","author":"JA Campbell","year":"2016","journal-title":"Am J Prev Med"},{"key":"pone.0336390.ref018","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.chiabu.2018.05.027","article-title":"Childhood adversity and adult health-risk behaviors: Examining the roles of emotion dysregulation and urgency","volume":"82","author":"HC Espeleta","year":"2018","journal-title":"Child Abuse Negl"},{"issue":"4","key":"pone.0336390.ref019","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1093\/pubmed\/fdx155","article-title":"Adverse childhood experiences and access and utilization of health care","volume":"40","author":"HE Alcal\u00e1","year":"2018","journal-title":"J Public Health (Oxf)"},{"issue":"2","key":"pone.0336390.ref020","first-page":"257","article-title":"Adverse childhood experiences and inequities in adult health care access","volume":"8","author":"JE Miller-Cribbs","year":"2016","journal-title":"Int Public Health J"},{"key":"pone.0336390.ref021","doi-asserted-by":"crossref","first-page":"115194","DOI":"10.1016\/j.socscimed.2022.115194","article-title":"Adverse Childhood Experiences, health insurance status, and health care utilization in middle adulthood","volume":"314","author":"A Testa","year":"2022","journal-title":"Soc Sci Med"},{"issue":"2","key":"pone.0336390.ref022","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/1077559509355316","article-title":"Long-term consequences of child abuse and neglect on adult economic well-being","volume":"15","author":"J Currie","year":"2010","journal-title":"Child Maltreat"},{"issue":"10","key":"pone.0336390.ref023","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.chiabu.2009.09.001","article-title":"Child maltreatment and adult socioeconomic well-being","volume":"33","author":"DS Zielinski","year":"2009","journal-title":"Child Abuse Negl"},{"issue":"10","key":"pone.0336390.ref024","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/OLQ.0000000000001846","article-title":"The Association Between Adverse Childhood Experiences and Human Papillomavirus Vaccination Coverage in US Young Adults: A Cross-Sectional Study","volume":"50","author":"S Zhang","year":"2023","journal-title":"Sex Transm Dis"},{"issue":"2","key":"pone.0336390.ref025","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-053915","article-title":"Associations between adverse childhood experiences, attitudes towards COVID-19 restrictions and vaccine hesitancy: a cross-sectional study","volume":"12","author":"MA Bellis","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0336390.ref026","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1353\/hpu.2019.0018","article-title":"Adverse Childhood Experiences and Trust in the Medical Profession among Young Adults","volume":"30","author":"RT Munoz","year":"2019","journal-title":"J Health Care Poor Underserved"},{"issue":"1","key":"pone.0336390.ref027","doi-asserted-by":"crossref","DOI":"10.1136\/bmjph-2023-000868","article-title":"Associations between adverse childhood experiences and trust in health and other information from public services, professionals and wider sources: national cross sectional survey","volume":"2","author":"MA Bellis","year":"2024","journal-title":"BMJ Public Health"},{"key":"pone.0336390.ref028","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.puhe.2021.02.025","article-title":"Vaccine hesitancy in the era of COVID-19","volume":"194","author":"G Troiano","year":"2021","journal-title":"Public Health"},{"issue":"2","key":"pone.0336390.ref029","doi-asserted-by":"crossref","DOI":"10.1093\/pnasnexus\/pgac034","article-title":"Deep-seated psychological histories of COVID-19 vaccine hesitance and resistance","volume":"1","author":"TE Moffitt","year":"2022","journal-title":"PNAS Nexus"},{"key":"pone.0336390.ref030","article-title":"Examining the relationship between adverse childhood experiences and COVID-19 vaccine status using 2022 BRFSS data: A cross-sectional study","author":"CA Chau-Valdivia","year":"2023","journal-title":"J Public Health"},{"issue":"12","key":"pone.0336390.ref031","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.2105\/AJPH.2023.307420","article-title":"Health disparities among sexual and gender minorities with adverse childhood experiences: insights from the 2021 behavioral risk factor surveillance system data","volume":"113","author":"MA Solberg","year":"2023","journal-title":"Am J Public Health"},{"key":"pone.0336390.ref032","doi-asserted-by":"crossref","first-page":"106227","DOI":"10.1016\/j.chiabu.2023.106227","article-title":"The impacts of adverse childhood experiences on socioeconomic disadvantage by sexual and gender identity in the U.S.","volume":"141","author":"LH Dosanjh","year":"2023","journal-title":"Child Abuse Negl"},{"issue":"1","key":"pone.0336390.ref033","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/jrh.12366","article-title":"Rural-Urban Differences in Adverse Childhood Experiences Across a National Sample of Children","volume":"36","author":"E Crouch","year":"2020","journal-title":"J Rural Health"},{"key":"pone.0336390.ref034","unstructured":"Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 2022 Summary Data Quality Report. 2023."},{"key":"pone.0336390.ref035","unstructured":"Behavioral Risk Factor Surveillance System. https:\/\/www.cdc.gov\/brfss\/index.html. Accessed 2024 November 27."},{"issue":"26","key":"pone.0336390.ref036","doi-asserted-by":"crossref","first-page":"707","DOI":"10.15585\/mmwr.mm7226a2","article-title":"Prevalence of Adverse Childhood Experiences Among U.S. Adults \u2014 Behavioral Risk Factor Surveillance System, 2011\u20132020","volume":"72","author":"EA Swedo","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"44","key":"pone.0336390.ref037","doi-asserted-by":"crossref","first-page":"999","DOI":"10.15585\/mmwr.mm6844e1","article-title":"Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention \u2014 25 States, 2015\u20132017","volume":"68","author":"MT Merrick","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"8","key":"pone.0336390.ref038","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.28027","article-title":"Adverse Childhood Experiences and Adult Household Firearm Ownership","volume":"7","author":"A Testa","year":"2024","journal-title":"JAMA Netw Open"},{"key":"pone.0336390.ref039","author":"Centers for Disease Control and Prevention","year":"2022"},{"issue":"1","key":"pone.0336390.ref040","article-title":"Examining rural and urban sentiment difference in COVID-19\u2013related topics on Twitter: word embedding\u2013based retrospective study","volume":"25","author":"Y Liu","year":"2023","journal-title":"J Med Internet Res"},{"issue":"4","key":"pone.0336390.ref041","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1111\/jrh.12481","article-title":"Half of rural residents at high risk of serious illness due to COVID-19, creating stress on rural hospitals","volume":"36","author":"BG Kaufman","year":"2020","journal-title":"J Rural Health"},{"issue":"3","key":"pone.0336390.ref042","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1111\/jrh.12477","article-title":"Community Susceptibility and resiliency to COVID-19 Across the rural-urban continuum in the United States","volume":"36","author":"DJ Peters","year":"2020","journal-title":"J Rural Health"},{"key":"pone.0336390.ref043","unstructured":"House TW. FACT SHEET: Biden Administration Announces Six-Week Campaign to Get More Americans their Updated COVID-19 Vaccine Before End of the Year. The White House. https:\/\/www.whitehouse.gov\/briefing-room\/statements-releases\/2022\/11\/22\/fact-sheet-biden-administration-announces-six-week-campaign-to-get-more-americans-their-updated-covid-19-vaccine-before-end-of-the-year\/. 2022. Accessed 2024 August 11."},{"key":"pone.0336390.ref044","unstructured":"House TW. FACT SHEET: President Biden to Announce Goal to Administer at Least One Vaccine Shot to 70% of the U.S. Adult Population by July 4th. https:\/\/www.whitehouse.gov\/briefing-room\/statements-releases\/2021\/05\/04\/fact-sheet-president-biden-to-announce-goal-to-administer-at-least-one-vaccine-shot-to-70-of-the-u-s-adult-population-by-july-4th\/. 2021. Accessed 2024 August 11."},{"issue":"2","key":"pone.0336390.ref045","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.amepre.2020.01.009","article-title":"Inside the adverse childhood experience score: strengths, limitations, and misapplications","volume":"59","author":"RF Anda","year":"2020","journal-title":"Am J Prev Med"},{"issue":"4","key":"pone.0336390.ref046","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1001\/jamapediatrics.2020.5602","article-title":"Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening","volume":"175","author":"JR Baldwin","year":"2021","journal-title":"JAMA Pediatr"},{"key":"pone.0336390.ref047","author":"CDC Foundation","year":"2023"},{"issue":"4","key":"pone.0336390.ref048","article-title":"Community efforts to promote vaccine uptake in a rural setting: a qualitative interview study","volume":"38","year":"2023","journal-title":"Health Promot Int"},{"issue":"6","key":"pone.0336390.ref049","doi-asserted-by":"crossref","first-page":"911","DOI":"10.3390\/vaccines10060911","article-title":"Traumatic events and vaccination decisions: a systematic review","volume":"10","year":"2022","journal-title":"Vaccines"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336390","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T18:40:48Z","timestamp":1762540848000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336390"}},"subtitle":[],"editor":[{"given":"Jennifer Annette","family":"Campbell","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":49,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0336390","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,7]]}}}