Do Adults with a Childhood Abuse History Delay Preventive Care?

Background: Timely preventive care utilization by adults with a childhood abuse history (CAH) is critical, given their elevated risk for chronic conditions (e.g. cancer, HIV/AIDS). Evidence of how adults with CAH use preventive care is limited. Methods: This study includes 23,650 participants from five states (DC, Hawaii, Nevada, Vermont, Wisconsin) that administered the 2010 BRFSS Adverse Childhood Experiences module. Weighted probit models adjusting for confounders, sociodemographics, other childhood adversity and access barriers (e.g. uninsured, no usual provider) estimated the marginal effect of any self-reported CAH (physical, sexual, emotional) on utilization of eight preventive services (check-up; flu shot; dental cleaning; HIV testing; breast/cervical/prostate/colorectal cancer screening) according to clinical guidelines. Flu shot and check-up were modeled as counterfactuals to highlight whether: 1) CAH selectively impacts preventive care; and 2) utilization disparities remain after adjusting for access barriers. Results: 33.58% of participants reported any CAH. After multivariate adjustment, women with CAH were 14.90 percentage points less likely to report a timely breast cancer screening (p=0.005). Adults with CAH were also significantly more likely to be at-risk for HIV; yet, compared to adults at-risk for HIV without CAH, were 47.10 percentage points less likely to report an annual HIV test (p<0.10). CAH was not significantly related to flu shot, check-up or other services. Conclusions: CAH selectively impacts preventive care, independent of common barriers to timely utilization. Future research should explore whether system barriers, health beliefs, and CAH-related factors (e.g. patient-provider communication problems) may be driving breast cancer and HIV screening disparities for this population.