Child sexual abuse and adult vaccination: Opposing patterns between routine and pandemic vaccines in a Nationwide survey

Yousuke Imanishi; Maria Iorini; Ichiro Wada; Sinchul Jwa; Takahiro Tabuchi; Mai Uchida

doi:10.1016/j.vaccine.2026.128299

Child sexual abuse and adult vaccination: Opposing patterns between routine and pandemic vaccines in a Nationwide survey

Vaccine. 2026 Mar 19:76:128299. doi: 10.1016/j.vaccine.2026.128299. Epub 2026 Feb 13.

Authors

Yousuke Imanishi¹, Maria Iorini², Ichiro Wada³, Sinchul Jwa⁴, Takahiro Tabuchi⁵, Mai Uchida⁶

Affiliations

¹ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Electronic address: rasheed0421@gmail.com.
² Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
³ Department of Interdisciplinary Studies, Faculty of International Liberal Arts, Dokkyo University, Saitama, Japan.
⁴ Department of Pediatrics, Osaka Metropolitan University, Osaka, Japan.
⁵ Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Miyagi, Japan.
⁶ Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

PMID: 41690291
DOI: 10.1016/j.vaccine.2026.128299

Abstract

Background: Child sexual abuse (CSA) is common and has long-term health consequences. Evidence remains limited regarding the association between CSA and adult vaccination, as well as potential effect modification by social capital and vaccine attitudes. We aimed to examine the association between childhood CSA and adult influenza and COVID 19 vaccination.

Methods: Participants were adults aged 18-79 years in the 2023 Japan COVID-19 and Society Internet Survey (JACSIS). Cases with unnatural responses and existing conditions were excluded. We defined CSA as an exposure. The primary outcome was vaccination status for influenza and COVID-19 in the past year. We examined the association between CSA and outcomes using inverse probability of treatment weighting (IPTW) based on a propensity score derived from socioeconomic factors. We also assessed effect modification by individual behaviors, social capital and institutional trust, and vaccine attitudes.

Results: CSA was significantly associated with lower influenza vaccination (adjusted odds ratio [aOR] 0.80; 95% confidence interval [CI] 0.74-0.86, p < 0.001), and was not with COVID-19 vaccination (aOR 1.05, 95%CI 0.97-1.14, p = 0.23). In stratified analyses, significant interactions were observed for COVID-19 vaccination with neighborhood networks (p for interaction 0.02) and vaccine attitudes (trust in vaccine efficacy p for interaction <0.001, anxiety about side effects p for interaction <0.001). In subgroups with weak neighborhood networks or low trust in vaccine efficacy, CSA was associated with higher COVID-19 vaccination than no CSA.No such interactions were observed for influenza vaccination.

Conclusion: CSA was associated with lower influenza vaccination rates, while COVID-19 vaccination did not differ overall by CSA status but showed heterogeneity by neighborhood network and vaccine attitudes. These findings highlight the need for trauma-informed vaccination strategies tailored to vaccine type, though further research is needed to evaluate their effectiveness.

Keywords: COVID-19 vaccine; Child sexual abuse; Influenza vaccine; Japan; Social capital; Vaccine hesitancy.

MeSH terms

Adolescent
Adult
Aged
COVID-19 Vaccines* / administration & dosage
COVID-19* / epidemiology
COVID-19* / prevention & control
Child Abuse, Sexual* / psychology
Child Abuse, Sexual* / statistics & numerical data
Female
Humans
Influenza Vaccines* / administration & dosage
Influenza, Human / prevention & control
Japan / epidemiology
Male
Middle Aged
SARS-CoV-2 / immunology
Surveys and Questionnaires
Vaccination Hesitancy
Vaccination* / psychology
Vaccination* / statistics & numerical data
Young Adult

Substances

Influenza Vaccines
COVID-19 Vaccines