Do Adults with a Childhood Abuse History Delay Preventive Care? Open Access

Philyaw, Meredith L. (2014)

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Timely preventive care by adults with a childhood abuse history is critical, given their elevated risk of chronic conditions which benefit from early detection. Yet, adults with a childhood abuse history may face unique psychological and psychosocial barriers to preventive care and evidence of how this population uses preventive care is limited.

Using data collected from 23,830 participants in five states that administered the 2010 BRFSS Adverse Childhood Experiences module, I examined whether adults with a self-reported history of recurrent childhood physical, sexual or emotional abuse reported receiving six preventive services (breast/cervical/prostate/colorectal cancer screenings, HIV tests, and dental cleanings) according to recommended guidelines for disease prevention and early detection. Two additional preventive services, flu vaccines and routine check-ups, were modeled as counterfactuals to illustrate that childhood abuse history selectively impacts preventive care, independent of common barriers to timely preventive care among vulnerable populations.

Multivariate weighted results indicate that women with a childhood abuse history were significantly less likely than women without a childhood abuse history to report receiving a timely breast cancer screening. I also found that, among adults at-risk for HIV, those with a childhood abuse history were less likely to report receiving an annual HIV test until further adjustment for HIV testing site. Adults with a childhood abuse history did not differ from adults without a childhood abuse history in their timely utilization of the remaining preventive services or the counterfactuals.

My findings suggest that adults with a childhood abuse history selectively delay preventive care. Identifying the mechanism(s) driving delayed breast cancer screening among this population is critical for attenuating their greater likelihood of late-stage breast cancer diagnoses. Further, since adults with a childhood abuse history regularly use trauma-reminding preventive services, it is important that providers are aware of sensitive practices when administering these procedures to affected individuals. Future studies are needed which examine the value of care used by adults with a childhood abuse history to inform strategies for slowing the economic impact of this high-need population on the U.S. healthcare system.

Table of Contents

Table of Contents

Introduction 1 Literature Review 4 Conceptual Framework 12 Methods 22 Results 33 Conclusions 46 Works Cited 51

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