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Adverse Childhood Experiences and Adolescent Substance Use: The Role of Developmental Contexts.

Rasmey Gomez, MPHc; Eric Shanazari, MPH; Xiao Zhang, MPHc; Olivia Hamidzadeh, MPHc; Timothy J. Grigsby, PhD; Myriam Forster, PhD, MPH

Background: Household dysfunction (e.g., parent/caregiver alcohol or drug misuse, mental
illness, suicidal ideation, and divorce), a type of adverse childhood experiences (ACE), is a
robust predictor of adolescent nicotine, alcohol, and cannabis use, and adult negative health
outcomes. Conversely, positive developmental contexts (e.g., personal, social, family, school,
and community) are assets that promote adaptive development and contribute to resilience. This
study investigates the relationship between ACE and substance use and examines whether
developmental context can offset the negative effects of ACE on substance use.

Methods: Data are baseline survey responses from diverse high school students (N=1,973) in a
school-based study investigating health and developmental outcomes. Logistic regression models
tested the hypothesized associations between ACE and nicotine, alcohol, and cannabis use, and
explored the role of developmental contexts as a moderator. All models adjusted for demographic covariates.

Results: Slightly more than half (52%) of the sample was female, and about one-third identified
as White (31%), followed by Black (31%), Hispanic (22%), Multiracial (9%), and Asian/AI/AN
(7%). Over 1 in 5 (22%) youth reported alcohol use, 16% reported nicotine use, and 16%
reported cannabis use. One in three youth (34%) reported one ACE, 6% reported two, and 5%
reported three or more. Compared to their peers with no ACE, youth with one had significantly
higher odds of alcohol (AOR: 1.56, 95% CI: [1.13, 2.17]) or cannabis use (AOR: 2.28, 95% CI:
[1.55, 3.34]), youth with two ACE had over twice the odds of nicotine use (AOR: 2.42, 95% CI:
[1.40, 4.18]), and more than three times the odds of alcohol (AOR: 3.22, 95% CI: [1.91, 5.41])
and cannabis (AOR: 3.50, 95% CI: [1.96, 6.24]) use, while youth with  3 had five times the
odds of using nicotine (AOR: 5.54, 95% CI: [3.08, 9.98]), four times the odds of using alcohol
(AOR: 4.05, 95% CI: [2.27, 7.21]), and seven times the odds of using cannabis (AOR: 7.51, 95%
CI: [3.99, 14.12]). Importantly, youth who experienced ACE and whose positive developmental
context scores were 1 to 2 standard deviations above the sample mean had lower odds of using
all three substances than their peers with similar ACE exposure (ps < .05).

Conclusion: These findings underscore how programs strengthening positive developmental
contexts can help mitigate the negative impact of ACE on substance use among vulnerable
youth.
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