Associations between adverse childhood experiences and adolescent cannabis and nicotine
product use: Moderation by ethnicity.

Eric Shanazari, Jennifer B. Unger, Xiao Zhang, Lizbeth Becerra, Rasmey Gomez,
Mikaela Rojas, Myriam Forster

Background: Nicotine and cannabis use during adolescence can impair healthy development and
increase the risk of adverse health outcomes in adulthood. Adverse childhood experiences
(ACE), correlated traumatic stressors experienced before age 18, negatively impact mental health
and are highly correlated with youth substance use. However, ethnic variation in the association
between ACE and substance use is understudied.

Methods: Data are baseline survey responses (N=1,973) from adolescent students enrolled in a
longitudinal study investigating social and environmental risk and protective factors for health
and school outcomes. Regression models tested the hypothesized association between ACE and
adolescents’ nicotine and cannabis product use. We explored ethnicity as a moderator of this
association, adjusting for demographic covariates.

Results: The sample was 53% female, 34% non-Hispanic White, 31% Black/African American,
22% Hispanic, 9% Multiethnic, and 7% Asian. Approximately 15% of respondents reported
lifetime nicotine product use, 16% reported lifetime cannabis product use, and 55% experienced
at least one ACE. Regression results suggest that every additional ACE was associated with
higher odds of nicotine (AOR: 1.58, 95%CI: 1.36-1.83) and cannabis (AOR: 1.38, 95%CI: 1.18-
1.93) product use. Significant ethnic differences were found in the relationship between ACE and
nicotine (p=0.024) but not cannabis use; In comparison to Asian youth, ACE were especially
risky for nicotine use among Non-Hispanic White (AOR: 1.85, 95%CI: 1.45-2.36),
Black/African American (AOR: 1.36, 95%CI: 1.04-1.79), and Hispanic (AOR: 1.76, 95%CI:
1.21-2.56).

Conclusion: Results highlight the risk for substance use associated with early trauma and that
intervention content needs to consider the evolving nicotine and cannabis product market as well
as culturally tailored messaging in programming for diverse, vulnerable youth populations.