Adverse Childhood Behaviors and Problem Drinking: A Gender-Specific, Population-Based Study

Objectives: Problem alcohol consumption engenders a range of detrimental consequences for individuals, families and societies. Past research has found several forms of childhood adversities, particularly physical abuse and sexual abuse, as contributing factors of problem drinking, but most do not provide gender-specific analyses. To provide a more complete picture of the relationship between adverse childhood experiences (ACE) and problem drinking, we conduct a gender-specific analysis using population-base data. We hypothesized that: 1) individual ACE is associated with increased binge and heavy drinking; and 2) there is a step-wise relationship between the number of ACEs and binge and heavy drinking.

Methods: The 2012 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed. The total sample consists of 39,434 individuals (15,583 men and 23,851 women) from Iowa, North Carolina, Oklahoma, Tennessee, and Wisconsin. These states included the ACE module in their 2012 BRFSS. Data were weighted based on the population weights and sampling units. Logistics regressions assessed the associations between nine childhood adversities and problem alcohol consumption, controlling for socio-demographic variables, depression and cigarette use. All models were stratified by gender. Bonferroni correction was used to correct multiple testing.

Results: Approximately 40% of participants reported never experiencing any form ACEs assessed in the study, while over 10% of participants had experienced four or more ACEs. Men’s heavy drinking rate was slightly but significantly higher than women’s (6.1% vs. 4.6% respectively) and their binge drinking was higher than women’s binge drinking (21.7% vs. 11.1%).  For hypothesis one, the odds of men’s heavy drinking is linked with childhood household drug abuse (OR=1.56, 95% CI=1.23-1.99; p<.0001), and men’s binge drinking is linked with childhood drug abuse (OR=1.33, 95% CI=1.13-1.56; p<.0001) and verbal abuse (OR=1.32, 95% CI=1.19-1.47, p<.0001). Among women, their odds binge drinking is associated with childhood verbal abuse (OR=1.26, 95% CI=1.09-1.44, p<.001). None of the nine ACEs is linked with women’s heavy drinking. For hypothesis 2, while experiencing four or more ACEs is associated with an elevated risk of heavy drinking for both men (OR=1.69, 95% CI = 1.36-2.10, p<.0001) and women (OR=1.62, 95% CI = 1.29-2.02, p<.0001), the findings did not suggest a graded relationship between the number of childhood adversities and problem drinking. Further examination of the results suggests that socio-economic status variables such as income are stronger correlates associated with problem drinking than ACEs, particularly among women. For example, women in the highest income category have 4 times the odds (p<.0001) to drink heavily and 2 times the odds (p<.0001) to binge drink compared to those in the lowest income group.

Conclusions: Findings from this population-based study show a limited relationship between ACEs and heavy and binge drinking in adulthood. Risk factors that have been documented extensively are not associated with any problem drinking behaviors in this study. Rather, factors such as socio-economic status play a stronger role in adult’s problem drinking behaviors. Future studies should continue to understand the interplay between different ACEs and drinking behaviors in relation to gender and socioeconomic determinants.