Adversity and Substance Use Behaviors Among a Longitudinal Cohort of Latinx Young Adults

Background and Purpose: Although a substantial literature base documents the strong association between Adverse Childhood Experiences (ACEs) and substance use later in life, much less is known about ACEs among U.S. Latinx youth and their substance use behaviors. Considering known health disparities among the Latinx immigrant population, understanding the association of ACEs with substance use behaviors has important implications for health equity. This study examines the longitudinal association of culturally relevant factors of substance use behaviors among Latinx youth, including acculturation, enculturation, and ethnic identity, collectively with the experience of ACEs.

Method: Survey data was collected at seven timepoints from 2005-2016; 1,179 participants participated in follow-up ACEs assessment in timepoint 5 (mean age of 21.6 years) and substance use measures in timepoint 7 (mean age of 23.9 years). ACEs measures included psychological, physical, and sexual abuse, parental domestic violence, separation/divorce, household alcohol/drug use, mental illness, and incarceration. A three-stage hierarchical regression strategy estimated an ordinary least squares (OLS) (i.e., alcohol use) and negative binomial (NB) regression models ( i.e., tobacco, problematic alcohol, and marijuana use) to assess associations of multiple factors known to influence substance use behaviors among Latinx youth.

Results: Initial models estimating sociodemographics showed sex and adolescent substance use behaviors were predictive of most substance use in young adulthood. Sex was the single predictive determinant of past 30-day tobacco use, all other variables were not significant. Acculturation significantly predicted alcohol use frequency, remaining statistically significant after adding all ACEs operationalizations – ACEs sum score (B = .03, p = .01), maltreatment (B = .16, p < .01), and household dysfunction (B = .12, p = .03). NB models of problematic drinking showed that enculturation (IRR = 0.90, 95% CI: .81 – 1.00) predicted lower odds of past 30-day problematic alcohol use. After adding ACEs, one additional increase in ACEs sum score (IRR = 1.05, 95% CI: 1.00, 1.11) significantly predicted 5% higher count of problematic alcohol use, and one additional adverse child maltreatment experience (IRR = 1.23, 95% CI: 1.00, 1.53) predicted 23% higher count of problematic alcohol use. Enculturation became non-significant once ACEs were added to problematic alcohol use models. ACEs also significantly predicted past 30-day marijuana use frequency; ACEs sum score (IRR = 1.13, 95% CI: 1.04, 1.22), child maltreatment (IRR = 1.50, 95% CI: 1.05, 2.13), and household dysfunction (IRR = 1.66, 95% CI: 1.18, 2.32) domains each predicted increased counts of past 30-day marijuana use.

Conclusions and Implications: Study results provide evidence of the predictive relationship between ACEs and substance use behaviors among Latinx youth. Over and above important culturally relevant risk and protective factors, ACEs remain predictive of increased substance use among Latinx youth for alcohol and marijuana, but not tobacco use. This research informs prevention of health disparities showing the weight of culturally related risk factors on substance use behaviors after accounting for ACEs. Future research must move beyond individual and family-level factors of substance use among Latinx youth and look to community and societal contexts to close the health gap.