Adverse Childhood Experiences (ACEs) and the Associations with Substance Use Among Korean College Students

Background and Purpose: Adverse childhood experiences (ACEs) have long-standing effects on health behavioral outcomes. The body of literature shows that ACEs increases the risk of substance abuse in later life. In Korea, alcohol abuse and smoke use are the most prevalent mental health problems in young adults, and the socioeconomic costs of alcoholism are a serious concern. This study inquires the links of ACEs to smoke use and alcohol abuse among Korean college students. This study aims to identify patterns of ACE exposure to better understand the multidimensional nature of early adversities in South Korea; also examine whether the patterns of ACEs are associated with smoke use and alcohol abuse.

Methods: This study used a cross-sectional survey design. The online survey recruited 1,037 college students across the nation. The survey employed a non-probability quota sampling to have a balanced ratio in gender (female and male) and geographic location (Seoul metropolitan area and elsewhere). We measured ACEs using 14 binary variables to capture the following adversities in childhood respectively: emotional abuse, physical abuse, sexual abuse, emotional neglect, parental separation or divorce, marital violence, household member with substance abuse, household member with mental illness, loss of parent or brother/sister, food or housing hardship, and public assistance receipt, and the three bullying victimization items – teasing, property and hit. We had two dependent variables: alcohol use and smoke use. Alcohol use was measured using the 10-item Alcohol Use Disorder Identification Test. The total score (range 0 to 40) was used to classify three groups based on the suggested cut-off points: normal drinkers, problem drinkers, and potential alcoholics. Smoke use was measured by one question asking whether the participants smoked daily or not. Latent Class Analysis (LCA) was employed to identify homogeneous classes with similar patterns of ACEs. Next, we conducted multinomial logistic regressions to examine the associations between ACE classes and each of substance use.

Results: LCA results indicated that four classes fit the data best. The four classes consisted of exposure to bullying victimization at school (7.4%), exposure to direct and indirect family violence (20.8%), economic-hardship (9.3%), and low ACEs (62.5%). Compared to the group with low ACEs, participants with bullying-victimization at school (OR=2.27, p< .01) and direct and indirect family violence (OR=1.92, p< .01) were more likely to report smoke daily controlling for sociodemographic factors. Also, participants with bullying-victimization at school (OR=2.63, p< .01) were more likely to report potential alcoholics than those with low ACEs controlling for sociodemographic factors.

Discussion and Implications: This study provides important evidence on discrete classes of young adults and associated substance abuse in Korea. It is important to note that the bullying-victimization at school class is identified as a heterogeneous group, whereas prior research rarely distinguishes exposure to school victimization from other ACEs. This study will discuss policy and practice implications that should be addressed to prevent adverse childhood experiences.