Childhood Adversity and Risk Behaviors Among Chinese Rural Youth: A Moderated Mediation Analysis

Background: Risk behaviors, which refer to violence related behaviors, early and unprotected sexual behaviors, substance use, unhealthy dietary behaviors, and inadequate physical activity, are significant public health problems contributing to the leading causes of morbidity and mortality. Many studies have documented that adverse childhood experiences (ACEs) have significant impacts on risky behaviors. However, few studies have explored if individuals’ perceived stress mediate the association between ACEs and risky behaviors; also, if social support moderate the pathways from ACEs to risky behaviors through perceived stress. The current study extends the literature by examining the mediation effect of perceived stress and buffering effect of social support in the study of ACEs and risky behaviors among a group of Chinese rural youth.

Methods: The study sample includes 1091 rural high school graduates from three different provinces of China. A web-based survey was used to assess demographic information, ACEs, perceived stress, social support, and eight types of risky behaviors: gang membership, physical fight, drinking, smoking, drug use, early sexual behaviors, social media overuse, and suicide attempt. ACEs was measured by the Childhood Experiences Survey. Perceived stress was assessed using the 4-item version of the Perceived Stress Scale (PSS-4). Social support was measured by the 4-item aversion of Medical Outcome Study Social Support Survey (MOS-SSS). The eight types of risky behaviors were measured via single-item questions or validated brief scales.

Statistical analyses involved three main procedures. First, a descriptive analysis was conducted to estimate the means and proportions of all study variables. Second, multivariate regression models were run to test associations between ACEs and different risky behaviors while controlling for confounding variables. Third, the mediation model (Model 4) and the moderated mediation model (Model 59) were performed using the PROCESS macro.

Results: 75.0% of participants endorsed at least one of the ten conventional ACEs. Multivariate regression results showed that, with increasing ACEs values, there was an increased likelihood of all risky behaviors. Mediation analysis indicated that the standardized effects of ACEs on risk behaviors ((b = 0.23, SE = 0.02, p < 0.001) and perceived stress (b = 0.25, SE = 0.06, p < 0.001) were both statistically significant. Perceived stress also forged a significant association with risky behaviors (b = 0.21, SE= 0.01, p < 0.001). The results of the moderated mediation model confirmed the significant direct and indirect effects of ACEs on risky behaviors. However, no significant moderating effect of social support was found.

Conclusion & Implications: In this rural Chinese youth sample, we found perceived stress significantly mediated the relationship between ACEs and risky behaviors. However, there was no evidence of moderating effect of social support. Further research is needed to examine other potential mechanisms that may also explain how risky behaviors are impacted by ACEs. Future studies should also explore the buffering effects of resilience and school support. Prevention and early intervention should be conducted to address rural Chinese youth's ACEs, risky behaviors and stress problems to promote their health and wellness.