Adverse Childhood Experiences, Gender, and Substance Use Preventive Skills Among Adolescents: Results from a Rural County in Taiwan

Background and Purpose: Adolescents are in a developmental stage where engagement in substance use behaviors can negatively impact educational and health outcomes. Recent research suggests that adverse childhood experiences (ACEs) were a barrier of substance use prevention for school-aged students (Richard et al., 2021). However, past studies rarely focused on participants from a rural county and very few conducted gender-specific analyses among adolescents. To address these limitations, students from grade 7 in a rural county in Taiwan were recruited. We hypothesized that: 1) individual ACE is associated with decreased substance use-related knowledge, anti-substance use attitudes, and substance use preventive skills; and 2) there is a gender difference in increasing number of ACEs and substance use-related knowledge, attitudes and preventive skills.

Methods: In a cross-sectional study through collaborative partnerships with seven secondary schools residing in a rural county in Taiwan, we recruited four schools to participate on March 2023, and three on March 2024. The coordinator from each school provided parents with an informed consent form to ensure assent for research participation. Informed consent from students was obtained prior to the survey. Participants completed questions about socio-demographic characteristics, ACEs (10 items), and three dependent variables, namely substance use-related knowledge, anti-substance use attitudes, and substance use preventive skills, such as substance refusal skills, assertiveness skills, relaxation skills, and self-control skills. Bivariate analyses were computed for each factor. Two sets of multivariate linear regression analysis estimated the association between ACEs and dependent variables for girls and boys separately, controlling for ethnic minority identity and school performance grades.

Results: In total, 606 students completed the online survey (46.7% girls and 53.3% boys). The prevalence of different exposure to ACEs were: 72.3% for no ACEs, 15.3% for one ACE, 5.8% for two ACEs, and 6.6% for 3+ ACEs. Statistically significant differences were found between girls and boys in that more boys than girls had bad school performance grades, had lived with a family member previous incarcerated, and experienced three or more ACEs. In multivariate linear regression analyses, for girls’ model, lower substance use-related knowledge (β = -0.15, p<0.01), fewer relaxation skills (β = -0.18, p<0.01), and fewer self-control skills (β = -0.19, p<0.01) were significantly associated with experiencing three or more ACEs. For boys’ model, lower substance use-related knowledge (β = -0.12, p<0.05), and fewer self-control skills (β = -0.14, p<0.05) were significantly associated with experiencing three or more ACEs. Anti-substance use attitudes were not significantly associated with ACEs.

Conclusions and Implications:

Our findings suggest that ACEs may be an inhibiting factor of substance use-related knowledge and self-control skills for adolescents living in a rural county in Taiwan. Moreover, our findings indicate that there are differences in ACE exposure and preventive skills learned between girls and boys. School social workers in Taiwan should consider using a trauma-informed lens, understand the prevalence of childhood trauma and its detrimental effects on substance use-related knowledge and preventive skills. More studies should further examine gender differences in ACEs and the outcome measures among adolescents living in a rural county.