Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

Abstract

Background: Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment. Objectives: To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males. Methods: Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome. Results: One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females' cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males' separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes. Conclusion: ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.

Interrelationships of Economic Stressors, Mental Health Problems, Substance Use, and Intimate Partner Violence among Hispanic Emergency Department Patients: The Role of Language-Based Acculturation

“…The models generated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) that quantified the strength of the association between the independent (exposure) variable and the outcome (dependent variable) after accounting for the other variables in the model. We stratified the models by gender, due to previous results showing significant gender differences in drinking, drug use, and IPV [44,45], and prior studies showing a more robust association between acculturation and alcohol use outcomes among Hispanic women than men [17]. In accordance with H1, we analyzed the association between economic stressors (being fired/laid off from a job, food insufficiency, financial strain) and each mental health outcome.…”

Annual Research Review: Prenatal opioid exposure – a two‐generation approach to conceptualizing neurodevelopmental outcomes

“…Fifty to 80% of women with substance use disorders report experiencing child maltreatment. The highest rates of substance use in adult women are observed among those who have experienced ACES (Cunradi et al., 2020). Exposure to ACES and stressors such as poverty (Ghertner & Groves, 2018) tend to be replicated across generations and likely alter the developing fetal central nervous system even when the exposure occurred before the pregnancy (Scorza et al., 2019).…”

Maternal Childhood Maltreatment, Internal Working Models, and Perinatal Substance Use: Is There a Role for Hyperkatifeia? A Systematic Review

“…6,9,[78][79][80][81][82][83][84][85][86][87]95 Of 14 studies specifically in young adults of reproductive age (which did not relate to adolescent or perinatal periods), all of these studies supported a relationship between childhood maltreatment experiences and substance use. 8,33,[59][60][61][62][63][64][88][89][90][91][92][93] The impact of each of these two domains on mother-infant relationships and offspring outcomes is addressed in the sections including interactions with internal working models, as these effects are likely mediated via this mechanism.…”