Objective: Traditional adverse childhood experiences (T-ACEs), such as abuse and neglect, have been associated with an increased risk of youth alcohol use and misuse. This study aims to compare associations of T-ACEs and expanded ACEs (E-ACEs), an expanded set of ACEs that encompass community-level adversities, with alcohol use and misuse by race/ethnicity. Method: Data came from a three-wave (1998-1999, 1999-2000, 2004-2005) community-based study in Houston, including youth transitioning into adulthood. We compared associations between ACEs at Wave 1 and past-year alcohol use, abuse, and dependence at Wave 3. Results: Participants (2,391) included White (908), Black (898), and Latinx ( 585) youth (M [SD] = 14.00 [2.04]) transitioning into young adulthood (M [SD] = 19.77 [2.34]). T-ACEs were associated with higher odds of alcohol use, abuse, and dependence (OR = 1.15, 1.18, 1.24, respectively) while E-ACEs increased the odds of alcohol dependence (OR = 1.23) in the total sample. No significant differences by race/ethnicity were found. Racial/ethnic differences in increased alcohol risk were observed for some ACE items, such as bullying and use for Latinx youth (OR = 2.13) and poverty and dependence for White youth (OR = 2.01). Conclusions: T-ACEs and E-ACEs increase the risk of alcohol use and misuse. Results highlight the importance of preventing ACE exposure as a risk factor for youth alcohol use and misuse. Public policies must also focus on preventing ACEs through multilevel interventions aimed at reducing violence, bullying, and financial instability.
Clinical Impact StatementConsistent with previous studies, we found that the family-level ACEs traditionally studied in the literature are associated with youth alcohol use and misuse. Additionally, our findings suggest that an expanded set of ACEs encompassing adversities particularly relevant to socioeconomically and racially/ethnically diverse populations are also associated with alcohol misuse. Racial and ethnic differences in alcohol use risk were observed for specific E-ACEs. It is imperative we expand our understanding and measurement of ACEs to include those occurring outside of the family, such as neighborhood violence and discrimination, which can detrimentally impact youth's mental health.