Elsevier

Journal of Adolescent Health

Volume 38, Issue 4, April 2006, Pages 444.e1-444.e10
Journal of Adolescent Health

Original article
Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence

https://doi.org/10.1016/j.jadohealth.2005.06.006Get rights and content

Abstract

Purpose

Alcohol is the most common and frequently used drug and has the potential to cause multiple deleterious effects throughout the lifespan. Because early age at initiation of alcohol use increases this potential and programs and laws are in place to attempt to delay the onset of alcohol use, we studied the relationship between multiple adverse childhood experiences (ACEs) and both the likelihood of ever drinking and the age at initiating alcohol use.

Methods

This was a retrospective cohort study of 8417 adult health maintenance organization (HMO) members in California who completed a survey about ACEs, which included childhood abuse and neglect, growing up with various forms of household dysfunction and alcohol use in adolescence and adulthood. The main outcomes measured were ever drinking and age at initiating alcohol use among ever-drinkers for four age categories: ≤ 14 years (early adolescence), 15 to 17 years (mid adolescence), and 18 to 20 years (late adolescence); age ≥ 21 years was the referent. The relationship between the total number of adverse childhood experiences (ACE score) and early initiation of alcohol use (≤14 years) among four birth cohorts dating back to 1900 was also examined.

Results

Eighty-nine percent of the cohort reported ever drinking; all individual ACEs except physical neglect increased the risk of ever using alcohol (p < .05). Among ever drinkers, initiating alcohol use by age 14 years was increased two- to threefold by individual ACEs (p < .05). ACEs also accounted for a 20% to 70% increased likelihood of alcohol use initiated during mid adolescence (15–17 years). The total number of ACEs (ACE score) had a very strong graded relationship to initiating alcohol use during early adolescence and a robust but somewhat less strong relationship to initiation during mid adolescence. For each of the four birth cohorts, the ACE score had a strong, graded relationship to initiating alcohol use by age 14 years (p < .05).

Conclusions

Adverse childhood experiences are strongly related to ever drinking alcohol and to alcohol initiation in early and mid adolescence, and the ACE score had a graded or “dose-response” relationship to these alcohol use behaviors. The persistent graded relationship between the ACE score and initiation of alcohol use by age 14 for four successive birth cohorts dating back to 1900 suggests that the stressful effects of ACEs transcend secular changes, including the increased availability of alcohol, alcohol advertising, and the recent campaigns and health education programs to prevent alcohol use. These findings strongly suggest that efforts to delay the age of onset of drinking must recognize the contribution of multiple traumatic and stressful events to alcohol-seeking behavior among children and adolescents.

Section snippets

Methods

The ACE Study is an ongoing collaboration between the Kaiser Health Plan’s Health Appraisal Center in San Diego, California, and the Centers for Disease Control and Prevention (CDC). The overall objective is to assess the impact of numerous interrelated ACEs on a wide variety of health behaviors and outcomes [15]. The ACE Study was approved by the institutional review boards of the Southern California Permanente Medical Group (Kaiser Permanente), Emory University, and the Office of Human

Prevalence of adverse childhood experiences and alcohol use outcomes

The prevalence of each specific adverse childhood experience (ACE) was higher for women than for men, except for physical abuse and physical neglect (Table 1). Sixty-eight percent of respondents reported at least one of the 10 ACEs; 42% reported two or more. The prevalence of initiation of alcohol use in early, mid, and late adolescence in the total population was 7.5%, 26.8%, and 32.8%, respectively. Among ever drinkers (n = 7519), the mean age at initiation (± SD) was 18.7 (± 4.6) years; mean

Discussion

Every category of adverse childhood experience (ACE) increased the likelihood of initiating alcohol use during early adolescence (≤14 years). In particular, for each of the 10 categories of ACEs there was a two- to threefold increased likelihood of initiating alcohol use by age 14. Moreover, we found a strong graded relationship between the ACE score and the likelihood of both ever initiating alcohol use and beginning alcohol use in early or mid adolescence.

The ARF for early initiation of

Acknowledgments

The Adverse Childhood Experiences Study was supported under a cooperative agreement #TS-44-10/11 from the Centers for Disease Control and Prevention through the Association of Teachers of Preventive Medicine (ATPM) and a grant from the Garfield Memorial Fund. Dr. Dong is funded through a Career Development Award via ATPM.

References (40)

  • D. Finkelhor et al.

    Sexual abuse in a national survey of adult men and womenprevalence, characteristics, and risk factors

    Child Abuse Negl

    (1990)
  • E. Burns

    The Spirits of AmericaA Social History of Alcohol

    (2004)
  • A. Barr

    DrinkA Social History of America

    (1999)
  • Tenth Special Report to the US Congress on Alcohol and Health

    (2000)
  • D.H. Jernigan et al.

    Sex differences in adolescent exposure to alcohol advertising in magazines

    Arch Pediatr Adolesc Med

    (2004)
  • Reducing Underage Drinking: A Collective Responsibility. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking

  • Youth Risk Behavior SurveillanceUnited States, 2003

    MMWR

    (2004)
  • R. Hingson et al.

    Age at first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students

    J Stud Alcohol

    (2003)
  • J.D. Hawkins et al.

    Exploring the effects of age of alcohol use initiation and psychological risk factors on subsequent alcohol misuse

    J Stud Alcohol

    (1997)
  • J.S. Chopak et al.

    Predicting alcohol and tobacco use in a sample of rural adolescents

    Am J Health Behav

    (1998)
  • Cited by (493)

    View all citing articles on Scopus
    View full text