Individual Contributions of Adverse Childhood Experiences to Adolescent Substance Use.

Background: Adverse childhood experiences (ACEs) are associated with adolescent substance use. However, the influence of individual ACEs after controlling for concurrent ACEs is understudied. Methods: Using longitudinal data from the Future of Families and Child Wellbeing Study (n = 3200), we evaluated binary logistic models to test associations from 11 individual ACEs at ages 3-9 (physical abuse; emotional abuse; neglect; housing instability; food insecurity; community violence; parental depression, problematic substance use, intimate partner violence [IPV], incarceration, and death) to adolescent cigarette, marijuana and heavy alcohol use at age 15, while controlling for sociodemographic characteristics and co-occurring ACEs. Results: Marijuana use was associated with neglect (aOR = 1.67, 95% CI = 1.08, 2.61) and parental mental illness (aOR = 1.28, 95% CI = 1.01, 1.62). Heavy alcohol use was associated with emotional abuse (aOR = 2.59, 95% CI = 1.23, 5.48). No ACEs were individually associated with cigarette use. Conclusions: Findings suggest a narrow set of ACEs may be driving well-documented associations between composite ACE indices and substance use outcomes. Emotional abuse may be a singularly salient risk factor for adolescent heavy alcohol use. Neglect and parental mental illness may be stronger risk factors for adolescent marijuana use. Findings provide guidance for tailored interventions and suggest composite ACE indices may incorrectly estimate adolescents' risk for substance use.