Background
Adverse childhood experiences (ACEs) and substance use
Prevention in the behavioral health system
The Arizona context
This paper
Methods
Data and samples
Measures
Dependent variables: past 30-day substance use
Independent variables: ACEs
Covariates
Analytic strategies
Results
Findings from the AYS youth sample
AYS demographics
Total Sample | ACEs 0 | ACEs 1–3 | ACEs 4–6 | |
---|---|---|---|---|
N; %/ Mean (SD) | N; %/ Mean (SD) | N; %/ Mean (SD) | N; %/ Mean (SD) | |
Sample size | 42,009; 100.00 | 11,407; 27.00 | 24,003; 57.00 | 6599; 16.00 |
Dependent Variables | ||||
Past 30-day use (1/0) | ||||
Smoking | 8954; 21.31 | 1106; 9.83 | 5155; 21.86 | 2693; 41.46 |
E-cig. | 3723; 8.86 | 405; 3.61 | 2113; 8.97 | 1205; 18.55 |
Illicit drugs | 8287; 19.73 | 1239; 10.86 | 4825; 20.10 | 2223; 33.69 |
Alcohol | 17,668; 42.06 | 2863; 25.73 | 10,710; 45.70 | 4095; 63.37 |
Binge drinking | 5264; 12.53 | 774; 6.91 | 3091; 13.16 | 1399; 21.62 |
Sample characteristics by ACEs score | ||||
Age | 15.36(1.17) | 15.26 (1.71) | 15.45 (17.44) | 15.52 (1.66) |
Gender | ||||
Female | 21,296; 51.51 | 5175; 45.92 | 12,342; 52.24 | 3779; 58.10 |
Male | 20,103; 48.62 | 6094; 54.07 | 11,284; 47.76 | 2725; 40.64 |
Race | ||||
White | 18,815; 44.79 | 5275; 46.86 | 10,770; 45.34 | 2770; 42.40 |
Black or African American | 1380; 3.29 | 339; 3.01 | 836; 3.52 | 205; 3.14 |
Multiracial | 2279; 5.43 | 489, 4.34 | 1339, 5.64 | 451, 6.90 |
Hispanic | 16,335; 38.88 | 4408;39.15 | 9249;38.94 | 2678;40.98 |
Education Level | ||||
8th Grade | 15,989; 38.06 | 4625; 40.55 | 9077; 37.82 | 2287; 34.66 |
10th Grade | 14,029; 33.40 | 3644; 31.95 | 8100; 33.75 | 2285; 34.63 |
12th Grade | 11,991; 28.54 | 3138; 27.51 | 6826; 28.44 | 2027; 30.72 |
AYS Logistic Regression Results of Past 30-day Substances Use on ACEs | |||||
---|---|---|---|---|---|
Cigarettes | E-cigarettes | Days with 1 or more drinks | Binge Drinking | Illicit Drugs | |
OR [95% CI] | OR [95% CI] | OR [95% CI] | OR [95% CI] | OR [95% CI] | |
ACEs (ref. = 0 ACEs) | |||||
1–3 ACEs | 2.46*** | 2.04*** | 1.87*** | 1.88*** | 2.58*** |
[2.26–2.69] | [1.87–2.23] | [1.68–2.08} | [1.71–2.08] | [2.33–2.85] | |
4–6 ACEs | 7.02*** | 3.77*** | 3.77*** | 3.90*** | 6.67*** |
[6.37–7.73] | [3.40–4.17] | [3.35–4.25] | [3.49–4.34] | [5.97–7.45] | |
Covariates | |||||
Age | 1.37*** | 1.21*** | 1.41*** | 1.38*** | 1.24*** |
[1.31–1.43] | [1.16–1.27] | [1.33–1.49] | [1.31–1.45] | [1.18–1.30] | |
Male | 0.97 | 0.73*** | 0.93 | 1.01 | 0.86*** |
[0.91–1.03] | [0.68–0.78] | [0.86–1.00] | [0.94–1.08] | [0.81–0.92] | |
Education levels (ref. = Grade 12) | |||||
Grade 8 | 1.09 | 1.06 | 0.70** | 0.81 | 0.54*** |
[0.91–1.31] | [0.87–1.29] | [0.55–0.89] | [0.66–1.01] | [0.44–0.67] | |
Grade 10 | 1.09 | 1.12 | 1.04 | 1.02 | 0.88* |
[0.97–1.22] | [0.99–1.29] | [0.90–1.20] | [0.90–1.17] | [0.77–1.00] | |
Race (ref. = White) | |||||
Black | 0.77* | 0.50*** | 0.72* | 0.78* | 0.99 |
[0.63–0.95] | [0.96–1.10] | [0.55–0.94] | [0.61–0.99] | [0.80–1.22] | |
Multiracial | 1.24** | 0.88 | 0.93 | 0.92 | 1.17* |
[1.08–1.42] | [1.87–2.23] | [0.78–1.11] | [0.78–1.09] | [1.01–1.36] | |
Hispanic | 1.45*** | 1.03 | 1.09* | 1.23*** | 1.22*** |
[1.36–1.55] | [0.96–1.10] | [1.01–1.19] | [1.14–1.33] | [1.14–1.31] | |
Constant | 0.001*** | 0.006*** | 0.000*** | 0.000*** | 0.003*** |
Observations | 31,253 | 31,932 | 32,028 | 31,879 | 32,143 |
Findings from the BRFSS adult sample
BRFSS demographics
Total Sample | ACEs 0 | ACEs 1–3 | ACEs 4–6 | |
---|---|---|---|---|
N; %/ Mean (SD) | N; %/ Mean (SD) | N; %/ Mean (SD) | N; %/ Mean (SD) | |
Sample Size | 5328; 100.00 | 727; 14.00 | 4296; 81.00 | 305; 5.00 |
Dependent Variables | ||||
Past 30-day use (1/0) | ||||
Smoking | 621; 11.66 | 64; 8.82 | 481; 11.20 | 76; 24.92 |
E-Cig. | 160; 3.00 | 13; 1.79 | 121; 2.82 | 26; 8.52 |
Illicit Drugs | 134; 2.52 | 5; 0.69 | 101; 2.35 | 28; 9.18 |
Alcohol | 2545; 48.21 | 244; 34.27 | 2146; 50.34 | 155; 50.99 |
Binge Drinking | 439; 8.29 | 45; 6.28 | 348; 8.14 | 46; 15.08 |
Sample characteristics by ACEs score | ||||
Age | 60.15(17.97) | 57.39 (19.86) | 61.16 (17.44) | 52.46 (18.03) |
Gender | ||||
Female | 3122; 58.60 | 391; 53.78 | 2555; 59.47 | 176; 57.70 |
Male | 2206; 41.40 | 336; 46.22 | 1741; 40.53 | 129; 42.30 |
Race | ||||
White | 3980; 74.70 | 454; 62.45 | 3312; 77.09 | 214; 70.16 |
Black Or African American | 114; 2.14 | 17; 2.34 | 85; 1.98 | 12; 3.93 |
Other | 513; 9.63 | 127; 17.47 | 355; 8.22 | 33; 10.82 |
Multiracial | 66; 1.24 | 15; 2.06 | 45; 1.05 | 6; 1.97 |
Hispanic | 655; 12.29 | 114; 15.68 | 501; 11.66 | 40; 13.11 |
Education Level | ||||
Primary Or Less | 130; 2.44 | 29; 3.99 | 97; 2.26 | 4; 1.31 |
Some High School | 230; 4.32 | 40; 5.50 | 175; 4.07 | 15; 4.92 |
High School Graduation | 1258; 23.61 | 193; 26.55 | 973; 22.65 | 92; 30.16 |
Some College Or Tech School | 1585; 29.75 | 212; 29.16 | 1277; 29.73 | 96; 31.48 |
College Graduation | 2125; 39.88 | 253; 34.80 | 1774; 41.29 | 98; 32.13 |
BRFSS regression results of past 30-day substance use on ACEs
VARIABLES | Cigarettes | E-cigarettes | Days with 1 or more drinks | Binge Drinking | Illicit Drugs |
---|---|---|---|---|---|
OR [95% CI] | OR [95% CI] | OR [95% CI] | OR [95% CI] | OR [95% CI] | |
ACEs (ref. = 0 ACEs) | |||||
1–3 ACEs | 1.49** | 1.80* | 1.82*** | 1.56** | 3.93** |
[1.13–1.98] | [1.00–3.23] | [1.53–2.16] | [1.12–2.17] | [1.59–9.76] | |
4–6 ACEs | 3.25*** | 4.29*** | 1.94*** | 2.42*** | 12.82*** |
[2.24–4.74] | [2.15–8.56] | [1.46–2.57] | [1.55–3.79] | [4.85–33.90] | |
Covariates | |||||
Age | 0.98*** | 0.97*** | 0.99** | 0.97*** | 0.97*** |
[0.98–0.99] | [0.96–0.97] | [0.99–1.00] | [0.96–0.97] | [0.96–0.97] | |
Male | 1.25* | 1.23 | 1.51*** | 2.32*** | 2.66*** |
[1.05–1.48] | [0.89–1.69] | [1.35–1.69] | [1.89–2.85] | [1.85–3.84] | |
Education levels | 0.65*** | 0.79** | 1.47*** | 1.04 | 1.06 |
[0.60–0.71] | [0.68–0.93] | [1.39–1.56] | [0.93–1.15] | [0.88–1.28] | |
Race (ref. = White) | |||||
Black | 1.10 | 0.90 | 1.01 | 1.21 | 0.85 |
[0.65–1.85] | [0.35–2.30] | [0.69–1.49] | [0.67–2.21] | [0.30–2.43] | |
Other | 0.74 | 0.51* | 0.47*** | 0.67* | 0.57 |
[0.55–1.00] | [0.28–0.92] | [0.38–0.58] | [0.47–0.95] | [0.31–1.06] | |
Multiracial | 1.74 | 0.64 | 0.67 | 0.85 | 1.62 |
[0.93–3.27] | [0.15–2.76] | [0.40–1.11] | [0.35–2.05] | [0.55–4.80] | |
Hispanic | 0.57*** | 0.47** | 0.75** | 0.95 | 0.23*** |
[0.43–0.76] | [0.27–0.81] | [0.63–0.91] | [0.70–1.29] | [0.10–0.55] | |
Observations | 5326 | 5326 | 5132 | 5279 | 5296 |
Discussion
Similarities and differences for youth and adult samples
Benefits of systems collaboration (implications)
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Select evidence-based programs to the extent that matches can be found between the target audiences and programs; at a minimum, all programs should demonstrate an evidence-informed framework and data results that show positive outcomes.
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Select trauma-specific services and/or infuse a trauma-informed component into all prevention, intervention, and treatment programs and policies.
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Address the co-morbidity of substance use and trauma as a major consideration in program and policy implementation.
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Adopt statewide policies that support the implementation of targeted prevention, intervention, and treatment programs and practices.
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Integrate prevention plans, programs, and policies across a variety of system-level and funding sources.