Adverse childhood experiences moderate the relationship between minoritized status and engaging in substance use among adolescent psychiatric inpatients

ObjectivesAdverse childhood experiences (ACEs; parental death, bullying) are linked to developing psychiatric disorders and substance use. Individuals with a minoritized status due to race, ethnicity, sexuality, or gender identity often have more ACEs. ACEs are linked to substance use, hypothesized due to coping. The study objective was to test whether the relationship between minoritized status and ever using a substance depends on ACEs in a sample of adolescent psychiatric inpatients.MethodsYouth hospitalized at a psychiatric unit in the Northeast United States (n = 417; 11-18 years; 64% female) completed surveys on substance use and demographic characteristics upon admission from April 2021 to May 2022. A total of 299 adolescents (71.7%) endorsed at least 1 minoritized identity (range: 0-8; median 1; racial, ethnic, sexuality, and/or gender identity). The number of ACEs ranged from 0 to 19 (x = 7.22; SD = 4.32). Adolescents indicated if they ever used cannabis or alcohol, or if they vaped nicotine. Logistic regression moderation analyses tested the association among minoritized status, ACEs, and type of substance use (covariates: age, sex). Significant interactions were probed at the 16th, 50th, and 84th percentiles (ACEs: 2, 7, 12).ResultsSample-wide, 46.5% vaped nicotine, 41.2% used alcohol, and 44.4% used cannabis. The number of ACEs significantly moderated the link between minoritized status and substance use. For cannabis, the slope for the effect of minoritized status was significant (p = .006) only with low ACEs (2; b = -0.52): minoritized youth had lower log-odds of cannabis use with low ACEs. For alcohol, the slope for the effect of minoritized status was significant (p = .015) only with high ACEs (12; b = 0.32): minoritized youth had greater log-odds of alcohol use with elevated ACEs. For vaping, the slopes for the effect of minoritized status was significant (p < .01) only with low ACEs (2; b = -0.57) or high ACEs (12; b = 0.46): minoritized youth had lower log-odds of vaping with low ACEs and greater log-odds with high ACEs.ConclusionsThe link between minoritized status and the use of different substances varied depending on the number of ACEs experienced. Considering ACEs and an intersectional perspective on life experiences may be beneficial for the treatment of minoritized youth inpatients in the context of comorbid psychiatric issues.NIDA, DEI, ICP ObjectivesAdverse childhood experiences (ACEs; parental death, bullying) are linked to developing psychiatric disorders and substance use. Individuals with a minoritized status due to race, ethnicity, sexuality, or gender identity often have more ACEs. ACEs are linked to substance use, hypothesized due to coping. The study objective was to test whether the relationship between minoritized status and ever using a substance depends on ACEs in a sample of adolescent psychiatric inpatients. Adverse childhood experiences (ACEs; parental death, bullying) are linked to developing psychiatric disorders and substance use. Individuals with a minoritized status due to race, ethnicity, sexuality, or gender identity often have more ACEs. ACEs are linked to substance use, hypothesized due to coping. The study objective was to test whether the relationship between minoritized status and ever using a substance depends on ACEs in a sample of adolescent psychiatric inpatients. MethodsYouth hospitalized at a psychiatric unit in the Northeast United States (n = 417; 11-18 years; 64% female) completed surveys on substance use and demographic characteristics upon admission from April 2021 to May 2022. A total of 299 adolescents (71.7%) endorsed at least 1 minoritized identity (range: 0-8; median 1; racial, ethnic, sexuality, and/or gender identity). The number of ACEs ranged from 0 to 19 (x = 7.22; SD = 4.32). Adolescents indicated if they ever used cannabis or alcohol, or if they vaped nicotine. Logistic regression moderation analyses tested the association among minoritized status, ACEs, and type of substance use (covariates: age, sex). Significant interactions were probed at the 16th, 50th, and 84th percentiles (ACEs: 2, 7, 12). Youth hospitalized at a psychiatric unit in the Northeast United States (n = 417; 11-18 years; 64% female) completed surveys on substance use and demographic characteristics upon admission from April 2021 to May 2022. A total of 299 adolescents (71.7%) endorsed at least 1 minoritized identity (range: 0-8; median 1; racial, ethnic, sexuality, and/or gender identity). The number of ACEs ranged from 0 to 19 (x = 7.22; SD = 4.32). Adolescents indicated if they ever used cannabis or alcohol, or if they vaped nicotine. Logistic regression moderation analyses tested the association among minoritized status, ACEs, and type of substance use (covariates: age, sex). Significant interactions were probed at the 16th, 50th, and 84th percentiles (ACEs: 2, 7, 12). ResultsSample-wide, 46.5% vaped nicotine, 41.2% used alcohol, and 44.4% used cannabis. The number of ACEs significantly moderated the link between minoritized status and substance use. For cannabis, the slope for the effect of minoritized status was significant (p = .006) only with low ACEs (2; b = -0.52): minoritized youth had lower log-odds of cannabis use with low ACEs. For alcohol, the slope for the effect of minoritized status was significant (p = .015) only with high ACEs (12; b = 0.32): minoritized youth had greater log-odds of alcohol use with elevated ACEs. For vaping, the slopes for the effect of minoritized status was significant (p < .01) only with low ACEs (2; b = -0.57) or high ACEs (12; b = 0.46): minoritized youth had lower log-odds of vaping with low ACEs and greater log-odds with high ACEs. Sample-wide, 46.5% vaped nicotine, 41.2% used alcohol, and 44.4% used cannabis. The number of ACEs significantly moderated the link between minoritized status and substance use. For cannabis, the slope for the effect of minoritized status was significant (p = .006) only with low ACEs (2; b = -0.52): minoritized youth had lower log-odds of cannabis use with low ACEs. For alcohol, the slope for the effect of minoritized status was significant (p = .015) only with high ACEs (12; b = 0.32): minoritized youth had greater log-odds of alcohol use with elevated ACEs. For vaping, the slopes for the effect of minoritized status was significant (p < .01) only with low ACEs (2; b = -0.57) or high ACEs (12; b = 0.46): minoritized youth had lower log-odds of vaping with low ACEs and greater log-odds with high ACEs. ConclusionsThe link between minoritized status and the use of different substances varied depending on the number of ACEs experienced. Considering ACEs and an intersectional perspective on life experiences may be beneficial for the treatment of minoritized youth inpatients in the context of comorbid psychiatric issues.NIDA, DEI, ICP The link between minoritized status and the use of different substances varied depending on the number of ACEs experienced. Considering ACEs and an intersectional perspective on life experiences may be beneficial for the treatment of minoritized youth inpatients in the context of comorbid psychiatric issues.