The Impact of Early Adverse Childhood Experience (ACE) on Drug Use, Physical Health and Material Hardship In Adolescent and Young Adults Years

Background: Adverse Childhood Experiences (ACEs), including child abuse and neglect as well as household dysfunction (e.g., mental illness, violence, divorce, incarceration, substance misuse), are linked to poorer adult health outcomes and many other risk factors for the leading cause of death in adult life (Felitti et al., 1998). However, most prior research relies on retrospective reports and examines limited outcomes (Fok et al., 2021; Shu et al., 2025). Using longitudinal data from the Future of Families and Child Wellbeing Study (FFCWS), this study constructs ACE scores from measured/observed variables from child abuse/neglect and household dysfunction domains during early childhood. We examine their associations with multiple adolescent/young adult outcomes, including general health (age 15), drug use (age 15) and material hardship (age 22), while also controlled for child, maternal and household characteristics.

Method: Based on the FFCWS data (n = 4,898), ACEs included child abuse (physical assault, psychological aggression), neglect (emotional and physical), and household dysfunction (parental divorce/separation, parental substance abuse, household violence, parental incarceration, and maternal depression/anxiety) that occurred starting from child age 1 to 9. Indicators were coded as ever (1) versus never (0) experienced across childhood. The number of ACE events were computed by summing up the total events occurred in early childhood. The score ranges from 0-8 (0 time: n=92; 1 time: n=319; 2 times: n=1582; 3 times: n=1470; 4 times: n=911; 5 times: n=374; 6 times: n=101; 7 times: n=37 and 8 times: n=12). Adolescent/adulthood outcomes were material hardship (at age 22), drug use (at age 15), self-reported general health (at age 15). The ordinary least squares (OLS) regression for material hardship at age 22 and general health at age 15 and the logistic regression for youth drug use at age 15 by controlling for individual and family baseline variables.

Results: The greater exposure to adverse childhood experiences (ACEs) was associated with worse outcomes across adolescence and early adulthood. Each additional ACE was linked to significantly higher material hardship at age 22 (b = 0.056, SE = 0.020, p = .005) and greater likelihood of drug use at age 15 (b = 0.056, SE = 0.027, p = .039). ACE exposure was also associated with poorer general health at age 15, although this association did not reach conventional statistical significance (b = -0.017, SE = 0.009, p = .068). Among baseline variables, adolescent living in cohabitant marital status showed higher material hardship and higher drug use. Lower socioeconomic status (low income, less years of maternal education) were likely to have more material hardship, higher drug use, and lower self-reported health.

Implication: These findings highlight ACEs as early indicators of behavioral and socioeconomic vulnerability across adolescence and early adulthood. Greater ACE exposure is associated with increased risk of adolescent drug use and material hardship, underscoring the need for early, integrated, trauma-informed interventions. Targeted strategies for high-risk groups, including youth in cohabiting households and those with lower socioeconomic status, are essential to reduce disparities and support healthier developmental trajectories among adolescent/young adult.