More Childhood Adversity Linked to More Frequent Cannabis Use in Teens | Research

The takeaway

High school students with higher cumulative adverse childhood experiences scores had significantly greater odds of cannabis use, with a dose-response pattern across all substances examined.

Parents, educators, school counselors, adolescent health researchers, prevention program designers

1.81x greater odds of frequent cannabis use per ACE score increase

What the researchers found

Cumulative ACE scores were positively associated with cannabis use frequency among US high school students. Higher ACE scores predicted greater odds of frequent cannabis use (OR=1.81, 95% CI: 1.65-1.99) and occasional use (OR=1.26, 95% CI: 1.01-1.57).

Why it matters

Understanding that childhood adversity predicts teen substance use across a dose-response pattern can help target prevention efforts. Addressing trauma early might reduce substance use risk later.

The numbers in context

Cannabis use OR: 1.81 (frequent), 1.26 (occasional) per unit increase in ACE score. Similar patterns for alcohol (OR=1.89), binge drinking (OR=1.69), and e-cigarettes (OR=1.89). The study used 8 ACE items from the YRBS.

How the study worked

Cross-sectional analysis of the 2023 Youth Risk Behavior Survey, a nationally representative survey of US high school students. Cumulative ACE scores were calculated from 8 self-reported lifetime experiences. Multinomial logistic regression analyzed associations with substance use frequency.

What this study cannot tell us

Cross-sectional design cannot determine whether ACEs caused substance use. Self-reported data may undercount both ACEs and substance use. The YRBS ACE measure captures only 8 experiences, potentially missing others.

How to read the evidence

Moderate: large nationally representative survey with validated measures, but cross-sectional design limits causal inference

When this study was published

Published in 2025 using 2023 Youth Risk Behavior Survey data

The bigger picture

The ACE-substance use connection is well established in adults, but this nationally representative teen data shows the pattern is already present in high school. The dose-response relationship (more adversity, more use) strengthens the case for trauma-informed prevention.

Questions still open

Which specific ACEs are most strongly linked to cannabis use vs. other substances? Would trauma-informed interventions actually reduce teen substance use?

Common questions

What counts as an adverse childhood experience?

The study measured 8 ACEs from the YRBS, which typically include experiences like abuse, neglect, household dysfunction (substance use, mental illness, incarceration), and violence exposure.

Is cannabis use the most affected substance?

The associations were similar across all substances: alcohol, binge drinking, cannabis, and e-cigarettes all showed significant dose-response relationships with ACE scores. Cannabis was not uniquely affected.

Read the original research

Cumulative Adverse Childhood Experiences and Frequency of Substance Use Among US High School Students.

Journal of primary care & community health, 16, 21501319251346102

View on PubMed ↗Publisher’s paper ↗

Citation

Azagba, Sunday; de Silva, Galappaththige S R; Ebling, Todd. (2025). Cumulative Adverse Childhood Experiences and Frequency of Substance Use Among US High School Students.. Journal of primary care & community health, 16, 21501319251346102. https://doi.org/10.1177/21501319251346102