More Childhood Adversity Linked to More Frequent Cannabis Use in Teens
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.
Quick Facts
What This Study 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).
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?Which specific ACEs are most strongly linked to cannabis use vs. other substances?
- ?Would trauma-informed interventions actually reduce teen substance use?
Trust & Context
- Key Stat:
- 1.81x greater odds of frequent cannabis use per ACE score increase
- Evidence Grade:
- Moderate: large nationally representative survey with validated measures, but cross-sectional design limits causal inference
- Study Age:
- Published in 2025 using 2023 Youth Risk Behavior Survey data
- Original Title:
- Cumulative Adverse Childhood Experiences and Frequency of Substance Use Among US High School Students.
- Published In:
- Journal of primary care & community health, 16, 21501319251346102 (2025)
- Authors:
- Azagba, Sunday(2), de Silva, Galappaththige S R, Ebling, Todd(2)
- Database ID:
- RTHC-05983
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked 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 More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-05983APA
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
MLA
Azagba, Sunday, et al. "Cumulative Adverse Childhood Experiences and Frequency of Substance Use Among US High School Students.." Journal of primary care & community health, 2025. https://doi.org/10.1177/21501319251346102
RethinkTHC
RethinkTHC Research Database. "Cumulative Adverse Childhood Experiences and Frequency of Su..." RTHC-05983. Retrieved from https://rethinkthc.com/research/azagba-2025-cumulative-adverse-childhood-experiences
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.