Adverse childhood experiences increased cannabis use disorder risk for all racial groups, but the effect was strongest among Asian/Pacific Islander respondents, and early cannabis use onset amplified the relationship in complex, race-specific ways.
Addiction researchers, public health professionals addressing health disparities, and prevention program designers.
What the researchers found
As ACEs increased, odds of lifetime CUD rose across all groups (aOR 1.45-3.03). The ACE-CUD relationship was strongest among Asian/Pacific Islander respondents. American Indian/Alaska Native individuals had the highest prevalence of lifetime CUD, most ACEs, and earliest onset. Earlier cannabis onset was associated with more CUD for most groups.
Why it matters
Treating cannabis use disorder risk as uniform across racial groups misses important differences. The finding that ACEs interact with age of onset differently by race suggests that prevention programs need culturally tailored approaches.
The numbers in context
Adjusted ORs for ACEs on lifetime CUD: 1.45-3.03 across groups. American Indian/Alaska Native: highest CUD prevalence, most ACEs, earliest onset. Asian/Pacific Islander: strongest ACE-CUD relationship. Earlier onset: lower lifetime CUD aORs 0.85-0.94 for most groups.
How the study worked
Cross-sectional analysis of NESARC-III data examining ACEs, age of cannabis onset, and their interaction on lifetime cannabis use and CUD across five racial/ethnic groups. Logistic regressions stratified by race/ethnicity with sociodemographic controls.
What this study cannot tell us
Cross-sectional NESARC-III data cannot establish temporal causation. Self-reported ACEs and cannabis use subject to recall bias. Some racial/ethnic subgroups had smaller sample sizes. Lumping diverse ethnicities into broad categories may mask within-group variation.
How to read the evidence
Large nationally representative sample (NESARC-III) with appropriate stratified analysis, though cross-sectional design limits causal inference.
When this study was published
2025 publication.
The bigger picture
This study connects three major risk factors, childhood trauma, early substance use, and racial disparities, in a single analysis, showing they interact in ways that simple additive models miss.
Questions still open
- What cultural factors explain the particularly strong ACE-CUD relationship among Asian/Pacific Islander respondents?
- Would ACE-informed, culturally tailored prevention programs reduce cannabis use disorder disparities?
Common questions
Why does race matter for cannabis use disorder risk?
Why was the ACE effect strongest for Asian/Pacific Islander individuals?
Read the original research
Relations between adverse childhood experiences, racial and ethnic Identity, and cannabis use outcomes.
Addictive behaviors, 167, 108361
Citation
Gette, Jordan A; Espinosa, Adriana. (2025). Relations between adverse childhood experiences, racial and ethnic Identity, and cannabis use outcomes.. Addictive behaviors, 167, 108361. https://doi.org/10.1016/j.addbeh.2025.108361
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