Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort
Author(s)
Type
Journal Article
Abstract
Background: Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as
substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.
Methods: Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India
was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood
Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking
and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis
explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and
family structure.
Results: 1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males
report more of every individual childhood adversity and are more likely to report misusing substances compared
with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5–11.7) and collective level
ACEs (adj OR 6.6, 95% CI 1.4–31.1) show associations with substance misuse whilst in young adults, child level ACEs
such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1–3.5).
Conclusion: ACEs such as abuse and domestic violence are strongly associated with substance misuse, most
commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE
resilience programmes and ‘trauma-informed’ approaches to tackling longer-term impact of ACEs in India.
Funding: Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the
Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).
substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.
Methods: Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India
was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood
Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking
and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis
explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and
family structure.
Results: 1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males
report more of every individual childhood adversity and are more likely to report misusing substances compared
with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5–11.7) and collective level
ACEs (adj OR 6.6, 95% CI 1.4–31.1) show associations with substance misuse whilst in young adults, child level ACEs
such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1–3.5).
Conclusion: ACEs such as abuse and domestic violence are strongly associated with substance misuse, most
commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE
resilience programmes and ‘trauma-informed’ approaches to tackling longer-term impact of ACEs in India.
Funding: Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the
Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).
Date Issued
2021-10-23
Date Acceptance
2021-09-07
Citation
BMC Public Health, 2021, 21 (1)
ISSN
1471-2458
Publisher
BioMed Central
Journal / Book Title
BMC Public Health
Volume
21
Issue
1
Copyright Statement
© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
License URL
Sponsor
Medical Research Council (MRC)
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000710126900002&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
RTJ964197401
Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Adverse childhood experiences
physical abuse
sexual abuse
Indian children
substance misuse
cVEDA
ABUSE
ADOLESCENTS
MALTREATMENT
CHILDREN
ADULTS
FAMILY
METAANALYSIS
PREVENTION
VIOLENCE
TOBACCO
Publication Status
Published
Article Number
ARTN 1920
Date Publish Online
2021-10-23