Date of Award

2025

Degree Type

Thesis

Degree Name

Master of Arts in Psychology

Specialization

Clinical Psychology

Department

Psychology

First Advisor

Nathn Cook

Abstract

Objective: Adverse childhood events (ACEs) are pervasive, affecting more than half the United States’ population. A large body of research has described an association between an increased number of ACEs and negative outcomes, including the development of a substance use disorder later in life. Further, ACEs are disproportionately experienced by individuals from historically marginalized groups. Thus, the interaction between ACEs and substance use may disproportionately impact individuals from historically marginalized groups (i.e., based on ethnicity and sex). The present study’s main aim was to examine the interaction of group differences, specifically based on sex and ethnicity, on the associations between ACEs and alcohol outcomes from a diverse group of high schoolers. Method: Participants (N = 1,932, 51.6% female, 47.7% male) ages 12-18 were recruited from high schools throughout Rhode Island and completed a computer-based survey. ACEs were assessed through a series of seven questions assessing: basic needs insecurity, sexual abuse, living with someone with a substance use disorder, living with someone with a mental health disorder, exposure to neighborhood violence, experiencing discrimination based on race or ethnicity, and experiencing discrimination based on gender identity or sexuality. Alcohol outcomes were assessed through initiating drinking before age 13, current alcohol use, and current binge drinking. Results: Descriptive analyses illustrated subgroup differences between ACEs exposures in multiracial, Black or African American, LGBTQ+, and Hispanic or Latino participants such that individuals belonging to these groups report higher total ACEs scores compared to White, non-Hispanic, heterosexual, and cisgender individuals. Path analyses indicated that ACEs were significantly associated with drinking alcohol before age 13 (β = -0.438, p < .001), current alcohol use (β = 0.469, p < .001), and current binge drinking behaviors (β = 0.431, p < .001). Measurement invariance testing supported configural, metric, and scalar invariance across ethnicity but not sex. Thus, additional path analyses examined the relationship between ACEs and alcohol outcomes, separately by ethnicity and illustrated that ACEs were more predictive of current alcohol use and current binge drinking in Hispanic or Latino youth (β = 0.412, R2= .17 p < .001; β = 0.617, R2 = .38, p < .001 respectively) compared to non-Hispanic or Latino participants (β = 0.368, R2 = .14, p < .001; β = 0.460, R2 = .21, p < .001 respectively). Conclusion: These findings highlight the positive associations between ACEs and negative alcohol outcomes within the study’s participants. Despite the negative impact of ACEs, future research should emphasize potential protective factors that might mitigate risk for negative outcomes. Given the significant public health burden of ACE-related outcomes, early screening and interventions are essential. Further research is needed in larger, more representative samples to ensure the psychometric properties of our surveys are adequate to make meaningful between group comparisons.

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