Adverse childhood experiences as predictors of alcohol and tobacco addiction risk among college students in Delhi-NCR, India

Substance use is a major public health concern, particularly among college students. Adverse Childhood Experiences (ACEs) have been shown to increase the risk of substance use in adulthood. Therefore, the present study aims to understand the impact of cumulative and domain-specific ACEs on alcohol and tobacco use, and associated addiction risks among college-going students in the Delhi-NCR, India. The study was conducted among 1813 college students from two universities in Delhi-NCR. Data on sociodemographic variables were collected using pre-tested and modified interview schedule. The WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to assess alcohol and tobacco use and their addiction risk, while the ACEs were measured using ACE-International Questionnaire (ACE-IQ). Statistical analysis was performed using SPSS version 22.0. The findings revealed higher prevalence of alcohol and tobacco use, and addiction risk among the ACE exposed group than the unexposed group. Higher odds of use and addiction risk for alcohol, tobacco and combined substances were observed among ACE exposed individuals. Age, socioeconomic status, parental education status, and mother's occupation were found to be significant predictors of substance use among both ACE exposed and unexposed groups. An early age of initiation of alcohol use was observed among those exposed to ACEs. Domain wise analysis revealed that ACEs related to household dysfunction were more consistently associated with the substance use, whereas those related to neglect and abuse were more strongly associated with addiction risk. Further, bullying was associated with substance use, whereas community and collective violence were more strongly associated with addiction risk to these substances. Overall, the study reveals the adverse effects of ACEs on alcohol and tobacco use, as well as addiction risk, among college students in Delhi-NCR, India. These findings highlight the urgent need to address ACEs in trauma-uninformed settings, which could help mitigate the burden of substance use, and also underscore the importance of integrating ACE-informed approaches into existing substance use prevention and intervention programs.