Associations of Loneliness and Childhood Adversity With ASSIST-Measured Substance Use Risk in a University Student Sample

Background Adverse childhood experiences (ACEs) are associated with substance use risk, yet few studies have examined substance-specific risk using the WHO Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in university populations.Methods Data were drawn from a cross-sectional survey of 2,393 students at a public university in Southern California conducted in Spring 2024. Multivariable logistic regressions assessed associations between ACEs and moderate- to high-risk use of alcohol, cannabis, and tobacco and whether loneliness moderated these associations.Results ACE exposure was significantly associated with increased substance use risk. Each additional ACE reported was associated with 1.15 times the odds of moderate/high-risk alcohol use (aOR = 1.15, 95% CI = 1.04–1.27), 1.16 times the odds of moderate/high-risk cannabis use (aOR = 1.16, 95% CI = 1.07–1.25), and 1.15 times the odds of moderate/high-risk tobacco use (aOR = 1.15, 95% CI = 1.04–1.26). Loneliness did not moderate the associations between ACEs and substance use risk (all p > 0.05).Conclusions Greater cumulative ACE exposure was strongly associated with elevated alcohol, cannabis, and tobacco use risk among university students, supporting the relevance of trauma-informed behavioral health approaches within campus health systems and highlighting the need for targeted prevention and intervention efforts.