Childhood Adversity and Health in Emerging Adulthood

Importance Adverse childhood experiences (ACEs) are robust estimators of poor health across the lifespan, yet most research relies on retrospective reports from adult samples and conventional ACE measures that exclude community-level adversity. Focusing on emerging adulthood—a developmental period when adversity may exert increased lifetime associations—provides a clearer view of near-term impacts and a critical window for intervention. Objectives To examine associations between conventional and community-level ACEs and mental health, substance use, interpersonal violence, and educational outcomes in emerging adulthood, and to assess the relative contributions of ACE domains to key outcomes. Design, Setting, and Participants Longitudinal cohort study using data collected in waves 5 (March to August 2023) and 6 (February to August 2024) of a population-based sample recruited from urban and suburban schools in the Southern US. Of 2768 participants, 1850 with complete data were included in the present analyses. Exposures Conventional and community-level ACEs assessed at wave 6, categorized as 0, 1 to 3, 4 to 5, or 6 or more exposures. Main Outcomes and Measures Depression, posttraumatic stress disorder, suicidality, substance use, dating violence (DV), sexual assault, and academic mobility. Results Among the 1850 participants (mean [SD] age at wave 6, approximately 19 [0.6 years; 1395 [50.4%] female; 389 [14.1%] Asian, 709 [25.6%] Black, 1025 [37.0%] Hispanic, 200 [7.2%] White, and 445 [16.1%] other race and ethnicity), higher ACE exposure showed graded associations with nearly all outcomes. Compared with 0 ACEs, those with 4 to 5 and 6 or more ACEs had higher rates of depression (70 [21.0%] individuals with 0 ACEs vs 165 [46.5%] with 4 to 5 ACEs and 141 [56.9%] with 6 or more ACEs), PTSD (7 [2.1%] with 0 ACEs vs 54 [15.2%] with 4 to 5 ACEs and 77 [30.9%]), suicidal ideation (20 [6.0%] with 0 ACEs vs 98 [27.8%] with 4 to 5 ACEs and 103 [41.4%] with 6 or more ACEs), illicit substance use (ie, speed, hallucinogens, heroin, or ecstasy; 1 [0.3%] with 0 ACEs vs 22 [6.3%] with 4 to 5 ACEs and 27 [10.8%] with 6 or more ACEs), and interpersonal violence (eg, experiencing physical DV, 9 [2.7%] with 0 ACEs vs 30 [8.5%] with 4 to 5 ACEs and 37 [14.9%] with 6 or more ACEs). Academic achievement and college attendance decreased with increasing ACE exposure. Ten of 14 ACE domains were independently associated with key outcomes and 11 with experiencing DV. Emotional abuse, sexual abuse, witnessing domestic violence, and discrimination showed the most consistent associations. Conclusions and Relevance In this cohort study of emerging adults, both conventional and community-level ACEs were associated with poorer mental health, interpersonal violence, substance use, and reduced academic mobility. These findings highlighted emerging adulthood as a critical period for intervention and suggested that, beyond cumulative exposure, specific forms of adversity were more consistently associated with adverse outcomes than others.