Understanding the Relationship Between Adverse Childhood Experiences, Positive Childhood Experiences, and Nicotine Product Use Among College Students

Abstract

BACKGROUND: Nicotine product use among college students has been a growing public health concern. To reduce nicotine product use among college students, it is important to identify risk factors associated with this behavior, such as adverse childhood experiences (ACEs). Although sufficient research has shown a dose-effect relationship between ACEs and nicotine use, there is a need for further exploration of less commonly measured ACEs among college students. No research has explored nicotine product use among college students using an expanded measure of ACEs. Additionally, no research has explored whether positive childhood experiences (PCEs) moderate the association between ACEs and current nicotine product use among college students. OBJECTIVE: This dissertation is composed of three studies that work together to understand the relationship between ACEs, PCEs, and nicotine product use among college students: 1) synthesize existing literature on ACEs and nicotine use among young adults; 2) assess ACEs and nicotine use among undergraduate college students; and 3) assess whether PCEs moderate the relationship between ACEs and nicotine use among undergraduate college students. METHODS: A scoping review was conducted for research aim one following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Inclusion criteria included published and grey literature between January 2000 to January 2022 that involved participants aged 18-27 years and measured at least one ACE exposure and use of at least one nicotine product. For research aims two and three, a cross-sectional survey study was conducted at a large Southwest university. Inclusion criteria included being at least 18 years old and enrolled at the university. Logistic regression analyses were conducted for research aims two and three. RESULTS: For research aim one, 19 studies were included in the review with 13 of them conducted with college students. Among the 19 studies, the average number of ACEs was two and the most common types were abuse and neglect. Eleven studies indicated that the number of ACEs increased the risk of nicotine use among young adults. Fourteen studies found that specific types of ACEs, including abuse and parental separation, were associated with nicotine use. For research aims two and three, a sample of 286 college students reported nicotine use rates of 36% within the past 30 days, with e-cigarette use being the most popular product (53%). For aim two specifically, most participants reported having more than two ACEs, and social isolation (62%) was the most prevalent ACE. Contrary to literature, parental separation or divorce decreased the odds of multiple nicotine product use (OR: 0.40, CI: 0.16-0.99, p=0.05). For research aim three specifically, the most prevalent PCE was having opportunities for a good time growing up (95%) and the average number of PCEs was 8.2, with about 42% of the participants reporting the maximum number of 10 PCEs. Having at least one good friend growing up decreased the odds of cigarette use (OR; 0.06, CI: 0.01-0.35, p=0.002). PCEs did not moderate the relationship between ACE items and nicotine use. CONCLUSION: Rate of abuse was significantly high in both the review and study. The review identified a gap in literature on the lack of expanded ACE measurements that prompted the use of a 31-ACE item measurement in the cross-sectional study. High prevalence of ACEs, PCEs, and nicotine use in this study highlight the need for additional research with a larger, diverse sample. Findings from this dissertation research may be used to inform the development of nicotine prevention and cessation initiatives. Furthermore, preventative efforts should be made to reduce ACEs and increase PCEs by considering a multilevel public health approach for both college students and youth.