Relations between adverse childhood experiences, racial and ethnic Identity, and cannabis use outcomes

Adverse childhood experiences (ACEs) and age of cannabis use onset are associated with cannabis use disorder (CUD), but their differential effect across race and ethnicity is unknown. Using NESARC-III, we examined ACEs, age of onset, and their interaction on lifetime cannabis use and CUD across racial and ethnic groups (Non-Hispanic White, Hispanic, Black/African American, Asian, American Indian/Alaska Native). ANOVAs found that American Indian/Alaska Native individuals reported the greatest prevalence of lifetime cannabis use and CUD, the greatest mean number of ACEs, and the earliest age of cannabis onset. Using logistic regressions, stratified by race and ethnic groups and adjusted for sociodemographic characteristics, we found that as ACEs increased, the odds of lifetime use (aORs 1.48-2.48), lifetime CUD (aORs 1.45-3.03), and past-year CUD (aORs 1.46-2.28) increased for all groups. The relations between ACEs and CUD were strongest among Asian/Pacific Islander respondents. Among respondents with lifetime use, increased age of onset was associated with lower lifetime CUD (aORs 0.85-0.94) and past-year CUD (aORs 0.88-0.97) for most groups. Three significant interactions between ACEs and age of onset predicting CUD emerged. Among Black and American Indian/Alaska Native individuals with an early age of cannabis initiation, ACEs exhibited a weaker relation with CUD. For White respondents, as number of ACEs increased, the impact of age of onset on CUD development diminished. Our findings highlight ACEs and age of onset as implicated in the progression from cannabis use to CUD and the importance of considering these factors in relation to racial and ethnic identity.