Childhood Family Violence and Tobacco, E-Cigarette, and Alcohol Use Among Adolescents: A Large School-Based Study in...

Background: Adolescent tobacco, e-cigarette, and alcohol use are important public health concerns in China. However, the associations of specific types and cumulative exposure to childhood family violence with different substance use outcomes remain insufficiently understood. This study examined these associations among Chinese adolescents. Methods: We analyzed data from a cross-sectional school-based survey of 41,146 students aged 10-19 years conducted from October 2022 to March 2023 in a mountainous city in western Guangdong Province, China. Childhood family violence was assessed using the validated Chinese Family Violence Questionnaire and a cumulative exposure index. Descriptive analyses and logistic regression models were conducted, with adjustment for demographic and environmental factors. Results: The mean age of participants was 14.8 years, and 51.7% were female. Overall, 25.1% of adolescents reported at least one type of childhood family violence. Verbal insults (18.6%) and emotional neglect (16.3%) were the most frequently reported types and were consistently associated with tobacco, e-cigarette, and alcohol use (adjusted odds ratios [ORs] = 1.4-1.5, p < 0.001). A cumulative exposure pattern was also observed. Compared with adolescents reporting no childhood family violence, those exposed to three or more types had higher odds of tobacco use (OR = 3.81; 95% CI: 3.42-4.23), e-cigarette use (OR = 3.90; 95% CI: 3.39-4.48), and alcohol use (OR = 3.95; 95% CI: 3.59-4.35). Peer smoking and access to tobacco products were also significantly associated with substance use. Conclusions: Childhood family violence, particularly verbal insults and emotional neglect, was associated with adolescent tobacco, e-cigarette, and alcohol use. The findings highlight the importance of considering emotional maltreatment, cumulative adversity, peer influences, and access to tobacco products in future prevention research and practice.