Associations of Adolescent Exposure to Severe Violence with Substance Use From Adolescence into Adulthood: Direct Versus Indirect Exposures

Abstract

Background: While previous research has documented the impact of violence on substance use, none has looked longitudinally across the lifespan to measure independent effects of direct and indirect violence exposure. Objective: To examine independent associations between adolescent experiences of violence and subsequent substance use in adolescence and adulthood in the United States. Method: Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we examined being shot or stabbed (“experienced”), being threatened with a knife or gun (“threatened”), and seeing someone either shot or stabbed (“witnessed”) during adolescence (Wave I) as correlates of substance use in adolescence and adulthood (Wave IV) via logistic regression. Results: Violence exposure was a significant correlate of drug use in adolescence and several associations remained significant in adulthood. Witnessing violence had the highest point estimates in the adjusted models in adolescence for each substance use outcome (e.g., Cocaine-Adjusted Odds Ratios [AOR] = 2.59, 95% confidence interval [CI] = 1.21, 5.54). However, the point estimates for threatened with violence or experienced violence were highest in three out of the four drug outcomes in adulthood (e.g., Threatened with violence: Binge drinking-AOR = 1.41, 95% CI = 1.08, 1.83). Conclusion/Importance: Adolescent exposure to witnessing violence had stronger effects on substance use in adolescence, while experiencing and being threatened with violence in adolescence had stronger effects on substance use in adulthood. Violence prevention efforts targeted toward adolescents may lead to a reduction in substance use throughout the life-course, and clinicians and policy makers should be aware of the downstream effects of violence experienced in adolescence.

Keywords:

• Add health
• adolescence
• gun violence
• life-course
• substance use

Acknowledgments

This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill. Special acknowledgment is due to Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from grant P01-HD31921 for this analysis.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Statement of Integrity

The article enclosed does not include any overlapping information in prior publications or submissions under review. This manuscript is currently not under review at any other journal, nor will it be submitted to any other journal while under consideration by Substance Use and Misuse.

Additional information

Funding

Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations, Grant Number: P01-HD31921. Additional support was provided by the National Institute on Drug Abuse (R01DA036414), as well as from the Behavioral Science Training program at NYU Rory Meyers College of Nursing (T32DA007233).