Research Article

Adverse childhood experiences and their Alcohol, and chat Consumption among school-going adolescents, Ethiopia: Cross-sectional study

Mekonnen Tsehay*, Mogesie Necho, Asmare Belete and Werkua Mekonnen

Published: 05 November, 2020 | Volume 4 - Issue 1 | Pages: 076-083

Background: Alcohol and chat use during adolescence is associated with academic and health problems, including abuse or dependence in adulthood. The aim of the present study was to investigate associations between adverse childhood experiences (ACEs) and early initiation of alcohol and chat use among school-going adolescents.

Methods: A cross-sectional study was performed with 546 school-going adolescents. The ACE International Questionnaire (ACE-IQ) was used to assess ACEs, Alcohol and chat use was assessed by questions prepared by the authors. Multiple logistic regression models were used to examine the associations between overall ACE score and alcohol use and the potential moderating effects of confounders.

Results: prevalence of chat chewing behavior was 26.6% followed by alcohol use 20%. A total of 66.2% of participants reported at least one ACE, and 5.93% reported four or more ACEs. High/Multiple ACEs (ACEs=1-3 and above 3) were significantly associated with increased alcohol use behaviors (AOR=1.491(1.072-3.078) and (AOR=3.171(1.330-7.560) respectively and increased chat use behaviors by 4.92 times (AOR=4.92, 95%CI=2.640-8.432) and 11.022 times (AOR=11.022, 95%CI=1.230-25.560) respectively controlling other factors.

Conclusion: ACEs were significantly associated with risk behaviors, alcohol and chat use may lead to poor health, and educational outcomes among adolescent students and numbers of ACEs have graded association. Social support, sex, residence, parent educational status, and current level of depressive symptoms were significant modulating factors, which parents, school teachers, psychologists, and adolescent health care providers should give the concern to decrease the effect on school-going adolescents. 

Read Full Article HTML DOI: 10.29328/journal.apmh.1001025 Cite this Article Read Full Article PDF


Alcohol; Chat; Adverse childhood experience; Social support; Adolescent


  1. Denton DA. National Health and Medical Research Council (NHMRC) 2009. 2009.
  2. Moore E, Coffey C, Carlin JB, Alati R, Patton GC. Assessing alcohol guidelines in teenagers: results from a 10‐year prospective study. Aus New Zealand J Public Health. 2009; 33: 154-159.
  3. Degenhardt L, Stockings E, Patton G, Hall WD, Lynskey M. The increasing global health priority of substance use in young people. The Lancet Psychiatry. 2016; 3: 251-264. PubMed: https://pubmed.ncbi.nlm.nih.gov/26905480/
  4. Simons-Morton B, Haynie D, Liu D, Chaurasia A, Li K, et al. The effect of residence, school status, work status, and social influence on the prevalence of alcohol use among emerging adults. J Studies Alcohol Drugs. 2016; 77: 121-132. PubMed: https://pubmed.ncbi.nlm.nih.gov/26751362/
  5. Kuntsche E, Rossow I, Simons‐Morton B, Bogt TT, Kokkevi A, Godeau E. Not Early Drinking but Early Drunkenness Is a Risk Factor for Problem Behaviors Among Adolescents from 38 E uropean and N orth A merican Countries. Alcohol Clin Exp Res. 2013; 37: 308-314. PubMed: https://pubmed.ncbi.nlm.nih.gov/23240610/
  6. Degenhardt L, Glantz M, Evans‐Lacko S, Sadikova E, Sampson N, et al. Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys. World Psychiatry. 2017; 16: 299-307. https://pubmed.ncbi.nlm.nih.gov/28941090/
  7. Organization WH. Global status report on alcohol and health 2018: World Health Organization; 2019.
  8. Monti PM, Miranda Jr R, Nixon K, Sher KJ, Swartzwelder HS, et al. Adolescence: booze, brains, and behavior. Alcoholism: Clinical and Experimental Research. 2005; 29: 207-220. PubMed: https://pubmed.ncbi.nlm.nih.gov/15714044/
  9. Witt ED. Research on alcohol and adolescent brain development: opportunities and future directions. Alcohol. 2010; 44: 119-124. PubMed: https://pubmed.ncbi.nlm.nih.gov/20113880/
  10. Olawole-Isaac A, Ogundipe O, Amoo EO, Adeloye D. Substance use among adolescents in sub-Saharan Africa: A systematic review and meta-analysis. South African J Child Health. 2018;12: s79-s84.
  11. !!! INVALID CITATION !!!
  12. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health. 2017; 2: e356-e366. PubMed: https://pubmed.ncbi.nlm.nih.gov/29253477/
  13. Pereda N, Guilera G, Forns M, Gómez-Benito J. The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clin Psychol Rev. 2009; 29: 328-338. PubMed: https://pubmed.ncbi.nlm.nih.gov/19371992/
  14. Stoltenborgh M, Bakermans-Kranenburg MJ, Alink LR, Van Ijzendoorn MH. The universality of childhood emotional abuse: a meta-analysis of worldwide prevalence. J Aggression, Maltreatment Trauma. 2012; 21: 870-890.
  15. Jansen HA, Watts C, Ellsberg M, Heise L, Garcia-Moreno C. Interviewer training in the WHO multi-country study on women’s health and domestic violence. Violence Against Women. 2004; 10: 831-849.
  16. Bartley M. Life gets under your skin: UCL, Research Departement of Epidemiology and Public Health; 2012.
  17. Anda R. The health and social impact of growing up with adverse childhood experiences: The human and economic costs of the status quo. Centers for Disease Control and Prevention. 2007.
  18. Campbell JA, Walker RJ, Egede LE. Associations between adverse childhood experiences, high-risk behaviors, and morbidity in adulthood. Am J Prev Med. 2016; 50: 344-352. PubMed: https://pubmed.ncbi.nlm.nih.gov/26474668/
  19. Hillis SD, Anda RF, Felitti VJ, Marchbanks PA. Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study. Family planning perspectives. 2001: 206-211. PubMed: https://pubmed.ncbi.nlm.nih.gov/11589541/
  20. Bellis MA, Lowey H, Leckenby N, Hughes K, Harrison D. Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. J Public Health. 2014; 36: 81-91. PubMed: https://pubmed.ncbi.nlm.nih.gov/23587573/
  21. Forster M, Grigsby TJ, Rogers CJ, Benjamin SM. The relationship between family-based adverse childhood experiences and substance use behaviors among a diverse sample of college students. Addict Behav. 2018; 76: 298-304. PubMed: https://pubmed.ncbi.nlm.nih.gov/28889058/
  22. Allem J-P, Soto DW, Baezconde-Garbanati L, Unger JB. Adverse childhood experiences and substance use among Hispanic emerging adults in Southern California. Addict Behav. 2015; 50: 199-204. PubMed: https://pubmed.ncbi.nlm.nih.gov/26160522/
  23. Lee K, Pang YC, Lee JAL, Melby JN. A study of adverse childhood experiences, coping strategies, work stress, and self-care in the child welfare profession. Human Service Organizations: Management, Leadership & Governance. 2017; 41: 389-402.
  24. Richard A, Rohrmann S, Vandeleur CL, Schmid M, Barth J, et al. Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLoS One. 2017; 12. PubMed: https://pubmed.ncbi.nlm.nih.gov/28715478/
  25. Armstrong MI, Birnie-Lefcovitch S, Ungar MT. Pathways between social support, family well being, quality of parenting, and child resilience: What we know. J Child Family Studies. 2005; 14: 269-281.
  26. Blum RW, Li M, Naranjo-Rivera G. Measuring adverse child experiences among young adolescents globally: Relationships with depressive symptoms and violence perpetration. J Adolescent Health. 2019; 65: 86-93. PubMed: https://pubmed.ncbi.nlm.nih.gov/30930089/
  27. Reda AA, Moges A, Wondmagegn BY, Biadgilign S. Alcohol drinking patterns among high school students in Ethiopia: a cross-sectional study. BMC public health. 2012; 12: 213. PubMed: https://pubmed.ncbi.nlm.nih.gov/22433230/
  28. Ho GW, Chan AC, Chien WT, Bressington DT, Karatzias T. Examining patterns of adversity in Chinese young adults using the Adverse Childhood Experiences—International Questionnaire (ACE-IQ). Child Abuse Neglect. 2019; 88: 179-188. PubMed: https://pubmed.ncbi.nlm.nih.gov/30513406/
  29. Anda RF, Croft JB, Felitti VJ, Nordenberg D, Giles WH, et al. Adverse childhood experiences and smoking during adolescence and adulthood. JAMA. 1999; 282: 1652-1658. PubMed: https://pubmed.ncbi.nlm.nih.gov/10553792/
  30. Gonçalves H, Soares ALG, Santos APGd, Ribeiro CG, Bierhals IO, Vieira LS, et al. Adverse childhood experiences and consumption of alcohol, tobacco and illicit drugs among adolescents of a Brazilian birth cohort. Cadernos de saude publica. 2016; 32: e00085815. PubMed: https://pubmed.ncbi.nlm.nih.gov/27828612/
  31. Kocalevent R-D, Berg L, Beutel ME, Hinz A, Zenger M, Härter M, et al. Social support in the general population: standardization of the Oslo social support scale (OSSS-3). BMC Psychol. 2018; 6: 31. PubMed: https://pubmed.ncbi.nlm.nih.gov/30016997/
  32. Gelaye B, Williams MA, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013; 210: 653-661. PubMed: https://pubmed.ncbi.nlm.nih.gov/23972787/
  33. Birhanu AM, Bisetegn TA, Woldeyohannes SM. High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis. BMC Public Health. 2014; 14: 1186. PubMed: https://pubmed.ncbi.nlm.nih.gov/25410657/
  34. Reda AA, Moges A, Biadgilign S, Wondmagegn BY. Prevalence and determinants of khat (Catha edulis) chewing among high school students in eastern Ethiopia: a cross-sectional study. PLoS One. 2012; 7. PubMed: https://pubmed.ncbi.nlm.nih.gov/22479484/
  35. Copeland LA, Shope JT, Waller PF. Factors in adolescent drinking/driving: binge drinking, cigarette smoking, and gender. J School Health. 1996; 66: 254-260. PubMed: https://pubmed.ncbi.nlm.nih.gov/8884665/
  36. Ellickson PL, McGUIGAN KA, Adams V, Bell RM, Hays RD. Teenagers and alcohol misuse in the United States: by any definition, it's a big problem. Addiction. 1996; 91: 1489-1503.
  37. Kim YH. Associations of adverse childhood experiences with depression and alcohol abuse among Korean college students. Child Abuse 2017; 67: 338-348. PubMed: https://pubmed.ncbi.nlm.nih.gov/28351730/
  38. Duke NN, Pettingell SL, McMorris BJ, Borowsky IW. Adolescent violence perpetration: associations with multiple types of adverse childhood experiences. Pediatrics. 2010; 125: e778-e86. https://pubmed.ncbi.nlm.nih.gov/20231180/
  39. Dube SR, Miller JW, Brown DW, Giles WH, Felitti VJ, Dong M, et al. Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. J Adolescent Health. 2006; 38: 444. e1-e10. https://pubmed.ncbi.nlm.nih.gov/16549308/
  40. Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB. Adverse childhood experiences and personal alcohol abuse as an adult. Addictive Behaviors. 2002; 27: 713-725. PubMed: https://pubmed.ncbi.nlm.nih.gov/12201379/
  41. Kiburi SK, Molebatsi K, Obondo A, Kuria MW. Adverse childhood experiences among patients with substance use disorders at a referral psychiatric hospital in Kenya. BMC Psychiatry. 2018; 18: 197. PubMed: https://pubmed.ncbi.nlm.nih.gov/29914409/
  42. Belew M, Kebede D, Kassaye M, Enquoselassie F. The magnitude of khat use and its association with health, nutrition and socio-economic status. Ethiopian Med J. 2000; 38:11-26. PubMed: https://pubmed.ncbi.nlm.nih.gov/11144876/
  43. Odenwald M, Neuner F, Schauer M, Elbert T, Catani C, Lingenfelder B, et al. Khat use as risk factor for psychotic disorders: a cross-sectional and case-control study in Somalia. BMC Med. 2005; 3: 5. PubMed: https://pubmed.ncbi.nlm.nih.gov/15707502/
  44. Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet. 2018; 391: 241-250. PubMed: https://pubmed.ncbi.nlm.nih.gov/29137869/
  45. Wills TA, Vaughan R. Social support and substance use in early adolescence. J Behav Med. 1989; 12: 321-339. PubMed: https://pubmed.ncbi.nlm.nih.gov/2600962/
  46. Wills TA, Cleary SD. How are social support effects mediated? A test with parental support and adolescent substance use. J Personality Soc Psychol. 1996; 71: 937. PubMed: https://pubmed.ncbi.nlm.nih.gov/8939042/
  47. Piko B. Perceived social support from parents and peers: Which is the stronger predictor of adolescent substance use? Substance use & misuse. 2000; 35: 617-630. PubMed: https://pubmed.ncbi.nlm.nih.gov/10741544/
  48. Chaffin M, Silovsky JF, Funderburk B, Valle LA, Brestan EV, et al. Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports. J Consulting Clin Psychol. 2004; 72: 500-510. PubMed: https://pubmed.ncbi.nlm.nih.gov/15279533/
  49. Reyno SM, McGrath PJ. Predictors of parent training efficacy for child externalizing behavior problems–a meta‐analytic review. J Child Psychol Psychiatry. 2006; 47: 99-111. PubMed: https://pubmed.ncbi.nlm.nih.gov/16405646/
  50. Conner KR, Pinquart M, Gamble SA. Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Substance Abuse Treatment. 2009; 37: 127-137. PubMed: https://pubmed.ncbi.nlm.nih.gov/19150207/
  51. Mulugeta Y. Khat chewing and its associated factor among college students in Bahir Dar Town, Ethiopia. Science J Public Health. 2013; 1: 209-214.
  52. Ageely HM. Prevalence of Khat chewing in college and secondary (high) school students of Jazan region, Saudi Arabia. Harm Reduction J. 2009; 6: 11.

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