ORCID

0009-0000-4315-5609 (Yang)

Document Type

Article

Publication Date

2026

DOI

10.1155/adph/5189161

Publication Title

Advances in Public Health

Volume

2026

Pages

5189161

Abstract

Background

While adverse childhood experiences (ACEs) are widely recognized risk factors for behavioral health problems, including drug use, prior research has largely been conducted in Western countries, focused primarily on males, and relied on convenience samples without comparison groups of nonusers. Limited work has examined the impact of ACEs on drug use in non-Western contexts. This study examines gender differences in the relationship between ACEs and drug use in China, using data from a population-based probability sample survey.

Methods:

Cross-sectional data were collected in 2019 from one city in Yunnan Province in Southwest China and one city in Guangdong Province through baseline population-based surveys of people who use drugs (PWUD, n = 848) and people who do not use drugs (PNUD, n = 1455), recruited using a three-stage stratified probability sampling method. Multivariable logistic regression was employed to examine the association between ACEs and drug use and to assess the moderating effect of gender. Multivariable logistic regression analyzed the association between ACEs and drug use and tested gender as a moderating factor. Odds ratios and 95% confidence intervals were calculated.

Results

ACEs were highly prevalent, with a dose–response relationship observed. Among PWUD, 73.0% reported at least one ACE, compared to 49.99% of PNUD (p  < 0.001). Additionally, 19.25% of PWUD experienced ≥3 ACEs, versus 3.94% of PNUD (p  < 0.001). ACEs significantly increased drug use risk (≥3 ACEs: OR = 4.82, 95% CI: 3.67–6.34), with stronger effects in females (OR = 6.31, 95% CI: 4.02–8.76) than males (OR = 3.95, 95% CI: 2.89–5.41).

Conclusion

The interplay between ACEs, gender, and drug use underscores the need for gender-sensitive and trauma-informed interventions. Integrating early ACE screening, family-based interventions to strengthen relationships and coping, and community-based support systems is essential for effective drug use prevention and harm reduction.

Rights

© 2026 Hongyun Fu et al.

This is an open access article under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Data Availability

Article states: "The data that support the findings of this study are available upon request from Xiushi Yang (co-author and PI of the R01). The data are not publicly available due to privacy or ethical restrictions."

Original Publication Citation

Fu, H., Monk-Turner, E., & Yang, X. (2026). Gender differences in the association between adverse childhood experiences and drug use: Findings from a community-based survey in China. Advances in Public Health, 2026(1), Article 5189161. https://doi.org/10.1155/adph/5189161

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