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. Author manuscript; available in PMC: 2022 May 1.
Published in final edited form as: Psychol Addict Behav. 2021 Mar 18;35(3):274–282. doi: 10.1037/adb0000597

Adverse Childhood Experiences, Racial Microaggressions, and Alcohol Misuse in Black and White Emerging Adults

Laura Reid Marks 1, Samuel F Acuff 2, Alton J Withers 2, James MacKillop 3, James G Murphy 2
PMCID: PMC8084861  NIHMSID: NIHMS1644394  PMID: 33734786

Abstract

Objective:

Research indicates that emerging adults (EAs) are at an increased risk for heavy drinking and its associated alcohol problems, and that both proximal and distal stressors (e.g., adverse childhood experiences [ACEs], and subtle racial discrimination [racial microaggressions]) may contribute to these high-risk outcomes. We investigated the relationship of ACEs with alcohol consumption and alcohol problems in a sample of Black and White EAs, and racial microaggressions with alcohol consumption and alcohol problems in the Black EAs in our sample.

Method:

Six hundred and two EAs (41.5% Black, 47% White; 57.3% women) completed measures assessing ACEs, alcohol consumption and alcohol problems.

One hundred and ninety-six Black EAs in the sample were also asked to complete a measure of racial microaggressions that assessed their level of distress related to these experiences.

Results:

Regression analyses demonstrated a positive association of ACEs with alcohol consumption and alcohol problems. Sex moderated the relation of ACEs with alcohol consumption such that the positive relationship between ACEs and alcohol consumption was minimally stronger for females. College status moderated the relation of ACEs with alcohol consumption such that the relationship between ACEs and alcohol consumption was stronger for college students than non-college students. Racial microaggressions were positively associated with alcohol problems, but not alcohol consumption.

Conclusion:

Findings underscore the importance of childhood stressors with alcohol consumption and problems for EAs, and the need for additional research on racial microaggressions and alcohol problems in Black EAs.

Keywords: Alcohol consumption, alcohol problems, adverse childhood experiences, emerging adults, racial microaggressions

Alcohol consumption is higher during emerging adulthood (ages 18-25 years) than in any other developmental period (Sussman & Arnett, 2014; Thompson et al., 2014; Winograd & Sher, 2015). Perhaps this is because emerging adulthood is a developmental period characterized by elevated impulsivity and negative affect, increased autonomy and access to alcohol, greater relative peer (versus family) influence on behavior, and numerous transitions and stressors (e.g., decisions around entering college, career and workforce choices, and movement out of the parental home) (Arnett, 2007; Sussman & Arnett, 2014). Excessive alcohol consumption can result in the development of alcohol use disorder (AUD), the practice of risky health behaviors (e.g., sexual risk behaviors), and poor health, social, and educational outcomes (Zapolski et al., 2014). Some studies suggest that Black emerging adults (EAs) report similar or even greater levels of alcohol problems than White EAs (Read et al, 2006; Zapolski et al., 2014), and that they experience additional stressors (e.g. racial discrimination; American Psychological Association; APA Working Group on Stress and Health Disparities, 2017). Given that alcohol consumption and its related problems tend to increase in emerging adulthood due to new and accumulating effects of past stressors, it is a critical time to examine factors that may be associated with increased alcohol consumption and problems in White and Black EAs.

Several theories exist that delineate how stressors may influence health outcomes and health behaviors in Black and White EAs. According to social stress theory (SST), stress is a natural consequence of the social structure of our society that has differential health effects based on race, social class standing, and other systematic hierarchies (Aneshensel, 1992). Using this framework, EAs with multiple marginalized identities may be at an increased risk for negative health outcomes (Lewis & Grzanka, 2016), which is often preceded by risky behaviors such as alcohol consumption. For example, EAs from lower socioeconomic status groups may experience higher levels of stress than EAs from higher socioeconomic groups because they possess fewer financial resources (e.g., lower income and educational attainment). Indeed, although EAs in college generally report higher rates of heavy episodic drinking than those not in college (Barnes et al., 2010), individuals who do not graduate from a 4-year college or university are at elevated risk for a developmentally persistent pattern of heavy drinking and associated problems (Grant et al., 2017). Consistent with the self-medication hypothesis, this accumulated stress may lead to increases in drinking to cope with negative affect, which is associated with increased prevalence of alcohol-related problems (Corbin et al., 2013; LaBrie et al., 2012; Park et al., 2004, In sum, SST and self-medication theories highlight that stressors may have detrimental alcohol-related effects on EAs, and that identity factors (i.e., race, social class, gender) may interact to enhance risk.

Adverse Childhood Experiences (ACEs)

Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood (0-17 years) such as experiencing or witnessing violence, abuse, or neglect or other significant stressors (e.g., natural disasters, homelessness) (Felitti et al., 1998). At a population level, ACEs are common and are associated with alcohol consumption and problems in both college and community samples (Crouch et al., 2018; Dube et al., 2002; Windle et al., 2018; Strine et al., 2012). Overall, the association between ACEs and these alcohol outcomes have been repeatedly demonstrated in the addiction literature; however, less is known about variables that may modify the strength of these relationships.

Previous research has shown that Black individuals are disproportionately affected by ACEs than White individuals. Data from the 2011 and 2012 Wisconsin Behavioral Risk Factor Surveillance System surveys indicated that Black individuals were more likely than non-Hispanic White individuals to have experienced an ACE (38.97% vs. 20.77%; Slack et al. (2017)). Compared to White individuals, Black individuals were more likely to experience multiple ACEs. Similarly, in a nationally representative college sample, Forster et al. (2019) found that Black EA were more likely to have experienced an ACE than non-Hispanic White EAs (58.8% versus 51.7%). Black EAs were more likely to have experienced 1-3 ACEs (45.4% versus 40.1%) and greater than 4 ACEs (2.9% versus 1.4%). In another study conducted by Lee and Chen (2017) race moderated the relationship between ACEs and heavy drinking such that Black individuals in the community who had experienced ACEs were more than three times likely to drink heavily than White individuals in the community. However, additional research is needed to investigate the relationship between ACEs and alcohol misuse within a high-risk community sample of EAs, and to determine if the association between ACEs and alcohol-risk is stronger for EAs who are Black or who are members of other marginalized groups (e.g., EA with lower incomes or who are not college students or graduates). Consistent with SST and the self-medication hypothesis, marginalized EAs may lack the resources to cope with ACEs and may thus be at greater risk for alcohol misuse.

Some studies in the addiction literature also suggest that sex may moderate the association between ACEs and alcohol consumption. One study found that that compared to women, men who experienced ACEs were two times more likely to binge drink and more than 60% likely to engage in any alcohol drinking in the past month (Loudermilk et al., 2018). However, research in this area is mixed and limited. Other studies have not found sex differences in the relationship between ACEs and alcohol consumption (Lee & Chen, 2017), and it is thus important to investigate the possibility of sex moderation in order to advance our understanding of potentially unique risk processes for men and women.

Racial Discrimination, Racial Microaggressions, and Alcohol Consumption among Black EA

Despite consuming less alcohol than White EAs, some research suggests that Black EAs are at an equal or increased risk for alcohol problems (Zapolski et al., 2014). This disparity may be related to the reality that Black EAs in the United States face unique race-related stressors that have been linked to numerous negative health outcomes (Paradies et al., 2015). Numerous studies suggest that the experience of racial discrimination may precipitate race-related trauma (Liu et al., 2019; Nadal et al., 2019) and increase alcohol misuse in Black EAs (e.g., Metzger et al., 2017a, Metzger et al., 2017b, Metzger et al., 2018, Terrell et al., 2006, and Hurd et al., 2014). For example, a recent meta-analysis examining the relationship between racial discrimination and alcohol use and related consequences found significant positive relationships between racial discrimination and alcohol consumption and problems for Black individuals (Desalu et al., 2019). Moreover, since racial discrimination are present before emerging adulthood and exist throughout the lifespan for Black individuals, they can also be viewed as an ACE faced by Black EAs. Like other ACEs, they may have equally detrimental effects as other ACEs on alcohol outcomes. However, the majority of published studies on race-related discrimination in the alcohol literature have focused on overt forms of racial discrimination, and less so on the effects of subtle and more common forms of racial discrimination, which fall under the umbrella of racial microaggressions.

Racial microaggressions refer to “brief and commonplace daily verbal, behavioral, and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults to the target person or group.” (Sue et al., 2007, p. 273). Racial microaggressions have been shown to be harmful to the mental health of Black individuals (Liao et al., 2016; Sue et al., 2008). For example, Nadal et al. (2014) demonstrated in a sample of diverse college students of color and community members that microaggressions were associated with overall poorer mental health outcomes. Overall, the burgeoning research on racial microaggressions has established a strong link between racial microaggressions and mental health outcomes and that the subtle nature of racial microaggressions makes them potentially as or more psychologically harmful than overt forms of racial discrimination to Black individuals (Liao et al., 2016; Nadal et al., 2014; Sue et al., 2008).The increased harm, relative to overt discrimination, may be related to their greater frequency and to the fact that microaggressions are often perpetrated by friends and co-workers, rather than by strangers or more distant acquaintances (Sue et al., 2007; Sue et al., 2008).

There is limited research examining the role of racial microaggressions in alcohol consumption and problems among Black EAs. Blume et al. (2012) conducted a study with 153 EA (including only 37 Black participants) at a predominantly White university and found that these students’ experience of past-month racial microaggressions was significantly positively associated with recent binge drinking and alcohol problems. Most recently, Su and colleagues (2020) examined the association of racial microaggressions and overt discrimination with alcohol consumption and problems in 383 Black EA and found a positive relationship between the both types of discrimination with alcohol consumption and problems. Both studies only assessed the frequency of racial microaggressions experienced and did not account for distress related to these experiences. Additional research is needed to replicate these findings and to further delineate identity factors that may influence the relationship between racial microaggressions and alcohol consumption and problems among Black EAs.

The Present Study

In the present study, we examined the relationship between ACEs and alcohol consumption and problems in a sample of Black and White EAs. Second, we investigated the association of racial microaggressions with alcohol consumption and alcohol problems in the Black EAs in our sample. Based on social stress and self-medication theories, it is anticipated that both classes of stressors would be positively associated with alcohol consumption and alcohol problems. We also examined key identity factors, namely sex assigned at birth (henceforth referred to as sex), income, race, and college status as moderators of the association of: (a) ACEs with alcohol consumption and alcohol problems in White and Black EAs and (b) racial microaggressions with alcohol consumption and alcohol problems in Black EAs. Consistent with social stress and self-medication theory, we hypothesized that:

  1. ACEs will be positively associated with alcohol consumption and alcohol problems for EAs.

  2. Racial microaggressions will be positively associated with alcohol consumption and alcohol problems for Black EAs.

  3. Sex, race, income, and college status will be significant moderators of the relationship of ACEs with alcohol consumption and alcohol problems, with more marginalized identities (female sex, Black race, lower income, and non-college status) increasing the strength of the association between ACEs and alcohol use and problems.

  4. Among Black EAs, biological sex, income, and college status will be significant moderators of the relationship of racial microaggressions with alcohol use and alcohol problems, with more marginalized identities increasing the strength of the association between racial microaggressions and alcohol use and problems.

Method

Participants

Participants were EAs (N = 602; 57.3% women; 64.6% seeking or having already obtained a 4-year degree) between the ages of 21.5 and 24.99 who reported drinking ≥3/4 drinks (for women and men, respectively), on at least two occasions in the past month. Participants were, on average, 22.63 (SD = 1.03) years of age. Participants in the sample identified as White (47%), Black (41.5%), Asian (3.8), Multiracial (5%), or Other (2.7%). Of the participants, 5.6% identified as Hispanic. The median pre-tax household yearly income was between $30,000 and $45,000 per year, with 68.1 percent reporting that their pre-tax household income was below $60,000. Since the Asian, Multiracial, and Other racial groups were so small, we only included the Black and White (N=533) participants in our ACEs analyses.

Procedure

The study took place in a city in the Southern United States. Participants were recruited through social media advertisements, flyers posted throughout the city, email screeners to students at the University and through in-person recruitment at various events (e.g., concerts, sporting events) with the goal of recruiting a diverse sample with respect to race/ethnicity, sex, and college status. Study personnel screened interested participants to ensure eligibility. Participants were deemed eligible if they were between the ages of 21.5 and 24.99 and reported drinking at least 3 or 4 alcoholic drinks for women or men, respectively, on at least two occasions in the past month. Individuals were ineligible if they were currently in alcohol or drug use treatment, reported a psychotic disorder, or were not fluent in English. Eligible participants attended a two-hour session in a university research lab, where they completed various measures on demographics, alcohol and drug use, and psychosocial risk factors (e.g., ACEs, racial microaggressions) related to alcohol and drug use. The racial microaggressions scale was given to only participants who identified as non-White. Further, since it was added to the study later, not all Black participants in our sample completed the measure. More specifically, of the 245 Black EAs in the study, 80% completed the racial microaggressions measure (N=196). After completing the session, participants were compensated $40 cash. All procedures were approved by the University of Memphis Institutional Review Board (project #4320).

Measures

Alcohol consumption and problems.

Typical drinks per week was measured with the Daily Drinking Questionnaire (DDQ; Collins et al., 1985), which asks participants their typical alcohol consumption on each day of a typical week in the past month. Values are summed to create a total score. Alcohol problems was measured with the Young Adult Alcohol Consequences Questionnaire (YAACQ; Read, Kahler, Strong, & Colder, 2006), a measure asking participants to report whether or not they had experienced 48 (range = 0 - 48) different consequences in the past month. Internal consistency for the YAACQ was α = .93.

Adverse childhood experiences.

The Adverse Childhood Experiences (ACEs) Questionnaire (Felitti et al., 1998) was used to assess the presence or absence of 10 adverse childhood experiences during participants first 17 years of life. Participants are asked to indicate whether or not they have had a specific adverse childhood experience (range = 0 – 10). Adversities include experiencing physical abuse, neglect, or sexual abuse and witnessing violence directed toward one’s caregiver. The items are summed to create a total ACEs score (α =.74).

Racial microaggressions.

Racial microaggressions in Black EAs were assessed using the Inventory of Microaggressions Against Black Individuals (IMABI; Mercer et al., 2011). On this 14-item scale (range = 0 –56), respondents indicate whether or not they have experienced specific racial microaggressions and the distress caused by the experience on a scale ranging from 0 (this has never happened to me) to 4 (this event happened, and I was extremely upset). The scale has demonstrated strong internal consistency (Mercer et al., 2011). Sample items include, “I was made to feel as if the cultural values of another race/ethnic group were better than my own” and “When successful, I felt like people were surprised that someone of my racial/ethnic background could succeed.” The scale has been validated in Black EA samples (Mercer et al., 2011). The Cronbach’s alpha in the present study was .95.

Demographic questions.

Participants were asked a series of demographic questions, which included information on age, sex (0 = Male, 1 = Female), income (1 = Less than $15,000; 2 = $15,000 - $30,000; 3 = $30,000 - $45,000; 4 = $45,000 - $60,000; 5 = $60,000 – $75,000; 6 = $75,000 - $90,000; 7 = $90,000 - $105,000; 8 = $105,000 – $120,000; 9 = Greater than $120,000), race (0 = White/European Ancestry, 1 = Black/African Ancestry), and college status (0 = EA who is not a 4-year college student or graduate, 1 = current 4-year college student or graduate).

Data Analysis

Outliers were identified as any value greater than 4 standard deviations from the mean and were adjusted to be one unit above the highest non-outlying value. Typical drinks per week was slightly kurtotic (4.04), and square root transformation brought the value into acceptable limits (Trochim & Donnelly, 2006). All other variables were normally distributed. First, we examined descriptive statistics and correlations between all study variables. Second, we examined the association between ACEs and both typical drinks per week and alcohol problems using hierarchical regressions, with sex, income, race, and college status included as covariates. We also examined the association between racial microaggressions and both typical drinks per week and alcohol problems using hierarchical regressions, with sex, income, and college status included as covariates. Due to the small sample of other non-White participants and the previous validation of the IMABI with only Black individuals (Mercer et al., 2011), only Black participants were included in the racial microaggression analyses. Third, we examined interactions between the primary study variables (microaggressions and ACEs) and our covariates (sex, income, race, and college status) in predicting typical drinks per week and alcohol problems. Given that only Black participants are included in the microaggression analyses, we only examined interactions between microaggressions, and sex, income, and college status. In total, 7 interaction models were examined. For each model, covariates were included in the first step, the mean centered independent effects of each variable in the interaction terms were included in the second step, and the interaction term was included in the third step. For any significant interactions, we further probe the effect by examining the effects of the primary study variables at different levels of the moderator (Aiken & West, 1991). For all analyses modeling alcohol problems as the dependent variable, we also included typical drinks per week as a covariate. All analyses were performed in SPSS v25.

Results

Descriptive Statistics and Correlations

Participants drank, on average, 17.05 (SD = 13.66) drinks per week and experienced 11.91 (SD = 9.31) alcohol problems in the past month. Means, standard deviations, and t-values resulting from independent sample t-tests are reported in Table 2. As reported in a previous study (Acuff et al., 2020), White and Black EAs consumed similar amounts of alcohol per week. However, White EAs reported a greater average number of alcohol problems than Black EAs. Non-college EAs reported consuming more drinks per week on average compared to college-attending or completing EAs, but these groups reported similar numbers of alcohol problems.

Table 2.

Differences in dependent variables based on race, college status, sex, and income.

White/European
Ancestry (n = 283)
M (SD)		 Black/African
Ancestry (n = 250)
M (SD)		 t-value (df), p-value
ACEs 1.96 (2.14) 2.35 (2.18) −2.05 (522), .04
Typical Drinks per Week 17.38 (13.95) 17.06 (13.31) .27 (530), .78
Alcohol Problems 12.74 (9.66) 10.96 (9.27) 2.16 (531), .03
Non-college (n =
219)
M (SD)		 College (n = 383)
M (SD)
ACEs 2.52 (2.31) 1.90 (1.99) 3.29 (388.39), .001
Microaggressions 14.06 (14.76) 23.88 (16.42) −4.40 (194), < .001
Typical Drinks per Week 20.33 (15.74) 15.19 (11.95) 4.19 (360.64), < .001
Alcohol Problems 12.45 (10.31) 11.60 (8.68) 1.03 (393.72), .30
Male (n = 250)
M (SD)		 Female (n = 342)
M (SD)
ACEs 1.82 (2.03) 2.35 (2.18) −2.98 (590), .003
Microaggressions 17.75 (15.90) 18.79 (16.44) −.41 (194), .68
Typical Drinks per Week 20.22 (15.06) 14.69 (12.01) 4.84 (476.61), < .001
Alcohol Problems 12.63 (9.68) 11.37 (8.99) 1.64 (600), .10
Less than $45,000 (n
= 323)
M (SD)		 Greater than $45,000
(n = 269)
M (SD)
ACEs 2.53 (2.26) 1.64 (1.87) 5.27 (589.98), < .001
Microaggressions 16.86 (15.85) 22.03 (16.66) −2.08 (194), .04
Typical Drinks per Week 18.06 (14.16) 15.84 (12.96) 1.99 (599), .047
Alcohol Problems 12.43 (9.69) 11.28 (8.79) 1.51 (600), .13
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Note. Analyses including microaggressions contained only a subsample of Black participants that completed the microaggressions measure (n = 196). M = Means; SD = Standard Deviation; df = degrees of freedom; ACE = Adverse Childhood Events.

Participants endorsed an average of 2.12 (SD = 2.13) ACEs. Of the participants, 150 (24.9%) reported four or more ACEs. A chi-square test suggests that more Black participants reported 4+ ACEs than White participants (Chi-square = 4.97, p = .026). 21% of White participants reported 4+ ACEs, while 29% of Black participants reported 4+ ACEs. The three most commonly reported ACEs were: “Were your parents ever separated or divorced?” (45.6%), “Did a parent or other adult in the household often or very often swear at you, insult you, put you down or humiliate you?” (34.1%), and “Did you often or very often feel that no one in your family loved you or thought that you were important or special? OR that your family didn’t look out for each other, feel close to each other, or support each other?” (28.9%). Black participants scored on average of 18.47 (SD = 16.24) on the IMABI. Of the participants, 75.5% reported experiencing microaggressions. The three most commonly reported microaggressions were: “Someone made a statement to me that they are not racist or prejudiced because they have friends from different racial/ethnic backgrounds” (62.4%), “Someone told me that they are not racist or prejudice even though their behavior suggests that they might be” (60.5%), and “Someone told me that I am not like other people of my racial/ethnic background” (60.4%). Correlations among study variables are reported in Table 1. Correlation analyses mostly revealed associations in the expected directions. Racial microaggressions were significantly positively correlated with ACEs and alcohol problems, but not alcohol consumption. ACEs was significantly positively correlated with both alcohol consumption and alcohol problems. College students or graduates were more likely to report microaggressions, but less likely to report ACEs and alcohol consumption. Black participants were more likely to experiences ACEs and reported less drinking. Women reported more ACEs, and less drinking compared to men. Finally, income was significantly negatively corrected with ACEs, alcohol consumption, and alcohol problems.

Table 1.

Correlations among Study Variables

1 2 3 4 5 6 7
1. College status -
2. Race −.32*** -
3. Sex −.03 .25*** -
4. Income .23*** −.33*** −.11** -
5. Microaggressions .30*** - .03 .18* -
6. ACEs −.14** .09* .12** −.24*** .36*** -
7. Typical drinks per week −.17*** −.01 −.20*** −.12** .01 .13** -
8. Alcohol Problems −.04 −.09* −.07 −.09* .20** .22*** .50***
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Note. The race variable represents a dichotomous variable of Black participants/White participants, College status coded 0 = Noncollege, 1 = College); Race coded 0 = White participants, 1 = Black participants; Sex coded 0 = male, 1 = female. Only a subsample of Black participants completed the microaggression measure, and thus correlations between microaggressions and all other variables are for this subsample of Black participants only.

Hypotheses 1 and 2: Relations among ACEs, Racial Microaggressions, Alcohol Consumption and Problems

Hierarchical regressions are reported in Table 3. After controlling for sex, college status, income, and race, reporting a higher number of ACEs was significantly associated with higher alcohol consumption (ΔR2 = .01, p = .007) and alcohol problems (ΔR2 = .02, p < .001). All analyses including the racial microaggressions variable used only Black participants. After controlling for sex, college status, and income, reporting greater levels of racial microaggressions was significantly associated with alcohol problems (ΔR2 = .04, p = .002), but not consumption (ΔR2 = .01, p = .11).

Table 3.

Hierarchical Regressions Predicting Typical Drinks per Week and Alcohol Problems

Typical Drinks per Week Alcohol Problems
Variable Beta (S.E.) C.I.
Lower,
Upper		 β T P ΔR2 Beta (S.E.) 95% C.I.
Lower,
Upper		 β t p ΔR2
Step 1
Sex −.73 (.13) −.98, −.47 −.24 5.65 < .001 .10 1.70 (.76) .21, 3.19 .09 2.25 .03 .29
College Status −.48 (.14) −.75, −.21 −.16 −3.53 < .001 .32 (.79) −1.23, 1.87 .02 .41 .69
Income −.08 (.03) −.13, −.03 −.14 −3.04 .002 −.28 (.15) −.57, .02 −.07 −1.85 .07
Race −.09 (.14) −.37, .18 −.03 −.66 .51 −2.38 (.80) −3.94, −.82 −.13 −3.00 .003
Typical Drinks per Week - - - - - 3.41 (.25) 2.92, 3.90 .53 13.59 < .001
Step 2 (separate)
Microaggressions† .01 (.007) −.002, .02 .12 1.60 .11 .01 .13 (.04) .05, .21 .22 3.16 .002 .04
ACEs .08 (.03) .02, .14 .12 2.70 .007 .01 .63 (.17) .30, .96 .14 3.73 < .001 .02
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Note. College status is coded 0 = noncollege, 1 = college; Race is coded 0 = White participants, 1 = Black participants; Sex is coded 0 = male, 1 = female. S.E. = Standard Error; C.I. = Confidence Interval.

†

The step 2 microaggression results only included black participants. All other results report for the full sample.

Hypothesis 3 and 4: Moderating Role of Sex, Income, Race, and College Status

The college status x ACEs interaction predicting typical drinks per week was significant (ΔR2 = .01, p = .05). Probing the interaction further suggested that the association between ACEs and typical drinks per week was significant for college students (ΔR2 = .04, p < .001), but not for non-college participants (ΔR2 = .00, p = .91). The sex x ACEs interaction predicting typical drinks per week was also significant (ΔR2 = .02, p = .001). Probing the interaction suggested that the association between ACEs and typical drinks per week was significant for women (ΔR2 = .07, p < .001), but not men (ΔR2 = .003, p = .43). No other interactions were significant.

Discussion

The study replicates previous research by indicating that ACEs are associated with alcohol use and problems among Black and White EAs (e.g., Crouch et al, 2018; Lee & Chen, 2017). Although these direct effects were small, they were significant in multivariate models that controlled for a variety of identity factors and were present despite the restricted range of drinking in the sample (all participants reported recent heavy drinking). Consistent with past research (e.g., Forster et al., 2019; Slack et al., 2016), we found that Black EAs reported a greater number of ACEs than White EAs. This finding may be due in part to the reality that more Black children live in poverty compared to White children in the United States (National Center for Education Statistics; NCES, 2019), and when a child lives in poverty, they are more likely to have negative childhood experiences. Black children also experience various forms of adversity and disparities that may increase risk for ACEs, including racial discrimination, community violence, and lack of access to quality schools, healthcare and community resources.

Our second hypothesis was partially supported by regression analyses that revealed a significant small magnitude positive association between racial microaggressions and alcohol problems, but not with alcohol consumption. Previous research has found a positive relationship for racial microaggressions with both alcohol consumption and alcohol problems (Blume et al., 2012; Su et al., 2020). The finding that racial microaggressions were not significantly associated with alcohol consumption may be accounted for the difference in our measurement of racial microaggressions. We assessed distress related to experiencing specific racial microaggressions rather than the frequency of experiencing different racial microaggressions. Additionally, as noted above, all participants were heavy drinkers so there was a restricted range in drinking behaviors and given that most drinking among EAs occurs in a social context, overall drinking level may be less closely tied with negative emotional experiences than drinking problems (Dennhardt et al., 2011). The finding that racial microaggressions were significantly associated with alcohol problems may be accounted for by the stress-dampening effects of alcohol consumption that may negatively reinforce drinking to cope with distress, which is uniquely associated with alcohol problems (Armeli et al., 2003; Desalu et al. , 2019). Future research should also investigate the possibility that coping strategies may mediate or moderate the relation between racial microaggressions and alcohol problems for Black EAs. This study extends previous research in these domains by examining identity factors (i.e., sex, income, race, and college status) as moderators of these associations.

Racial microaggressions were significantly positively correlated with ACEs. This finding is not surprising since Black EA experience racial discrimination as a race-related stressor (APA Working Group on Stress and Health Disparities, 2017). It seems likely that racial microaggressions are in fact an ACE that Black children/teens experience and continue to experience into emerging adulthood and beyond. Future research examining ACEs in Black and White EA populations should also include a measure of overt racial discrimination and racial microaggressions to increase understanding of these ACEs in relation to alcohol outcomes. Perhaps, there are protective factors that many Black EAs possess that inhibit alcohol consumption. For example, studies with Black EAs has shown that religion and spirituality (Ransome & Gillam, 2016; Turner-Musa et al., 2007), ethnic identity (Pugh & Bry, 2007), perceived social and family support (Black & Sartor, 2020; Turner-Musa et al., 2007), and perceived close friends’ substance use (Stevens-Watkins & Rostosky, 2010) are all protective against excessive alcohol use. In the same vein then it would not be surprising that race is negatively correlated with alcohol consumption. For those EAs who do consume alcohol, racial microaggressions may place them at an increased risk for alcohol problems as research has shown the link between racial microaggressions and negative mental health (Nadal, 2018; Nadal, 2011; Sue et al., 2008) and alcohol outcomes (Blume et al., 2012; Su et al., 2020). ACEs was significantly positively correlated with both alcohol consumption and alcohol problems as expected and shown in previous research (Crouch et al., 2018; Dube et al., 2002). In addition, supporting past research, race was significantly positively correlated with ACEs (Slack et al., 2016). College status was significantly negatively correlated with racial microaggressions, and significantly positively associated with ACEs and alcohol consumption. Also as expected, sex was significantly positively associated with ACEs and significantly negatively correlated with alcohol consumption. Finally, given the increased health risk that poverty poses for children and adults, as expected income was significantly negatively correlated with ACEs, alcohol consumption, and alcohol problems (Braveman et al., 2010).

Our third hypothesis was also partially supported. Regression analyses revealed that sex moderated the relation of ACEs with consumption such that the positive relationship between ACEs and consumption was only minimally stronger for women. Past research has shown that men may be more likely to binge drink than women when they have experienced ACEs (Loudermilk et al., 2018), which contradicts our findings. Perhaps, societal norms make it more acceptable from men to drink than women, hence women may choose more societally accepted forms of coping (e.g., binge eating; Heron et al., 2014). With still a small, but more substantial effect size college status moderated the relation of ACEs with alcohol consumption such that the relationship between ACEs and consumption was stronger for college students. Based on past research that college students tend to consume more alcohol than their same-aged peers, this finding is not too surprising. College is a time when many EA consume alcohol for social engagement (Arnett, 2007) or to cope with life stressors (O'Hara et al., 2014).

Finally, our fourth hypothesis was not supported. None of the identity factors that we examined significantly moderated the association of racial microaggressions with alcohol consumption or alcohol problems. Racial microaggressions were not related to alcohol consumption, but they were related to the negative consequences associated with drinking behavior in the lives of Black EAs. Neither sex, income, nor college status changed these associations. This finding aligns well with past research demonstrating that racial discrimination is important for all Black individuals (Paradies et al., 2015), however somewhat contradicts theory, which posits that additional marginalized identities (e.g., income, sex, etc.) might predispose one to increased stress and perhaps increase alcohol consumption and problems. In other words, theory would suggest that these relationships would be weakened or strengthened in certain groups of EAs with intersecting marginalized identities, but we did not find this to be true in our sample. Thus, male sex, and higher education and income may not buffer against the impact of microaggressions on alcohol problems among Black EAs.

Our findings have implications for the prevention and treatment of alcohol misuse in Black and White EAs. Alcohol prevention should begin early (before emerging adulthood) and it should focus on examining stressors in the lives of children and teaching them to implement positive coping strategies that will assist them as they transition to emerging adulthood where they will face additional transitional stressors. Racial discrimination in both its overt and subtle forms (i.e., racial microaggressions) should be discussed with children and EA so they are able to articulate how these experiences are experienced differently and that these experiences have negative effects, including racial trauma and its associated negative outcomes (Liu et al., 2019; Nadal et al., 2019). Furthermore, training on what racial microaggressions are and the ways in which to combat them at the individual, institutional, and societal levels (Sue et al., 2019) should be implemented in schools and in the workplace to reduce the prevalence of racial microaggressions. Overall, it seems like a key to addressing these issues is addressing ACEs (including racial microaggressions for Black EAs) across the lifespan. Substance use prevention programs should focus on teens and EAs who have reported or are at high risk for ACEs and microaggressions.

Limitations and Future Directions

This study has several limitations. First, cross-sectional studies have been critiqued for their inability to determine causality, so although current research on overt and subtle racial discrimination and alcohol problems has alluded to the negative effects of racial discrimination on alcohol problems, causality cannot be inferred. Future research should incorporate longitudinal designs to determine the casual relationship of racial microaggressions with alcohol problems. Second, in this study we examined ACEs as a total score, instead of examining different ACEs and their relationships with alcohol consumption and alcohol problems. For our investigation, we elected to do so because of our interest in understanding the role of specific moderators in these relationships. However, like some past research has done, future research could examine specific types of ACEs and how these relate to alcohol consumption and alcohol problems. Third, we chose to examine how identity variables may influence the relationship of racial microaggressions with alcohol consumption and alcohol problems, but we did not examine potential cultural moderators that may weaken or strengthen the relationships that exist among these variables. Given that racial microaggressions significantly predicted alcohol problems in Black EAs in this study, but none of the identity factors examined moderated this relationship, future research should examine additional moderators of this relationship. For example, future research could examine how potential strengths (e.g., ethnic and racial identity, critical consciousness, coping strategies, etc.) may buffer the effects of racial microaggressions for Black individuals. Finally, only Black EAs completed the racial microaggressions scale. Future research may want to ask all participants to complete a measure of racial microaggressions to determine differences that exist among racial groups.

Conclusion

This study documents the role of ACEs in alcohol consumption and alcohol problems for EAs. It also illuminates some significant moderators (i.e., sex and college status) of the relationship between ACEs and alcohol consumption for EAs. More specifically, the relationship between ACEs and alcohol consumption was stronger for women than for men, and the relationships between ACEs and alcohol consumption was stronger for college students than for non-college students. The study also reinforced the importance of racial microaggressions for Black EAs demonstrating a positive relationship between racial microaggressions and alcohol problems. We suggest that racial microaggressions may be an important ACE that should be studied in conjunction with other ACEs in future addiction research.

Figure 1.

Figure 1.

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Graphs showing the interaction effects for ACEs x sex and ACEs x college status

Public Health Significance.

This study indicates that adverse childhood experiences (ACEs) are associated with alcohol consumption and problems in emerging adults (EAs), and that sex and college status moderated the relationships of ACEs with alcohol consumptions. Furthermore, racial microaggressions are a risk factor for alcohol problems among Black EAs who consume alcohol.

Acknowledgments

This work was supported by research grants from the National Institutes of Health (R01 AA020829, JGM & JM; 1F31AA027140-01A1, SFA). The funding source had no role other than financial support. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health.

Footnotes

Data from this manuscript was presented as an abstract in the 2020 Research Society of Alcoholism (RSA) Virtual Poster Session, and the abstract will also be printed in the abstract supplement of Alcoholism: Clinical and Experimental Research. Some data from the larger study has been published and presented at conferences:

Acuff, S. F., MacKillop, J., Murphy, J. G. (2020). Integrating behavioral economic and social network influences in understanding alcohol misuse in a diverse sample of emerging adults. Alcoholism: Clinical & Experimental Research. https://doi.org/10.1111/acer.14351

Hwangbo Y., Pace R., Wallace W., MacKillop J. & Murphy J. (2020, April). Attributions for Change Among Young Adult Binge Drinkers (ISSN:2184-3414), Poster presented at Portugal International Psychological Applications Conference and Trends, Madeira, Portugal.

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