Associations of Loneliness and Childhood Adversity With ASSIST-Measured Substance Use Risk in a University Student Sample.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with substance use risk, yet few studies have examined substance-specific risk using the WHO Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in university populations. METHODS: Data were drawn from a cross-sectional survey of 2,393 students at a public university in Southern California conducted in Spring 2024. Multivariable logistic regressions assessed associations between ACEs and moderate- to high-risk use of alcohol, cannabis, and tobacco and whether loneliness moderated these associations. RESULTS: ACE exposure was significantly associated with increased substance use risk. Each additional ACE reported was associated with 1.15 times the odds of moderate/high-risk alcohol use (aOR = 1.15, 95% CI = 1.04-1.27), 1.16 times the odds of moderate/high-risk cannabis use (aOR = 1.16, 95% CI = 1.07-1.25), and 1.15 times the odds of moderate/high-risk tobacco use (aOR = 1.15, 95% CI = 1.04-1.26). Loneliness did not moderate the associations between ACEs and substance use risk (all p > 0.05). CONCLUSIONS: Greater cumulative ACE exposure was strongly associated with elevated alcohol, cannabis, and tobacco use risk among university students, supporting the relevance of trauma-informed behavioral health approaches within campus health systems and highlighting the need for targeted prevention and intervention efforts.