Pathways from Childhood Adversity to Prescription Drug Misuse Among Young Adult African Immigrants.

PURPOSE: African immigrants remain underrepresented in research on adverse childhood experiences (ACEs) and substance misuse. This study examined the relationship between ACEs and non-medical prescription drug use (NMPDU) among young adult African immigrants in the United States and explored whether mental health distress, perceived discrimination, and self-esteem mediated this relationship. MATERIALS AND METHODS: Data were drawn from a cross-sectional survey of 599 African immigrants in the United States; analyses focused on a subsample of 297 young adults ages 18-25. Ordinary least squares regression analyses examined the association between ACEs and NMPDU while controlling for age, sex, race, education, income, and immigrant generation. Separate mediation analyses were conducted using PROCESS Macro for SPSS. RESULTS: Approximately 76% of participants reported at least one ACE, and 55% reported NMPDU within the past year. ACEs were significantly associated with greater NMPDU (β = .22, p < .01) after adjusting for covariates. Mediation analyses revealed significant indirect effects through mental health distress, self-esteem, and perceived discrimination, with all indirect effects remaining significant after controlling for covariates. DISCUSSION AND CONCLUSION: Findings suggest that childhood adversity may increase vulnerability to NMPDU through multiple psychosocial pathways, including psychological distress, diminished self-esteem, and experiences of discrimination. Results highlight the importance of culturally responsive, trauma-informed interventions that address these psychosocial risk factors to reduce substance misuse and promote behavioral health among young adult African immigrants.