Peer-reviewed article
Childhood Family Violence and Tobacco, E-Cigarette, and Alcohol Use Among Adolescents: A Large School-Based Study in China.
Zhen Z, Liu Y, Gao Y, An J, Zare H ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This large school-based study of over 41,000 Chinese adolescents examined the association between childhood family violence and substance use. The researchers found that one in four adolescents reported experiencing family violence, with verbal insults and emotional neglect being most common. Adolescents exposed to family violence had significantly higher rates of tobacco, e-cigarette, and alcohol use, with the risk increasing with cumulative exposure to multiple types of violence.
Key points
- 25.1% of adolescents reported experiencing at least one type of childhood family violence
- Verbal insults (18.6%) and emotional neglect (16.3%) were the most frequently reported types of family violence
- Adolescents with three or more types of family violence exposure had nearly 4 times higher odds of tobacco use (OR=3.81), e-cigarette use (OR=3.90), and alcohol use (OR=3.95) compared to those with no exposure
- Verbal insults and emotional neglect were consistently associated with all three substance use outcomes (adjusted ORs=1.4-1.5)
- Peer smoking and access to tobacco products were also significantly associated with adolescent substance use
Limitations
This is a cross-sectional study, so it cannot establish causation or temporal relationships between family violence and substance use. The study was conducted in one mountainous city in western Guangdong Province, which may limit generalizability to other regions of China or other countries.
Abstract
Background: Adolescent tobacco, e-cigarette, and alcohol use are important public health concerns in China. However, the associations of specific types and cumulative exposure to childhood family violence with different substance use outcomes remain insufficiently understood. This study examined these associations among Chinese adolescents. Methods: We analyzed data from a cross-sectional school-based survey of 41,146 students aged 10-19 years conducted from October 2022 to March 2023 in a mountainous city in western Guangdong Province, China. Childhood family violence was assessed using the validated Chinese Family Violence Questionnaire and a cumulative exposure index. Descriptive analyses and logistic regression models were conducted, with adjustment for demographic and environmental factors. Results: The mean age of participants was 14.8 years, and 51.7% were female. Overall, 25.1% of adolescents reported at least one type of childhood family violence. Verbal insults (18.6%) and emotional neglect (16.3%) were the most frequently reported types and were consistently associated with tobacco, e-cigarette, and alcohol use (adjusted odds ratios [ORs] = 1.4-1.5, p < 0.001). A cumulative exposure pattern was also observed. Compared with adolescents reporting no childhood family violence, those exposed to three or more types had higher odds of tobacco use (OR = 3.81; 95% CI: 3.42-4.23), e-cigarette use (OR = 3.90; 95% CI: 3.39-4.48), and alcohol use (OR = 3.95; 95% CI: 3.59-4.35). Peer smoking and access to tobacco products were also significantly associated with substance use. Conclusions: Childhood family violence, particularly verbal insults and emotional neglect, was associated with adolescent tobacco, e-cigarette, and alcohol use. The findings highlight the importance of considering emotional maltreatment, cumulative adversity, peer influences, and access to tobacco products in future prevention research and practice.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
Problem
Adolescent tobacco, e-cigarette, and alcohol use among children exposed to childhood family violence
- Intervention
- No intervention was tested; this is an observational study examining associations between childhood family violence exposure and substance use outcomes
- Population
- 41,146 school-based students aged 10-19 years in a mountainous city in western Guangdong Province, China (mean age 14.8 years, 51.7% female)
Key finding
25.1% of adolescents reported at least one type of childhood family violence
Z et al. · Europe PMC · 23 Jun 2026