# Impact pathways of adverse childhood experiences on infectious diseases among substance abusers in border regions: structural equation modeling

## TL;DR

The study explores how childhood trauma and drug injection use are linked to infectious diseases in adults, using data from a border region in China.

## Contribution

The paper identifies direct and indirect pathways linking adverse childhood experiences and drug injection to infectious diseases using structural equation modeling.

## Key findings

- Infectious disease is directly positively affected by drug injection use and directly negatively affected by adverse childhood experiences.
- Age, ethnicity, education, and ACEs have indirect effects on infectious disease.
- ACEs may act as a predictor for infectious disease, while drug injection increases risk.

## Abstract

Injection of drug abuse could result in infectious disease, and adverse childhood experiences (ACEs) possibly are associated with infectious disease. However, there is a paucity of literature on a direct or indirect relationship between ACEs, injection of drug use and infectious disease. We thus identified the pathway of influence of ACEs in adulthoods and injection of drug use on infectious disease by structural equation models (SEM).

A cross-sectional study was conducted by respondent driving sampling and consecutive sampling among people who use drugs in southwest of China in 2021. R software 4.2.1 was used to conduct descriptive, univariate, and SEM analysis.

There were 404 participants in total, with an average age of 34 and most males (98.3%) and minorities (79.6%). 95.5% of respondents experienced ACEs with 46.6% of reporting 4 or more ACEs. Correlations in SEM showed that infectious disease might be directly positively affected by injection of drug use (β = 0.184), and directly negatively affected by ACEs (β = −0.188). Age (β = 0.029), Ethnic (β = −0.021), Education (β = 0.019), Gender (β = 0.022), Sex partners (β = −0.017), and ACEs (β = −0.029) might have indirect effects on infectious disease.

ACEs might be a direct or indirect predictor for infectious disease in adulthood, injection of drug use might be a risk factor and moderate other factors of infection of infectious disease. Strategies for creating a positive home environment, minimizing traumatic or stressful childhood experiences, and increasing awareness of the risks associated with drug injection use are all ways to lower the chances of contracting infectious diseases.