Pathways of effects of adverse childhood experiences on infectious diseases among border drug-use adults: A Structural Equation Modeling

Abstract

Background 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). Methods A cross-sectional study was conducted by respondent driving sampling and consecutive sampling among adult drug users in southwest of China in 2021. R software 4.2.1 was used to conduct descriptive, univariate, and SEM analysis. Results 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 was 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) had indirect effects on infectious disease. Conclusions ACEs could be a direct or indirect predictor for infectious disease in adulthood, injection of drug use could 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 chance of contracting infectious diseases.