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Does adult alcohol consumption combine with adverse childhood experiences to increase involvement in violence in men and women? A cross-sectional study in England and Wales
  1. Mark A Bellis1,2,
  2. Karen Hughes1,2,
  3. Kat Ford1,
  4. Sara Edwards3,
  5. Olivia Sharples4,
  6. Katie Hardcastle2,
  7. Sara Wood2
  1. 1 College of Health and Behavioural Sciences, Bangor University, Bangor, UK
  2. 2 Policy, Research and International Development Directorate, Public Health Wales, Cardiff, UK
  3. 3 School of Medicine, Trinity College Dublin, Dublin, Republic of Ireland
  4. 4 Exeter Medical School, University of Exeter, Exeter, UK
  1. Correspondence to Professor Mark A Bellis; m.a.bellis{at}


Objectives To examine if, and to what extent, a history of adverse childhood experiences (ACEs) combines with adult alcohol consumption to predict recent violence perpetration and victimisation.

Design Representative face-to-face survey (n=12 669) delivered using computer-assisted personal interviewing and self-interviewing.

Setting Domiciles of individuals living in England and Wales.

Participants Individuals aged 18–69 years resident within randomly selected locations. 12 669 surveys were completed with participants within our defined age range.

Main outcome measures Alcohol consumption was measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and childhood adversity using the short ACEs tool. Violence was measured using questions on perpetration and victimisation in the last 12 months.

Results Compliance was 55.7%. There were strong positive relationships between numbers of ACEs and recent violence perpetration and victimisation in both sexes. Recent violence was also strongly related to positive AUDIT-C (≥5) scores. In males, heavier drinking and ≥4ACEs had a strong multiplicative relationship with adjusted prevalence of recent violent perpetration rising from 1.3% (95% CIs 0.9% to 1.9%; 0 ACEs, negative AUDIT-C) to 3.6% (95% CIs 2.7% to 4.9%; 0 ACEs, positive AUDIT-C) and 8.5% (95% CI 5.6% to 12.7%; ≥4ACEs, negative AUDIT-C) to 28.3% (95% CI 22.5% to 34.8%; ≥4ACEs, positive AUDIT-C). In both sexes, violence perpetration and victimisation reduced with age independently of ACE count and AUDIT-C status. The combination of young age (18–29 years), ≥4ACEs and positive AUDIT-C resulted in the highest adjusted prevalence for both perpetration and victimisation in males (61.9%, 64.9%) and females (24.1%, 27.2%).

Conclusions Those suffering multiple adverse experiences in childhood are also more likely to be heavier alcohol users. Especially for males, this combination results in substantially increased risks of violence. Addressing ACEs and heavy drinking together is rarely a feature of public health policy, but a combined approach may help reduce the vast costs associated with both.

  • alcohol
  • violence
  • adverse childhood experiences
  • child maltreatment

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  • Contributors MAB and KHu designed and directed the studies. MAB undertook the analyses and wrote the first draft of this manuscript. KHu and KF coordinated study implementation, contributed to data management and edited the manuscript. KHa contributed to data management and manuscript editing. SE, OS and SW contributed to literature review, data quality assurance and manuscript editing.

  • Funding The studies were funded by Public Health Wales; Public Health England; Luton, Northamptonshire and Hertfordshire Councils; Higher Education Funding Council for England; and National Health Service Research and Development Funds.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval for all studies was obtained through Liverpool John Moores University Research Ethics Panel with additional approval provided by Public Health Wales for the Welsh survey.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets analysed in the current study are available from the corresponding author on reasonable request.

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