Racial/ethnic and sexual orientation disparities in adverse childhood experiences, marijuana use and subjective cognitive decline: A mediational approach

Abstract Background Adverse childhood experiences (ACEs) have been shown to be positively associated with substance use and abuse, and have also been linked to subjective cognitive decline (SCD). However, studies examining potential pathways between ACEs and SCD are lacking. In addition, this relationship and related pathways may differ by race/ethnicity and sexual orientation. The aim of this study was to determine the mediational role of marijuana use in the association between ACEs and SCD. The secondary aim was to determine the potential disparities by race/ethnicity and sexual orientation. Method Data were obtained from the 2019 Behavioral Risk Factor Surveillance System (N = 14,248). Path analysis was used to determine the mediating role of marijuana use between ACEs and SCD. Overall analyses adjusted for gender, age, income, education, employment and race/ethnicity. Stratified path analyses by race/ethnicity and sexual orientation were also conducted. Result Overall, there was a direct association between ACEs and marijuana use (B = 0.102, p = <0.001), marijuana use and cognitive decline (B = 0.119, p<0.001); and between ACEs and cognitive decline (B = 0.047, p<0.001). There was an indirect association where marijuana use mediated the association between ACEs and SCD (B = 0.005, p<0.001). Stratified analyses by race/ethnicity found that marijuana use mediated the association between ACEs and SCD among White (B = 0.003, p<0.001), but not Black, Other or Hispanic respondents. Stratified analyses by sexual orientation found that marijuana use mediated the association between ACEs and SCD among heterosexual (B = 0.002, p = 0.006) but not LGBT respondents. Conclusion Disparities by race and sexual orientation existed in the mediating pathway of ACEs and SCD. Intervention programs addressing early trauma and cognitive function should consider these disparities. Future research should examine additional pathways between ACEs and SCD, especially for racial/ethnic and sexual minority populations.