The Influence of Adverse Childhood Experiences on Perpetration of Intimate Partner Violence Among Black Men: The Moderating Role of Alcohol Use

Abstract

This study examined the moderating role of alcohol use on the association between adverse childhood experiences (ACEs) and intimate partner violence (IPV) perpetration among Black men in the United States. We conducted bivariate and logistic regression analyses using data from Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Bivariate results revealed significant relationships between eight of the 10 ACE factors physical neglect; emotional, physical and sexual abuse; witnessing a mother being abused; and having a parent guardian with an alcohol and drug problem and who was incarcerated and IPV perpetration. Similarly, examination of the relationship between ACEs and alcohol use in adulthood also revealed significant associations, with the exception of exposure to emotional neglect, emotional and sexual abuse, and witnessing a mother being abused. Findings from the logistic regression models revealed that alcohol use significantly moderated the relationship between ACEs and IPV perpetration, but only for men exposed to 1, 2, and ≥4 adversities in childhood. However, alcohol use appeared to exacerbate the relationship between ACEs and IPV perpetration for men without childhood adversity. Implications for practice, policy, and areas for further research are discussed.

Keywords

adverse childhood experiences alcohol use intimate partner violence Black men

Introduction

Intimate partner violence (IPV), including stalking, physical, sexual, or psychological harm toward a current or former intimate partner (Breiding et al., 2014; Centers for Disease Control [CDC], 2018a), is a serious social and public health problem in the United States and globally (CDC, 2017; World Health Organization [WHO], 2013). In the United States, an estimated 19% of men perpetrate IPV (Walsh et al., 2020). IPV is associated with a massive economic cost of almost $3.6 trillion dollars, of which approximately $2.1 trillion was associated with medical costs (CDC, 2018b).

African Americans have consistently reported higher rates of past year and lifetime IPV perpetration in comparison to their White counterparts and other ethnic groups (Cunradi et al., 2013; Straus et al., 1980; West, 2012). Despite the high incidence of violence within Black/populations, studies focused on this group of men in particular are scarce (Lee et al., 2020). Most of the research that examines IPV perpetration has focused on non-Hispanic White males (Ports et al., 2017) and often utilizes treatment samples. Of the studies that have examined IPV perpetration by men, adverse childhood experiences (ACEs) and alcohol use are consistently reported as risk factors.

Adverse Childhood Experiences (ACEs)

Adverse childhood experiences are negative and traumatic events that occur before age 18. Within the US approximately 45% of children experience one or more ACEs (Sacks & Murphy, 2018), of which 17.6% of Black children are disproportionately exposed to one or more adversities in childhood (Bethell et al., 2017). ACEs generally include various forms of negative exposures that affect healthy development (Finkelhor, 2020). The most common ACEs are emotional and physical neglect (Anda et al., 2006); verbal, physical, and sexual abuse; and household dysfunction (i.e., substance abuse, mental illness, domestic violence, and incarceration; CDC, 2010; Felitti et al., 1998). Exposure to ACEs is not limited to a single traumatizing event but also includes ongoing and/or multiple types of violence throughout the life course (Finkelhor et al., 2007).

ACEs and IPV Perpetration

Exposure to adversities in childhood has been found to have a moderate to strong association with IPV perpetration in adulthood (Roberts et al., 2011). Studies that have focused on the perpetration of IPV by men have found a connection between their childhood maltreatment experiences and exposure to violence in childhood (Cui et al., 2010; Mbilinyi et al., 2012). Although not all men exposed to adversities in childhood perpetrate IPV in adulthood (Delsol & Margolin, 2004), studies have shown that, in general, as boys with experiences of childhood abuse or neglect age they are at increased risk for IPV perpetration against women when compared to those without such adversities (McKinney et al., 2009; Widom et al., 2014). Other studies have also found that adversities in childhood predict male-to-female partner violence (MFPV, e.g., McMahon et al., 2015; Valandra et al., 2019).

In a dose-response impact of ACEs on IPV perpetration, higher ACE scores are reflective of greater risk for perpetration by men (Cunradi et al., 2013). Anda et al. (2006) found that men who had a battered mother, or were physically or sexually abused were 200%, 120%, and 80% more likely to perpetrate IPV, respectively, when compared to men without such exposure. Similarly, in a study of Sri Lankan men, Fonseka et al. (2015) found that experiences of childhood abuse were significantly associated with IPV perpetration. Notably, men exposed to sexual abuse had the greatest increase in risk for IPV perpetration, while witnessing the abuse of one’s mother was more strongly associated with perpetration of physical violence.

The risk associated with IPV perpetration as a result of ACEs is further exacerbated when combined with stressors in adulthood (Roberts et al., 2010, 2011). Toxic stress and ACEs have been found to impact the allostatic load—the cumulative physiological wear and tear on the body due to overactivation of the physiologic stress response (McEwen, 2000; McEwen & Seeman, 1999)—which manifests in poor behavioral, biological, and physiological outcomes later in life. Furthermore, because exposure to childhood adversities negatively affects the developing brain of a child and often results in a reduction in tolerance for stressful events (Nurius et al., 2015; Shern et al., 2016), individuals with high levels of childhood adversity exposed to stressful events have an increased risk for perpetrating IPV (Roberts et al., 2011).

Alcohol Use and IPV Perpetration

Research suggests that alcohol use is positively associated with IPV perpetration (Averett & Wang, 2016; Graham et al., 2011; Mair et al., 2013), although few studies have found differing results (Feingold et al., 2008, 2015). The effect of alcohol use on male-to-female IPV has been found to be of moderate size (d = 0.32-0.47) in meta-analytic studies, which is almost as strong as attitudes related to traditional sex roles or violence approval (Crane et al., 2016; Foran & O’Leary, 2008).

IPV perpetration has been found to be more severe, across cultures, when one or both partners consumed alcohol (Graham et al., 2011). IPV is often viewed as a gendered issue that reflects the unequal power between men and women in heterosexual relationships (Reed et al., 2010). This relational inequality and inequity are further compounded by alcohol use, which has been found to play an important role in IPV perpetration by men in comparison to women (White & Chen, 2002). Notably, in cases where men consume alcohol, perceived snubs by their female partners may be interpreted as threats to their masculinity, resulting in an aggressive response to reassert their masculine identity (Graham et al., 2013). Furthermore, research has shown that when under the influence of alcohol, one’s ability to receive internal and external cues consistently and in extracting meaning from the cues contributes to the high rates of IPV perpetration when intoxicated (Eckhardt et al., 2015).

ACEs, Alcohol Use, and IPV Perpetration

Most research has examined alcohol use and IPV perpetration, ACEs and alcohol use in adulthood, and alcohol use in adulthood and IPV perpetration in isolation. Only a few studies that have examined the interrelationships of these variables. Brown et al. (2015) found that sexual abuse and parental violence had a direct positive effect on intimate partner aggression (IPA) and that substance abuse fully mediated the relationship between physical and psychological abuse and IPV among men, suggesting that ACES is associated with IPA via substance use. Conversely, Machisa et al. (2016) found a nonsignificant mediating effect of alcohol use (i.e., binge drinking) on child trauma and IPV perpetration. Moreover, few studies have examined these relationships using representative samples of Black men (Cunradi et al., 2013; Schafer et al., 2004). A systematic review by Lee et al. (2020) found mixed results regarding the role of race in the interrelationships of ACEs, alcohol use and IPV perpetration. However, among studies that included race as a predictor variable, findings showed that Black men had increased risk of ACEs, alcohol use and IPV perpetration when compared to other racial/ethnic groups. In this study, we seek to address the gap in knowledge regarding the interrelationships of ACEs, alcohol use, and IPV perpetration, and the moderating role of alcohol use in the ACEs-IPV relationship among Black men, a sample underrepresented in IPV research. A sole focus on Black men acknowledges that the experiences of all Black men are not universal, and also allows for a racial and gendered contextualization of the understanding of risk factors associated with IPV perpetration (Cole, 2009).

Theoretical Framework

This study is guided by two theoretical frameworks: (1) feminist perspective with a focus on threats to masculinity (Ali & Naylor, 2013), and (2) the stress process model (SPM; Pearlin et al., 1981) with a focus on ACEs and social and economic factors (e.g., race, income). Taken together these theoretical frameworks will provide a clearer understanding of the factors that contribute to IPV perpetration by Black men in heterosexual relationships.

Threats to Masculinity

Feminist perspective highlights that violence in heterosexual relationships is a result of gendered socialization and structures, where men are viewed through more patriarchal and masculine lens as the head of the household (Peralta & Tuttle, 2013; Priestley & Lee, 2019). Masculinity is neither static (a fixed characteristic) nor a personality trait, but instead is supported by cultural and social expectations of gendered behaviors that vary across cultures, groups, and time periods (Connell & Messerschmidt, 2005). Regardless of cultural and social contexts, enacting masculinity is associated with the use of violence toward an intimate female partner and is often manifested when expected female gender norms (e.g., sexual performance, caring for children, household chores, meal preparation) are not adhered to (Jewkes et al., 2015; Peralta & Tuttle, 2013). Specifically, when men perceive threats to their masculine identities by their intimate partner, violence is used as a means of discipline and maintaining control and power within their relationships. Stress has also been shown to be associated with increased risk for violence perpetration and perceived threats to masculine identities (Peralta & Tuttle, 2013).

Stress Process Model

An adapted version of the stress process model (SPM; Pearlin et al., 1981) was also used to guide this study. The SPM has been adapted for use in numerous studies including but not limited to examination of ACEs on adult mental health (Nurius et al., 2012, 2015); impact of race on cultural factors (Hilgeman et al., 2009), and in exploring children’s exposure to physical family and community violence (Foster & Brooks-Gunn, 2011). The SPM examines the multiple levels of support and stress at the individual, family, and community levels that predict mental health outcomes (Pearlin, 1999). As such, we hypothesize that social and economic status (i.e., marital status, income, age, education, employment, race) serves as background factors that may influence how an individual will cope with a primary stressor (i.e., ACEs). Alcohol use was also explored as a coping mechanism which moderates the effect of the primary stressor on a behavioral health outcome (i.e., IPV perpetration).

Using these frameworks, we asked the following research questions: (a) What is the association between ACEs and physical IPV perpetration among Black men in heterosexual relationships? (b) What are the associations between individual ACE factors and alcohol use in adulthood among Black men in heterosexual relationships? (c) Does alcohol use in adulthood moderate the relationship between ACEs and physical IPV perpetration among Black men in heterosexual relationships?

Methods

Data Source and Sample Population

Data source. We analysed data from Wave 2 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC II; 2004-2005). The NESARC is a nationally representative sample of noninstitutionalized civilians, aged 18 years or older, residing in all 50 states within the United States and the District of Columbia. NESARC II was the second wave of a longitudinal study first completed in 2001-2002. Data were collected using face-to-face surveys of individuals residing in household or group quarters within the United States. To increase minority representation non-Hispanic Blacks and Hispanics were oversampled. Of the total sample (n = 43,093) from the Wave 1 interview, 34,654 individuals, aged 20 years or older, were reinterviewed in Wave 2. Data from both Waves 1 and 2 were weighted at the individual and household levels to adjust for selection, nonresponse, and oversampling. After weighting, data were adjusted to be reflective of the U.S. population based on the 2000 Decennial Census. The response rate for Wave 2 was 86.7%. This study was approved by the University of Maryland, Baltimore Institutional Review Board (IRB). The present study included a sample (N = 1,127) of non-Hispanic Black men aged 20 years or older at the Wave 2 interview who reported being in an intimate relationship in the year prior to the NESARC Wave 2 interview, were heterosexual, and current drinkers since the last interview.

Measures

Intimate partner violence. Five questions adapted from previous studies (Cunradi et al., 1999; Lipsky et al., 2006) that asked about perpetration of physical violence toward an intimate partner in the past 12 months assessed IPV. These questions included the frequencies of (a) pushing, grabbing, shoving; (b) slapping, kicking, biting, or hitting; (c) threatening with a weapon like a knife or a gun; (d) cutting or bruising; and (e) injuring a spouse or partner enough that they needed medical care. The response frequencies were 0 = never; 1 = once; 2 = 2-3 times; 3 = once per month; and 4 = more than once per month. This scale has shown to have acceptable reliability (Cronbach’s α) of 0.70 within a general sample (Ruan et al., 2008) and not specifically among Black/African Americans. Because this variable was not normally distributed it was dichotomized into no IPV perpetration (ref) and IPV perpetration.

ACEs. Ten items were used to assess ACEs including physical (5 items) and emotional (5 items) neglect; physical (2 items), sexual (4 items), and emotional (3 items) abuse; witnessing violence against a mother or female caregiver (4 items); having a parent or caregiver with a drug (1 item) or alcohol problem (1 item); who was incarcerated (1 item); and who had a mental illness (3 items). These items were adapted from the Conflict Tactics Scale (CTS; Straus, 1979; Straus & Gelles, 1990) and the Childhood Trauma Questionnaire (CTQ; Bernstein et al., 1994; Wyatt, 1985). Items were dichotomously coded (0 = no, 1 = yes) to reflect experiences of childhood adversity in univariate and bivariate analyses and categorized into numbers of ACEs by type (0, 1, 2, 3, and ≥4) based on existing research for multivariate analyses (Vaughn et al., 2017).

Alcohol use. Questions related to alcohol use were taken from the Alcohol Use Disorder and Associated Disability Interview Schedule-DSM-IV version (AUDAIS-IV). Alcohol use was measured using daily ethanol consumption in the last 12 months prior to the Wave 2 NESARC interview, by summing beverage-specific volumes across four individual beverage types (i.e., coolers, beer, wine, and liquor). The alcohol use variable was developed and coded by NESARC survey developers (National Institutes of Health, 2010). The alcohol use measure had responses ranging from 0.0002 to 37.4102 ounces, which was recoded into number of standard drinks consumed using 0.6 oz. for one standard drink of pure alcohol (NESARC 2 Data Notes, 2008; NIAAA, n.d.). The measure has shown adequate reliability (intraclass correlation) of 0.72 (Grant et al., 2003). The alcohol variable was not normally distributed in this study and was log-transformed for multivariate analyses.

Control variables. The following sociodemographic and functioning variables were assessed at Wave 2 and included as control variables in multivariate analyses: Age, education, household income, marital status, employment; perceived stress (PSS4; Cohen & Hoberman, 1983; Cohen & Williamson, 1988), racial discrimination (experiences of discrimination scale; Krieger, 1990, 2003; Krieger & Sidney, 1997; Krieger et al., 1998, 2005), and norm-based mental health component summary (NBMCS) score (Ware et al., 2002).

Education was coded into three categories (1 = <high school (ref); 2 = high school (i.e., completed high school or graduate equivalency degree [GED]); and 3 = >high school); income into five categories (1 = <$2,500 (ref); 2 = $25,000-$39,999; 3 = $40,000-$69,999; 4 = $70,000-$99,999; and 5 = ≥$100,000); marital status into three categories (1 = married/living with someone as if married, 2 = widowed/divorced/separated, and 3 = never married (ref)); and employment was dichotomized (0 = unemployed (ref); 1 = employed).

Age, perceived stress, racial discrimination and NBMCS were treated as continuous variables. Given that limited studies (Caetano et al., 2007; Smith Slep et al., 2010) have been conducted to examine the role of stress in IPV perpetration, it was included as a control variable. The effects of racial discrimination were also explored among this sample due to the association with negative behavioral and health outcomes (Sellers et al., 2006; Taylor et al., 2007). Because of the heightened experiences of social and economic inequalities among Black individuals, based on racial status, additional layers of stress are created (Pearlin et al., 2005), which may manifest in alcohol use and IPV perpetration. Finally, studies have consistently shown the effects of mental illness on alcohol use and IPV perpetration, as such NBMCS was included as a global measure of mental health functioning.

Data Analysis

We conducted bivariate and multivariate analyses to estimate the effect of ACEs and alcohol consumption on IPV, and then tested for moderation via a product term (alcohol use × ACEs). First, chi-square analyses were run to examine the relationship between individual ACE factors and IPV perpetration. Similarly, independent samples t-tests were used to assess the association between individual ACE factors and alcohol use. Logistic regression analysis was performed to examine the moderating effects of alcohol use on the association between ACEs and IPV perpetration while controlling for age, employment status, income, education, marital status, norm-based mental component summary (NBMCS), racial discrimination, and perceived stress.

Data analyses were performed using survey analysis commands (SVY) in Stata version 16 (StataCorp, 2019). All models incorporated survey weights to account for nonresponse, sample attrition, and to derive population estimates and survey design variables to adjust standard errors using Taylor series linearization.

Results

Sample Characteristics

Participants had a mean age of 42.05 years (SD = 16.27), were mostly born in the U.S. (89.6%; n = 1,018) and were married or living with someone as if married (61.2%; n = 665; Table 1). Only 7.1% (n = 81) of Black men reported IPV perpetration. Close to three quarters (72.2%; n =815) of men were exposed to adversities in childhood, with 18.4% (n = 205), 18.7% (n = 213), 14.6% (n=149), and 20.4% (n = 248) having experienced one, two, three, and four or more ACEs, respectively. The most common ACEs were emotional (48%; n = 549) and physical (44.2%; n = 514) abuse, and physical neglect (32.4%; n = 378). Men consumed an average of 0.62 (SD = 2.01) standard drink of alcoholic beverage per day.

Table 1.

Participants’ Descriptive Data (N = 1,127).

Characteristics	n (%)	Characteristics	n (%)
Marital status (n = 1,127)		Types of ACEs
Married/living with as married	665 (61.2)	Physical neglect (n = 1,126)
Widowed/divorced/separated	184 (12.6)	No	748 (67.6)
Never married	278 (26.2)	Yes	378 (32.4)
Education (n = 1,127)		Emotional neglect (n = 1,126)
Less than high school	31 (2.3)	No	1.073 (95.2)
High School	493 (45.0)	Yes	53 (4.8)
Greater than high school	603 (52.7)	Emotional abuse (n = 1,125)
Household income (n = 1,127)		No	576 (52.0)
< $25,000	271 (24.6)	Yes	549 (48.0)
$25,000-$39,999	212 (17.9)	Physical abuse (n = 1,125)
$40,000-$69,999	327 (29.5)	No	611 (55.8)
$70,000-$99,999	185 (15.6)	Yes	514 (44.2)
≥ $100,000	132 (12.4)	Sexual abuse (n = 1,125)
Employment status (n = 1,127)¹		No	1,044 (92.2)
Employed	865 (77.8)	Yes	81 (7.8)
Retired	128 (9.1)	Battered mother (n = 1,123)
Unemployed	104 (9.9)	No	889 (80.3)
Other	30 (3.2)	Yes	234 (19.7)
Perpetrated IPV (n = 1,127)		Mental illness in household (n = 1,126)
No	1,046 (92.8)	No	1,055 (94.5)
Yes	81 (7.1)	Yes	71 (5.5)
ACEs (n = 1,126)		Alcohol problem in household (n = 1,125)
No	311 (27.8)	No	891 (79.0)
Yes	815 (72.2)	Yes	234 (21.0)
Number of ACEs; (n = 1,126)²		Drug problem in household (n = 1,123)
0	311 (27.9)	No	1,047 (92.9)
1	205 (18.4)	Yes	76 (7.1)
2	213 (18.7)	Incarcerated household Member (n = 1,125)
3	149 (14.6)	No	997 (88.2)
≥4	248 (20.4)	Yes	128 (11.8)

Note. Weighted data used for all frequencies and percentages; ¹Employment status was coded using a hierarchical method (i.e., employed, retired, unemployed, and other) to account for individuals in multiple categories. The other category refers to individuals who were either students, full-time homemakers, or engaged in some other activity; ²ACEs = adverse childhood experiences; no participant had an ACE score of 10.

Bivariate Models

Chi-square analyses indicated a statistically significant relationship between all but two ACE factors—emotional neglect and having a parent or caregiver in the household with a mental illness—and IPV perpetration (Table 2). Black men who experienced emotional and physical abuse and physical neglect had higher rates of IPV perpetration when compared to those without such experiences.

Table 2.

Bivariate Comparisons Between Adverse Childhood Experiences (ACEs) Factors and IPV Perpetration.

ACEs	Perpetrated IPV		χ²
ACEs	No (N = 1,046) n (%)	Yes (N = 81) n (%)	χ²
Physical neglect			χ² (40, n = 1,126) = 33.72, p < .001)
No	705 (63.6)	43 (4.0)
Yes	340 (29.3%)	38 (3.1)
Emotional neglect			χ² (40, n = 1,126) = 1.26, p = .267)
No	997 (88.3)	76 (6.9)
Yes	48 (4.5)	5 (0.2%)
Emotional abuse			χ² (40, n = 1,125) = 31.66, p < .001)
No	554 (49.8)	22 (2.2)
Yes	490 (43.0)	59 (5.0%)
Physical abuse			χ² (40, n = 1,125) = 16.17, p = .0002)
No	581 (52.7)	30 (3.1)
Yes	463 (40.1)	51 (4.1)
Sexual abuse			χ² (40, n = 1,125) = 73.86, p < .001)
No	975 (86.5)	69 (5.7)
Yes	69 (6.4)	12 (1.4)
Battered mother			χ² (40, n = 1,123) = 31.63, p < .001)
No	835(75.6)	54 (4.7)
Yes	208 (17.3)	26 (2.4)
Mental illness in household			χ² (40, n = 1,126) = 3.94, p = .054)
No	980 (88.0)	75 (6.5)
Yes	65 (4.8)	6 (0.7)
Alcohol problem in household			χ² (40, n = 1125) = 8.29, p = .006)
No	833 (74.1)	58 (4.9)
Yes	211 (18.7)	23 (2.3)
Drug problem in household			χ² (40, n = 1,123) = 16.11, p = .0003)
No	977 (86.9)	70 (6.1)
Yes	66 (6.0)	10 (1.0)
Incarcerated household member			χ² (40, n = 1,125) = 14.87, p = .0004)
No	933 (82.7)	64 (5.5)
Yes	112 (10.2)	16 (1.6)

Note. χ² = chi square; weighted data were used for all frequencies, percentages, and chi-square test.

Statistically significant relationships were found between alcohol use and various ACE factors (Table 3). Having experiences of physical neglect and having a parent or guardian in the home with a drug or alcohol problem or who was incarcerated and alcohol use in adulthood had a significant and positive relationship with alcohol use in adulthood. Conversely, being exposed to physical abuse and having a parent or guardian in the household with a mental illness were significantly, yet negatively, associated with alcohol use in adulthood among Black men.

Table 3.

Bivariate Comparisons Between Adverse Childhood Experience (ACEs) Factors and Alcohol Use Among Black Men.

ACEs	T	B	95% CIs (of B)
Physical neglect (N = 1,121)	2.92**	0.18	[0.05, 0.30]
Emotional neglect (N = 1,121)	0.17	0.01	[–0.15, 0.17]
Emotional abuse (N = 1,120)	0.83	0.06	[–0.09, 0.22]
Physical abuse (N = 1,120)	–3.73*	–0.25	[–0.39, –0.11]
Sexual abuse (N = 1,120)	0.60	0.26	[–0.63, 1.16]
Battered mother (N = 1,118)	0.10	0.006	[–0.12, 0.13]
Mental illness in household (N = 1,121)	–2.38**	–0.17	[–0.32, –0.02]
Alcohol problem in household (N = 1,120)	6.24*	0.99	[0.67, 1.31]
Drug problem in household (N = 1,118)	2.40**	1.10	[0.17, 2.03]
Incarcerated household member (N = 1,120)	4.54*	0.31	[0.17, 0.44]

Note. Weighted data were used these analyses; B = unstandardized coefficient; *p < .001; ** p ≤ .05

Main Effects Model Without Interaction Term

In comparison to Black men without ACEs, those who were exposed to 1, 2, 3 and ≥4 ACEs had higher odds of IPV perpetration, with the largest effect being for men exposed to 4 or more ACEs (Table 4). The average number of standard drinks of alcohol consumed daily was also significantly associated with IPV perpetration. Three control variables—age, income, and perceived stress—were significantly associated with IPV perpetration. That is, age had a negative association with IPV perpetration. Also, having an income between $25,000 and $39,999 and between $70,000 and $99,999 were positively and negatively associated with IPV perpetration, respectively, when compared to men with an annual income >$25,000. Experiences of perceived stress were also positively associated with IPV perpetration.

Table 4.

Logistic Regression Analysis for Independent Effects of Alcohol Use, Adverse Childhood Experiences (ACEs), and Covariates on IPV Perpetration (N = 1,121).

Predictor	B	SE_B	OR	SE_OR	95% CI
Age	–0.03*	0.006	0.96*	0.006	[0.95, 0.97]
Employment status¹
Employed	0.02	0.24	1.02	0.24	[0.62, 1.67]
Income²
$25,000-$39,999	0.56**	0.21	1.75**	0.37	[1.14, 2.69]
$40,000-$69,999	–0.30	0.19	0.73	0.14	[0.49, 1.09]
$70,000-$99,999	–0.76**	0.23	0.46**	0.11	[0.29, 0.75]
≥ $100,000	–0.05	0.17	0.94	0.16	[0.65, 1.34]
Education³
High school	0.73	1.06	2.08	2.21	[0.24, 17.88]
Greater than high school	0.55	1.06	1.73	1.84	[0.20, 14.88]
Marital status⁴
Married/living with someone as if married	0.38	0.21	1.46	0.31	[0.95, 2.27]
Widowed/divorced/separated	0.20	0.26	1.23	0.32	[0.72, 2.09]
NBMCS	0.004	0.007	1.00	0.007	[0.99, 1.02]
Racial discrimination	0.003	0.02	1.00	0.02	[0.95, 1.04]
Perceived stress	0.14*	0.03	1.15*	0.03	[1.08, 1.23]
Number of ACEs⁵
1	0.94*	0.23	2.58*	0.61	[1.60, 4.16]
2	0.83**	0.31	2.31**	0.72	[1.22, 4.37]
3	0.75**	0.36	2.11**	0.76	[1.02, 4.39]
≥ 4	1.50*	0.33	4.49*	1.48	[2.30, 8.76]
Alcohol use	0.15*	0.03	1.16*	0.04	[1.09, 1.25]
Constant	–3.70**	1.20	0.02**	0.02	[0.002, 0.28]

Note. Weighted data were used in these analyses; B = standardized coefficients; SE = standard error; OR = odds ratio; CI = confidence interval; 153 strata were removed from this analysis because they contained no data for Black men; ¹Reference = not employed; ²Reference = < $25,000; ³Reference = less than high school education; ⁴Reference = never married; ⁵Reference = 0 (no ACEs); NBMCS = norm-based mental component summary score; Alcohol Use = average # of standard drink (0.6 fl oz of pure alcohol) consumed daily; *p < 0.001, **p < 0.05

Moderating Effect of Alcohol Use on IPV Perpetration

Alcohol use in adulthood significantly moderated the relationship between ACEs and IPV perpetration for men exposed to 1, 2, and 4 or more ACEs (Table 5). That is, in comparison to men with no ACEs who consumed alcohol, men with 1, 2, and ≥4 ACEs who consumed alcohol were less likely to perpetrate IPV. However, alcohol use appeared to exacerbate the relationship between ACEs and IPV perpetration for men who were not exposed to adversities in childhood but who consumed alcohol (Figure 1).

Several control variables − age, income and perceived stress − were also significantly associated with IPV perpetration in this model. Older age was significantly associated with lower odds of perpetrating IPV among Black men. When compared to Black men with an annual household income of <$25,000, those who earned $25,000-$39,999 and $70,000-$99,999 had greater and lower odds of perpetrating IPV, respectively. For every one-point increase in perceived stress Black men had 16% increased odds of perpetrating IPV. Employment status, education, marital status, NBMCS, and racial discrimination were not significantly associated with IPV perpetration in this model.

Table 5.

Logistic Regression Analysis for the Moderating Effects of Alcohol Use on Adverse Childhood Experiences (ACEs) and IPV Perpetration (N = 1,121).

Predictor	B	SE_B	OR	SE_OR	95% CI
Age	–0.03*	0.006	0.96*	0.006	[0.95, 0.97]
Employment status¹
Employed	0.003	0.24	1.00	0.24	[0.60, 1.65]
Income²
$25,000-$39,999	0.57**	0.20	1.78**	0.37	[1.17, 2.71]
$40,000-$69,999	–0.29	0.19	0.74	0.14	[0.50, 1.08]
$70,000-$99,999	–0.77**	0.23	0.46**	0.10	[0.29, 0.73]
≥$100,000	–0.08	0.17	0.92	0.15	[0.65, 1.29]
Education³
High school	0.67	1.06	1.97	2.09	[0.23, 16.84]
Greater than high school	0.50	1.06	1.65	1.76	[0.19, 14.21]
Marital status⁴
Married/living with someone as if married	0.39	0.22	1.47	0.32	[0.94, 2.31]
Widowed/divorced/separated	0.17	0.26	1.18	0.31	[0.70, 2.02]
NBMCS	0.004	0.006	1.00	0.007	[0.99, 1.01]
Racial discrimination	0.006	0.02	1.00	0.02	[0.96, 1.05]
Perceived stress	0.15*	0.03	1.16*	0.03	[1.09, 1.24]
Number of ACEs⁵
1	0.61**	0.29	1.85**	0.54	[1.02, 3.35]
2	0.48	0.36	1.62	0.59	[0.77, 3.40]
3	0.46	0.42	1.59	0.68	[0.67, 3.77]
≥4	1.14**	0.38	3.14**	1.20	[1.45, 6.81]
Alcohol use	0.50*	0.12	1.65*	0.19	[1.29, 2.10]
Number of ACEs × alcohol use
1	–0.38**	0.12	0.68**	0.08	[0.53, 0.87]
2	–0.40**	0.15	0.67**	0.10	[0.49, 0.91]
3	–0.30	0.21	0.73	0.15	[0.48, 1.13]
≥4	–0.39**	0.12	0.67**	0.08	[0.52, 0.87]
Constant	–3.31**	1.28	0.03**	0.04	[0.002, 0.49]

Note. Weighted data were used in these analyses; B = standardized coefficients; SE = standard error; OR = odds ratio; CI = confidence interval; 153 strata were removed from this analysis because they contained no data for Black men; ¹Reference = not employed; ²Reference = < $25,000; ³Reference = less than high school education; ⁴Reference = never married; ⁵Reference = 0 (no ACEs); NBMCS = norm-based mental component summary score; alcohol use = average # of standard drink (0.6 fl. oz of pure alcohol) consumed daily; *p < .001, **p < .05

Figure 1.

Note. The number of standard drinks consumed daily in this analysis was modified for presentation to reflect drinks between 0 and 4. The recommended daily drinking limit for men is 4 drinks per occasion with a weekly limit of 14 drinks (Wave 2 NESARC data notes, 2008).

Discussion

Results of this study shed light on how ACEs and alcohol use may influence risk for IPV perpetration alone or in tandem among Black men in the United States. Findings that Black men who were exposed to physical neglect; emotional, physical and sexual abuse; witnessing their mother being abused; having someone in the household with an alcohol or drug problem; and having an incarcerated parent were significantly associated with IPV perpetration are in alignment with the extant literature (e.g., Cui et al., 2010; Watt & Scrandis, 2013). Multivariate analyses indicate that Black men with 4 or more ACEs have the greatest odds of perpetrating IPV, which is consistent with the literature on IPV (e.g., Fonseka et al., 2015). These significant findings regarding the association between ACEs and IPV perpetration among Black men extend existing research to a previously understudied group.

Furthermore, emotional neglect and household mental illness were not found to be associated with IPV perpetration. It is possible that these ACEs are less problematic in that they do not involve either witnessing or being the victim of violence from a parent or caregiver. This finding could also be due in part to the relatively small number of respondents with such exposure who reported perpetrating IPV, or the specific measures used. That is, ACEs were measured retrospectively, which may have increased recall bias, and questions used to assess adversity do not account for the mental state of the child at the time the incident(s) occurred, which could impact their perceived experiences. Also, only one question was used to assess mental illness of a household member, and no information relating to the nature, type, and severity of such mental illness, and/or the utilization of formal mental health services by victims and/or caregivers or parents were included.

With regards to the role of ACEs on alcohol use in adulthood, this study’s findings show that six factors were significantly associated with alcohol use in adulthood. The significant findings are consistent with existing research that implicate ACEs as being associated with alcohol use (Crouch et al., 2018). Overall, study findings enhance our understanding that ACEs are associated with alcohol use in adulthood and IPV perpetration.

When ACEs and alcohol use are considered together, alcohol use was more strongly associated with IPV perpetration for men without childhood adversities than for men exposed to 1, 2, or ≥ 4. Alcohol use appears to exacerbate IPV perpetration for men with no ACEs, but for men with a history of childhood adversity, the effect of alcohol use on perpetration is less substantial. One plausible explanation is that alcohol use has a greater disinhibiting effect on Black men without exposure to childhood adversity, resulting in their inability to resist the urge to behave in an aggressive manner (Eckhardt et al., 2015). However, this may not be the case for men with substantial ACEs, where the traumatic experiences of ACEs supersede any impact of alcohol consumption on IPV. Given the effects of ACEs on brain development (Nurius et al., 2015; SAMSHA, 2018) and subsequent IPV perpetration (Anda et al., 2006; Whitfield et al., 2003), the effects of alcohol use for men with childhood adversity do not appear to worsen IPV perpetration.

Overall, our findings provide support for the use of both the adapted Stress Process Model and the feminist perspective with a focus on threats to masculinity. Although to our knowledge, the SPM has never been used to explain IPV perpetration or with specifically Black samples, our findings support its use in elucidating the effects of ACEs and alcohol use, on IPV perpetration, while examining the overall influence of Black men’s social and economic status (e.g., marital status, income, age, employment). Our findings also shed light on the role of childhood and economic stress as factors that may act as threats to Black men’s perceived masculinity and in turn contribute to increased risk for IPV. Traditionally, masculine identity includes the provider and breadwinner roles, and in cases where men are not able to perform these gendered roles, violence is often used to compensate for economic failures and assert dominance through the creation of an alternative masculine identity (de Visser & McDonnell, 2013; Melzer, 2002). In a country and culture where masculinity is rooted in White male patriarchy, Black men may have limited access to resources to achieve their ideal masculinity (Hall & Pizarro, 2011) resulting in increased alcohol use, as a coping mechanism, and subsequent IPV perpetration.

Limitations

This study adds to the literature with nationally representative data, allowing for generalization of study findings and improving on methodological limitations (e.g., convenience samples, small sample size) of existing studies that have explored the role of ACEs and alcohol use in adulthood on IPV perpetration. This is the first known study to examine the effect of ACEs and alcohol use in adulthood on IPV perpetration among Black men, which can be used to inform future research on IPV specific to this population.

Despite the strengths of this study, there are also limitations. The use of retrospective self-report data related to childhood adversities, alcohol use, and IPV perpetration is prone to recall and social desirability bias. However, measures in the NESARC survey display adequate stability and reliability for ACEs (da Silva & da Costa Maia, 2013), alcohol use, and IPV perpetration (Ruan et al., 2008). Cross-sectional data does not allow for causality to be determined, especially related to alcohol use and IPV given that drinking and violence often co-occur. The current study did not explore ethnic differences in rates of IPV perpetration specific to Black men. Samples were too small to allow for potentially valuable subgroup analyses. Finally, the NESARC survey lacks specific cultural measures (e.g., John Henryism, gendered norms, patriarchal beliefs about IPV) which made exploration of culturally specific factors impossible.

Implications

Perhaps the most striking finding of the current study was the severe impact of multiple ACEs on IPV risk. To reach the same probability of IPV risk, a person with no ACES would have an average of three drinks per day (150% of current risk guidelines). From a policy perspective, ACEs prevention efforts should be integrated with long-term antiviolence initiatives that may pay generational dividends in the form of lower violence levels in the future. In Black communities in the United States, prevention efforts will have particular value due to higher rates of some ACES (i.e., household drug abuse, household mental illness, parental separation/divorce, incarceration history in home, parental IPV) in this population (Lee & Chen, 2017). Additionally, efforts to prevent the deleterious effects of ACEs on children should include development of social- and community-level interventions that address the material disadvantage and social isolation which most children with ACEs experience (Lorenc et al., 2020). Similarly, efforts to improve the neighborhood environments within which children live, through community development and other forms of intervention, may be effective in reducing health inequities and improving the overall health of children (Acevedo-Garcia et al., 2014). Although alcohol consumption was associated with greater risk among Black men, there was little evidence of an additive effect for alcohol use. Nonetheless, public health efforts should address both problems as threats to the health and well-being of Black men and their families. Specifically, combined alcohol and IPV interventions should be developed to treat Black men who abuse alcohol and perpetrate IPV. Additionally, community-level interventions aimed at changing the narrative, norms and acceptability of alcohol use and IPV, in the context of expanding male and masculine identities, should also be implemented to aid in the prevention of alcohol use and IPV perpetration.

Finally, research should further investigate the role of ACEs and substance use on IPV with a specific focus on Black men. This should include exploration of within group differences among Black men of different ethnicities (e.g., African immigrant, Caribbean Black) to explore specific risk and protective factors. Future study should consider the role of culture-specific risk and protective factors to inform intervention development. Approaches should also draw from a variety of data sources (e.g., qualitative, administrative data, biomarkers) and methods (e.g., experimental, survey, longitudinal cohort) to understand the complexity of how early adverse experiences lead to adult IPV.

Footnotes

Declaration of Conflicting Interests

Funding

The author(s) disclosed the following financial support for the research, authorship, and/or publication of this article: The National Epidemiological Survey on Alcohol and Related Conditions (NESARC) was conducted and funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), with supplemental support from the National Institute on Drug Abuse (NIDA).

The first author also received dissertation funding from the University of Maryland Baltimore School of Social Work to carry out this study.

ORCID iD

Kerry A. Lee

Author Biographies

Kerry A. Lee, PhD, MSW, is currently a postdoctoral fellow in the Human Development and Quantitative Methodology Department at the University of Maryland, College Park. Her research focuses on trauma (e.g., adverse childhood experience [ACEs]), child maltreatment prevention; violence perpetration and prevention within Black families; child and adolescent mental health services; substance use; and social determinants of health.

Charlotte Lyn Bright, PhD, MSW, is an associate professor and associate dean for doctoral and postdoctoral education at the University of Maryland, School of Social Work. Her research focuses on justice system involvement, gender, trauma and maltreatment, services for youth and families, and implementation science.

Paul Sacco, PhD, LCSW, is an associate professor and the associate dean for research at the University of Maryland, School of Social Work. His research focuses on behavioral health and addictions with a focus on life course development. He has conducted research on the epidemiology of alcohol use and pathological gambling among older adults with an emphasis on epidemiology and health services use. In addition to these interests, he is interested in the application of latent variable modeling approaches to understanding developmental process in behavioral health and exploring heterogeneity in life course development.

Melissa E. Smith, PhD, MSSW, is an associate professor at the University of Maryland, School of Social Work. Her research focuses on community-based mental health services, Black populations diagnosed with serious mental illnesses, youth and young adults at clinical high risk for psychosis, and the intersection of race, ethnicity, sociocultural factors and serious mental illness across the life span.

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