Open Access

ARTICLE

The Relationship between Adverse Childhood Experiences and Health Risk Behaviors of Adolescents: The Mediating Role of Executive Function Deficits

Riza Hayati Ifroh, Xiaosong Gai^*

Developmental and Educational Psychology, School of Psychology, Northeast Normal University, Changchun, 130024, China

* Corresponding Author: Xiaosong Gai. Email:

(This article belongs to the Special Issue: Healthy Lifestyle Behaviours and Mental Health in Children and Adolescents)

International Journal of Mental Health Promotion 2025, 27(6), 787-807. https://doi.org/10.32604/ijmhp.2025.065065

Received 03 March 2025; Accepted 28 May 2025; Issue published 30 June 2025

Abstract

Background: Adverse childhood experiences (ACEs) are a significant issue in adolescent health due to their robust correlation with deficits in executive functions (EF) and health risk behaviors (HRBs). This study aimed to examine the association between ACEs and a range of HRBs, including substance use, sexual risk behavior, suicidal ideation, physical inactivity, and violence. Methods: This cross-sectional study used self-administered questionnaire and cluster sampling in seven junior high schools in Samarinda, Indonesia, with a sample size of 534 students. Data analysis using descriptive statistics, the Chi-square test, the independent t-test, ANOVA, binary logistic regression, and mediation analysis with macro-PROCESS. Results: The most common ACEs were community violence (68.0%), physical neglect (52.8%), psychological/emotional abuse (52.6%), physical abuse (50.4%), and peer bullying (45.9%). Adolescents with more than five ACEs showed significantly higher involvement in smoking/vaping (67.9%), suicidal ideation (75.2%), sexual risk behavior (57.7%), bullying (64.3%), and physical fighting (59.7%) (p < 0.001). ACEs were significantly correlated with EF deficits (r = 0.471, p < 0.01) and HRB (r = 0.578, p < 0.01). Regression analysis confirmed that ACEs predicted EF deficits (β = 0.466, p < 0.001) and HRB (β = 0.469, p < 0.001), with EF deficits partially mediating this relationship (β = 0.107, 95% CI [0.045, 0.094]). In addition, two subdomains of EF deficits, self-motivation (β = 0.042) and self-regulation of emotion (β = 0.032), significantly mediated the relationship between ACEs and HRBs. Conclusion: These findings suggest an important role for EF deficits in linking childhood adversity to engagement in risky behaviors. Addressing ACEs and EF deficits (self-motivation and self-regulation of emotion) through early intervention may be important in reducing long-term health risks among Indonesian adolescents.

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