Impulsivity mediates the impact of early life adversity on high risk behaviors among Tunisian adolescents

Imen Mlouki, Ines Bouanene, Imen Sioud, Abdallah Bchir, Mustafa al'Absi, Sana El Mhamdi

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6 Scopus citations


Adverse childhood experience (ACE) has become an alarming phenomenon exposing youth at a great risk of developing mental health issues. Several studies have examined the mechanism by which ACE affects adolescent's engagement in risky behaviors. However, little is known about these associations in the Tunisian/African context. We investigated the role of impulsivity in the link between ACE and health risk behaviors among schooled adolescents in Tunisia. We performed a cross sectional study among 1940 schooled adolescents in the city of Mahdia (Tunisia) from January to February 2020. To measure ACE, we used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale and the Internet Addiction Test were used as screening tools for impulsivity and internet addiction. A total of 2520 adolescents were recruited. Of those, 1940 returned the questionnaires with an overall response rate of 77%. The majority (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported intra-familial ACEs. Males had higher rates of exposure to social violence than females. The most common risky behavior was internet addiction (50%, 95%CI = [47.9–52.3%]). Our survey revealed that ACEs score predict problematic behaviors through impulsiveness (% mediated = 16.7%). Specifically, we found a major mediating role of impulsivity between the exposure to ACE and the risk of internet addiction (% mediated = 37.5%). Our results indicate the role of impulsivity in translating the risk associated with ACE leading to engagement in high risk behaviors.

Original languageEnglish (US)
Article number101424
JournalPreventive Medicine Reports
StatePublished - Sep 2021

Bibliographical note

Funding Information:
Authors would like to thank Dr. Maha Almuneef for his valuable help. The authors wish also to thank the following individuals for their help in data collection: Houcem Elomma Mrabet, Nejla Rezg, Faouzia Chebbi, Sarra Nouira, Ines Daldoul, Fethi Aroui, Asma Sayadi. We take this opportunity to extend our gratitude to the team of the Department of Epidemiology and Preventive Medicine at the University Hospital Taher Sfar Mahdia.

Publisher Copyright:
© 2021


  • Adolescent
  • Adverse childhood experiences
  • Health risk behaviors
  • Impulsive behavior
  • Tunisia


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