IntroductionAdverse childhood experiences, such as violence victimization, substance misuse in the household, or witnessing intimate partner violence, have been linked to leading causes of adult morbidity and mortality. Therefore, reducing adverse childhood experiences is critical to avoiding multiple negative health and socioeconomic outcomes in adulthood.MethodsBehavioral Risk Factor Surveillance System data were collected from 25 states that included state-added adverse childhood experience items during 2015–2017. Outcomes were self-reported status for coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, cancer (excluding skin cancer), kidney disease, diabetes, depression, overweight or obesity, current smoking, heavy drinking, less than high school completion, unemployment, and lack of health insurance. Logistic regression modeling adjusting for age group, race/ethnicity, and sex was used to calculate population attributable fractions representing the potential reduction in outcomes associated with preventing adverse childhood experiences.ResultsNearly one in six adults in the study population (15.6%) reported four or more types of adverse childhood experiences. Adverse childhood experiences were significantly associated with poorer health outcomes, health risk behaviors, and socioeconomic challenges. Potential percentage reductions in the number of observed cases as indicated by population attributable fractions ranged from 1.7% for overweight or obesity to 23.9% for heavy drinking, 27.0% for chronic obstructive pulmonary disease, and 44.1% for depression.Conclusions and implications for public health practiceEfforts that prevent adverse childhood experiences could also potentially prevent adult chronic conditions, depression, health risk behaviors, and negative socioeconomic outcomes. States can use comprehensive public health approaches derived from the best available evidence to prevent childhood adversity before it begins. By creating the conditions for healthy communities and focusing on primary prevention, it is possible to reduce risk for adverse childhood experiences while also mitigating consequences for those already affected by these experiences.

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Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher) that results in harm, potential for harm, or threat of harm to a child. 3 There are four common types of child maltreatment: 3 • Physical abuse is the use of physical force, such as hitting, kicking, shaking, burning, or other shows of force against a child. • Sexual abuse involves inducing or coercing a child to engage in sexual acts. It includes behaviors such as fondling, penetration, and exposing a child to other sexual activities. • Emotional abuse refers to behaviors that harm a child's self-worth or emotional well-being. Examples include name calling, shaming, rejection, withholding love, and threatening. • Neglect is the failure to meet a child's basic physical and emotional needs. These needs include housing, food, clothing, education, and access to medical care. Child abuse and neglect is highly prevalent. Self-report data suggest that at least 1 in 7 children have experienced child abuse and/or neglect in the last year. 4 Not all children, however, experience abuse and neglect at the same rates. Younger children are more likely to experience fatal abuse and neglect, 5 while 14-to 17-year-olds are more likely to experience non-fatal abuse and neglect. 4 Race and ethnicity and family income are also factors that may affect a child's exposure. Child protective services data show high rates of victimization among African-American children. African-American children experience abuse and neglect at rates that are nearly double those for white children. These differences are generally attributed to various community and societal factors, including poverty as well as differences in reporting and investigation. 5 Children living in families with a low socioeconomic status (SES) * have rates of child abuse and neglect that are five times higher than those of children living in families with a higher SES. 6 Irrespective of data source, definitions, and measures, the true magnitude of child abuse and neglect is likely underestimated, and children of all ages, races, and ethnicities deserve safe, stable, nurturing relationships and environments to achieve maximal health and life potential. Child abuse and neglect is associated with several risk factors. Risk for child abuse and neglect perpetration and victimization is influenced by a number of individual, family, and environmental factors, all of which interact to increase or decrease risk over time and within specific contexts. Risk factors for victimization include child age and special needs that may increase caregiver burden (e.g., developmental and intellectual disabilities, mental health issues, and chronic physical illnesses). 7 Risk factors for perpetration include young parental age, single parenthood, large number of dependent children, low parental income, parental substance abuse, parental mental health issues, parental history of abuse or neglect, social isolation, family...

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Child maltreatment incurs a high lifetime cost per victim and creates a substantial US population economic burden. This study aimed to use the most recent data and recommended methods to update previous (2008) estimates of 1) the per-victim lifetime cost, and 2) the annual US population economic burden of child maltreatment. Three ways to update the previous estimates were identified: 1) apply value per statistical life methodology to value child maltreatment mortality, 2) apply monetized quality-adjusted life years methodology to value child maltreatment morbidity, and 3) apply updated estimates of the exposed population. As with the previous estimates, the updated estimates used the societal cost perspective and lifetime horizon, but also accounted for victim and community intangible costs. Updated methods increased the estimated nonfatal child maltreatment per-victim lifetime cost from $210,012 (2010 USD) to $830,928 (2015 USD) and increased the fatal per-victim cost from $1.3 to $16.6 million. The estimated US population economic burden of child maltreatment based on 2015 substantiated incident cases (482,000 nonfatal and 1670 fatal victims) was $428 billion, representing lifetime costs incurred annually. Using estimated incidence of investigated annual incident cases (2,368,000 nonfatal and 1670 fatal victims), the estimated economic burden was $2 trillion. Accounting for victim and community intangible costs increased the estimated cost of child maltreatment considerably compared to previous estimates. The economic burden of child maltreatment is substantial and might off-set the cost of evidence-based interventions that reduce child maltreatment incidence.

IMPORTANCE-Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to address violence often lack broad, cross-sector collaboration, and there is limited awareness of effective strategies to prevent violence.OBJECTIVES-To describe the burden of interpersonal violence in the United States, explore challenges to violence prevention efforts and to identify prevention opportunities.

Context-Although partner violence screening has been endorsed by many health organizations, there is insufficient evidence that it has beneficial health outcomes.

Food and housing insecurity may be important considerations for the prevention of SV and IPV or the reductions of their consequences, although future research is needed to disentangle the direction of the association. Strategies aimed at buffering economic insecurity may reduce vulnerability to IPV and SV victimization.