Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States

Abstract

IMPORTANCE Early adversity is associated with leading causes of adult morbidity and mortality and effects on life opportunities. OBJECTIVE To provide an updated prevalence estimate of adverse childhood experiences (ACEs) in the United States using a large, diverse, and representative sample of adults in 23 states. DESIGN, SETTING, AND PARTICIPANTS Data were collected through the Behavioral Risk Factor Surveillance System (BRFSS), an annual, nationally representative telephone survey on health-related behaviors, health conditions, and use of preventive services, from January 1, 2011, through December 31, 2014. Twenty-three states included the ACE assessment in their BRFSS. Respondents included 248 934 noninstitutionalized adults older than 18 years. Data were analyzed from March 15 to April 25, 2017. MAIN OUTCOMES AND MEASURES The ACE module consists of 11 questions collapsed into the following 8 categories: physical abuse, emotional abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce. Lifetime ACE prevalence estimates within each subdomain were calculated (range, 1.00-8.00, with higher scores indicating greater exposure) and stratified by sex, age group, race/ethnicity, annual household income, educational attainment, employment status, sexual orientation, and geographic region. RESULTS Of the 214 157 respondents included in the sample (51.51% female), 61.55% had at least 1 and 24.64% reported 3 or more ACEs. Significantly higher ACE exposures were reported by participants who identified as black (mean score, 1.69; 95% CI, 1.62-1.76), Hispanic (mean score, 1.80; 95% CI, 1.70-1.91), or multiracial (mean score, 2.52; 95% CI, 2.36-2.67), those with less than a high school education (mean score, 1.97; 95% CI, 1.88-2.05), those with income of less than $15 000 per year (mean score, 2.16; 95% CI, 2.09-2.23), those who were unemployed (mean score, 2.30; 95% CI, 2.21-2.38) or unable to work (mean score, 2.33; 95% CI, 2.25-2.42), and those identifying as gay/lesbian (mean score 2.19; 95% CI, 1.95-2.43) or bisexual (mean score, 3.14; 95% CI, 2.82-3.46) compared with those identifying as white, those completing high school or more education, those in all other income brackets, those who were employed, and those identifying as straight, respectively. Emotional abuse was the most prevalent ACE (34.42%; 95% CI, 33.81%-35.03%), followed by parental separation or divorce (27.63%; 95% CI, 27.02%-28.24%) and household substance abuse (27.56%; 95% CI, 27.00%-28.14%). CONCLUSIONS AND RELEVANCE This report demonstrates the burden of ACEs among the US adult population using the largest and most diverse sample to date. These findings highlight that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others. Although identifying and treating ACE exposure is important, prioritizing primary prevention of ACEs is critical to improve health and...

Relationships Between Adverse Childhood Experiences and Health Status in Systemic Lupus Erythematosus

“…Estimates from large surveys (Kaiser Permanente and BRFSS in multiple states) conducted from 1998-2014 showed a range in prevalence of ACE exposures (50.5-63.9% of individuals had ACE scores ≥1, and 6.2-15.8% had ACE scores ≥4). ACE domains such as abuse and household challenges were also frequently documented in these studies (abuse prevalence 10.6-35.0%; household challenge prevalence 3.4-26.9%, respectively) (15)(16)(17)39,40). We found that for CLUES and BRFSS participants, overall ACE levels were generally comparable; >60% identified at least 1 ACE (60.4 and 65.6%, respectively), and >15% indicated ≥4 ACEs (15.0 and 19.6%, respectively).…”

Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample

“…9,10 On the other hand, children with adverse childhood experiences (ACEs) are at risk for observable changes in brain anatomy, 11 gene expression, 12,13 and delays in social, emotional, physical, and cognitive development lasting into adulthood. [3][4][5][14][15][16][17] According to standardized measures, an estimated 61.5% of adults 18 and 48% of children 19 in the United States have been exposed to ACEs, with more than one-third of these having multiple exposures. 18,19 The wide-ranging negative associations between exposure to multiple ACEs and diminished adult and child health are well documented.…”

“…[3][4][5][14][15][16][17] According to standardized measures, an estimated 61.5% of adults 18 and 48% of children 19 in the United States have been exposed to ACEs, with more than one-third of these having multiple exposures. 18,19 The wide-ranging negative associations between exposure to multiple ACEs and diminished adult and child health are well documented. 14,[19][20][21][22] Most notable is the especially strong evidence linking ACEs with adult mental health problems including depression.…”

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017

“…Adverse childhood experiences are common and have important implications for health and well-being ( 6 , 9 ). Whereas everyone is at risk for adverse childhood experiences, numerous studies have documented inequities in such experiences attributed to the historical, social, and economic environments in which some families live ( 9 – 11 ).…”