Adverse childhood experiences have a lasting, harmful effect on health and wellbeing.1
Adverse Childhood Experiences (ACEs) affect nearly two million children in California across socioeconomic lines, putting them at risk for health, behavioral, and learning problems.2 ACEs are traumatic childhood experiences - which include abuse, neglect, and being exposed to violence, mental illness, divorce, substance abuse, or criminal activity in the home - that often leave people more vulnerable to environments and behaviors that can lead to poor health. The more ACEs an individual has experienced, the higher their risk climbs.3
The National Survey of Children’s Health (NSCH) tracks the percent of California children who have experienced ACEs. It uses a set of questions on family, economic, and community adversity to ask parents about current adverse experiences to which their children have been exposed. This population-based survey measures adversity among California children by asking parents about the trauma their children have experienced while they are still children, compared to methods that ask adults to recall their childhood experiences, such as adult retrospective data from the California Behavioral Risk Factor Surveillance System (BRFSS).2,4
Adverse Childhood Experiences (Parent Reported)
In 2016-2019 (baseline year), 36.0% of children are exposed to one or more adverse experience (parent reported). The most recent data available (2016-2019) show 36.0%. The target is to be determined (TBD) for this indicator.
More Data about Adverse Childhood Experiences (Parent Reported)
Adverse Childhood Experiences (Adult Retrospective)
In 2008-2009 (baseline year), 59.0% of adults reported having been exposed to one or more adverse childhood experience before the age of 18. The most recent data available (2015) show 63.5%. We hope to reach a target of 45.0% or lower by 2022.
More Data about Adverse Childhood Experiences (Adult Retrospective)
California Essentials for Childhood Initiative
The California Essentials for Childhood (EfC) Initiative seeks to address child maltreatment as a public health issue; aims to raise awareness and commitment to promoting safe, stable, nurturing relationships, and environments (SSNR&E); creates the context for healthy children and families through social norms change, programs, and policies; and utilizes data to inform actions. Utilizing a collective impact model, the EfC Initiative advances the common agenda of multiple agencies and stakeholders through alignment of activities, programs, policies, and funding so that all California children, youth, and their families achieve SSNR&E. Learn more »
ACEs Lead to Increased Risk of Negative Physical Health Outcomes
A person with four or more ACEs is:
- 2.1 times as likely to die from heart disease3,4
- 2.3 times as likely to die from cancer3,4
- 5.9 times as likely to contract a sexually transmitted infection3,4
ACEs Lead to Increased Risk of Negative Mental Health Outcomes
A person with four or more ACEs is:
- 4.4 times as likely to suffer from depression 3,4
- 4.7 times as likely to seek help from a mental health professional 3,4
- 30.1 times as likely to attempt suicide 3,4
ACEs Lead to Increased Risk of Substance Use
A person with four or more ACEs is:
- 2.9 times as likely to smoke 4
- 7.4 times as likely to experience alcoholism 4
- 10.3 times as likely touse injection drugs 4
Early Intervention is Key
Screening for ACEs in children as early as possible and providing children and their families with the support services they need is a critical step to prevent and undo the existing and future harm to children’s brains and bodies caused by toxic stress. 5
- Working to educate parents and caregivers about the impact a child’s environment and
exposures may be having on children’s health may help parents become a buffer for that impact
- With the right tools, children can thrive despite having experienced trauma
Having ACEs in Your Past Doesn’t Have to Define Your Future
While ACEs are clearly related to health and behaviors later in life, they aren’t a guarantee of anything. The negative health effects of ACEs can be buffered by increasing individual and community- level protective factors that build resilience, for example:
- Building skills in practices such as mindfulness, goal setting, positive coping, and conflict
- Eating well, getting plenty of sleep, and staying active
- Caring relationships with parents, teachers, counselors, or others actively involved in a child’s life
- Safe, stable, and nurturing relationships and environments 7
Data Snapshot: Trends & Disparities
A person with four or more ACEs is:
- 21% as likely to live at or below 250 percent of the Federal Poverty Level (FPL) 4
- 27% as likely to have not graduated college 4
- 39% as likely to be unemployed 4
16.3% of California adults reported having been exposed to four or more Adverse Childhood Experiences (ACEs) before the age of 18. 10
- 27 out of 58 counties (46.6%) in California were above the state average prevalence of adults reporting having been exposed to four or more ACEs 10
- Humboldt, Trinity, Kings, and San Benito counties had the highest reported prevalence of adults reporting having been exposed to four or more ACEs 10
Proportion of Children Who Are Exposed to Adverse Experiences (Parent Reported)
Proportion of Respondents Who Have Been Exposed to Adverse Childhood Experiences Before the Age of 18 (Adult Retrospective)
Childhood adversity and resilience measures originate from two separate data sources and provide a rich and conceptually-related perspective on childhood adversity. However, due to differences in methodology, data from the two sources should not be directly compared.
Indicator: Proportion of children who are exposed to one or more adverse experience (parent reported)
Description: The Your Family and Household module of the National Survey of Children’s Health (NSCH) is sponsored by the United States Department of Health and Human Services (HHS), Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB). The survey asks adult respondents questions about their child’s physical and emotional health and well-being before the age of 18. Question topics specifically addressing ACES include asking if their child: experienced economic hardship; was treated unfairly because of race; had a parent or guardian divorced; had a parent or guardian die; had a parent or guardian spend time in jail; had and adult slap, hit kick, or punch them; was a victim of violence; lived with someone mentally ill; lived with a person with an alcohol or drug problem. A cumulative ACEs score is calculated for each respondent by counting the number of these items that a respondent reported experiencing, creating a score ranging from 0 to 9.
Data Limitations: The ACEs module captures adverse childhood experiences by asking parents about their child’s exposures. Limitations include: 1) relies on self-reported information, 2) provides prevalence, not incidence data, 3) based on population survey and are subject to both sampling and nonsampling error, 4) designed to provide state-level population health estimates and does not provide sub-state estimates. The data methodology for this indicator helps form a more comprehensive picture and differs from LGHCs other ACEs indicator. Data from the two should not be compared directly.
Indicator Source: National Survey of Children’s Health
Indicator Calculation Methodology: 9 questions about ACEs are condensed into an ordinal scale from 0 to 9 possible ACEs. This indicator shows the prevalence of children whose guardian/parent reported their child had one or more ACEs.
Data Collection Methodology:
Census NSCH Data Documentation; NSCH Methodology Report Sept. 2020 ; https://www.census.gov/programs-surveys/nsch/technical-documentation/complete-technical-documentation.html
Program URL Link:
Indicator: Proportion of adults reporting having been exposed to one or more adverse childhood experience before the age of 18 (adult retrospective)
Description: The ACEs module of the Behavioral Risk Factors Surveillance System (BRFSS) asks respondents questions about eight different traumatic childhood experiences that occurred before the age of 18. These include verbal/emotional abuse, physical abuse, sexual abuse, and negative household situations including the incarceration of an adult, alcohol or drug abuse by an adult, violence between adults, mental illness of a household member, and parental divorce or separation. A cumulative ACEs score is calculated for each respondent by counting the number of these items that a respondent reported experiencing, creating a score ranging from 0 to 8.
Data Limitations: The ACEs module is a “lagging” indicator capturing childhood experiences retrospectively by asking adults 18+ years of age. Additional limitations include: 1) relies on self-reported information, 2) provides prevalence, not incidence data, 3) bias or measurement error associated with telephone-administered survey of a sample of the population (e.g., response bias, sampling variation), 4) designed to provide state-level population health estimates and does not provide sub-state estimates or estimates by racial sub-groups (e.g., Asian sub-groups) unless multiple years are combined. The data methodology for this indicator helps form a more comprehensive picture and differs from LGHCs other ACEs indicator. Data from the two should not be compared directly.
Indicator Source: California Behavioral Risk Factor Surveillance System (BRFSS)
Indicator Calculation Methodology: 11 questions about ACEs are condensed into an ordinal scale from 0 to 8 possible ACEs. This indicator shows the prevalence of adults who reported having one or more ACEs. Other data cuts are also available, e.g., 3 or more ACEs.
Data Collection Methodology:
CDC BRFSS Data Documentation 2013; BRFSS User Guide June 2013; http://www.cdc.gov/brfss/data_documentation/index.htm
Program URL Link:
1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention (2020). About the CDC-Kaiser ACE Study. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/about.html.
2. Child and Adolescent Health Measurement Initiative. 2017-2018 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved September 21, 2020 from www.childhealthdata.org.
3. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health, 2, e356–66. Retrieved from https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30118-4/fulltext.
4. Center for Youth Wellness (n.d.). Data report: a hidden crisis: findings on adverse childhood experiences in California. Retrieved from https://centerforyouthwellness.org/wp-content/themes/cyw/build/img/building-a-movement/hidden-crisis.pdf.
5. Middlebrooks, J.S., & Audage, N.C. (2008). The effects of childhood stress on health across the lifespan. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Retrieved from https://stacks.cdc.gov/view/cdc/6978.
6. Substance Abuse and Mental Health Services Administration. (2012). Supporting infants, toddlers, and families impacted by caregiver mental health problems, substance abuse, and trauma: a community action guide. DHHS Publication No. SMA-12-4726. Rockville (MD): Substance Abuse and Mental Health Services Administration. Retrieved from https://store.samhsa.gov/product/supporting-infants-toddlers-families-impacted-caregiver-mental-health-problems-substance/SMA12-4726.
7. Wisconsin Department of Health Services, Division of Public Health, Office of Policy and Practice Alignment (2018). Wisconsin State Health Improvement Plan. Retrieved from https://healthy.wisconsin.gov/content/aces.
8. American Psychological Association. (n.d.). The road to resilience. Retrieved from http://www.apa.org/helpcenter/road-resilience.aspx.
9. Egerter, S., Barclay, C., Grossman-Kahn, R., & Braveman, P. (2011). How social factors shape health: violence, social disadvantage and health. Robert Wood Johnson Foundation. Retrieved from https://www.preventioninstitute.org/publications/how-social-factors-shape-health-violence-social-disadvantage-and-health.
10. California Department Public Health, Injury and Violence Prevention Branch and the California Department of Social Services, Office of Child Abuse Prevention, California Essentials for Childhood Initiative, the University of California, Davis Violence Prevention Research Program, the University of California, Firearm Violence Research Center. Adverse Childhood Experiences Data Report: Behavioral Risk Factor Surveillance System (BRFSS), 2011-2017: An Overview of Adverse Childhood Experiences in California. CA: California Department of Public Health and the California Department of Social Services; 2020. Retrieved from https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/SACB/CDPH%20Document%20Library/Essentials%20for%20Childhood%20Initiative/ACEs-BRFSS-Update_final%2010.26.20.pdf.
11. California Department Public Health, Maternal, Child and Adolescent Health Division. Maternal & Infant Health Assessment (MIHA). Retrieved from https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/Pages/default.aspx.
12. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. Behavioral Risk Factor Surveillance System ACE Data. Retrieved from https://www.cdc.gov/violenceprevention/aces/ace-brfss.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Face-brfss.html.
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