In the recent Centers for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report (MMWR), researchers provided adverse childhood experience (ACE) prevalence estimates for adult United States (U.S.) residents by sociodemographic variables.
Study: Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. Image Credit: AfricaStudio/Shutterstock.com
Background
ACEs are characterized as avoidable, potentially devastating events that happen to individuals before the age of 18 and are linked to a variety of detrimental consequences. ACE inequalities are frequently attributed to the economic and social situations in which certain groups of families reside.
Understanding the frequency of adverse childhood experiences by sociodemographic variables is critical for treating and mitigating ACEs and reducing inequities; however, population-level ACE data are limited.
About the report
In the present report, researchers provided ACE estimates for adults residing in the 50 states of the U.S. and the District of Columbia (D.C.).
Data were obtained from the 2011-2020 Behavioral Risk Factor Surveillance System (BRFSS) yearly surveys of non-institutionalized individuals living in the U.S.
Countries and territories may include jurisdiction-authorized additional sections along with jurisdiction-incorporated topics and the fundamental questions presented every year to all respondents.
Between 2011 and 2020, all U.S. states included ACEs items in the Behavioral Risk Factor Surveillance System survey a minimum of once, either as part of a separate option (between 2011 and 2012 and from 2019 to 2020) or as jurisdiction-included items (between 2013 and 2018). The latest year of data was chosen for countries that contained ACE items beyond one year.
The additional ACEs modules comprised 11.0 questions designed to assess exposure to different ACEs: sexual assault, emotional abuse, physical attack, witnessing domestic violence, drug use in the family, family mental disorders, parental divorce or separation, and imprisoned family members.
Scores for ACEs were determined by accumulating affirmative replies to all the ACE categories and subsequently categorizing them as none, one ACE, two or three ACEs, or at least four ACEs.
Given the evidence connecting at least four ACEs to unfavorable life and health outcomes, four were chosen as the higher limit. Individual and total ACE score prevalence estimates were adjusted for weighting by jurisdictional and sociodemographic factors (age, sex, race, ethnicity, yearly family income, level of education, and job status). In addition, estimates of age-stratified regional prevalence for at least four ACEs were calculated.
Results
Individuals with inadequate information on any form of ACE (79,797) were eliminated, resulting in a sample population of 264,882 (73.0%).
The survey's response rate varied by jurisdiction, ranging from 31% in 2017 in Illinois to 67% in 2020 in Mississippi. Approximately 64% of U.S. individuals had at least one ACE: 23% had one, 24% had two to three, and 17% had at least four.
Females (19%), individuals aged between 25.0 and 34.0 years (25%), non-Hispanic American Indians or Alaska Natives (32%), multicultural adults (32%), non-Hispanic multicultural adults (32%), adults with annual incomes below $15,000.0 (24.0%), adults who had not attained high school-level education (21%), and jobless individuals (26%) or not able to find employment (29%), had the highest incidence of at least four ACEs.
The incidence of at least four adverse childhood experiences was lowest in individuals aged 65.0 years and older (7.70%). Emotional abuse (34.0%), parental divorce or separation (28%), and drug use in the family (27%) were the most prevalent ACE types.
The prevalence of various categories of ACEs varied according to sociodemographic factors. The prevalence estimates for at least four ACEs varied significantly between countries, ranging from 12% in New Jersey (N.J.) to 23% in Oregon. Emotional assault was prevalent in Alaska (42%), but recorded harm was relatively low (19%).
Geographic trends in having at least four ACEs varied by age, with persistent regional disparities reported by age (e.g., higher prevalence of at least four ACEs among Pacific Northwestern region residents).
Individual and overall ACE incidence patterns differed by jurisdictional and sociodemographic variables, underscoring the need for jurisdictional and regional ACE data collection to guide focused prevention and reduce disparities.
The CDC recently issued avoidance resources, such as Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence, to assist countries and local governments in providing the most effective strategies for avoiding violence along with other ACEs and advice regarding strategy implementation to the greatest possible effect.
Conclusions
Based on the report's findings, ACEs are a significant risk for adults in the U.S., with two-thirds reporting at least one ACE and one out of six reporting at least four ACEs.
These ACEs are highest among women, individuals aged 25 to 34, non-Hispanic American Indian or Alaska Native adults, non-Hispanic multiracial adults, adults with less than a high school education, and unemployed or unable-to-work adults.
The CDC highlighted the necessity of collecting ACE information at the local and population levels for tailored prevention and interventional measures.
Factors such as demographic patterns, domestic violence policies, historical trauma, social conditions, and economic support for families contribute to ACEs. The CDC's Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence provides strategies for preventing and mitigating ACEs, particularly among disproportionately affected populations.
Physicians and other health experts are critical to minimizing and avoiding ACEs, ensuring access to healthcare services, and addressing detected concerns.
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