Adverse Childhood Experiences Across America, 2011–2020

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events before age 18, linked to many harms later in life. Earlier data from 25 states showed they were common; differences between groups often reflect the social and economic conditions some families live in. Using the Behavioral Risk Factor Surveillance System (BRFSS) for 2011–2020, CDC produced the first estimates for all 50 states and the District of Columbia.

What was measured

BRFSS is an annual survey of adults' health risks and chronic conditions. Its ACE questions — asked in every state at least once in the decade — cover eight types:

A person's score is the number of types they reported, grouped as 0, 1, 2–3, or 4 or more — the level most research links to harm. Where a state asked more than once, its latest year was used. 264,882 adults answered every question.

How common

63.9% of U.S. adults reported at least one ACE:

The most common types were emotional abuse (34.0%), parental separation or divorce (28.4%) and household substance abuse (26.5%).

Who reported the most

Four or more ACEs were most common among:

The far lower figure among older adults might reflect recall, real change over time — or early death: people with six or more ACEs die about 20 years earlier on average than those with none.

By state

Among states that asked all eight questions, four or more ACEs ranged from 11.9% in New Jersey to 22.7% in Oregon, and the mix of types varied: Alaska, for instance, had one of the highest rates of emotional abuse (42.2%) but one of the lower rates of physical abuse (19.4%). Some regional patterns held across age groups — higher rates in the Pacific Northwest, for example. Differences may reflect demographics, policies on domestic violence, economic support for families, historical and ongoing discrimination, and social conditions.

Prevention

CDC's Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence sets out strategies to prevent ACEs and soften their effects, especially among the groups hit hardest. States can set their ACE data beside other BRFSS measures such as the social determinants of health. Clinicians and others who work with families can help at every stage — from home visiting programs that prevent ACEs to trauma-informed care and links to services that reduce their harm.

Limits

1. Data span ten years; rates may have changed where data are old, and adults may have grown up in a different state.
2. Arkansas and New Hampshire asked some questions differently; New Hampshire had no emotional abuse or divorce questions.
3. 79,797 people with missing answers were excluded — and they reported more ACEs on the questions they did answer, so the figures may be underestimates.
4. People may not remember, or want to disclose, childhood trauma.
5. BRFSS covers only some ACEs — not racism, discrimination or community violence, for example — and not their severity or frequency.

Sources

Based on Swedo EA, Aslam MV, Dahlberg LL, Niolon PH, Guinn AS, Simon TR, Mercy JA, "Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020," MMWR Morbidity and Mortality Weekly Report volume 72, number 26, Centers for Disease Control and Prevention (as corrected); a work of the United States government in the public domain.