Adverse childhood experiences (ACEs) are preventable, potentially traumatic events before age 18. Decades of research — mostly in adults — show they harm health and narrow life chances: about two thirds of U.S. adults report at least one, and 17% report four or more. But data on adolescents have mostly come from parents, and left out key violence-related ACEs such as abuse. This report gives the first national estimates of ACEs reported by high school students themselves.
Image from the Centers for Disease Control and Prevention
Why ask teenagers directly? Their experiences are recent, so recall is better than adults looking back decades; they may know things their parents don't; and parents may be the ones responsible for abuse or neglect.
The survey
- 2023 Youth Risk Behavior Survey (YRBS): 20,103 students in grades 9–12, nationally representative; the analysis kept the 17,838 who were under 18.
- Eight ACEs, adapted from the original CDC–Kaiser Permanente ACE Study and tested with high school students: emotional, physical and sexual abuse; physical neglect; witnessing intimate partner violence; household substance use; household poor mental health; and a parent or guardian incarcerated or detained.
- 16 outcomes, mostly in the past year or month: weapon carrying, fighting, electronic vapor product use, drinking, binge drinking, prescription opioid misuse, sexual risk behaviors, weight, persistent sadness or hopelessness, and suicidal thoughts and attempts.
How common ACEs are
- 76.1% — three in four — had at least one ACE; 18.5% — nearly one in five — had four or more.
| ACE | Students |
|---|---|
| Emotional abuse | 61.5% |
| Physical abuse | 31.8% |
| Household poor mental health | 28.4% |
| Household substance use | 25.1% |
| Witnessed intimate partner violence | 18.6% |
| Parent or guardian incarcerated or detained | 14.5% |
Who is most affected — four or more ACEs:
- female students — 23.9% (and more of every ACE except physical neglect);
- American Indian or Alaska Native students — 28.1%, though they also had the highest share with none (30.9%);
- multiracial students — 25.9%;
- LGBQ+ students, especially those who describe their identity some other way (38.6%) and bisexual students (35.1%).
Asian students had the lowest rates of several ACEs — sexual abuse, witnessed partner violence, household substance use and poor mental health, and parental incarceration — yet, with Black students, the highest rate of physical abuse (38.2%). Such patterns suggest prevention should be tailored to cultural context, not one-size-fits-all.
By age, only household substance use and household poor mental health rose between students 14 and under and those 17 — more likely growing awareness than more exposure, which supports preventing ACEs early in childhood.
ACEs and health
The more ACEs, the stronger the links — a dose-response pattern. Even one ACE raised the prevalence of 10 of 16 outcomes, and four or more raised 15 of 16; the strongest links were with attempted suicide (adjusted prevalence ratio 12.42), seriously considering suicide and prescription opioid misuse.
What preventing ACEs could do — the share of each outcome associated with having any ACE:
| Outcome | Potential reduction |
|---|---|
| Attempted suicide | 89.4% |
| Seriously considered suicide | 85.4% |
| Prescription opioid misuse | 84.3% |
| Alcohol or drug use before last sex | 80.2% |
| Electronic vapor product use | 73.2% |
| Persistent sadness or hopelessness | 65.6% |
| Carrying a weapon at school | 65.2% |
| Binge drinking | 64.5% |
| No condom at last sex | 64.0% |
| Overweight or obesity | 4.2% |
Every outcome except the weight-related ones exceeded 50%. Students with four or more ACEs were also more likely to have overweight or obesity, suggesting obesity programs could address ACEs too — for example, with social workers helping families reach benefits such as the Supplemental Nutrition Assistance Program or Women, Infants, and Children, and trauma-informed care.
Preventing ACEs
Every child deserves safe, stable, nurturing relationships and environments — and preventing ACEs could also cut many other health problems. CDC's Preventing Adverse Childhood Experiences Resource for Action sets out evidence-based strategies: economic supports for families, social norms that protect against ACEs, a strong start for children, teaching skills, connecting youth to caring adults and activities, and lessening the harms when ACEs happen. For the most common ACEs, that could mean parenting and family-relationship programs against emotional abuse, high-quality child care to reduce physical abuse and help household mental health, and family-centered treatment for substance use.
Limitations
- Eight categories cannot capture every trauma, or how severe it was.
- The data are cross-sectional: some ACEs may have come after the outcome, so links are correlations, not proof of cause.
- Social determinants of health that drive both ACEs and outcomes could not be assessed.
- Young people with many ACEs may be more often in the justice system, unstably housed or absent from school — and missed by a school survey, so ACEs may be underreported.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.
Sources
Based on "Adverse Childhood Experiences and Health Conditions and Risk Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2023," by Elizabeth A. Swedo, Sanjana Pampati, Kayla N. Anderson and colleagues, MMWR Supplements 73(4), Centers for Disease Control and Prevention; a work of the United States government in the public domain.
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