Prevalence of Adverse Childhood Experiences (Adult Retrospective), by Primary Health Care Coverage
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- Definition: Estimated percentage of adults with and without adverse childhood experiences (ACEs) before age 18, by presence of children ages 0-17 in the household, number of ACEs, and primary health insurance/source of care (e.g., in 2013-2019, among California adults ages 18 and older covered by Medi-Cal and living in households with children, 21.6% had been exposed to four or more ACEs).
- Data Source: California Dept. of Public Health, Injury and Violence Prevention Branch, California Behavioral Risk Factor Surveillance System custom tabulation (Apr. 2022).
- Footnote: This indicator reports on eight adverse childhood experiences: (1) parents were separated or divorced, (2) witnessed domestic violence in the home, (3) household member was mentally ill, (4) household member abused alcohol or drugs, (5) household member was sentenced to serve time in jail or prison, (6) experienced physical abuse at home, (7) experienced verbal abuse at home, (8) experienced sexual abuse. 'Military programs' include Dept. of Defense TRICARE and Dept. of Veterans Affairs (VA) programs. 'Indian, native, or tribal services' include the Indian Health Service. These estimates are based on a survey of the population and are subject to both sampling and nonsampling error. The notation S refers to estimates that have been suppressed because the margin of error is greater than 10 percentage points. The annotation [!] indicates that the margin of error is greater than 5 percentage points but not greater than 10 percentage points.
Learn More About Childhood Adversity and Resilience
- Measures of Childhood Adversity and Resilience on Kidsdata.org
Childhood adversity and resilience measures on kidsdata.org originate from three separate data sources and provide a rich and conceptually-related perspective on childhood adversity. Taken together, they present a broad framework to look at child adversity across the lifespan and provide useful data to inform and facilitate interventions. However, due to differences in methodology, data from the three sources should not be compared. The data sources are:Each of these data sources produces at least one overall index of childhood adversity. An overall index should be viewed as a more comprehensive measure than any of its individual items because it captures the cumulative magnitude of experiencing hardships.
NSCH data are collected by the U.S. Census Bureau on behalf of the Maternal and Child Health Bureau of the Department of Health and Human Services. NSCH uses a set of family, economic, and community adversity indicators to ask parents about current adverse experiences to which their children (ages 0 to 17) have been exposed. This is the most direct population-based survey measure of adversity among California children because it asks parents about the trauma their children have experienced while they are still children, compared with more traditional methods of asking adults to recall their childhood experiences.
MIHA is a collaborative effort of the Maternal, Child and Adolescent Health Division and the Women, Infant and Children Division of the California Department of Public Health and the Center on Social Disparities in Health at UC San Francisco. MIHA surveys postpartum women (ages 15 and older) who deliver a live birth about their own childhood hardships prior to age 14.
The BRFSS ACEs Module is adapted from the Adverse Childhood Experiences (ACEs) study by Kaiser Permanente and the Centers for Disease Control and Prevention. The data presented here were prepared by the California Department of Public Health’s Injury and Violence Prevention Branch. They are based on adult recollections of their childhood experiences during the first 17 years of life and thus do not provide direct information about the current status of California’s children.
NSCH, MIHA, and BRFSS data together provide a comprehensive framework for understanding and addressing child adversity across the lifespan. Among these three data sources, NSCH indicators are the most contemporary because they tap into parents’ views of their children’s current experiences. MIHA adds an intergenerational perspective by providing information about childhood hardships experienced by mothers of newborns. BRFSS provides a well-established standard measure of adult retrospective reports of adverse childhood experiences. Both NSCH and MIHA include a wider range of potentially adverse experiences, such as exposure to extreme poverty, community violence, and food and housing insecurity, whereas BRFSS focuses primarily on family dysfunction. Each source provides a unique but conceptually-related perspective on childhood adversity.
- Childhood Adversity and Resilience
- Children with Adverse Experiences (Parent Reported), by Number (CA & U.S. Only)
- Children with Adverse Experiences (Parent Reported), by Type (CA & U.S. Only)
- Children with Two or More Adverse Experiences (Parent Reported), by Race/Ethnicity (CA & U.S. Only)
- Children Who Are Resilient (Parent Reported)
- Prevalence of Childhood Hardships (Maternal Retrospective)
- Basic Needs Not Met (Maternal Retrospective)
- Parental Drinking or Drug Problem (Maternal Retrospective)
- Parental Legal Trouble or Incarceration (Maternal Retrospective)
- Parental Divorce or Separation (Maternal Retrospective)
- Family Hunger (Maternal Retrospective)
- Moved Due to Problems Paying Rent or Mortgage (Maternal Retrospective)
- Foster Care Placement (Maternal Retrospective)
- Prevalence of Adverse Childhood Experiences (Adult Retrospective; CA Only)
- Characteristics of Children with Special Needs
- Child Abuse and Neglect
- Family Structure
- Food Security
- Housing Affordability and Resources
- Foster Care
- First Entries into Foster Care
- Children in Foster Care
- Foster Youth in Public Schools
- Timely Medical Exams for Children in Foster Care
- Timely Dental Exams for Children in Foster Care
- Median Number of Months in Foster Care
- Number of Placements After One Year in Foster Care
- Placement Distance from Home After One Year in Foster Care
- Exit Status One Year After Entry into Foster Care
- Exit Status Four Years After Entry into Foster Care
- Re-Entries into Foster Care
- Length of Time from Foster Care to Adoption
- Intimate Partner Violence
- Why This Topic Is Important
Childhood adversity—such as poverty, maltreatment, experiences of racism, exposure to violence, and growing up with substance abuse or mental illness at home—can have negative, long-term impacts on health and well being (1, 3). More than one-third of children statewide and nationally have had at least one adverse childhood experience (ACE) (2). Early experiences affect brain structure and function, which provide the foundation for learning, emotional development, behavior, and health (3). The toxic stress associated with traumatic and often prolonged early adverse experiences can disrupt healthy development and lead to behavioral, emotional, academic, and health problems during childhood and adolescence (1, 3). It also can lead to serious behavioral, emotional, and health issues in adulthood, such as chronic diseases, obesity, substance abuse, and depression (1, 3). The more traumatic childhood events experienced, the more likely the impact will be substantial and lasting, especially if the child does not receive buffering supports (3).
Resilience—adapting well in the face of adversity, trauma, threats, or other significant sources of stress—involves a combination of internal and external factors (3). Internal factors go beyond biological predispositions and encompass adaptive responses—thoughts, actions, and habits that can be taught, learned, and developed by anyone—to interrupt the harmful effects of ACEs and toxic stress (3). Externally, having safe, stable, nurturing relationships and environments within and outside the family can reduce ACEs and strengthen resilience (1, 3).For more information, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Centers for Disease Control and Prevention. (2021). Adverse childhood experiences prevention strategy. Retrieved from: https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-Plan_Final_508.pdf
2. As cited on kidsdata.org, Children with adverse experiences (parent reported), by number. (2022). National Survey of Children's Health.
3. Bhushan, D., et al. (2020). Roadmap for resilience: The California Surgeon General's report on adverse childhood experiences, toxic stress, and health. Office of the California Surgeon General. Retrieved from: https://osg.ca.gov/sg-report
- How Children Are Faring
Childhood adversity is common, and many children experience multiple adverse circumstances or events that can pose a lifelong threat to their well being. The most timely assessment of childhood adversity comes from the National Survey of Children's Health (NSCH), in which parents report on the current status of their children ages 0-17. NSCH estimates from 2016-2020 show that, from birth until the time of survey, 42% of U.S. children had been exposed to one or more adverse childhood experiences (ACEs). In California, more than 1 in 3 children (36%) had at least one ACE, more than 1 in 7 (15%) had two or more ACEs, and nearly 1 in 25 (4%) had four ACEs or more. Statewide and nationally, African American/black children were more likely than their Hispanic/Latino and white peers to have two or more ACEs.
At the local level, the share of children with two or more adverse experiences ranged from fewer than 1 in 8 (12%) to more than 1 in 4 (29%) across regions with data, according to estimates based on the 2016-2019 NSCH.
The California Behavioral Risk Factor Surveillance System (BRFSS) ACEs Module, in which adults reflect on their own adverse experiences before age 18 using a related but distinct set of ACEs, shows that in 2013-2019 an estimated 67% of California adults living in households with children had at least one ACE, and 18% had at least four ACEs. Among adults in households with children, those with lower educational attainment or lower household income were more likely to have four or more BRFSS ACEs, as were those with Medi-Cal or without any health care coverage when compared with privately-insured adults.
- Policy Implications
In recent years, policymakers, researchers, and other leaders increasingly have focused on childhood adversity (e.g., abuse, neglect, caregiver substance abuse or mental illness, and exposure to violence), recognizing that it can have harmful, lifelong consequences (1, 2). Children exposed to multiple adverse childhood experiences (ACEs) are more likely to develop negative health behaviors and chronic diseases in adulthood (1, 2). Unaddressed ACEs place strain on public systems and have been estimated to cost more than $112 billion annually in California alone (1, 2). Policymakers and leaders in multiple sectors have a role in helping to prevent ACEs, as well as in ensuring early identification and intervention for children and families affected by trauma (1, 2). Community conditions can help prevent and buffer the effects of adversity, or increase the risk for additional trauma; policymakers also can work to reduce these risk factors (1, 3, 4).
California has taken major steps to address adversity and its associated health- and development-disrupting stress, setting an ambitious goal to cut ACEs and toxic stress in half in one generation (1). The state has passed legislation to support early identification and intervention for ACEs and toxic stress, and made substantial investments in screening, research, and other cross-sector efforts (1). Still, ACEs remain common among California children, with children of color and those in poverty disproportionately impacted by adversity and trauma (1, 3). Continued efforts are needed to ensure that all families have the opportunity to help their children thrive and reach their full potential (1, 3).
Policy and program options to help prevent, interrupt, and mitigate the effects of childhood adversity include continuing to:
For more information, see kidsdata.org’s Research & Links section or visit ACEs Aware, PACEs Connection, and Safe and Sound. Also see Policy Implications in kidsdata.org’s Child and Youth Safety and Emotional and Behavioral Health topics.
- Raise public awareness about the serious risks of ACEs and toxic stress, ways to reduce these risks, and positive social norms that protect against adversity (1, 2, 3)
- Promote safe, nurturing family relationships and environments by ensuring that effective, resilience-building prevention services are in place, including skill-based parent training, home visiting, preschool with family engagement, and social support programs (1, 2, 4)
- Support policies that help reduce family stress and increase stability for children, e.g., improving the social safety net for families, increasing access to affordable housing, strengthening family-friendly business practices, and ensuring quality child care is affordable and accessible (1, 2, 4)
- Provide safe, positive environments and access to supportive adults at school and in the community, with opportunities for social-emotional learning and a range of services to meet student needs, along with meaningful afterschool and mentoring programs (1, 2, 3)
- Institutionalize trauma-informed policies and practices (designed specifically to address the consequences of trauma and facilitate resilience and healing) across public and private systems and organizations that serve children and families (1, 4)
- Support workforce education on trauma-informed approaches to ACEs and toxic stress for health care providers, educators, administrators, social services staff, law enforcement and juvenile justice staff, and other professionals who work with children and families (1, 4)
- Advance the statewide ACEs Aware screening initiative, supporting multi-sector coordination to improve interventions for ACEs and toxic stress, coordination of care, and reimbursement for services (1)
- Promote strategies to ensure that all children and families have access to culturally responsive, trauma informed, and resilience-building mental health care, substance abuse treatment, victim services, and other community resources (1, 2)
- Increase collaboration across sectors to reduce community risk factors for ACEs and to remove systemic barriers to preventing and treating trauma (1, 2, 3, 4)
- Advance research on measuring, preventing, and mitigating ACEs and toxic stress, with a focus on reducing inequities and building resilience to prevent and buffer against adversity (1, 4)
Sources for this narrative:
1. Bhushan, D., et al. (2020). Roadmap for resilience: The California Surgeon General's report on adverse childhood experiences, toxic stress, and health. Office of the California Surgeon General. Retrieved from: https://osg.ca.gov/sg-report
2. Centers for Disease Control and Prevention. (2019). Preventing adverse childhood experiences (ACEs): Leveraging the best available evidence. Retrieved from: https://stacks.cdc.gov/view/cdc/82316
3. Sims, J., & Aboelata, M. J. (2020). Beyond screening: Achieving California's bold goal of reducing exposure to childhood trauma. Prevention Institute & California Funders Workgroup on Prevention and Equity. Retrieved from: https://preventioninstitute.org/publications/beyond-screening-achieving-californias-bold-goal-reducing-exposure-childhood-trauma
4. National Academies of Sciences, Engineering, and Medicine. (2019). Vibrant and healthy kids: Aligning science, practice, and policy to advance health equity. National Academies Press. Retrieved from: https://www.nap.edu/catalog/25466/vibrant-and-healthy-kids-aligning-science-practice-and-policy-to
- Research & Links
- Websites with Related Information
- ACEs Aware. UCLA-UCSF ACEs Aware Family Resilience Network.
- California Dept. of Social Services: Office of Child Abuse Prevention
- California Essentials for Childhood (EfC) Initiative. California Dept. of Public Health & California Dept. of Social Services.
- Center on the Developing Child. Harvard University.
- Centers for Disease Control and Prevention: Adverse Childhood Experiences (ACEs)
- Changing Minds. Futures Without Violence.
- Child and Adolescent Health Measurement Initiative: Flourishing in Action
- Child Welfare Information Gateway. U.S. Dept. of Health and Human Services, Children’s Bureau.
- National Child Traumatic Stress Network. UCLA & Duke University.
- PACEs Connection
- Robert Wood Johnson Foundation: Adverse Childhood Experiences
- Safe and Sound
- Strategies Technical Assistance
- Key Reports and Research
- ACE Screening Implementation How-To Guide. ACEs Aware.
- Adult Health Burden and Costs in California During 2013 Associated with Prior Adverse Childhood Experiences. (2020). PLoS ONE. Miller, T. R., et al.
- Adverse Childhood Experiences Data Report: Behavorial Risk Factor Surveillance System (BRFSS), 2013-2019. (2022). California Essentials for Childhood Initiative.
- Beyond Screening: Achieving California's Bold Goal of Reducing Exposure to Childhood Trauma. (2020). Prevention Institute & California Funders Workgroup on Prevention and Equity. Sims, J., & Aboelata, M. J.
- California Essentials for Childhood Case Study: Collective Impact Through Strategic Opportunities. (2019). International Journal on Child Maltreatment: Research, Policy and Practice. Abbott, M., & Wirtz, S.
- Child Well-Being and Adverse Childhood Experiences in the U.S. (2017). Academic Pediatrics. Solloway, M. R., et al. (Eds.)
- Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. (2019). Morbidity and Mortality Weekly Report. Merrick, M. T., et al.
- Evaluating Community-Based Family Support Networks to Reduce Adverse Childhood Experiences. Mathematica Policy Research.
- Home Visiting Is a Valuable Investment in California’s Families. (2018). California Budget and Policy Center. Hutchful, E.
- How to Implement Trauma-Informed Care to Build Resilience to Childhood Trauma. (2019). Child Trends. Dym Bartlett, J., & Steber, K.
- Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence. (2019). Centers for Disease Control and Prevention.
- Receipt of Behavioral Health Services Among U.S. Children and Youth with Adverse Childhood Experiences or Mental Health Symptoms. (2021). JAMA Network Open. Finkelhor, D., et al.
- Resources to Support Children’s Emotional Well-Being amid Anti-Black Racism, Racial Violence, and Trauma. (2020). Child Trends. Parris, D., et al.
- Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. (2020). Office of the California Surgeon General. Bhushan, D., et al.
- The Promise of Adolescence: Realizing Opportunity for All Youth. (2019). National Academies Press. National Academies of Sciences, Engineering, and Medicine.
- Transforming Practice with HOPE (Healthy Outcomes from Positive Experiences). (2021). Maternal and Child Health Journal. Burstein, D., et al.
- Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity. (2019). National Academies Press. National Academies of Sciences, Engineering, and Medicine.
- County/Regional Reports
- Data Briefs on Adverse Childhood Events Among California’s Children. (2014). Child and Adolescent Health Measurement Initiative.
- More Data Sources For Childhood Adversity and Resilience
- California Behavioral Risk Factor Surveillance System. California Dept. of Public Health.
- Maternal and Infant Health Assessment (MIHA). California Dept. of Public Health & University of California San Francisco.
- National Survey of Children's Health. Child and Adolescent Health Measurement Initiative.
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