Prevalence of Adverse Childhood Experiences (Adult Retrospective), by County

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Learn More About Childhood Adversity and Resilience

Measures of Childhood Adversity and Resilience on
Childhood adversity and resilience measures on 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
Characteristics of Children with Special Needs
Child Abuse and Neglect
Family Structure
Food Security
Housing Affordability and Resources
Foster Care
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’s Research & Links section.

Sources for this narrative:

1.  Centers for Disease Control and Prevention. (2021). Adverse childhood experiences prevention strategy. Retrieved from:

2.  As cited on, Children with adverse experiences (parent reported), by number. (2023). 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:
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 2017-2021 show that, from birth until the time of survey, 40% of U.S. children had been exposed to one or more adverse childhood experiences (ACEs). In California, more than 1 in 3 children (34%) had at least one ACE, more than 1 in 7 (15%) had two or more ACEs, and 1 in 25 (4%) had four ACEs or more. Statewide and nationally, African American/black and Hispanic/Latino children are more likely to have two or more ACEs than their white peers.

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:
  • 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, survivor 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)
For more information, see’s Research & Links section or visit ACEs Aware, PACEs Connection, and Safe and Sound. Also see Policy Implications in’s Child and Youth Safety and Emotional and Behavioral Health topics.

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:

2.  Centers for Disease Control and Prevention. (2019). Preventing adverse childhood experiences (ACEs): Leveraging the best available evidence. Retrieved from:

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:

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:
Websites with Related Information
Key Reports and Research
County/Regional Reports
More Data Sources For Childhood Adversity and Resilience