Adverse Childhood Experiences Resources

Related Pages

Fact Sheet:

CDC Reports:

Case Studies:
The state case studies provide detailed descriptions of how selected states have valued and used ACE data to inform their child abuse and neglect prevention efforts.

Morbidity and Mortality Weekly Reports (MMWRs):

ACEs Questionnaires:
The questionnaires are not copyrighted, and there are no fees for their use. If you include the ACE Study questionnaires in your research, a copy of the subsequent article(s) is requested (send to dvpinquiries@cdc.gov).

The Family Health History and Health Appraisal questionnaires were used to collect information on child abuse and neglect, household challenges, and other socio-behavioral factors in the original CDC-Kaiser ACE Study.

The BRFSS ACE module was adapted from the original CDC-Kaiser ACE Study and is used to collect information on child abuse and neglect and household challenges.

Commentary:

Overview:

Chronic Disease:

Autoimmune Disease

Cancer

Chronic Obstructive Pulmonary Disease

Disability

Frequent Headaches

Health-Related Quality of Life

Ischemic Heart Disease

Liver Disease

Health Risk Behaviors:

Alcohol Abuse

Drug Abuse

Obesity

Sexual Risk Behavior

Smoking

Life Opportunities:

Mental Health:

Depression/Depressed Affect

Hallucinations

Neurobiology

Suicidality

Methodological Issues:

ACE Screeners

Age Cohort Differences

Assessment of Mediating Pathways

Basis for ACE Score

Bias Assessment

Consistency by Birth Cohort

Interrelation of ACEs

Severity and Frequency of Violent Experience

Test-Retest Reliability

Reproductive Health/Sexual Behavior:

Fetal Death

Multiple Sex Partners

Sexual Risk Behaviors in Women

Sexually Transmitted Diseases

Teen Pregnancy

Unintended Pregnancy

Special Populations:

Children Living with Parents Who Have Alcohol Use Disorder

Child Sexual Abuse Victims

Children Exposed to Parental Incarceration

Children with Disabilities

Men Who Have Sex with Men

Victimization and Perpetration:

Intimate Partner Violence

Sexual Violence

Other Health and Social Issues:

CDC Data Sources:

  • Behavioral Risk Factor Surveillance System (BRFSS)
    The BRFSS is an annual, state-based, random-digit-dial telephone survey that collects self-reported data from non-institutionalized U.S. adults regarding health conditions and risk factors. ACEs data have been included on state BRFSS surveys since 2009.
  • Multiple Cause of Death or Mortality File
    This is a portal to the online data dissemination activities of the Division of Vital Statistics, including both interactive online data access tools and downloadable public use data files. Data related to child abuse deaths can be queried using these tools.
  • National Health Interview Survey Injury Section (NHIS)
    The NHIS has monitored the health of the nation since 1957. NHIS data on a broad range of health topics are collected through personal household interviews. Recent survey years include data on adverse experiences like neighborhood violence, parental incarceration, household mental illness or substance use, food insecurity, and poverty.
  • National Hospital Ambulatory Medical Care Survey (NHAMCS)
    NHAMCS collects data on the use and provision of ambulatory care services in hospital emergency and outpatient departments and ambulatory surgery locations. Some years include the International Classification of Diseases (ICD) reason for visit code, which can be used to look at child abuse and neglect.
  • National Hospital Discharge Survey (NHDS)
    NHDS was a national probability survey designed to meet the need for information on characteristics of inpatients discharged from non-Federal short-stay hospitals in the United States. The dataset contains information on injury-related hospital stays; first and second diagnosis (ICD- 9CM including e-codes) codes can be used to look at child abuse and neglect.
  • National Violent Death Reporting System (NVDRS)
    NVDRS links information about the “who, when, where, and how” from data on violent deaths and provides insights about “why” they occurred. Includes information on such variables as victim-perpetrator relationship, suspect information when available, mechanism, and toxicology. Some states have added a child abuse and neglect module.
  • Pregnancy Risk Assessment Monitoring System (PRAMS)
    PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. Some states have added ACEs items.
  • Violence Against Children Survey (VACS)
    VACS is a nationally representative survey of children 13-24, that measures physical, emotional, and sexual violence against girls and boys.
  • Youth Risk Behavior Surveillance System (YRBSS)
    YRBSS monitors health risk behaviors that contribute to the leading causes of death, disability, and social problems among 9th through 12th grade students in the United States. State and national datasets include self-reported data on past 12-month incidence of interpersonal violence victimization, dating violence, and sexual assault. Some local and state health departments have included ACEs questions.

Other Federal Data Sources:

  • The Adoption and Foster Care Analysis and Reporting System (AFCARS)external icon
    AFCARS collects case-level information from state and tribal title IV-E agencies on all children in foster care and those who have been adopted with title IV-E agency involvement. Data reported include demographic information on the foster child as well as the foster and adoptive parents, the number of removal episodes, the number of placements in the current removal episode, and the current placement setting.
  • Health Care Costs and Utilization Project (HCUP) National Inpatient Sample (NIS)external icon
    HCUP includes the largest collection of longitudinal hospital care data in the United States. ICD codes can be used to examine abusive head trauma, child abuse, and neglect.
  • Longitudinal Studies of Child Abuse and Neglect (LONGSCAN)external icon
    The goal of LONGSCAN is to follow the 1300+ children and their families until the children themselves become young adults. Maltreatment data are collected from multiple sources, including review of Child Protective Service records every two years. Yearly telephone interviews allow the sites to track families and assess yearly service utilization and important life events.
  • National Child Abuse and Neglect Data System (NCANDS)external icon
    NCANDS is a federally sponsored effort that annually collects and analyzes data on child abuse and neglect known to child protective services (CPS) agencies in the United States.
  • National Crime Victimization Survey (NCVS)external icon
    NCVS is the primary source of information on criminal victimization in the U.S. NCVS collects information from victims aged 12 years and older about incidents of nonfatal personal crimes, including physical and sexual abuse, both reported and not reported to police.
  • National Electronic Injury Surveillance System (NEISS)external icon
    NEISS collects data on all injuries and any illnesses if the incident is related to a consumer product, medical device, or recreational or work activity. It includes information on the intent and external cause of the injury, which can be used to look at child abuse and neglect.
  • National Epidemiological Survey on Alcohol and Related Conditions Wave 3 (NESARC-III)external icon
    The NESARC-III is cross-sectional, based on a nationally representative sample of the civilian noninstitutionalized population of the United States aged 18 years and older. The survey contains 29 questions pertaining to 10 ACE categories (child abuse, neglect, and household challenges).
  • National Incidence Study (NIS)external icon
    The NIS studies are designed to estimate the incidence of child maltreatment in the United States more broadly by including both cases that are reported to the authorities as well as those that are not. NIS datasets contain measures related to abuse and neglect.
  • National Longitudinal Survey of Youth (NLSY 79)external icon
    The NLSY79 is a nationally representative sample of 12,686 young men and women who were 14-22 years old when they were first surveyed in 1979. These individuals were interviewed annually through 1994 and are currently interviewed on a biennial basis. In 2012, ACE-related questions were asked, including childhood physical abuse, household alcohol abuse, household mental illness, and emotional neglect.
  • National Longitudinal Survey of Young Adultsexternal icon
    In 1986, a separate survey of all children born to NLSY79external icon female respondents began. In addition to all the mother’s information from the NLSY79, the child survey includes assessments of each child as well as additional demographic and development information collected from either the mother or child. In 2012 and 2014, respondents were asked ACE-related questions, including items assessing mental illness and substance abuse in household, physical abuse, emotional neglect, and family conflict.
  • National Survey of Child and Adolescent Well-Being (NSCAW 1, 2, 3)external icon
    NSCAW is a nationally representative, longitudinal survey of children and families who have been the subjects of investigation by Child Protective Services. NSCAW examines child and family well-being outcomes in detail and seeks to relate those outcomes to experience with the child welfare system and to family characteristics, community environment, and other factors. ACE-related items include neglect, abuse, and household challenges, as reported by parents, caregivers or caseworkers.

Non-Federal Data Sources:         

  • Adolescent Brain Cognitive Development Study (ABCD)external icon
    The ABCD Study is the largest long-term study of brain development and child health in the United States. ACEs assessed include physical abuse, sexual abuse, household violence, household substance abuse, mental illness in household, incarcerated household member, emotional neglect, and physical neglect.
  • Monitoring the Future Study (MTF)external icon
    MTF is an ongoing study of the behaviors, attitudes, and values of Americans from adolescence through adulthood. Adverse experiences measured by MTF include physical violence victimization.
  • National Comorbidity Survey – adolescent supplement (NCS-A)external icon
    NCS-A was designed to estimate the lifetime-to-date and current prevalence, age-of-onset distributions, course, and comorbidity of DSM-IV disorders in the child and adolescent years of life among adolescents in the United States; to identify risk and protective factors for the onset and persistence of these disorders; to describe patterns and correlates of service use for these disorders; and to lay the groundwork for subsequent follow-up studies that can be used to identify early expressions of adult mental disorders. The dataset includes variables assessing interpersonal violence (physical abuse by caregiver, physical assault by romantic partner, other physical assault, mugged/ threatened with weapon), rape, sexual assault, being stalked, and witnessing domestic violence.
  • National Longitudinal Study of Adolescent Health (Add Health)external icon
    Add Health is a longitudinal study of a nationally representative sample of adolescents in grades 7-12 in the United States during the 1994-95 school year. Wave IV variables include childhood/adolescent adversities, such as death of a parent or caregiver, parental incarceration, death of a sibling, sexual violence victimization, child abuse, and neglect.
  • National Survey of Children’s Exposure to Violence (NatSCEV)external icon
    NatSCEV, funded by the Office of Juvenile Justice and Delinquency Prevention and the CDC, is designed to document the incidence and prevalence of children’s exposure to violence, with special emphasis on exposure to domestic and community violence.
  • National Survey of Children’s Health (NSCH)external icon
    NSCH provides data on multiple, intersecting aspects of children’s lives including physical and mental health, access to quality health care, and the child’s family, neighborhood, school, and social context. NSCH is funded and directed by the Health Resources and Services Administration (HRSA)external iconMaternal and Child Health Bureau (MCHB)external icon. NSCH measures household challenges, such as socioeconomic hardship, parental separation or divorce, substance abuse in the household, witnessing neighborhood violence, witnessing domestic violence, incarcerated parent, racial or ethnic discrimination, and death of a parent.
  • Project on Human Development in Chicago Neighborhoods (PHDCN)external icon
    PHDCN is an interdisciplinary study of how families, schools, and neighborhoods affect child and adolescent development. In particular, the Project examined the pathways to juvenile delinquency, adult crime, substance abuse, and violence. ACE items measured included household mental illness, parental incarceration, witnessed violence, and parental report of children’s exposure to physical and sexual violence.
  • Rochester Youth Development Study (RYDS)external icon
    RYDS was initiated in 1986 to study the causes and consequences of delinquency and drug use in an urban sample of adolescents. ACE measures included neglect and physical and sexual abuse.
  • Rochester Intergenerational Study (RIGS)external icon
    The intergenerational component of the RYDS examines the development of antisocial behavior in a three-generation prospective panel study, by making the children of the original subjects of the RYDS the focal subjects of a long-term study. Adverse experience items included family conflict, harsh parenting, and financial strain.

CDC Resources:

  • Child Development
    CDC’s Web page on child development includes information on developmental milestones, screening, and positive parenting.
  • Developmental Milestones
    Interactive web resource developed by CDC’s Division of Birth Defects and Developmental Disabilities to support parents and caregivers understand important child development milestones.
  • Essentials for Childhood
    Framework proposes strategies that communities can consider to promote the types of relationships and environments that help children grow to be healthy and productive citizens so that they, in turn, can build stronger and safer families and communities for their children.
  • Essentials for Parenting Toddlers and Preschoolers
    CDC’s Web resource on strategies parents can use to help build a safe, stable, and nurturing relationship with their child. Includes information on common parenting challenges and solutions. Also available Spanish.
  • Parent’s Portal
    A wealth of information from across all of CDC, covering everything from safety at home and the community to immunization schedules and developmental milestones.

CDC Trainings and Tools:

  • ACEs Trainings
    These online trainings are designed to help users understand, recognize, and prevent ACEs from occurring in the first place. There is an introductory Training Module as well as modules with information for professionals working directly with and on behalf of kids and families.
  • ACE Study Infographic
    Visual, interactive representation of data from the 1995-1997 CDC-Kaiser Permanente study on Adverse Childhood Experiences prevalence and relationship to health outcomes.
  • ACEs Snapshot
    Interactive tool that provides insight into how ACEs can be prevented and how to minimize negative effects.
  • Connecting the Dots
    A free, online training that helps users explore shared risk and protective factors across multiple forms of violence.
  • Making the Case: Engaging Businesses
    A free online resource that explains how communities can work with the business sector to assure safe, stable, nurturing relationships, and environments for all children and families.
  • Principles of Prevention
    Online training on how to apply key concepts of primary prevention, the public health approach, and the social-ecological model for violence prevention work.
For more free, online trainings, tools, and resources, see CDC’s VetoViolence website.

 

Other Federal Resources:

Tribal Government Resources:

  • National Indian Health Board ACEs Hubexternal icon
    This information hub includes a “resource basket” designed for American Indian and Alaska Native individuals, families, communities, professionals, and leaders that can assist Tribes to learn more about ACEs, research, tools, and interventions.

Presentation Graphics

Association Between ACEs and Negative Outcomes

How can we prevent child abuse and neglect?

Source: Fortson, B. L., Klevens, J., Merrick, M. T., Gilbert, L. K., & Alexander, S. P. (2016). Preventing child abuse and neglect: A technical package for policy, norm, and programmatic activities. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

ACE Pyramid

Prevalence of ACEs by Category for CDC-Kaiser ACE Study Participants, Waves 1 and 2.

types-of-aces-abuse-household-challenges-neglect

Note: Research papers that use Wave 1 and/or Wave 2 data may contain slightly different prevalence estimates.

Source: Centers for Disease Control and Prevention, Kaiser Permanente. The ACE Study Survey Data [Unpublished Data]. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2016.

ACE Score Prevalence for CDC-Kaiser ACE Study Participants, Waves 1 and 2.

ACE Score Prevalence for CDC-Kaiser ACE Study Participants, Waves 1 and 2.

Note: Research papers that use Wave 1 and/or Wave 2 data may contain slightly different prevalence estimates.

Source: Centers for Disease Control and Prevention, Kaiser Permanente. The ACE Study Survey Data [Unpublished Data]. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2016.

States Collecting BRFSS ACE Data by Year, 2009-2018.

ACEs Map BRFFS

Prevalence of ACEs by Category for Participants Completing the ACE Module on the 2010-2014 BRFSS.

prevalence of aces by category abuse household challenge

Note: Reports and articles that use data from other years and/or other states may contain different estimates.

Source: Merrick, M.T., Ford, D.C., Ports, K. A., Guinn, A. S. (2018). Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States. JAMA Pediatrics, 172(11), 1038-1044.

ACE Score Prevalence for Participants Completing the ACE Module on the 2011-2014 BRFSS.

how common are ace

Note: Reports and articles that use data from other years and/or other states may contain different estimates.
Source: Merrick, M.T., Ford, D.C., Ports, K. A., Guinn, A. S. (2018). Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States. JAMA Pediatrics, 172(11), 1038-1044.

Page last reviewed: April 10, 2020
Content source: National Center for Injury Prevention and Control, Division of Violence Prevention