Definition

Adverse Childhood Experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years) such as experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide. Also included are aspects of the child's environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance misuse, mental health problems, or instability due to parental separation or incarceration of a parent, sibling or other member of the household.

Numerator

The BRFSS respondents who responded affirmatively to the eleven questions in the Adverse Childhood Experience (ACE) Module.

Denominator

The number of adults aged 18 and above who participated in the BRFSS.

Data Interpretation Issues

The Adverse Childhood Experiences (ACEs) Module was included in the Utah BRFSS in 2013, 2016, 2018, 2020, and 2022. '''ACEs Module Questions:'''[[br]] Looking back before you were 18 years of age--- # Did you live with anyone who was depressed, mentally ill, or suicidal? # Did you live with anyone who was a problem drinker or alcoholic? # Did you live with anyone who used illegal street drugs or who abused prescription medications? # Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility? # Were your parents separated or divorced? # How often did your parents or adults in your home ever slap, hit, kick, punch or beat each other up? # Before age 18, how often did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way? Do not include spanking. # How often did a parent or adult in your home ever swear at you, insult you, or put you down? # How often did anyone at least 5 years older than you or an adult, ever touch you sexually? # How often did anyone at least 5 years older than you or an adult, try to make you touch sexually? # How often did anyone at least 5 years older than you or an adult, force you to have sex?[[br]] [[br]] In the 2022 survey, the three sexual abuse questions were combined into one, How often did anyone at least 5 years older than you or an adult, ever touch you sexually, OR ever try to make you touch them sexually, OR force you to have sex? '''Module Weaknesses:''' * Limited to specific more common adversities * Severity or frequency of potential trauma is unknown * All experiences are weighted equally * Module does not account for protective factors in the past that might prevent or mitigate the negative long-term impacts of childhood adversities.

Why Is This Important?

Childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. Exposure to ACEs may result in toxic stress responses that can impede a child's development, such as changes in gene expression, changes in brain connectivity and immune function, and changes in the type of coping strategies adopted. While many coping strategies are healthy and help reduce acute stress, some (e.g. smoking cigarettes, drinking alcohol, using substances, engaging in risky sexual behavior) present additional risks to health and wellbeing. As such, exposure to early adversity can increase the risk of later chronic and infectious health conditions through changes in physiological mechanisms, as well as increased engagement in health risk behaviors, and can ultimately result in premature death. ACEs are common; as nearly two-thirds (63.9%) of surveyed U.S. adults experienced at least one ACE and many adults experienced more than one. Some populations are more vulnerable, however, to experiencing ACEs, such as children living in poverty and racial and ethnic minorities, because of the structural and social conditions in which some children and families live, learn, work, and play. It is important to remember that ACEs are preventable, and when present their effects can be mitigated with the help of healthy relationships.

How Do We Compare With the U.S.?

When comparing BRFSS data, the prevalence of 4+ ACEs in Utah is higher than nationally (18.8% vs 17.3%). National prevalence comes from a 2023 Swedo EA, Aslam MV, Dahlberg LL, et al. study that included 2011-2020 BRFSS data from 25 states, while Utah prevalence is from the ACEs Module included in the Utah BRFSS in 2018, 2020, and 2022. Source: Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults---Behavioral Risk Factor Surveillance System, 2011-2020. MMWR Morb Mortal Wkly Rep 2023;72:707-715. DOI: [http://dx.doi.org/10.15585/mmwr.mm7226a2].

Evidence-based Practices

Promote safe stable nurturing relationships and environments for all children by: # Strengthening Economic Support for Families # Promoting Social Norms that Protect Against Violence and Adversity # Ensuring a Strong Start for Children # Teaching Skills # Connecting Youth to Caring Adults and Activities, and # Intervening to Lessen Immediate and Long-term Harms.[[br]] [[br]] See the CDC's Adverse Childhood Experiences Prevention Resource for Action report,[[br]] [https://www.cdc.gov/violenceprevention/pdf/ACEs-Prevention-Resource_508.pdf].

Available Services

The Violence and Injury Prevention Program housed in the Utah Department of Health and Human Services in coordination with the Utah Coalition for Protecting Childhood (UCPC) has developed a State Action Plan for the Primary Prevention of Child Maltreatment in Utah utilizing the CDC's Essentials for Childhood framework. This plan includes specific strategies and approaches to preventing ACEs and mitigating their negative effects by creating safe, stable, and nurturing relationships and environments for all Utah children. The state plan can be found at [https://vipp.utah.gov/essentials-for-childhood/ucpc/]. This is a sensitive topic. If you need information or help finding support for your own experiences of childhood adversity please call 1-800-422-4453.

Relevant Population Characteristics

As the number of ACEs increases so does the risk of injury, sexually transmitted infections (including HIV), mental health problems, maternal and child health problems, teen pregnancy, involvement in sex trafficking, a wide range of chronic diseases, and dying from one of the leading causes of death (such as cancer, diabetes, heart disease, and suicide). ACEs can also negatively impact education, employment, and earnings potential. However, it is important to remember that the presence of ACEs does not mean a child will experience poor outcomes. The presence of positive childhood experiences and protective factors like healthy connections can prevent and mitigate the negative effects of childhood adversity.

The most common ACE experienced by adults in Utah in 2022 was emotional abuse with 44.5% indicating a parent or adult in the home had sworn at them, insulted them, or put them down before the age of 18. The next most prevalent ACEs in Utah were physical abuse, household substance abuse, and household mental illness (30.5%, 27.7%, and 27.5%). Compared to national data using the most recent BRFSS data from 25 states (2011-2020), Utahns had a higher prevalence of emotional abuse (44.5% vs 34.0% nationally), household mental illness (27.5% vs 17.3% nationally), physical abuse (30.5% vs 23.3% nationally), domestic violence (19.6% vs 17.2% nationally), and incarcerated household member (10.3% vs 8.6% nationally). Nationally, there was a higher prevalence of parental separation/divorce (28.4% vs 25.9% in Utah). The prevalences were about the same for sexual abuse (12.6% nationally vs 12.3% in Utah) and household substance abuse (26.5% nationally vs 27.7% in Utah). *Note this figure uses just the most recent year of Utah BRFSS data (2022) to reflect the national study design. Utah data, however, has changed significantly for all of the captured ACEs since the first year this data was collected in 2013. It is supposed that the same changes in openness to reporting childhood adversity would have happened nationally, so comparing data from different years across the country might not be the best approach. For better comparison with the other figures in this indicators report using the last three years of Utah data (2018, 2020, and 2022), Utah BRFSS respondents indicated the following prevalence of each of the different ACEs: 41.5% experienced emotional abuse, 25.3% experienced household substance misuse, 26.3% experienced household mental illness, 24.1% experienced parental separation/divorce, 25.4% experienced physical abuse, 17.6% witnessed domestic violence, 14.3% experienced sexual abuse, and 9.2% experienced an incarcerated household member.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   [[br]][[br]] Source of national data: Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults---Behavioral Risk Factor Surveillance System, 2011-2020. MMWR Morb Mortal Wkly Rep 2023;72:707-715. DOI: [http://dx.doi.org/10.15585/mmwr.mm7226a2].

In Utah, 65.7% of adults have experienced at least one ACE, and over one in four have experienced three or more (28.5%). Among Utah women, 31.2% experienced three or more ACEs compared with 25.8% of men, a statistically significant difference. Females affirmed experiencing more household substance abuse, house mental illness, domestic violence, and emotional abuse. Also, females were two times more likely to affirm experiencing sexual abuse than males. Males affirmed experiencing more physical abuse and incarcerated household members.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   [[br]][[br]] Age-adjusted to the U.S. 2000 standard population.

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

Adults who report being Hispanic/Latino are impacted with an increased prevalence of 4+ ACEs compared with the state as a whole (21.7% vs 18.7%).

Data Notes

All questions refer to the time period before respondents were 18 years of age.   [[br]][[br]] The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores. Age-adjusted to the U.S. 2000 standard population.

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

Adults who report being American Indian or Alaska Native are impacted with the highest numbers of ACEs, with 30.5% having 4+ ACEs; followed by Black at 25.9%.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   [[br]][[br]] The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores. Age-adjusted to the U.S. 2000 standard population based on 3 age groups: 18-34, 35-49, and 50+.

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

Compared to those with no disabilities, individuals with one or more disabilities indicated a statistically higher prevalence of experiencing all eight of the surveyed ACEs with sexual abuse being more than two times more prevalent (25.0% vs 11.9%).

Data Notes

All questions refer to the time period before respondents were 18 years of age.   [[br]][[br]] Age-adjusted to the U.S. 2000 standard population.

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

ACEs are common across all sociodemographic characteristics, yet some populations are more vulnerable to experiencing ACEs, such as children living in poverty and racial and ethnic minorities, because of the structural and social conditions in which some children and families live, learn, work, and play. Lower-income households are impacted with significantly more ACEs than the state as a whole, 27.3% of adults living in households making less than $25,000 affirmed 4+ ACEs.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   [[br]][[br]] The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores. Age-adjusted to the U.S. 2000 standard population.

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

Some local health districts (LHDs) are significantly impacted by higher or lower prevalence than the state overall. LHDs with a statistically higher prevalence of high ACE scores (4+ ACEs) include Salt Lake County and Weber-Morgan. LHDs with a statistically lower prevalence of high ACE scores include Central Utah, Summit County, and Utah County.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   [[br]][[br]] The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores. Age-adjusted to the U.S. 2000 standard population.

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

To facilitate data reporting at the community level, Utah has been divided into 99 Small Areas. These areas are determined based on specific criteria, including population size, political boundaries of cities and towns, and economic similarity. Some Utah Small Areas are significantly impacted by higher or lower prevalence than the state overall. The Utah Small Areas with statistically higher prevalence of high ACE scores (4+ ACEs) include Brigham City, South Ogden, Riverdale, West Valley (East) V2, South Salt Lake, Salt Lake City (Sugar House), Murray, and Sandy (West). The Utah Small Areas with a statistically lower prevalence of high ACE scores include Woods Cross/West Bountiful, Bountiful, Millcreek (East), Sandy (Northeast), Eagle Mountain/Cedar Valley, Saratoga Springs, and Delta/Fillmore.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   [[br]][[br]]*Use caution in interpreting; the estimate has a coefficient of variation > 30% and is therefore deemed unreliable by Utah Department of Health and Human Services standards. **The estimate has been suppressed because 1) the relative standard error is greater than 50% or 2) the observed number of events is very small and not appropriate for publication. The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores. Age-adjusted to the U.S. 2000 standard population. A description of the Utah Small Areas may be found on IBIS at the following URL: [https://ibis.utah.gov/ibisph-view/resource/Guidelines.html].

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]