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]]
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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]]
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See the CDC's Adverse Childhood Experiences Prevention Resource for Action report,[[br]] [https://www.cdc.gov/violenceprevention/pdf/ACEs-Prevention-Resource_508.pdf].
