Prevalence of adverse childhood experiences from the 2011-2014 behavioral risk factor surveillance system in 23 states
Open accessAbstract
Importance: Early adversity is associated with leading causes of adult morbidity and mortality and effects on life opportunities. Objective: To provide an updated prevalence estimate of adverse childhood experiences (ACEs) in the United States using a large, diverse, and representative sample of adults in 23 states. Design, Setting, and Participants: Data were collected through the Behavioral Risk Factor Surveillance System (BRFSS), an annual, nationally representative telephone survey on health-related behaviors, health conditions, and use of preventive services, from January 1, 2011, through December 31, 2014. Twenty-three states included the ACE assessment in their BRFSS. Respondents included 248 934 noninstitutionalized adults older than 18 years. Data were analyzed from March 15 to April 25, 2017. Main Outcomes and Measures: The ACE module consists of 11 questions collapsed into the following 8 categories: physical abuse, emotional abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce. Lifetime ACE prevalence estimates within each subdomain were calculated (range, 1.00-8.00, with higher scores indicating greater exposure) and stratified by sex, age group, race/ethnicity, annual household income, educational attainment, employment status, sexual orientation, and geographic region. Results: Of the 214 157 respondents included in the sample (51.51% female), 61.55% had at least 1 and 24.64% reported 3 or more ACEs. Significantly higher ACE exposures were reported by participants who identified as black (mean score, 1.69; 95% CI, 1.62-1.76), Hispanic (mean score, 1.80; 95% CI, 1.70-1.91), or multiracial (mean score, 2.52; 95% CI, 2.36-2.67), those with less than a high school education (mean score, 1.97; 95% CI, 1.88-2.05), those with income of less than $15 000 per year (mean score, 2.16; 95% CI, 2.09-2.23), those who were unemployed (mean score, 2.30; 95% CI, 2.21-2.38) or unable to work (mean score, 2.33; 95% CI, 2.25-2.42), and those identifying as gay/lesbian (mean score 2.19; 95% CI, 1.95-2.43) or bisexual (mean score, 3.14; 95% CI, 2.82-3.46) compared with those identifying as white, those completing high school or more education, those in all other income brackets, those who were employed, and those identifying as straight, respectively. Emotional abuse was the most prevalent ACE (34.42%; 95% CI, 33.81%-35.03%), followed by parental separation or divorce (27.63%; 95% CI, 27.02%-28.24%) and household substance abuse (27.56%; 95% CI, 27.00%-28.14%). Conclusions and Relevance: This report demonstrates the burden of ACEs among the US adult population using the largest and most diverse sample to date. These findings highlight that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others. Although identifying and treating ACE exposure is important, prioritizing primary prevention of ACEs is critical to improve health and life outcomes throughout the lifespan and across generations.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(98)00017-8 · Cited by 18,943 · see citing works
Child abuse: Adolescent records vs. adult recall
Femina, D. D., Yeager, C. A., & Lewis, D. O. (1990) · Child Abuse & Neglect · doi:10.1016/0145-2134(90)90033-p · Cited by 8,820 · see citing works
Sensitive questions in surveys.
Tourangeau, R., & Yan, T. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.5.859 · Cited by 3,057 · see citing works
Validity of adult retrospective reports of adverse childhood experiences: review of the evidence
Hardt, J., & Rutter, M. (2004) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2004.00218.x · Cited by 2,827 · see citing works
Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2015) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2015.0676 · Cited by 1,264 · see citing works
Cronholm, P. F., Forke, C. M., Wade, R., Bair-Merritt, M. H., Davis, M., Harkins-Schwarz, M., Pachter, L. M., & Fein, J. A. (2015) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.02.001 · Cited by 1,064 · see citing works
Garner, A. S., Shonkoff, J. P., Siegel, B., Dobbins, M. I., Earls, M. F., Garner, A. S., McGuinn, L. J., Pascoe, J. M., & Wood, D. L. (2011) · PEDIATRICS · doi:10.1542/peds.2011-2662 · Cited by 1,039 · see citing works
Adverse childhood experiences and life opportunities: shifting the narrative
Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017) · Children and Youth Services Review · doi:10.1016/j.childyouth.2016.10.021 · Cited by 713 · see citing works
Self-citationImproving the Adverse Childhood Experiences Study Scale
David Finkelhor, B., Shattuck, A., Turner, H. A., & Hamby, S. L. (2012) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.420 · Cited by 617 · see citing works
Childhood Adversity and Adult Chronic Disease
Gilbert, L. K., Breiding, M. J., Merrick, M. T., Thompson, W., Ford, D. C., Dhingra, S. S., & Parks, S. E. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.09.006 · Cited by 615 · see citing works
Self-citationAsmundson, G. J. G., & Afifi, T. O. (2020) · Elsevier eBooks · doi:10.1016/c2017-0-03827-2 · Cited by 580 · see citing works
National Center for Injury Prevention and Control (U.S.). Division of Violence Prevention., Fortson, B. L., Klevens, J., Merrick, M. T., Gilbert, L. K., & Alexander, S. P. (2016) · doi:10.15620/cdc.38864 · Cited by 334 · see citing works
Self-citationFord, D. C., Merrick, M. T., Parks, S. E., Breiding, M. J., Gilbert, L. K., Edwards, V. J., Dhingra, S. S., Barile, J. P., & Thompson, W. W. (2014) · Psychology of Violence · doi:10.1037/a0037723 · Cited by 301 · see citing works
Self-citationCapitalizing on Advances in Science to Reduce the Health Consequences of Early Childhood Adversity
Shonkoff, J. P. (2016) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2016.1559 · Cited by 283 · see citing works
Font, S. A., & Maguire‐Jack, K. (2015) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.05.013 · Cited by 252 · see citing works
Basile, K. C., DeGue, S. A., Jones, K., Freire, K. E., Dills, J., Smith, S. G., & Raiford, J. L. (2016) · doi:10.15620/cdc.39126 · Cited by 74 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Diamond, L. M., & Alley, J. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104720 · Cited by 412 · see citing works
Garner, A., Yogman, M., COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, Lavin, A., Askew, G. L., Baum, R. A., Berger-Jenkins, E., Johnson, T. J., Jutte, D., Nasir, A. A., et al. (2021) · Pediatrics · doi:10.1542/peds.2021-052582 · Cited by 392 · see citing works
Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review
Leza, L., Siria, S., López-Goñi, J. J., & Fernández-Montalvo, J. (2021) · Drug and alcohol dependence · doi:10.1016/j.drugalcdep.2021.108563 · Cited by 305 · see citing works
Xiao, Y., Cerel, J., & Mann, J. J. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.13513 · Cited by 166 · see citing works
Frequencies and patterns of adverse childhood events in LGBTQ+ youth
Craig, S. L., Austin, A., Levenson, J., Leung, V. W. Y., Eaton, A. D., & D’Souza, S. A. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104623 · Cited by 164 · see citing works
Cruz, D., Lichten, M., Berg, K., & George, P. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.800687 · Cited by 158 · see citing works
Gee, D. G. (2021) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2021.21090944 · Cited by 148 · see citing works
Moser, D. A., Glaus, J., Frangou, S., & Schechter, D. S. (2020) · European Psychiatry · doi:10.1192/j.eurpsy.2020.56 · Cited by 88 · see citing works
Grasso, D. J., Drury, S., Briggs-Gowan, M., Johnson, A., Ford, J., Lapidus, G., Scranton, V., Abreu, C., & Covault, J. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104604 · Cited by 65 · see citing works
ADHD and risk for subsequent adverse childhood experiences: understanding the cycle of adversity
Lugo‐Candelas, C., Corbeil, T., Wall, M., Posner, J., Bird, H., Canino, G., Fisher, P. W., Suglia, S. F., & Duarte, C. S. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13352 · Cited by 60 · see citing works
Guinn, A. S., Ports, K. A., Ford, D. C., Breiding, M., & Merrick, M. T. (2019) · Injury Prevention · doi:10.1136/injuryprev-2018-042927 · Cited by 57 · see citing works
Self-citationEarly childhood trauma, substance use and complex concurrent disorders among adolescents
Cabanis, M., Outadi, A., & Choi, F. (2021) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000718 · Cited by 47 · see citing works
Paternal adverse childhood experiences: Associations with infant DNA methylation
Merrill, S. M., Moore, S. R., Gladish, N., Giesbrecht, G. F., Dewey, D., Konwar, C., MacIssac, J. L., Kobor, M. S., & Letourneau, N. L. (2021) · Developmental Psychobiology · doi:10.1002/dev.22174 · Cited by 42 · see citing works
Jenkins, N. D. M., Rogers, E. M., Banks, N. F., Tomko, P. M., Sciarrillo, C. M., Emerson, S. R., Taylor, A., & Teague, T. K. (2021) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00123.2021 · Cited by 42 · see citing works
Hubel, G. S., Davies, F., Goodrum, N. M., Schmarder, K. M., Schnake, K., & Moreland, A. D. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.104877 · Cited by 48 · see citing works
Jones, M. S., Burge, S. W., Sharp, S. F., & McLeod, D. A. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2019.104237 · Cited by 34 · see citing works
Suglia, S. F., Appleton, A. A., Bleil, M. E., Campo, R. A., Dube, S. R., Fagundes, C. P., Heard-Garris, N. J., Johnson, S. B., Slopen, N., Stoney, C. M., et al. (2021) · Preventive Medicine · doi:10.1016/j.ypmed.2021.106736 · Cited by 31 · see citing works
Anderson, K. N., Swedo, E. A., Clayton, H. B., Niolon, P. H., Shelby, D., & McDavid Harrison, K. (2022) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.11.017 · Cited by 31 · see citing works
Roque-Lopez, S., Llanez-Anaya, E., Álvarez-López, M. J., Everts, M., Fernández, D., Davidson, R. J., & Kaliman, P. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105349 · Cited by 31 · see citing works
“In this study, 86.4% of participants reported 4 or more categories of ACEs, a level of trauma exposure which is found with a prevalence between 2 and 15% in the general population (Hughes et al., 2017; Kessler et al., 2010; Merrick et al., 2018).”
InfluentialCammack, A. L., Gazmararian, J. A., & Suglia, S. F. (2020) · Preventive Medicine · doi:10.1016/j.ypmed.2020.106176 · Cited by 21 · see citing works
Arslan, G., Özdemir Bişkin, S., & Kocaayan, F. (2025) · Children and Youth Services Review · doi:10.1016/j.childyouth.2024.108109 · Cited by 20 · see citing works
Rogers, E. M., Banks, N. F., Tomko, P. M., Sciarrillo, C. M., Emerson, S. R., Thomas, E. B. K., Taylor, A., Teague, T. K., & Jenkins, N. D. M. (2023) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00524.2022 · Cited by 11 · see citing works
Zota, A. R., Chu, M. T., Marfori, C. Q., Khati, N. J., Al-Hendy, A., & Taggart, T. (2022) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2022.04.028 · Cited by 7 · see citing works
Multidimensional ADHD Symptom Profiles: Associations with Adverse Childhood Experiences
Rodriguez, V. J., Basurto, K. S., Finley, J.-C. A., Liu, Q., Khalid, E., Halliburton, A. M., Tse, P. K. Y., Resch, Z. J., Soble, J. R., & Ulrich, D. M. (2025) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acae050 · Cited by 8 · see citing works
Addressing Intimate Partner Violence and Child Maltreatment: Challenges and Opportunities
Spearman, K. J., Alhusen, J. L., Ho, G. W. K., Smith, K. F., & Campbell, J. C. (2022) · Child Maltreatment · doi:10.1007/978-3-030-82479-2_16 · Cited by 6 · see citing works
Kallman, J., Mamey, M. R., Vanderbilt, D. L., Imagawa, K. K., Schonfeld, D. J., & Deavenport-Saman, A. (2025) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01655-1 · Cited by 1 · see citing works
Hong, S.-J., Vu, M. H., Vanderbilt, D., Yin, L., Imagawa, K. K., & Deavenport-Saman, A. (2025) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001395 · Cited by 1 · see citing works
Liu, H., Tang, J., Zhao, Z., Zhou, Y., Ding, H., Liu, N., Ji, Y., Wang, P., Wu, X., Liu, F., et al. (2026) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2026.101820
- Authors
- Merrick, M. T., Ford, D. C., Ports, K. A., & Guinn, A. S.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Merrick, Melissa T.
- ORCID
- Merrick, Melissa T.
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2018-11-01
- Volume
- 172
- Issue
- 11
- Pages
- 1038
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC6248156
- OpenAlex
- W2891121957
- Cited by
- 1,189
- References
- 16
- Citations by year
- 2026: 116 · 2025: 179 · 2024: 159 · 2023: 159 · 2022: 202 · 2021: 181 · 2020: 131 · 2019: 56 · 2018: 4 · 2012: 1
- FWCI
- 109.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Arizona Department of Health Services
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Social Sciences › Health › Intimate Partner and Family Violence
- Keywords
- adverse childhood experiences, childhood abuse, household dysfunction, domestic violence, parental separation, incarceration, racial and ethnic disparities, socioeconomic disparities, educational attainment, household income, sexual orientation, sex differences, adult health outcomes, Behavioral Risk Factor Surveillance System, United States adults
- MeSH terms
- Adverse Childhood Experiences, Adult, Black or African American, Female, Hispanic or Latino, Humans, Male, Risk Factors, Socioeconomic Factors, United States, Prevalence, Domestic Violence, Behavioral Risk Factor Surveillance System, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
