Building infrastructure for surveillance of adverse and positive childhood experiences: integrated, multimethod approaches to generate data for prevention action.
Open accessAbstract
Adverse and positive childhood experiences have a profound impact on lifespan health and well-being. However, their incorporation into ongoing population-based surveillance systems has been limited. This paper outlines critical steps in building a comprehensive approach to adverse and positive childhood experiences surveillance, provides examples from the Preventing Adverse Childhood Experiences: Data to Action cooperative agreement, and describes improvements needed to optimize surveillance data for action. Components of a comprehensive approach to adverse and positive childhood experiences surveillance include revisiting definitions and measurement, including generating and using uniform definitions for adverse and positive childhood experiences across data collection efforts; conducting youth-based surveillance of adverse and positive childhood experiences; using innovative methods to gather and analyze near real-time data; leveraging available data, including from administrative sources; and integrating data on community- and societal-level risk and protective factors for adverse childhood experiences, including social and health inequities such as racism and poverty, as well as policies and conditions that create healthy environments for children and families. Comprehensive surveillance data on adverse and positive childhood experiences can inform data-driven prevention and intervention efforts, including focusing prevention programming and services to populations in greatest need. Data can be used to evaluate progress in reducing the occurrence of adverse childhood experiences and bolstering the occurrence of positive childhood experiences. Through expansion and improvement in adverse and positive childhood experiences surveillance-including at federal, state, territorial, tribal, and local levels-data-driven action can reduce children's exposure to violence and other adversities and improve lifelong health and well-being.
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Collection of ACE data among adolescents decreases recall bias, improves the ability to track trends in ACEs over time, and permits quicker assessment of the impact of current prevention and mitigation efforts in disproportionately affected populations.
“Collection of ACE data among adolescents decreases recall bias, improves the ability to track trends in ACEs over time, and permits quicker assessment of the impact of current prevention and mitigation efforts in disproportionately affected populations (9).”
From Adverse childhood experiences and health conditions and risk behaviors among high school students—Youth Risk Behavior Survey, United States, 2023 (2024) · cites this paper as [9]
The section on proximal surveillance says collecting ACE data from adolescents can reduce recall bias relative to retrospective adult surveys and make data more useful for monitoring trends and informing current prevention. The paper links assessment of prevention efforts in disproportionately affected communities to comprehensive surveillance, not adolescent data collection alone; its section on timely methods also notes that youth-survey data may take 1–2 years to become available. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPopulation-level estimates of ACEs among adolescents and their effects have largely been limited to parent-report or a small number of ACEs.
“Population-level estimates of ACEs among adolescents and their effects have largely been limited to parent-report or a small number of ACEs (8).”
From Adverse childhood experiences and health conditions and risk behaviors among high school students—Youth Risk Behavior Survey, United States, 2023 (2024) · cites this paper as [8]
The Introduction (page unavailable) says population-level data collected during childhood and adolescence are less available, and the Definitions and Measurement section says surveillance largely measures the original 10 ACE types. The Moving Toward Proximal Surveillance section (page unavailable) contrasts adolescent reports with parent reports, but does not establish that adolescent population estimates have largely relied on parents or that estimates of ACEs’ effects in adolescents share these limitations. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe 2023 Youth Risk Behavior Survey (YRBS) is a cross-sectional, school-based survey conducted biennially since 1991 with a nationally representative sample of public and private school students in grades 9-12 in the 50 U.S. states and the District of Columbia.
“This report includes data from the 2023 Youth Risk Behavior Survey (YRBS) (N = 20,103), a cross-sectional, school-based survey conducted biennially since 1991.”
From Adverse childhood experiences and health conditions and risk behaviors among high school students—Youth Risk Behavior Survey, United States, 2023 (2024) · cites this paper as [8]
The Introduction section on proximal surveillance identifies the Youth Risk Behavior Survey as an existing youth-based survey and discusses its 2021 state and local administrations. It does not establish that the survey is cross-sectional, school-based, or biennial since 1991, nor does it describe the 2023 sample, its size, or its national representativeness. No page number is available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCollecting and analyzing self-reported ACEs data among adolescents is valuable because of the proximity of the event to the time of report and adolescents' knowledge of their own experiences that might be unknown to or not disclosed by their parents.
“Collecting and analyzing self-reported ACEs data among adolescents is valuable for several reasons, most notably the proximity of the event to the time of report and adolescents’ knowledge of their own experiences that might be unknown to or not disclosed by their parents (9).”
From Adverse childhood experiences and health conditions and risk behaviors among high school students—Youth Risk Behavior Survey, United States, 2023 (2024) · cites this paper as [9]
Retrospective reports of ACEs on surveys require adults to recall events that occurred decades ago, introducing the potential for significant recall bias.
“Retrospective reports of ACEs on surveys, such as the Behavioral Risk Factor Surveillance System (BRFSS), require adults to recall events that occurred decades ago, introducing the potential for significant recall bias (9).”
From Adverse childhood experiences and health conditions and risk behaviors among high school students—Youth Risk Behavior Survey, United States, 2023 (2024) · cites this paper as [9]
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References 59 · Cited by 31
Research works printed but not linked: 4
- [3]Asmundson GJG, Afifi TO. Adverse Childhood Experiences: Using Evidence to Advance Research, Practice, Policy, and Prevention. London, United Kingdom: Elsevier Academic Press, 2020.
- [7]Holden GW, Gower T, Chmielewski M. Methodological considerations in ACEs research. In: Asmundson GJ, Afifi TO, eds. Adverse Childhood Experiences: Using Evidence to Advance Research, Practice, Policy, and Prevention. London, United Kingdom: Elsevier Academic Press, 2020: 161– 182.
- [8]Afifi TO. Considerations for expanding the definition of ACEs. In: Asmundson GJ, Afifi TO, eds. Adverse Childhood Experiences: Using Evidence to Advance Research, Practice, Policy, and Prevention. London, United Kingdom: Elsevier Academic Press, 2020: 35– 44.
- [53]Wolfersteig W, Moreland D, Diaz M, Gotlieb E. Prevent Abuse of Children Text and Chat Hotline (PACTECH) Project. Scottsdale, AZ: ChildHelp National Child Abuse Hotline, 2021. https://www.childhelp.org/wp-content/uploads/2021/04/April-2021-PACTECH-Quarterly-Data-Report.pdf. Accessed January 21, 2022.
- Authors
- Anderson, K. N., Swedo, E. A., Clayton, H. B., Niolon, P. H., Shelby, D., & McDavid Harrison, K.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Anderson, Kayla N.
- ORCID
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 62
- Issue
- 6
- Pages
- S31-S39
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC9210215
- OpenAlex
- W4280564474
- Cited by
- 31
- References
- 59
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 11 · 2023: 3 · 2022: 8
- FWCI
- 5.71
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Preventive Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by-nc-nd)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Keywords
- adverse childhood experiences, positive childhood experiences, surveillance systems, near real-time data, administrative data, risk and protective factors, racism, poverty, childhood violence, data integration
- MeSH terms
- Adverse Childhood Experiences, Adolescent, Child, Humans, Population Surveillance, Poverty, Violence, Protective Factors
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