Prevalence of adverse childhood experiences among U.S. adults—Behavioral Risk Factor Surveillance System, 2011–2020.

Swedo, Elizabeth A.; Aslam, Maria V.; Dahlberg, Linda L.; Niolon, Phyllis Holditch; Guinn, Angie S.; Simon, Thomas R.; Mercy, James A.

doi:10.15585/mmwr.mm7226a2

Cited by 386Child Abuse and TraumaChild Welfare and AdoptionIntimate Partner and Family Violence

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Prevalence of adverse childhood experiences among U.S. adults—Behavioral Risk Factor Surveillance System, 2011–2020.

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Swedo, Elizabeth A., Aslam, Maria V., Dahlberg, Linda L., Niolon, Phyllis Holditch, Guinn, Angie S., Simon, Thomas R., Mercy, James A.·2023·MMWR Morbidity and Mortality Weekly Report

DOI 10.15585/mmwr.mm7226a2PMC PMC10328489

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Abstract

Adverse childhood experiences (ACEs) are defined as preventable, potentially traumatic events that occur among persons aged <18 years and are associated with numerous negative outcomes; data from 25 states indicate that ACEs are common among U.S. adults (1). Disparities in ACEs are often attributable to social and economic environments in which some families live (2,3). Understanding the prevalence of ACEs, stratified by sociodemographic characteristics, is essential to addressing and preventing ACEs and eliminating disparities, but population-level ACEs data collection has been sporadic (1). Using 2011-2020 Behavioral Risk Factor Surveillance System (BRFSS) data, CDC provides estimates of ACEs prevalence among U.S. adults in all 50 states and the District of Columbia, and by key sociodemographic characteristics. Overall, 63.9% of U.S. adults reported at least one ACE; 17.3% reported four or more ACEs. Experiencing four or more ACEs was most common among females (19.2%), adults aged 25-34 years (25.2%), non-Hispanic American Indian or Alaska Native (AI/AN) adults (32.4%), non-Hispanic multiracial adults (31.5%), adults with less than a high school education (20.5%), and those who were unemployed (25.8%) or unable to work (28.8%). Prevalence of experiencing four or more ACEs varied substantially across jurisdictions, from 11.9% (New Jersey) to 22.7% (Oregon). Patterns in prevalence of individual and total number of ACEs varied by jurisdiction and sociodemographic characteristics, reinforcing the importance of jurisdiction and local collection of ACEs data to guide targeted prevention and decrease inequities. CDC has released prevention resources, including Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence, to help provide jurisdictions and communities with the best available strategies to prevent violence and other ACEs, including guidance on how to implement those strategies for maximum impact (4-6).

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Approximately two thirds of U.S. adults have experienced at least one ACE and 17% have experienced four or more ACEs.
“Approximately two thirds of U.S. adults have experienced at least one ACE and 17% of U.S. adults have experienced four or more ACEs (4).”
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 [4]

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“(Aslam et al., 2024; Swedo et al., 2023).”
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Influential
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Influential
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“Based on 2011– 2020 BRFSS data, Swedo et al. have reported a prevalence of ≥ 1 adverse childhood experiences (ACEs) in 70% of US adults and ≥ 4 in 17% of US adults [24].”
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“Some earlier studies have examined the ACE data in the BRFSS that we examine below [36–38].”
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“The most endorsed ACE types were emotional abuse (25%), emotional neglect (20%), and physical abuse (17%), which align with findings from other community-based samples of Asian Americans (J. Lee & Choi, 2018; Nagaraj et al., 2019; Santoro et al., 2021; Swedo et al., 2023).”
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“For overlapping years, the difference between percentage of adults with past exposure to 4+ACEs from this study and from Swedo et al was greatest for Nevada (10.7 percentage points), of which 2.”
ResultInfluential
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Authors: Swedo, E. A., Aslam, M. V., Dahlberg, L. L., Niolon, P. H., Guinn, A. S., Simon, T. R., & Mercy, J. A.
Corresponding author: Swedo, Elizabeth A.
ORCID: Swedo, Elizabeth A.
Aslam, Maria V.
Niolon, Phyllis Holditch
Simon, Thomas R.
Mercy, James A.
Venue: MMWR Morbidity and Mortality Weekly Report
Publisher: Centers for Disease Control MMWR Office
Published: 2023-06-30
Volume: 72
Issue: 26
Pages: 707-715
ISSN: 0149-2195 (ISSN-L)
1545-861X
DOI: 10.15585/mmwr.mm7226a2
PMC: PMC10328489
OpenAlex: W4382632554
Cited by: 386
References: 7
Citations by year: 2026: 146 · 2025: 147 · 2024: 86 · 2023: 7
FWCI: 112.53
Type: journal article
Language: en
Open access: diamond
doi.org
Locations: MMWR Morbidity and Mortality Weekly Report (publishedVersion)
PubMed Central (publishedVersion, public-domain)
PubMed (publishedVersion)
Funders: State of Connecticut Department of Public Health
Louisiana Department of Health
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Topics: Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Sociology and Political Science › Child Welfare and Adoption
Social Sciences › Health › Intimate Partner and Family Violence
Keywords: adverse childhood experiences, prevalence, sociodemographic disparities, American Indian and Alaska Native adults, unemployment, educational attainment, sex differences, state-level variation, Behavioral Risk Factor Surveillance System
MeSH terms: Adverse Childhood Experiences, Adult, Female, Humans, Violence, Prevalence, Behavioral Risk Factor Surveillance System

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Prevalence of adverse childhood experiences among U.S. adults—Behavioral Risk Factor Surveillance System, 2011–2020.

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