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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“…63 % of our participants experienced at least one ACE (vs. 63.9 % in U.S. adults [27]), 17 % experienced 4 + ACEs (vs. 17.3 % of U.S. adults [27]), and 33 % experienced physical or sexual abuse (vs. 23.3 % of U.S. adults experiencing physical abuse and 12.6 % experiencing sexual abuse [27]).”
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Parental Aggravation and Adverse Childhood Experiences as Influential Factors in Adolescent Depression and Anxiety
Reis, V., Llorens, C., Soto, P., Dunn, A. L., Jimenez, S., Starr, A., Burgoa, S., Lewis, K., & Sacca, L. (2025) · Youth · doi:10.3390/youth5040120 · Cited by 1
“Adverse childhood experiences (ACE) are defined as preventable and potentially traumatic events experienced by individuals less than 18 years old (Swedo, 2023).”
Safety Net Programs as Primary Prevention Against Adverse Childhood Experiences (ACEs) in the United States: Natural Experiments with Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP)
Jahangir, T., Woods-Jaeger, B. A., Komro, K. A., & Livingston, M. D. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22111750 · Cited by 1
Childhood trauma and risky sexual behaviors: Comparing positive and negative emotion-related processes
Avalos, I. F., & Johnson, P. S. (2025) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107804 · Cited by 1
Unveiling the Veil: Exploring ethical leadership in a context of abuse and depravity
Chibaya, S. (2025) · International Journal of Educational Research Open · doi:10.1016/j.ijedro.2025.100558 · Cited by 1
From Adversity to Purpose: How Self-compassion and Age Influence Meaning in Life Among Adults with Adverse Childhood Experiences
Gentry, M. M., Manjanatha, D., Patapoff, M. A., & Palmer, B. W. (2025) · Journal of Adult Development · doi:10.1007/s10804-025-09547-5 · Cited by 2
Enhanced trauma‐informed policing (E‐ TIP ): A neurocognitive, organizational, and leadership framework for advancing officer well‐being and public safety
Brooker, M., & Mack, G. I. (2025) · Journal of Forensic Sciences · doi:10.1111/1556-4029.70245 · Cited by 2
“In the United States, approximately 50% of adults re - port experiencing at least one traumatic event in their lifetime [ 1 ], and over 17% report having been exposed to four or more adverse child - hood experiences [ 2 ].”
Adverse Childhood Experiences and Depressive Symptoms Among Older Korean Americans in Affordable Senior Housing: The Moderating Role of Social Networks and Family Solidarity
Rhee, M., Park, J., Park, H., Lee, I., & Jang, Y. (2025) · Journal of Applied Gerontology · doi:10.1177/07334648251412078 · Cited by 1
“There is considerable variation in ACEs across sociodemographic groups, with higher rates reported among individuals in low SES and racial and ethnic minority groups (Felitti et al., 1998; Petruccelli et al., 2019; Swedo et al., 2023).”
The indirect effect of emotion regulation on the association between adverse childhood experiences and food addiction
Ghaffari, N., Hassija, C. M., & Lee, A. A. (2026) · Appetite · doi:10.1016/j.appet.2026.108455 · Cited by 1
Early Intervention Providers’ Use of Trauma-Informed Care: A Qualitative Exploration
Chudzik, M., Williams, C. S., & Holden, E. A. L. (2026) · Journal of Early Intervention · doi:10.1177/10538151251407395 · Cited by 1
“Estimates of adults’ exposure to trauma vary, but recent studies have suggested that between 50% and 70% of adults in the United States have experienced trauma (Swedo et al., 2023).”
“My childhood affected my ability to be resilient in both good and bad ways”: A mixed methods examination on the links between adverse childhood experiences, resilience, and transactional sex among young South African women
Baron, D., Gottfredson, N. C., Lightfoot, A. F., Kuo, C., Lippman, S. A., Gómez-Olivé, F. X., Kahn, K., Pettifor, A. E., & Maman, S. (2026) · PLoS ONE · doi:10.1371/journal.pone.0341216 · Cited by 1
Rats exposed to a low resource environment in early life display sex differences in blood pressure and pro-inflammatory markers in the brain and kidney during adulthood
Smith, J., Smith, S., Jones, K., Castillo, A., Bolton, J. L., Howard, A., Colón-Pérez, L. M., Femi-Ogunyemi, F., Burkes, A., & Cunningham, M. (2026) · Biology of Sex Differences · doi:10.1186/s13293-026-00842-8 · Cited by 1
“ACEs can negatively impact a person’s mental and physical health throughout life [10–12].”
Forgiveness and Adverse Childhood Experiences: A Scoping Review
Kanter, R. L., & Wortham, J. S. (2026) · Trauma Violence & Abuse · doi:10.1177/15248380251410088 · Cited by 2
Life course adversity and risk of incident atrial fibrillation: causal mediation analysis of psychological distress in the population-based Tromsø Study
Çağlayan, Ş., Grønli, O., & Høye, A. (2026) · BMJ Public Health · doi:10.1136/bmjph-2025-003463 · Cited by 1
“Integrating life course epidemiologic models and causal mediation analysis may offer insights into disease pathways and provide opportunities for early intervention.”
Subtypes of adverse childhood experiences and depression among adult cancer survivors: Evidence from a population-based study
Baiden, P., Sesay, B. J., Ramsey-Soroghaye, B. N., Agboh, H. N. K., Anagbonu, J. S., Jenoch, J., Glikpo, R. M., Nebe, B. U., Wang, Y., & LaBrenz, C. A. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121689 · Cited by 1
Does income moderate the adverse childhood experiences – School engagement relationship?
Augustinovic, A., Walcott, C. M., Schultz, B. K., & Smith, A. W. (2026) · Children and Youth Services Review · doi:10.1016/j.childyouth.2026.108912 · Cited by 1
Recalibrating stress regulation through mindfulness: a framework for adapting interventions for ACE-affected populations
Beylin, N. R., & Zawadzki, M. J. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1801095 · Cited by 1
“In addition, ACEs are highly prevalent, far exceeding rates of diagnosable PTSD, which makes them especially relevant for understanding population-level risk and identifying modifiable pathways with broad public health impact (Swedo, 2023).”
Clinicians' Experiences and Recommendations for Implementing Trauma‐Informed Care in Perinatal Settings
Goldstein, E., Li, Y., Johnson, S., Biggers, A., Shankar, M., & Koenig, M. D. (2026) · Research in Nursing & Health · doi:10.1002/nur.70077 · Cited by 1
Intertwined adversities: a mixed methods study of ACEs and migration trauma among Latinx immigrants.
Estrada, M., Haanstad, T., Reyes, N., Marchena, C. M., Dhatt, S., Estrada-Serrano, J., & Nagy, G. A. (2026) · Journal of behavioral medicine · doi:10.1007/s10865-026-00664-4 · Cited by 1
Adverse Childhood Experiences Are Associated With Blunted Cardiovascular Reactivity and Poorer Recovery From Acute Psychological Stress
Costello, A. M., Plagge, A., & O’Riordan, A. (2026) · Psychophysiology · doi:10.1111/psyp.70307 · Cited by 2
“According to the Center for Disease Control and Prevention, among US adults from all 50 states, 63.9% report at least one ACE, while 17.3% report four or more ACEs (Swedo et al. 2023).”
Influential
The mediating role of depression between adverse childhood experiences and violent discipline among Chinese parents of preschool children
杨飞, Yin, L., Li, X., Zhou, M. D., Fu, Z., Meng, Z., & Zhou, H. (2026) · PeerJ · doi:10.7717/peerj.21130 · Cited by 1
“The total ACE score was calculated by summing the scores across all items for each participant ( Peterson et al., 2023 ; Swedo et al., 2023 ).”
Parenting with a History of ACEs: Examining the Impact of Cumulative Exposure and Child Sexual Abuse on Mothers’ and Fathers’ Reports of Parent-Child Relationship Quality
Pastor-Cerezo, V., Maiorano, N., & Swords, L. (2026) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-026-00895-2 · Cited by 1
“…in childhood is not uncommon, with approximately 60% of adults globally reporting that they had experienced some form of abuse, neglect or household dysfunction (e.g. domestic violence, incarcerated fam - ily members) before the age of 18 years (Madigan et al., 2023; Swedo et al., 2023).”
Positive and Adverse Childhood Experiences and Adult Health and Economic Outcomes
Aslam, M., Burstein, D., Hannan, K., Niolon, P. H., Swedo, E. A., Besera, G., Bethell, C., Jones, J., de Cuba, S. E., & Sege, R. D. (2026) · PEDIATRICS · doi:10.1542/peds.2025-074543 · Cited by 1
Longitudinal associations between patterns of childhood adverse experiences and positive experiences and depression and anxiety symptom trajectories among college students
Xiao, W., Xu, H., Deng, S., Gao, Y., Song, X., Wang, R., & Wan, Y. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2660607 · Cited by 1
“A study from the American Behavioral Risk Factor Surveillance System (BRFSS) demonstrated that 63.9% of participants had experienced at least one type of ACEs, while 17.3% had suffered from four or more types of ACEs (Swedo et al., 2023).”
Influential
The body and the brain keep the score: a data-driven conceptual model linking trauma and postural tachycardia syndrome
Crouch, T. B., Chelimsky, G. G., Boylan, L. E., Maxwell, M., Westcott, G., Chase, S. O., Redman, T., Burch, J., Gharbo, R. S., Wells, M. J., et al. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1829434 · Cited by 1
“Both of these figures represent ACE exposures higher than those observed in general population samples (Swedo et al., 2023), while also highlighting that ACEs are far from a necessary or sufficient explanation for the development of POTS.”
Childhood abuse, adolescent legal cynicism, and early adult criminal justice involvement: A five-wave longitudinal analysis of timing, typology, and cumulative exposure
Shi, J., Jiang, C., & Shi, D. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2026.108187 · Cited by 1
Adverse childhood experiences, early menopause, cognition, and dementia in older adults in the United States
Nakanishi, M., DeVylder, J., Knowles, G., Hasegawa, M., Richards, M., & Nishida, A. (2026) · Communications Health · doi:10.1038/s44528-026-00003-8 · Cited by 1
“%) than women (9.7%), which contrasts with previous ﬁ ndings 18 .”
Influential
Medical Trauma on the Inpatient Medicine Service: Perspectives of Recently Hospitalized Patients, Residents, and the Interdisciplinary Care Team
Singh, R., Mokhtar, I. B., Chakraborty, Y., Thachapuzha, U., Jean‐Jacques, M., Didwania, A. K., Schaeffer, C., Theodorou, M. E., O’Conor, R. M., & Pierre-Wright, M. J. (2026) · Journal of General Internal Medicine · doi:10.1007/s11606-026-10614-0 · Cited by 1
Dyadic Reports of Men’s and Women’s Adverse Childhood Experiences, Current Relational Risk, and Couple Relationship Communication: A Latent Profile Analysis
Richardson, E. W., Futris, T. G., Cataluna, M. V., Nelson, I., & Hines, V. (2026) · Journal of Family Communication · doi:10.1080/15267431.2026.2719925 · Cited by 1
“In the United States, approximately 64% of adults report experiencing at least one ACE before age 18, and 17.3% report experiencing four or more ACEs (Centers for Disease Control and Prevention, 2024; Swedo et al., 2023).”
Influential
Family Disclosure of Adverse Childhood Experiences: Motivations, Tendencies, Communication Accommodation, and Adult Well-Being
Nelson, L. R., Dhillon, A., Peterson, E., & Gilmore, A. (2026) · Journal of Family Communication · doi:10.1080/15267431.2026.2721453 · Cited by 1
Unresolved Childhood Trauma in Women Leaders: A Phenomenological Qualitative Study
Davis, A. M., & Zolnikov, T. R. (2026) · American Journal of Qualitative Research · doi:10.66815/ajqr/19199 · Cited by 1
Advancing School‐Based Efforts to Reduce Trauma and Violence Influences on Youth
Knox, J. L., Beason, T. S., & Johnson, S. B. (2026) · Journal of School Health · doi:10.1111/josh.70238 · Cited by 1
Clinician actions in response to Adverse Childhood Experience (ACE) screening
Ashwood, J. S., Malika, N. M., Williamson, S. L., Engel, C. C., Machtinger, E. L., Thompson, N., Shekarchi, A., Thyne, S. M., McCaw, B. R., Lightfoot, M. A., et al. (2024) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2024.102887 · Cited by 1
“ACEs are common; as many as two out of three adults have experienced an ACE and one out of six have experienced four or more ACEs (Swedo et al., 2023).”
Background
Pediatric Surgical Nurses and Trauma-Informed Care
Binford, L., Ellison, D. L., & Wilson, D. R. (2025) · Journal of Pediatric Surgical Nursing · doi:10.1177/23320249251318364 · Cited by 1
“Almost 64% of American adults report at least one traumatic experience in childhood (Swedo et al., 2023).”
Addressing Adverse Childhood Experiences in the Latino Community: An Innovative Parental Education Program -Strikeout Toxic Stress!
Barrera, I., & Sharma, V. (2024) · Journal of Mental Health and Social Behaviour · doi:10.33790/jmhsb1100190 · Cited by 1
Examining associations of mindfulness with early-life trauma and risky health behaviors using a network analysis approach in a sample of U.S. college students
Williams, M. A., Eadeh, H., Markon, K. E., Adamowicz, J. L., & Thomas, E. B. K. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100917 · Cited by 1
Adverse Childhood Experiences Among d/Deaf and Hard of Hearing Persons: Risks and Protective Factors
Guth, D., Martin, D., & Brumley, L. D. (2025) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-025-00796-w · Cited by 1
“However, sexual abuse was much less prevalent (14% compared to 22%), parallel to trends in newer studies, for example, by Swedo et al. ( 2023 ), which similarly document highest rates of abuse in psychological categories and lowest in sexual abuse.”
Influential
Parent-Reported Adverse Childhood Experiences (ACEs) and Food Insecurity Among Children in Non-English-Speaking Households in the United StatesPreprint
Chipalo, E., Nkwanzi, V., Odii, I. O., & Malele, K. P. (2024) · Research Square · doi:10.21203/rs.3.rs-4850491/v1 · Cited by 1
Increased prevalence of childhood adversity in comorbid posttraumatic stress disorder and substance use disorders compared to either disorder alonePreprint
Patel, H., Pelham, W. E., & Davis, I. S. (2024) · doi:10.31219/osf.io/r7uzd
Supporting Parents Affected by Childhood Adversity: Embedding a Trauma-Informed Parenting Program in an Urban School District Serving High Poverty CommunitiesPreprint
Gross, D. A., Yu, Z., Wyatt, K., Cunningham, E., Hoppe, E. R., Chen, W., Plesko, C. M., Bower, K. M., & Bettencourt, A. F. (2024) · doi:10.31234/osf.io/gydwp
Art, Healing, and Carceral Health
Hagan, L. M., Durkin, A., VanHouten-Maldonado, D., & Breedlove, B. (2024) · Emerging infectious diseases · doi:10.3201/eid3013.ac3013

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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