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Walsh, Elliot
Research Dissemination Coordinator

e wals0421@umn.edu

What Are Adverse Childhood Experiences (ACEs)? ACEs Definition, Data Challenges, and Resources

November 14, 2024:

Basics Blog Introduction

SHADAC has created a series of “Basics Blogs” to familiarize readers with common terms, concepts, and topics that are frequently covered.

Children’s health is impacted by a number of factors – family life and income, housing, neighborhood, nutrition, health care access and cost, amongst others.

Adverse Childhood Experiences (ACEs) is a broad term for a range of negative experiences people may experience as children that can have profound implications for their health. Sometimes ACEs may occur in the form of a single traumatic event, such as a violent incident, but ACEs may also be the result of recurring, lower-grade stress, such as continual food insecurity.

Many research studies conducted over the course of decades have found ACEs to be linked not only with short-term health implications for children, but also long-term health burden that can last well into adulthood. Unfortunately, they are quite common. One SHADAC brief reports that nearly half (46.3%) of U.S. children have experienced at least one adverse childhood experience, with the CDC reporting that 1 in 6 adults have experienced four or more ACEs in their childhood.

There is ample evidence that ACEs are linked to increased risk of chronic health conditions (asthma, chronic obstructive pulmonary disease, stroke, obesity, etc.), engaging in coping behaviors with health risks (drug use, heavy drinking, unprotected sex, etc.), and long-term behavioral and/or mental health issues (depression, anxiety, substance use disorders, etc.). Evidence also shows that those who experience ACEs have poorer health outcomes, lower educational attainment, and higher unemployment rates.

In this blog, we will provide you with:

Adverse childhood experience definition and examples
Data collection challenges
Comments on ACEs and health equity
Resources on ACEs and related topics from SHADAC

Gaining a better understanding of ACEs can help people recognize them. With that knowledge, people can seek to prevent ACEs and seek health care that recognizes them as underlying risk factors that can influence people’s health. Understanding ACEs and disparities in their prevalence may help to improve public health and enhance health equity. We can work towards reducing the prevalence of childhood trauma and stresses that can comprise ACEs, as well as their impacts on health in both the short- and the long-term for different and diverse communities.

What Are Adverse Childhood Experiences?

First coined by Vincent Felitti, Robert Anda, and their colleagues in a study published in 1998, Adverse Childhood Experiences (ACEs) are defined by the CDC as, “potentially traumatic events that occur in childhood.”

There is no single, comprehensive definition of what experiences do and don’t constitute ACEs. Initial definitions focused heavily on childhood abuse and neglect, and dysfunction and violence in the household, but some experts have proposed broader definitions that encompass systemic issues, such as housing instability and food insecurity, which research suggests can have similar long-term health impacts.

Some examples of potential adverse childhood experiences include:

Experiencing neglect or abuse (e.g., emotional, physical, sexual)
Separation from a parent, guardian, or caregiver due to death, incarceration or divorce
Witnessing violence and/or domestic violence
Family member attempting or dying by suicide
Growing up in a household with substance abuse and/or mental health problems
Housing instability and food insecurity
Peer-based bullying
Experiencing or witnessing racism

These only represent a small number of what could be considered an adverse childhood experience.

ACEs and Health Equity

It has been established by a number of studies that certain populations experience ACEs at a higher prevalence. In the SHADAC study on ACEs and Health Equity, we found that, “Black children had the highest rate of ACEs exposure, at 63.7%, followed closely by American Indian and Alaska Native children, at 63.0%. Each of those was significantly different from the total population rate of 46.3%.”

Figure 1. Percent of children with one or more adverse childhood experiences by race and ethnicity, 2016-2019

The CDC reports groups with the highest prevalence of ACEs in the U.S. include:

Women
Racial and ethnic minorities (particularly American Indian or Alaska Native (AIAN) people and multiracial people)
Members of the LGBTQ+ community
Those considered low-income
Those who are unemployed or can’t work
Adults with less than a high school education

It follows, then, that these groups with a higher prevalence of ACEs would also experience the health impacts of these events at higher rates, which goes on to impact quality of life, overall health, and can impact the children of people in these groups as well. This can perpetuate a cycle of generational trauma and continue to widen the disparities between these and other groups.

It is also worth noting that even with the finding that these groups have higher prevalence of ACEs exposure compared to the total population, it could still be an overall underestimation of ACE prevalence because of demographic data collection challenges both for minority groups and for collection of ACE data in general.

You can learn more about demographic data collection and its impacts in the SHADAC brief on The Collection of Race, Ethnicity, Language Data on Medicaid Applications.

Adverse Childhood Experiences and Data Collection Challenges

As noted earlier, there are challenges when it comes to ACEs data collection.

One such challenge is who the data is collected from. Many surveys are filled out by a parent or guardian reporting on their child. This can result in underestimation of ACEs experienced by the child for a few reasons. Firstly, the parent or guardian filling out the survey could be unaware of a traumatic experience their child has had. Additionally, the parent or guardian could feel uncomfortable or unable to report that their child has had certain adverse experiences, like abuse or experiencing a parent’s mental health issues.

If a child is filling out the survey themselves, some of the questions may be inappropriate to ask of young children, the children may be reluctant to report some forms of trauma, or they may not even recognize that an event was a traumatic one.

As SHADAC researcher Colin Planalp mentions in his brief on ACEs and health equity, “Another approach [for data collection] could be to survey adults about their experiences as children, but that approach may also face some of the same limitations of reluctance to report some forms of trauma, and adults may simply not recall traumatic experiences that occurred decades ago. And by surveying adults about their own traumatic experiences as children, those data would by nature be retrospective— telling us little about the prevalence and types of ACEs among today’s children, which may change over time.”

Another issue is the feasibility of including all types of ACEs in a survey. As we mentioned in the previous section, we only listed a small number of possible ACEs. Surveys often condense or simplify the number of ACEs that it asks about – it simply isn’t feasible to list out every single type of ACE or trauma, which likely results in an overall underestimation of experienced ACEs in the population.

Adverse Childhood Experiences: Resources from SHADAC

Hopefully this has given you a general overview on the question, “What are ACEs?” But, as you could probably glean, this is a complex topic with many factors to consider and learn about. ACEs and their impact touch upon a number of issues, including health care cost & access, mental health care, housing, generational trauma, drug and substance use, structural oppression (like racism, homophobia, ableism, etc.), children’s health, and more. Each factor exists amongst and with the others, creating complex systems to unravel and intersectional identities to consider.

Additionally, this is a relatively new area of study, with that original Felitti et al. study published in 1998. New information and research continue to expand our understanding of ACEs, health disparities, and their impacts on health later in life – for example, a study published in Health Affairs in 2024 found a link between ACEs and adults experiencing financial and housing problems, social network problems, and food insecurity, and found that “those with ACEs had substantially higher [health care] utilization and 26.3 percent higher expenditures.”

Continued study and research can help us identify these issues, understand the groups impacted, and work towards both prevention and post-trauma support. Working on this issue has implications to improve the health of children and adults, reduce risk of chronic and mental health conditions, reduce related costs, and, hopefully, reduce the impact and prevalence of childhood trauma.