CDC Report: Adverse Childhood Experiences Reported by Adults

Adverse childhood experiences (ACEs) include verbal, physical, or sexual abuse as well as family dysfunction (an incarcerated, mentally ill, or substance-abusing family member, domestic violence, and absence of a parent due to divorce or separation).

Adverse Childhood Experiences (ACEs) have been linked to a wide range of health outcomes in adulthood including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality.


Using the 2009 ACE module of the Behavioral Risk Factor Surveillance System (BRFSS) to examine whether a history of ACEs was common, 26,229 adults were interviewed in 5 states- Arkansas, Louisiana, New Mexico, Tennessee, and Washington. The MMWR report on ACEs among U.S. adults summarizes the results of that analysis. The module consisted of 11 questions that yielded 8 categories of ACEs (verbal abuse, physical abuse, sexual abuse, household mental illness, household substance abuse, domestic violence, parental separation/divorce and incarcerated family members). Respondents were asked to refer to the time period before they were 18 years of age when answering questions.


Overall, 59.4% of respondents reported having had at least one ACE while 8.7% reported five or more ACEs. Given the high prevalence of ACEs, additional efforts are needed at the state and local level to reduce and prevent childhood maltreatment and associated family dysfunction in the US, and further the development and dissemination of trauma-focused services to treat stress-related health outcomes associated with ACEs.
The most common ACEs were:

• Separated or divorced parents
• Verbal abuse
• Family member with depression or mental illness
• Witness of domestic violence
• Physical abuse
• Sexual abuse

Differences by gender

Men and women reported similar prevalence for having grown up with a mentally ill household member (22.0% for women, 16.7% for men) and growing up with a substance-abusing family member (30.6% for women, 27.5% for men). A difference between men and women was observed in the ACE category of sexual abuse, where women reported more than twice as many experiences as men (17.2% for women, 6.7% for men).

Differences by race/ethnicity

Black, non-Hispanic respondents had the lowest prevalence of each ACE category among all racial-ethnic groups. However, compared to all racial-ethnic groups Black non-Hispanics reported higher prevalence of having had an incarcerated family member (12.9%) and experiencing parental divorce (37.9%). Compared to Whites, Hispanics more frequently reported physical abuse (14.6% for Whites, 19.8% for Hispanics), witnessing domestic violence (15.1% for Whites, 21.7% for Hispanics), and having an incarcerated family member (6.2% for Whites, 9.5% for Hispanics).


These findings reinforce that adverse childhood experiences are common across racial/ethnic groups and states, further reinforcing the need to expand evidence-based child abuse prevention programs such as home visiting and parent education.

Data Source

CDC. Adverse Childhood Experiences Reported by Adults — Five States, 2009. MMWR 59(49);1609-1613.

More Information

• Academy on Violence and Abuse
• Adverse Childhood Experiences Study
• American Professional Society on the Abuse of Children
• American Psychological Association Trauma Psychology Division
• Childhood Maltreatment Prevention
• Legacy for Children™
• National Clearinghouse on Child Abuse and Neglect Information
• Preventing Child Maltreatment: Program Activities Guide

Video Series on: The A.C.E. Study - Adverse Childhood Experiences

ACE Study - 

Vincent Felitti, MD 

 

"We saw that things like intractable smoking, things like promiscuity, use of street drugs, heavy alcohol consumption, etc., these were fairly common in the backgrounds of many of the patients...These were merely techniques they were using, these were merely coping mechanisms that had gone into place."– Vincent Felitti, MD

When Dr. Vincent Felitti, head of the Department of Preventive Medicine at Kaiser Permanente in San Diego, began to delve into the reasons for the high dropout rate of patients who'd been successfully losing weight in Kaiser’s obesity program, he found to his surprise that a high proportion of those dropping out had histories of childhood abuse or neglect. Dr. Robert Anda, who had been doing research with the Centers for Disease Control and Prevention on the psychosocial origins of health-risk behaviors in patients at VA hospitals, heard Felitti speak about his findings, and in 1992 the two began to collaborate on the largest-scale study to date of the incidence and effects of childhood trauma, known as the Adverse Childhood Experiences (ACE) Study.

According to data collected from the over 17,000 Kaiser patients in this ongoing retrospective and prospective study, adverse childhood experiences, though well concealed, are unexpectedly common, have a profound negative effect on adult health and well-being a half century later, and are a prime determinant of adult health status in the United States.


The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study  

Vincent J. Felitti, MD - Department of Preventive Medicine - Kaiser Permanente Medical Care Program

ABSTRACT:
A population-based analysis of over 17,000 middle-class American adults undergoing comprehensive, biopsychosocial medical evaluation indicates that three common categories of addiction are strongly related in a proportionate manner to several specific categories of adverse experiences during childhood. This, coupled with related information, suggests that the basic cause of addiction is predominantly experience-dependent during childhood and not substance-dependent. This challenge to the usual concept of the cause of addictions has significant implications for medical practice and for treatment programs....

Our overall findings, presented extensively in the American literature, demonstrate that:
• Adverse childhood experiences are surprisingly common, although typically concealed and unrecognized.
• ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness.
• Adverse childhood experiences are the main determinant of the health and social well-being of the nation....

Conclusion:
The current concept of addiction is ill founded. Our study of the relationship of adverse childhood experiences to adult health status in over 17,000 persons shows addiction to be a readily understandable although largely unconscious attempt to gain relief from well-concealed prior life traumas by using psychoactive materials 


The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead 

By Vincent J Felitti, MD  

The ACE Study reveals a powerful relation between our emotional experiences as children and our adult emotional health, physical health, and major causes of mortality in the United States. Moreover, the time factors in the study make it clear that time does not heal some of the adverse experiences we found so common in the childhoods of a large population of middle-aged, middle-class Americans. One doesn't "just get over" some things.