Adverse Childhood Experiences Update

Article Review: “Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States”  https://www.ncbi.nlm.nih.gov/pubmed/30242348

Full-text link: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2702204

The foundation for lifelong health, well-being and prosperity begins during an individual’s childhood. Early adversity and trauma can increase adult morbidity and mortality rates, as well as decrease access to certain life opportunities.

The goal of this study was to provide an updated estimate on the prevalence of adverse childhood experiences (ACEs) in the United States. The data for this study were collected through the Behavioral Risk Factor Surveillance System (BRFSS), which is an annual, national telephone survey that asks adults health-related questions, specifically focused on health-related behaviors, health conditions, and use of preventative services. The BRFSS includes a large, diverse, and representative sample of adults from 23 different states. Merrick and her team used these data to look at ACE-related information, which included 8 categories: physical abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce.

Of the 214,157 respondents included in the sample, more than 60% reported at least one ACE, and about 25% reported three or more ACEs. Significantly higher ACE exposures was reported by participants who identified as Black, Hispanic and multiracial, gay/lesbian and bisexual, as well as those with less than a high school education, those with income of less than $15,000 per year, those who were unable to work, and those who were unemployed. The most prevalent ACE was emotional abuse, followed by parental separation or divorce and household substance abuse. The mean ACE score for men was 1.46, whereas for women it was 1.68. The study found that 8.58% of men reported having an incarcerated household member as a child, compared to 7.26% of women. There were additional differences among prevalence of incarcerated household members when it came to race. 6.59% of white participants reported incarceration of a household member, whereas this number rose to 13.25% for Black participants, and 10.29% for Hispanic participants. Their average ACE scores were 1.52, 1.69, and 1.80 respectively.

The findings of this study reveal that ACEs are prevalent across all demographic groups, though some vulnerable individuals experience an unequal burden. Social and structural conditions can impact the risk of exposure to childhood adversity, and exposure to ACEs may exacerbate inequities across generations regarding health, social, and economic outcomes.

There were several limitations to this study. It is important to note that the BRFSS data are cross-sectional, as the survey asked respondents to retrospectively report on childhood experiences.

Such self-report data may allow for the potential of memory or response bias. Furthermore, this study did not take in account the entire spectrum of potential ACEs, nor did it include severity or age of onset of each ACE.

Despite the limitations, this study highlights the importance of understanding why some groups are at higher risk than others for experiencing ACEs. By ensuring that children have access to safe, stable, nurturing relationships and environments regardless of each aspect of their identity, we can hopefully alleviate the effects on ACEs, thus achieving multiple public health goals. While this study does not give us the answers for addressing the issue of the prevalence of ACEs in the U.S., it certainly helps us understand how common ACEs are.

Citation: Merrick MT, Ford DC, Ports KA, Guinn AS. (2018). Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states. JAMA Pediatrics. doi:10.1001/jamapediatrics.2018.253

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