ISSUE BRIEF

October 2017

A national and across-state profile

on Adverse Childhood Experiences
among U.S. children and possibilities
to heal and thrive About the Study

All findings reported here are

This issue brief offers hope and a way forward so that all children and their based on analysis of data from the
families can attain optimal physical, social, and emotional development and 2016 National Survey of Childrens
well-being. Presented are the latest data documenting the prevalence of Adverse Health (NSCH). This brief includes
Childhood Experiences (ACEs) among children in the United States. ACEs U.S. maps and a table of findings
include a range of experiences that can lead to trauma and toxic stress and across U.S. states on key topics.
impact childrens brain development and physical, social, mental, emotional, and All comparisons by ACE status
behavioral health and well-being (Table 1).1,2 There is growing evidence that it are statistically significant unless
is the general experience of multiple ACEs, rather than the specific individual otherwise noted. Most findings
impact of any one experience, that matters.3,4 The impact of ACEs extends beyond replicate those also found and
children and can have far-reaching consequences for entire communities;5 published using the 201112 NSCH.
consequently, this brief also points to strategies that families, caregivers, See methods notes for more details.
providers, and communities can implement to reduce the negative health effects
associated with ACEs, heal, and help children thrive in the face of adversity.5-9

TABLE 1: National and Across-State Prevalence of ACEs among Children and Youth

National Prevalence, by Age of Child

Adverse Childhood Experiences (ACEs) Range Across States
All Children Age 0-5 Age 6-11 Age 12-17
Child had 1 Adverse Childhood Experience 46.3% 35.0% 47.6% 55.7% 38.1% (MN) 55.9% (AR)
Child had 2 Adverse Childhood Experiences 21.7% 12.1% 22.6% 29.9% 15.0% (NY) 30.6% (AZ)
Nine assessed on the 2016 NSCH1 % with 1+ Additional ACEs
Somewhat often/very often hard to get by on income* 25.5% 24.1% 25.7% 26.5% 54.4%
Parent/guardian divorced or separated 25.0% 12.8% 27.5% 34.2% 68.0%
Parent/guardian died 3.3% 1.2% 2.9% 5.9% 74.7%
Parent/guardian served time in jail 8.2% 4.5% 9.2% 10.6% 90.6%
Saw or heard violence in the home 5.7% 3.0% 6.1% 8.0% 95.4%
Victim/witness of neighborhood violence 3.9% 1.2% 3.7% 6.5% 92.1%
Lived with anyone mentally ill, suicidal, or depressed 7.8% 4.4% 8.6% 10.3% 82.4%
Lived with anyone with alcohol or drug problem 9.0% 5.0% 9.3% 12.7% 90.7%
Often treated or judged unfairly due to race/ethnicity** 3.7% 1.2% 4.1% 5.7% 75.3%
*47% of children in households with poverty level incomes have parents who reported often hard to get by on income. **1 in 10 black and other race/ethnicity children had parents who reported
their children often were treated or judged unfairly. 4.4% of Hispanic and Asian/Non-Hispanic children had parents who reported this (1% for white children)

Citation: Bethell, CD, Davis, MB, Gombojav, N, Stumbo, S, Powers, K. Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive.
Johns Hopkins Bloomberg School of Public Health, October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/
The importance of a population-wide, ACEs impact not just the individual child who has them, but
multi-systems approach their friends, families, neighbors, and entire communities. Three
factors support a population-wide, multi-systems approach to
In 2016, 34 million children, nearly half of all U.S. children ages ACEs in the United States: (1) high rates for all children as well as
0-17, had at least one of nine ACEs, and more than 20 percent among the adults that care for them; (2) similar risks to childrens
experienced two or more (Table 1). These findings are similar health status and school engagement once ACEs do occur; and
to those reported for the 2011-12 NSCH.11 ACEs are common (3) the intergenerational and cascading effects of ACEs for all
among all children; and most who have experienced one often children and the communities they live in.
experience at least one other.10

KEY FINDINGS Recognizing the lifelong impact from

The rate of children across U.S. states with one or more of childhood trauma
nine ACEs assessed varies from 38.1 percent to 55.9 percent.
Social and emotional skills, along with school attendance and
Those with two or more ACEs varies from15.0 percent to 30.6
engagement, are important predictors of lifelong health and
percent. Most children with any one ACE had at least one
well-being for children. Most children will experience a social,
other, ranging from 54.4 percent to 95.4 percent.
emotional, or school engagement challenge at some point. Yet
ACEs are prevalent among children with both public and
those with ACEs face greater risks and challenges. Knowing this
private health insurance coverage. Nearly two-thirds of publicly
changes how we support children with challenges.
insured children have ACEs (65.2 percent), yet they represent
45 percent of children with ACEs.
ACEs are also common across all income groups, though SOCIAL AND EMOTIONAL CHALLENGES COMPOUNDED
58percent of U.S. children with ACEs live in homes with Compared to those with no ACEs, children ages 3-5 with 2+
incomes less than 200 percent of the federal poverty level ACEs are over four times more likely to have three or more
(Table 2). of the six social and emotional challenges that can impact
Black children are disproportionately represented among learning listed in Figure 1.
children with ACEs. Six in 10 have ACEs and represent 17.4 About two-thirds of children ages 6-17 who bully, pick on,
percent of all children in the United States with ACEs (Table 2). or exclude other childrenor are themselves bullied, picked
on, or excludedhave ACEs.11

TABLE 2: Prevalence of ACEs by Race/Ethnicity and Income SCHOOL SUCCESS IMPACTED

All White,
Hispanic
Black, Asian, Other, More than three in four (76.3 percent) U.S. children
Children NH* NH* NH* NH*
ages 3-5who were expelled (asked to stay home) from
% of all US children 51.9% 24.5% 12.7% 4.5% 6.3%
preschool already had ACEs.
% 1+ ACEs 46.3% 40.9% 51.4% 63.7% 25.0% 51.5%
Children ages 6-17 with no ACEs are half as likely to be
% 2+ ACEs 21.7% 19.2% 21.9% 33.8% 6.4% 28.3%
disengaged in school compared to those with 2+ACEs
% among children
46.0% 27.0% 17.4% 2.4% 7.1% (24.1percent vs. 49.0 percent).11
with 1+ ACES
Income < 200% of Federal Poverty Level (43.7% of all US children;
58% of children with 1+ ACEs)
% 1+ ACEs 61.9% 63.3% 57.0% 70.5% 36.4% 70.6%
% 2+ ACEs 31.9% 34.7% 25.1% 39.9% 9.0% 44.4%
Income 200-399% of Federal Poverty Level (26.8% of all US Children;
25.1% of children with 1+ ACEs)
% 1+ ACEs 43.2% 39.7% 46.8% 59.1% 24.8% 50.7%
% 2+ ACEs 19.0% 17.2% 19.8% 29.4% 7.0% 24.5%
Income 400% of Federal Poverty Level (29.5% of all US Children;
17.0% of children with 1+ ACEs)
% 1+ ACEs 26.4% 24.4% 35.5% 41.2% 14.3% 27.3%
% 2+ ACEs 9.2% 8.6% 12.1% 14.1% 3.6% 10.5%

*NH=Non-Hispanic

Citation: Bethell, CD, Davis, MB, Gombojav, N, Stumbo, S, Powers, K. Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive.
Johns Hopkins Bloomberg School of Public Health, October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/
FIGURE 1: Prevalence of Social and Emotional Skills and Resilience and supporting family
Challenges of Children and Youth, by ACEs
relationships are the key

0 ACEs 1 ACE Teaching resilience and promoting positive family

communication, routines, and habits are important for all
Often cannot calm self 15.8%
down when excited/ children and are powerful protective and healing factors for
wound up (age 3-5) 28.4%
children with ACEs. Children and families with ACEs can
Loses control of 10.2% become among the most resilient and healthiest when they
temper all or most of
the time (age 3-5) 20.8% learn to cope and heal from the physical, emotional, and social
effects of trauma and toxic stress associated with ACEs. The most
4.1%
Doesnt often play well effective ways to address trauma and toxic stress require full
with others (age 3-5) 10.6%
engagement of children and families to practice resilience skills
Easily distracted all or 12.7% and community environments that help them do so.
most of the time
(age 3-5) 23.6%
Children age 6-17 with 2+ ACEs who learn to stay calm and in
Doesnt often keep 23.8%
working at something control when faced with challenges are over three times more
38.5%
until finished (age 3-5) likely to be engaged in school compared to children who have
Difficulty making 10.2%
not learned these skills (71.4 percent vs. 19.2 percent).11
and keeping friends
(age 3-5) 18.1% Children with 2+ ACEs are nearly six times more likely to
have learned this resilience skill when parents do very well
Has 3 or more of 6
social or emotional
7.3% in sharing ideas and about things that matter with their
challenges (age 3-5) 19.7% child versus not well.12
Meets each of 3 48.4%
flourishing criteria
(age 6-17) 32.7%
Consistently trusting and respectful
Definitely engaged in 75.9% relationships matter
school (age 6-7) 57.9%
Research shows that patients with trusting and respectful
relationships with their health care providers are more likely to
discuss potentially sensitive issues like ACEs, and have better
health outcomes.13 Consistently positive communication between
TABLE 3: Prevalence of all children with 2+ ACEs whose
families practice resilience when facing problems and practice parents and their childrens health care providers is linked to
protective routines and habits, by experiences during health stronger family resilience and a higher number of nationally
care visits recommended family routines and habits. For children ages 0-5,
Family often practices 3 or more of 5 protective recommended family routines and habits include limiting TV/
4 qualities of resilience family routines and
when facing problems habits practiced
screen time, ensuring no tobacco use in the home, reading to
How often providers spend enough time* children daily, breastfeeding, and sharing family meals (Table 3).14
Always 73.1% 74.7%
Sometimes/Never 47.9% 53.6% Children with 2+ ACEs whose parents report that their
How often providers listen carefully to parents* childs health care providers always listen, spend needed
Always 71.0% 72.6% time, and give needed information are over 1.5 times more
Sometimes/Never 46.1% 56.0% likely to live in families that practice four basic resilience
How often specific information needed is provided* skills when they face problems.
Always 70.7% 72.5% Children whose parents report always having positive
Sometimes/Never 45.9% 51.9% communication with their childs health care providers are
*Odds ratios adjusted for income/FPL and race/ethnicity all significant: With always over 1.5 times more likely to practice three or more (of five)
responses to each experience of health care factors, odds are 2.68-2.79 greater that families
often practice 4 resilience qualities than with sometimes/never (1.46-1.54 for usually). recommended protective family routines and habits.
Odds.41-.50 less for practicing 2 or fewer (vs. 3-5) protective family routines and habits with
always responses compared to sometimes/never (usually responses did not differ from
sometimes/never).

Citation: Bethell, CD, Davis, MB, Gombojav, N, Stumbo, S, Powers, K. Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive.
Johns Hopkins Bloomberg School of Public Health, October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/
FIGURE 2: Child and Parent Health and Neighborhood Nearly three in four children with chronic conditions involving
Support, by ACEs emotional, mental or behavioral (EMB) problems have ACEs.11
Children with 2+ ACEs are 2.76 times more likely to live in
0 ACEs 1 ACE 2+ ACEs
families where parents had to cut back on or stop working due
75.3% to their childs health.11

61.3%
57.0%
Creating through any door coping and
50.7%
healing supports
40.1% 40.2%
33.3%
A strong family unit is essential when it comes to addressing
ACEs, but broader community support is critical to strengthen
20.3% families. Health care providers, early child care professionals,
13.6% teachers, home visitors, and community health workers all play a
pivotal role. The relational skills of those who work with children
is especially important.20,21 Importantly, research shows that
Prevalence of Prevalence of children Prevalence of children professionals who practice mindfulness skills, like being open,
children with chronic whose parent reports whose mothers calm, mentally and emotionally present, flexible, and responsive
conditions and special living in a supportive health is very good
health care needs neighborhood or excellent during interactions with childrenand encourage families to
practice similar skillshelps children.22 These skills and practical
tools to effectively engage and coach families to reflect and identify
strengths, needs, and priorities for well-visits, for example, have
been shown to increase conversations about a childs social and
emotional well-being and family and household issues that can
A pivotal role for health care, social, and impact children.23,24
community services

Children who have ACEs are more likely to have a chronic Building a Culture of Health for children
condition that requires above routine health care services and and families
mothers who are not in very good physical and mental health.11
As a result, health care providers and services can play an All children need nurturing environments to grow up healthy,
especially important role in their direct patient interactions, to and all families should have the opportunity to provide those
learn about ACEs and by ensuring families connect with other environments for their children. A childs physical, social, and
supports and resources in their communities.13 Addressing emotional well-being are inextricably linked. A childs experiences
ACEs can also reduce health care costs by addressing the roots can determine health and well-being throughout life. This brief
of many health problems.15 demonstrates that despite the significant prevalence of ACEs,
policymakers, families, community leaders, and health care service
Because children with ACEs are also less likely to live providers can create environments where children can flourish and
in neighborhoods described by parents as supportive thrive.25 The earlier we nurture childrens well-beingbeginning
(seemethods notes), it follows that the families requiring while they are in uterothe more likely that they will have the love
the greatest community supports and services are least likely and support needed for lifelong health and happiness.
to havethem (Figure 2). Building the resilience of entire
communities is pivotal in addressing ACEs.16-19

Citation: Bethell, CD, Davis, MB, Gombojav, N, Stumbo, S, Powers, K. Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive.
Johns Hopkins Bloomberg School of Public Health, October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/
Percent of Children Age 0-5 with
One or More Adverse Childhood
Experiences in the US

Nationwide: 35.0%

State Range: 23.1%49.1%

Percent of Children Age 0-17 with

One or More Adverse Childhood
Experiences in the US

Nationwide: 46.3%

State Range: 38.1%55.9%

Citation: Bethell, CD, Davis, MB, Gombojav, N, Stumbo, S, Powers, K. Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive.
Johns Hopkins Bloomberg School of Public Health, October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/
Percent of Children Age 0-17 or
with Two More Adverse Childhood
Experiences in the US

Nationwide: 21.7%

State Range: 15.0%30.6%

TABLE 4. Description of the Measures Presented in Table 5

Measure Labels Description of the Measures

Prevalence of children with one or more adverse childhood experiences (ACEs), age 0-17 years. The NSCH includes nine ACEs items:
Hard to get by on income (somewhat or very often) Victim/witness of neighborhood violence
Parent/guardian divorced or separated Lived with anyone mentally ill, suicidal, or depressed
1+ ACEs, 0-17 years Parent/guardian died Lived with anyone with alcohol or drug problem
Parent/guardian served time in jail Often treated or judged unfairly due to race/ethnicity
Saw or heard violence in the home
For more information about the methods to assess ACEs click here.
2+ ACEs, 0-17 years Prevalence of children with two or more ACEs, age 0-17 years.
1+ ACEs, 0-5 years Prevalence of children with one or more ACEs, age 0-5 years.
Chronic Health Prevalence of children with chronic health conditions identified by the Children with Special Health Care Needs (CSHCN) Screener, among
Condition children age 0-17 years with one or more ACEs. To learn about the CSHCN Screener click here.
CSHCN with EMB Prevalence of CSHCN with ongoing emotional, developmental and/or behavioral (EBD) health conditions identified by the CSHCN Screener,
Conditions among children age 0-17 years with one or more ACEs.
Prevalence of children whose mothers physical and mental health are both either excellent or very good, among children age 0-17 years with one
Mothers Health
or more ACEs.
Prevalence of children whose parents reported that they handle the day-to-day demands of raising children very well, among children age 0-17
Parent Coping
years with one or more ACEs.
Prevalence of children definitely engaged in school, among children age 6-17 years with one or more ACEs. In the 2016 NSCH, children are
School Engagement considered to be engaged in school if their parents reported definitely true to both of the following: their child cares about doing well in school
and their child does all required homework.
Resilience, Prevalence of children demonstrating resilience, among children age 6-17 years with one or more ACEs. In the 2016 NSCH, resilience is defined
6-17 years as definitely staying calm and in control when faced with a challenge.
Prevalence of children who live in supportive neighborhoods, among children age 0-17 years with one or more ACEs. In the 2016 NSCH, children
Supportive are considered to live in supportive neighborhoods if their parents reported definitely agree to at least one of the items below and somewhat
Neighborhood agree or definitely agree to the other two: People in my neighborhood help each other out; we watch out for each others children in this
neighborhood; when we encounter difficulties, we know where to go for help in our community.
Cut Back or Prevalence of children whose parents either cut back on their work hours or stopped working because of their childs health or health conditions,
Stopped Working among children age 0-17 years with one or more ACEs.
Prevalence of children who live in families with fewer than 3 out of 5 family routines and habits, among children age 0-17 years with one or more
ACEs. The 5 family routines and habits for different age groups are:
Children age 0-5: Children age 6-17:
Family Routines No tobacco use in the home No tobacco use in the home
and Habits Family shares a meal at least 4 days/week Family shares a meal at least 4 days/week
Child has no more than 2 hours of screen time/day Child has no more than 2 hours of screen time/day
Child is read to every day Child does required homework
Child was ever fed breast milk Parents participate in their childs events/activities

Citation: Bethell, CD, Davis, MB, Gombojav, N, Stumbo, S, Powers, K. Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive.
Johns Hopkins Bloomberg School of Public Health, October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/
 TABLE 5. Across State Multiple Indicator Table: Percent of Children who Experienced Adverse Childhood Experiences (ACEs) and
Prevalence of Selected Child and Family Health Measures^ among Children Who Experienced One or More ACEs

Among Children with One or More Adverse Childhood Experiences

2+ 1+ 1+
Cut Family
ACEs, ACEs, ACEs, Chronic Children School Resilience, Supportive
State Back or Routines Mothers Parent
0-17 0-17 0-5 Health with EBD Engagement, 6-17 Neighbor-
Stopped and Health** Coping**
years* years* years* Condition* conditions* 6-17 years** years** hood**
Working* Habits*
Nation 21.7 46.3 35.0 26.4 12.8 7.4 27.4 49.6 61.5 57.9 43.0 44.2
State Range 15.0 30.6 38.155.9 23.149.1 17.233.9 8.620.2 4.412.0 16.634.8 38.661.0 48.675.0 45.968.5 24.153.6 29.563.8
Alaska 23.8 44.3 23.1 23.0 13.4 6.2 23.8 45.6 58.5 49.2 40.3 50.0
Alabama 27.7 50.1 37.0 29.2 13.4 5.1 30.8 46.1 61.8 58.9 40.0 52.3
Arkansas 29.6 55.9 40.6 29.8 14.0 6.2 28.9 42.8 63.0 50.8 39.8 50.7
Arizona 30.6 49.4 44.4 26.3 12.9 7.3 34.8 40.9 54.0 50.1 44.2 40.3
California 16.4 42.1 33.1 24.0 11.7 8.0 28.8 52.8 59.7 58.9 45.0 37.6
Colorado 22.3 46.3 36.0 24.2 11.5 10.2 21.2 49.9 56.9 51.4 47.5 44.1
Connecticut 19.4 42.2 38.3 29.5 18.0 6.7 29.4 58.4 65.3 64.5 45.3 44.9
District of
21.8 47.1 32.3 25.2 12.6 5.6 21.5 60.6 67.2 65.1 51.5 38.9
Columbia
Delaware 22.6 48.3 37.1 30.6 15.1 6.0 32.8 47.7 68.3 60.0 38.4 46.1
Florida 24.8 52.0 36.9 25.8 12.1 7.3 25.7 57.3 70.6 68.2 50.5 43.7
Georgia 25.0 47.7 29.3 27.1 14.5 5.0 27.3 43.1 70.3 54.8 39.2 43.7
Hawaii 21.4 43.2 37.1 17.2 9.1 6.8 22.7 55.3 51.8 57.0 43.8 45.6
Iowa 20.0 43.8 34.4 25.6 14.1 6.9 22.5 51.5 63.2 54.8 41.9 54.6
Idaho 23.4 50.9 38.4 24.2 15.6 6.2 20.3 48.7 53.5 54.0 39.0 51.4
Illinois 19.5 39.7 24.9 26.4 14.2 8.8 25.2 46.3 56.7 68.5 45.1 43.5
Indiana 24.2 47.3 33.6 33.9 19.8 12.0 28.5 45.2 60.6 54.0 42.1 54.9
Kansas 21.7 45.2 31.0 25.3 13.5 7.2 26.3 50.1 55.7 50.2 42.7 49.6
Kentucky 26.9 53.1 42.5 32.1 15.8 4.4 33.4 43.2 70.4 51.1 31.6 47.7
Louisiana 28.2 53.7 36.7 30.3 13.7 6.9 27.8 51.6 63.7 60.1 43.1 51.3
Massachusetts 15.9 38.8 27.3 28.0 20.2 11.3 27.9 53.2 61.7 58.1 41.8 48.8
Maryland 15.4 41.0 27.5 29.2 15.4 5.1 28.7 55.6 75.0 59.5 53.6 47.3
Maine 24.6 51.7 39.9 33.1 17.3 9.4 20.5 42.6 60.7 51.9 36.0 46.9
Michigan 21.8 46.2 36.4 25.8 11.0 4.7 29.1 50.2 64.8 59.3 42.7 43.1
Minnesota 16.8 38.1 26.2 25.8 15.4 4.7 27.9 52.0 60.2 56.4 39.7 51.6
Missouri 27.2 47.8 34.1 31.6 14.3 4.8 27.3 41.3 59.3 55.7 38.0 49.7
Mississippi 27.2 53.4 35.5 32.3 18.6 7.9 25.4 46.1 65.6 51.5 28.5 47.6
Montana 26.1 50.7 37.2 26.9 16.2 6.6 19.1 42.0 56.1 53.2 35.1 53.5
North Carolina 23.8 49.6 41.7 26.2 11.1 8.6 31.8 44.2 55.6 55.6 44.5 44.1
North Dakota 15.8 39.9 32.5 26.8 12.7 6.5 18.4 46.6 61.2 59.3 37.4 63.8
Nebraska 19.9 42.1 34.0 25.9 12.6 7.3 25.0 44.5 57.0 62.6 43.0 49.8
New Hampshire 19.7 42.5 31.1 26.4 14.0 6.7 19.5 45.7 57.6 57.5 37.0 54.7
New Jersey 18.1 41.4 33.1 22.4 12.4 7.8 25.0 61.0 58.1 68.0 49.6 42.7
New Mexico 27.8 53.3 38.2 25.3 14.7 10.1 18.4 38.6 61.2 51.9 40.7 44.2
Nevada 25.0 52.4 40.4 20.2 11.6 10.9 31.0 47.5 54.3 54.1 43.2 29.5
New York 15.0 45.3 38.7 19.9 8.6 7.6 27.1 60.6 68.3 58.4 40.6 40.0
Ohio 27.1 49.5 37.3 30.6 11.9 5.6 29.7 44.7 62.8 57.6 45.5 46.6
Oklahoma 26.6 53.7 49.1 26.4 12.0 6.6 27.4 39.6 55.3 50.4 38.9 47.5
Oregon 22.4 47.3 32.8 25.6 13.9 10.3 21.3 44.0 53.4 45.9 41.4 44.8
Pennsylvania 21.2 47.1 37.3 25.8 13.5 4.9 29.2 50.3 62.6 58.6 41.9 50.7
Rhode Island 21.5 45.8 39.0 29.1 16.7 9.7 24.4 45.0 64.5 56.4 37.1 41.5
South Carolina 25.3 48.3 36.2 27.5 13.3 5.8 28.0 41.5 62.3 54.0 40.3 42.7
South Dakota 22.0 45.6 33.2 21.7 9.0 4.6 20.3 57.7 64.5 49.9 38.4 55.2
Tennessee 24.6 48.1 36.1 25.7 12.7 7.2 28.2 49.9 66.7 58.9 44.5 40.4
Texas 23.9 49.7 35.3 26.0 10.0 9.0 27.4 50.2 56.2 59.7 41.6 37.4
Utah 16.9 41.0 34.2 23.0 13.8 6.8 23.3 45.6 48.6 46.5 32.2 55.7
Virginia 19.3 41.2 27.9 29.7 13.8 9.5 25.2 48.4 62.9 57.2 48.1 50.3
Vermont 19.9 45.0 35.2 31.7 18.6 7.7 16.6 43.9 60.5 57.8 41.3 53.8
Washington 19.3 42.5 33.7 28.6 13.4 7.9 25.7 44.6 58.7 48.3 41.6 42.2
Wisconsin 20.3 41.4 31.6 28.2 15.6 4.9 23.5 47.1 63.4 58.3 44.2 49.5
West Virginia 26.1 52.4 45.1 29.0 14.2 5.0 29.0 38.6 66.7 53.7 39.3 51.1
Wyoming 26.0 46.7 35.1 30.8 15.0 9.4 21.3 48.4 62.5 47.2 24.1 50.6
^See Table 2 for more information on individual measures *Lower percentage indicates better performance **Higher percentage indicates better performance Relative confidence interval width is greater than 120%

Significantly lower than nation Lower than nation, but not statistically significant Higher than nation, but not statistically significant Significantly higher than nation

Citation: Bethell, CD, Davis, MB, Gombojav, N, Stumbo, S, Powers, K. Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive.
Johns Hopkins Bloomberg School of Public Health, October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/
ADDITIONAL INFORMATION ON VARIABLES
Definitions of selected variables referenced in this issue brief are provided Protective Family Routines and Habits: Prevalence of children who live in
below. See Table 5 for more information or go to the NSCH Learn about the families with fewer than three out of five family routines and habits, among
Survey link. children ages 0-17 with one or more ACEs. The five family routines and habits
for different age groups are: Children ages 0-5: No tobacco use in the home;
CSHCN: Prevalence of children with chronic health conditions identified Family shares a meal at least four days/week; Child has no more than two
by the Children with Special Health Care Needs (CSHCN) Screener, among hours of screen time/day; Child is read to every day; Child was ever fed breast
children ages 0-17 with one or more ACEs. milk. Children ages 6-17: No tobacco use in the home; Family shares a meal at
least four days/week; Child has no more than two hours of screen time/day;
Engaged in School: Prevalence of children definitely engaged in school, Child does required homework; Parents participate in their childs events/
among children ages 6-17 with one or more ACEs. In the 2016 NSCH, children activities.
are considered to be engaged in school if their parents reported definitely
true to both of the following: their child cares about doing well in school and Flourishing (ages 6-17): Prevalence of school-age children whose parents
their child does all required homework. report they observe each of three qualities of flourishing in their child: (1) is
curious and interested in learning new things; (2) can usually stay calm and in
Supportive Neighborhood: Prevalence of children who live in supportive control when faced with a challenge; (3) can usually focus and complete tasks
neighborhoods, among children ages 0-17 with one or more ACEs. In the they have begun.
2016 NSCH, children are considered to live in supportive neighborhoods if
their parents reported definitely agree to at least one of the items below Family Resilience Practices: Prevalence of children whose parent reports
and somewhat agree or definitely agree to the other two: 1. People in my often practicing each of four family communication and belief habits that build
neighborhood help each other out; 2. We watch out for each others children in resilience when they face family problems. These are: 1. Talk about what to do;
this neighborhood; 3. When we encounter difficulties, we know where to go for 2. Work together to solve their problems; 3. Know they have strengths to draw
help in our community. on; 4. Stay hopeful even in difficult times.

REFERENCES ABOUT THE DATA

1. Shonkoff, et al: https://www.ncbi.nlm.nih.gov/pubmed/22201156 The 2016 NSCH surveyed a representative sample of children ages 017
2. Jones, et al: http://doi.org/10.2105/AJPH.2015.302630
(50, 212 children, with representative samples per state). Child level
3. Arkin, et al: https://www.rwjf.org/content/dam/farm/reports/reports/2014/
rwjf409002#page=44 household surveys were conducted with parents or guardians under
4. RWJF Commission: http://www.commissiononhealth.org/Recommendations.aspx the leadership of the Maternal and Child Health Bureau (MCHB) and
5. National Child Traumatic Stress Network: http://www.nctsn.org/resources implemented through the U.S. Bureau of the Census. Data were weighted
6. Sesame Street In Communities: https://sesamestreetcommunities.org/
to represent the population of noninstitutionalized children ages 017
7. Provider Resources: http://www.cahmi.org/wp-content/uploads/2015/01/ACEs-
Resource-Packet_ all-pages_12_06-16.pdf nationally and in each state. With funding from MCHB, the Child and
8. Academic Pediatrics, 17(7S): S51-S69. Academic Pediatrics supplement, Adolescent Health Measurement Initiative (CAHMI), a national initiative
Sept/Oct 2017 Child Well-being and Adverse Childhood Experiences in the US: based in the Johns Hopkins Bloomberg School of Public Health, partners
http://www.academicpedsjnl.net/issue/S1876-2859(17)X0002-8
with MCHB and the US Bureau of the Census to develop the NSCH and
9. Sege, et al: http://www.academicpedsjnl.net/article/S1876-2859(17)30107-9/pdf
10. NSCH ACEs Measure: http://www.academicpedsjnl.net/article/S1876- disseminates data files, variable coding and micro-data findings on its Data
2859(17)30324-8/pdf Resource Center website (www.childhealthdata.org). See the CAHMI Data
11. Bethell, et al: https://www.ncbi.nlm.nih.gov/pubmed/25489028 Resource Center websites NSCH Learn About the Survey information on
12. Bethell, et al: https://www.ncbi.nlm.nih.gov/m/pubmed/26980120
the sampling, administration and content for the 2016 NSCH.
13. Szilagyi, et al: https://www.ncbi.nlm.nih.gov/m/pubmed/27157045
14. Bright Futures Guidelines: https://brightfutures.aap.org/materials-and-tools/
guidelnes-and-pocketguide/Pages/default.aspx ABOUT THE STUDY
15. Bellis, et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549819/
16. Porter, et al: http://www.academicpedsjnl.net/article/S1876-2859(16)30496-X/pdf CAHMI used 2016 NSCH public use files to construct variables and conduct
17. Pachter, et al: http://www.academicpedsjnl.net/article/S1876-2859(17)30168-7/pdf analysis and statistical tests for this study. The national and across state
18. Bruner, et al: http://www.academicpedsjnl.net/article/S1876-2859(17)30352-2/pdf
profile of adverse childhood experiences and opportunities to promoting
19. Ellis, et al: http://www.academicpedsjnl.net/article/S1876-2859(16)30552-6/pdf
http://www.academicpedsjnl.net/article/S1876-2859(17)30352-2/pdfBruner healing and thriving largely represented updated results on previously
20. Brown, et al: http://www.academicpedsjnl.net/article/S1876-2859(17)30015-3/pdf published peer reviewed publications led by CAHMI using the 2011-12 NSCH.
21. Becker, et al: https://link.springer/com/article/10.1007/s10826-015-0352-y See references noted throughout this Issue Brief. Note that all differences
22. Magen, et al: http://www.academicpedsjnl.net/article/S1876-2859(17)30106-7/pdf
in key variables by a childs ACEs status reported here are statistically
23. Cocker, et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771128
24. Head Start Tool: https://eclkc.ohs.acf.hhs.gov/webinar/introducing-well-visit- significant using standard tests of differences or regression analysis.
planner-tool-family-engagement-head-start-early-head-start-centers
25. National Agenda: http://www.academicpedsjnl.net/article/S1876-2859(17)30354- ACKNOWLEDGEMENTS
6/pdf
Work to conduct this study and prepare the issue brief report was
supported through grants to CAHMI/JHU by the Robert Wood Johnson
Foundation and the Childrens Hospital Association in partnership with
AcademyHealth to advance national and state policy to address ACEs and
Citation: Bethell, CD, Davis, MB, Gombojav, N, Stumbo, S, Powers, K. Issue Brief: A promote child well-being in childrens health services in the US, as set
national and across state profile on adverse childhood experiences among children
and possibilities to heal and thrive. Johns Hopkins Bloomberg School of Public Health, forth in a recently published national agenda for doing so.
October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/

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