Adverse Childhood Experiences By Experience, Demographic Group and State
Samantha Liv
2025 Council of State and Territorial Epidemiologists (CSTE) Annual Conference
Background
Adverse childhood experiences (ACEs) are potentially traumatic events linked to negative health outcomes in adulthood. The National Survey of Children's Health (NSCH) expanded its ACEs measure to include discrimination based on sexual orientation and gender identity and discrimination based on health conditions in 2020 and 2021, respectively.
Methods
This study analyzed 2022-2023 data from NSCH. Prevalence estimates, state disparity ratios and 95% confidence intervals were calculated for children aged 0-17 experiencing two or more ACEs. Prevalence estimates were stratified by state, gender, race/ethnicity, and caregiver education, and individual ACEs were analyzed separately without stratification. Analyses were conducted using R 4.3.1.
Results
In 2022-2023, 14.5% of U.S. children (approximately 10,108,000) experienced two or more ACEs. Significant disparities occurred across demographic groups. American Indian/Alaska Native children had the highest prevalence at 32.3%, which was 8.7 times higher than the lowest prevalence found among Asian children (3.7%). Children of caregivers with a high school diploma/GED had a prevalence of two or more ACEs that was 2.1 times higher than children of college-educated caregivers (21.1% vs. 10.0%). Geographically, the prevalence was 2.3 times higher in Montana (22.5%) than in New Jersey (9.6%).
The discrimination-based ACEs had lower prevalences but notable state disparities. Race/ethnicity discrimination affected 4.4% of children (3,036,600), health condition or disability discrimination affected 2.8% of children (1,914,200) and sexual orientation or gender identity discrimination affected 1.9% of children ages 12-17 (902,800). Discrimination based on health conditions or disability was 3.0 times higher in West Virginia and Maine (both 4.5%) than in Hawaii (1.5%); discrimination based on race or ethnicity was 3.4 times higher in Mississippi (6.4%) than in Utah (1.9%); and sexual orientation or gender identity discrimination among children ages 12-17 had the highest state disparity ratio, which was 5.8 times higher in Oregon (4.6%) than in New Jersey (0.8%).
Parental divorce or separation was the most prevalent individual ACE, affecting 21.6% of children (14,955,400). Mental illness in the household impacted 8.6% of children (5,945,300), substance misuse in the household affected 8.2% of children (5,649,600) and parental incarceration impacted 6.0% of children (4,164,900) and had the second highest state disparity ratio, at 5.3 times higher in Arkansas (12.3%) than Massachusetts (2.3%).
Conclusion
This analysis reveals disparities in overall ACE prevalence across racial and ethnic, educational, and geographic lines in the United States. The inclusion of discrimination-based ACEs provides a more comprehensive picture of childhood adversity, highlighting the need for targeted interventions to address ACEs.
