Definition

Childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. The ACEs included here are a collection of common experiences that may be traumatic to children and youth. They include abuse, neglect, and household challenges that occur during the first 18 years of life. ACEs have been shown to have a potential impact on future violence, victimization, and perpetration, as well as lifelong health and opportunity. ACEs are common; as nearly two-thirds (61.6%) of surveyed U.S. adults experienced at least one ACE and many adults experienced more than one. ACEs can affect optimal health and development across the lifespan, particularly in the absence of protective factors. However, ACEs are preventable, and when present their effects can be mitigated.

Numerator

The 2013, 2016, 2018, and 2020 BRFSS respondents who responded affirmatively to the eleven questions in the Adverse Childhood Experience (ACE) Module.

Denominator

The number of adults aged 18 and above who participated in the 2013, 2016, 2018, and 2020 BRFSS.

Data Interpretation Issues

BRFSS Adverse Childhood Experience (ACE) Module Looking back before you were 18 years of age---. 1) Did you live with anyone who was depressed, mentally ill, or suicidal? 2) Did you live with anyone who was a problem drinker or alcoholic? 3) Did you live with anyone who used illegal street drugs or who abused prescription medications? 4) Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility? 5) Were your parents separated or divorced? 6) How often did your parents or adults in your home ever slap, hit, kick, punch or beat each other up? 7) Before age 18, how often did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way? Do not include spanking. 8) How often did a parent or adult in your home ever swear at you, insult you, or put you down? 9) How often did anyone at least 5 years older than you or an adult, ever touch you sexually? 10) How often did anyone at least 5 years older than you or an adult, try to make you touch sexually? 11) How often did anyone at least 5 years older than you or an adult, force you to have sex? Module Weaknesses: Limited to specific more common adversities; Severity or frequency of potential trauma is unknown; All experiences are weighted equally; Module does not account for protective factors in the past that might prevent or mitigate the negative long-term impacts of childhood adversities.

Why Is This Important?

Exposure to ACEs may result in toxic stress responses that can impede a child's development, such as changes in gene expression, changes in brain connectivity and immune function, and changes in the type of coping strategies adopted. While many coping strategies are healthy and help reduce acute stress, some (e.g. smoking cigarettes, drinking alcohol, using substances, engaging in risky sexual behavior) present additional risks to health and wellbeing. As such, exposure to early adversity can increase the risk of later chronic and infectious health conditions through changes in physiological mechanisms, as well as increased engagement in health risk behaviors, and can ultimately result in premature death.

Healthy People Objective IVP-38:

Reduce nonfatal child maltreatment
U.S. Target: 8.5 maltreatment victims per 1,000 children

How Do We Compare With the U.S.?

When comparing BRFSS data, the prevalence of 4+ ACEs in Utah is lower than nationally (15.4% vs 15.8%). National prevalence comes from a 2018 Merrick, et al. study that included 2011-2014 BRFSS data from 23 states, while Utah prevalence is from the ACEs Module included in the Utah BRFSS in 2013, 2016, 2018, and 2022. Source: Merrick, M.T., Ford, D.C., Ports, K. A., Guinn, A. S. (2018). Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States. JAMA Pediatrics, 172(11), 1038-1044.

Evidence-based Practices

Promote safe stable nurturing relationships and environments for all children by:

Available Services

The Violence and Injury Prevention Program housed in the Utah Department of Health in coordination with the Utah Coalition for Protecting Childhood (UCPC) has developed a State Action Plan for the Primary Prevention of Child Maltreatment in Utah utilizing the CDC's Essentials for Childhood framework. This plan includes specific strategies and approaches to preventing ACEs and mitigating their negative effects by creating safe, stable, and nurturing relationships and environments for all Utah children. The state plan can be found at vipp.health.utah.gov This is also a sensitive topic and if you need information or help finding support for your own experiences you can dial 1-800-422-4453.

Relevant Population Characteristics

As the number of ACEs increases so does the risk of injury, sexually transmitted infections (including HIV), mental health problems, maternal and child health problems, teen pregnancy, involvement in sex trafficking, a wide range of chronic diseases, and dying from one of the leading causes of death (such as cancer, diabetes, heart disease, and suicide). ACEs can also negatively impact education, employment, and earnings potential. However, it is important to remember that the presence of ACEs does not mean a child will experience poor outcomes. The presence of positive childhood experiences and protective factors like healthy connections can prevent and mitigate the negative effects of childhood adversity.

The most common ACE experienced by adults in Utah was emotional abuse with 38.3% indicating a parent or adult in the home had sworn at them, insulted them, or put them down before the age of 18. The next most prevalent ACEs in Utah are household substance abuse reported by 23.8% of adults and household mental illness reported by 23.7% of adults. Compared with national respondents, Utahns had a higher prevalence of Household Mental Illness (23.7% vs 16.5% nationally), Sexual Abuse (13.9% vs 11.6% nationally), Emotional Abuse (38.3 vs 34.4% nationally), and Physical Abuse (21.4% vs 17.9% nationally). Nationally, there are a higher prevalence of Divorce (27.6% vs 22.8% in Utah), Household Substance Abuse (27.6% vs 23.8% in Utah) and Domestic Violence (17.5% vs 15.7% in Utah).

Data Notes

All questions refer to the time period before respondents were 18 years of age.   Source of national data: Merrick, M.T., Ford, D.C., Ports, K. A., Guinn, A. S. (2018). Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States. JAMA Pediatrics, 172(11), 1038-1044.

In Utah, 63% of adults have experienced at least one ACE, and over one in four have experienced three or more. Among Utah women, 28.1% experienced three or more ACEs compared with 23.3% of men, a statistically significant difference. Females affirmed experiencing more household substance abuse, house mental illness, domestic violence, divorce, and emotional abuse. Also, females were two times more likely to affirm experiencing sexual abuse than males. Males affirmed experiencing more physical abuse and incarcerated household members.

Data Notes

All questions refer to the time period before respondents were 18 years of age.

Data Source

The Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS)

ACEs are common across all sociodemographic characteristics, yet some populations are more vulnerable to experiencing ACEs, such as children living in poverty and racial and ethnic minorities, because of the structural and social conditions in which some children and families live, learn, work, and play. Adults who identify as American Indian or Alaska Native are impacted with the highest numbers of ACEs, 31.2% having 4+ ACEs (almost double the overall prevalence); followed by Multiracial at 23.2% and Black at 22.2%.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores.

Data Source

The Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS)

Compared to those with no disabilities, individuals with one or more disabilities indicated a statistically higher prevalence of experiencing all eight of the surveyed ACEs with sexual abuse being more than two times more prevalent (26% vs 12.2%).

Data Notes

All questions refer to the time period before respondents were 18 years of age.

ACEs are common across all sociodemographic characteristics, yet some populations are more vulnerable to experiencing ACEs, such as children living in poverty and racial and ethnic minorities, because of the structural and social conditions in which some children and families live, learn, work, and play. Lower-income households are impacted with significantly more ACEs than the state as a whole, 24.8% of households making less than $25,000 affirmed 4+ ACEs. Households in extreme poverty (less than 50% of the poverty level) are even more impacted with 29.3% having 4+. This is more than two times the prevalence of 4+ ACEs experienced by households making more than $75,000.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores.

Data Source

The Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS)

When comparing the impact of high ACE scores (4+ ACEs) by population density (Urban, Rural, Frontier), there is not a significant difference in the distribution. However, there are Local Health Districts (LHDs) that are significantly impacted by higher or lower prevalence than the state overall. LHDs with a statistically higher prevalence of high ACE scores (4+ ACEs) include Salt Lake County, Tooele County, and Weber-Morgan. LHDs with statistically lower prevalence of high ACE scores include Bear River, Summit County, Utah County, and Wasatch County.

Data Notes

All questions refer to the time period before respondents were 18 years of age.   The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores.

Data Source

The Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS)

In order to facilitate data reporting at the community level, Utah has been divided into 99 Small Areas. These areas are determined based on specific criteria, including population size, political boundaries of cities and towns, and economic similarity. When comparing Utah Small Areas by population density (Urban, Rural, Frontier), there is not a significant difference in the distribution of ACEs. However, there are Utah Small Areas that are significantly impacted by more ACEs or fewer ACEs than the state as a whole. Utah Small Areas with statistically higher prevalence of high ACE scores (4+ ACEs) include Tooele County (Other), South Salt Lake, Taylorsville (West), Magna, Taylorsville (East)/Murray (West), Kearns V2, Murray, Sandy (West), Ogden (Downtown), Riverdale, West Vally (East) V2, and Layton/South. Utah Small Areas with a statistically lower prevalence of high ACE scores include Hurrican/La Verkin, Alpine, Woods Cross/West Bountiful. North Salt Lake, Delta/Fillmore, Draper, North Logan, Orem (West), Spanish Fork, Summit County (East), West Jordan (West)/Copperton, Park City, and Wasatch County

Data Notes

All questions refer to the time period before respondents were 18 years of age.   The 4+ ACE score is highlighted here because research suggests a higher prevalence of negative long-term impacts with higher ACE scores. Utah Small Areas. Retrieved on 10/25/2021 from Utah Department of Health, Center for Health Data and Informatics, Indicator-Based Information System for Public Health website: https://ibis.health.utah.gov/ibisph-view/pdf/resource/UtahSmallAreaInfo.pdf.

Data Source

The Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS)