Schwehr, Natalie
Senior Research Associate

e schwe425@umn.edu

New State Health Compare estimates on Adverse Childhood Experiences aim to improve understanding of health inequities

SHADAC has posted updated estimates of the prevalence of adverse childhood experiences (ACEs) to State Health Compare. These new estimates combine six years of data from the National Survey of Children’s Health (NSCH) to enable more precise and granular estimates for smaller racial and ethnic subpopulation groups that often are under-researched due to data limitations. For instance, the new ACEs estimates include both U.S.- and state-level rates for American Indian/Alaska Native children, Asian children, and Native Hawaiian and Other Pacific Islander children, as well as Black/African American children, Hispanic/Latino children, and White children.

Earlier in 2023, SHADAC researchers Colin Planalp and Andrea Stewart published an issue brief on ACEs, explaining the relationship between potentially traumatic childhood experiences and long-term health impacts. Over the past quarter-century, an established and growing body of research has linked exposure to ACEs with a litany of health conditions that can last into adulthood, including physical health impacts, such as heart disease and diabetes, mental health conditions, and substance use disorders.

These new data build on SHADAC’s earlier work in two important ways. First, while Planalp and Stewart’s issue brief combined four years of NSCH data to allow for disaggregation of racial and ethnic groups at the U.S. and state levels, our decision to combine six years of NSCH data resulted in additional precision, which supports equity-focused analysis for demographically small populations. While that approach entails tradeoffs, such as making the data a bit less recent, we believe the advantages outweigh the disadvantages, especially for assessing the relationship between ACEs and health equity.

Second, the referenced issue brief reported estimates for one or more ACEs—a useful measure for examining the prevalence of ACEs, but this measure has limitations for understanding the implications of ACEs. Research suggests that ACEs carry a “dose effect,” meaning that exposure to one ACE carries some health risk, but exposure to multiple ACEs during childhood entails a substantially higher risk of associated health burdens. For the updated SHC estimates pooling six years of data, we were able to produce three estimates: Percent of children with zero reported ACEs, percent of children with one reported ACE, and percent of children with multiple (i.e., two or more) ACEs.

As with SHADAC’s earlier work on the topic, these new estimates of ACEs prevalence illustrate clear health disparities. For instance, American Indian/Alaska Native children had the highest reported exposure to multiple ACEs, at almost four in 10 children, while Asian children had the lowest, at less than one in 10 children (see table below).

Percent of Children Exposed to Two or More ACEs by Race/ethnicity, 2016-2021

Sources: SHADAC analysis of 2016-2021 National Survey of Children’s Health

Together with research linking ACEs to long-term health burdens, these new estimates on SHADAC’s State Health Compare bolster our understanding of how childhood experiences influence health equity: By intervening to reduce the prevalence of ACEs and eliminate disparities in their prevalence, the U.S. might not only improve the lives of children now but improve their health well into adulthood and enhance health equity across our society.

Related Reading

Supporting Families: Associations between Neighborhood Support and Child Health Outcomes Blog
The Kids Aren't Alright: Adverse Childhood Experiences and Implications for Health Equity, Issue Brief 
Neighborhood Support Matters for Child Health, Blog