Adverse Childhood Experiences 

Adverse Childhood Experiences (ACEs) have a widespread impact on the public and social health of communities and people across the United States.  ACEs refer to a combination of negative early life experiences involving emotional, physical and sexual abuse, neglect and exposure to violence, mental illness, substance use, parental separation, and incarceration in the household endured before the age of 18.[1],[2] According to a recent study, almost 62% of adults have experienced an ACE during early childhood, with nearly one-fourth experiencing three or more ACEs.[3] Traditionally obtained through surveys and interviews, the presence of these indicators from a person’s early life are added up or summed to produce an ACE score. Even though studies vary on the specific indicators used to make up an ACE score, many studies count ACEs out of 10.[4] These experiences are linked to a variety of outcomes such as poor physical and mental health, trauma, and antisocial behavior, like criminal offending.[5]                                                                                                                                                                   
Importantly, studies show that the prevalence of ACEs differs based on some key demographic characteristics nationally. For example, Native Americans tend to experience higher numbers of ACEs relative to other groups.[6] Being Black, Hispanic, gay, lesbian, bisexual, unemployed, and having a lower education are associated with a higher number of ACEs.[7] Disabled adults in the United States experience more ACEs than other adults.[8] In contrast, first-generation immigrants have reported fewer ACEs compared to second-generation immigrants and native-born Americans, but their experiences and how they report them may differ based on the policies and history of the city or county where they live.[9],[10]
The Community Health Statistics Unit in the County of San Diego’s Health and Human Services Agency compiled a report based on data from the California Behavioral Risk Factor Surveillance System in 2015, 2017, and 2019.[11] (Details on how ACEs were defined and how these data were collected are available in the cited report). Disaggregated ACE data by single year at the county level are not publicly available, so 2019 data could not be analyzed separately. Race and sex categories were available, but data were not available for disability status or whether the individual was an immigrant.
ACEs have a major impact on residents of San Diego County. In 2019, 63% of adults in San Diego County had experienced one or more ACEs before the age of 18.[12] The most common ACEs experienced were emotional abuse, parental separation or divorce, and physical abuse. Prevalence of ACEs varied by race/ethnicity and sex (Figure 1). The non-Hispanic Other racial group had the highest prevalence of one or more ACEs, followed by non-Hispanic White and Hispanic. Males reported a higher percentage of one or more ACEs than females (Figure 2).
To reduce ACEs and their subsequent effects, prevention efforts must be made at the local and family level. The County of San Diego’s “ACEs in San Diego County” report highlighted prevention strategies to reduce the prevalence of ACEs and harm to public health.[13] Primary prevention strategies typically work towards a more secure and healthy home environment. These include improving financial support for families embedded in poorer communities, promoting family bonds, and providing access to high quality childcare, education, and healthcare.[14],[15] Lastly, the report, as well as much of the research, notes the importance of being able to screen for or detect the presence of ACEs early and effectively.
In California, notable ACE-based initiatives have been launched to bring awareness to the topic and inspire positive change in diverse California communities. One such initiative is “The Story of Your Number” campaign, which has worked with San Diego communities to understand, detect, and reduce the toxic impact of ACEs on people and subsequent generations of families.[16],[17] Since ACEs reflect a variety of experiences—and knowing the existence of one ACE often signals the presence of another—detection efforts can be crafted towards addressing specific community needs at the local level in San Diego (e.g., schools, economic programs for those in need). Because these experiences are often very personal and traumatic, future detection and intervention efforts should carefully safeguard respondent data.
To that end, several relevant agencies signed a Memorandum of Understanding to cooperate and design trauma-informed services across child welfare, juvenile justice, education, developmental, and mental health children's services.[18] The San Diego County Office of Education has compiled resources for schools and educators[19] and the San Diego ACEs Connection gathers interested people within and outside of government around ACEs awareness and trauma-informed programs.[20]

Data Information
Data Source: From Centers for Disease Control (CDC) and The Behavioral Risk Factor Surveillance System (BRFSS) 2015, 2017, 2019. Prepared by the County of San Diego, Health and Human Services Agency. Adverse Childhood Experiences (ACEs) in San Diego County. September 1, 2022.
References
  1. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
  2. Craig, J. M., Wolff, K. T., & Baglivio, M. T. (2022). Clustering of adverse and positive childhood experiences: the nature and correlates of risk and protective factors. Child Abuse & Neglect, 134, 105878.
  3. 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.
  4. Centers for Disease Control and Prevention. (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
  5. Malvaso, C. G., Cale, J., Whitten, T., Day, A., Singh, S., Hackett, L., ... & Ross, S. (2022). Associations between adverse childhood experiences and trauma among young people who offend: A systematic literature review. Trauma, Violence, & Abuse, 23(5), 1677-1694.
  6. Richards, T. N., Schwartz, J. A., & Wright, E. (2021). Examining adverse childhood experiences among Native American persons in a nationally representative sample: differences among racial/ethnic groups and race/ethnicity-sex dyads. Child Abuse & Neglect, 111, 104812.
  7. 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.
  8. Schüssler-Fiorenza Rose, S. M., Xie, D., & Stineman, M. (2014). Adverse childhood experiences and disability in U.S. adults. PM&R, 6(8), 670–680. https://doi.org/10.1016/j.pmrj.2014.01.013
  9. Vaughn, M. G., Salas-Wright, C. P., Huang, J., Qian, Z., Terzis, L. D., & Helton, J. J. (2017). Adverse childhood experiences among immigrants to the United States. Journal of Interpersonal Violence, 32(10), 1543-1564.
  10. Barajas-Gonzalez, R. G., Ayón, C., Brabeck, K., Rojas-Flores, L., & Valdez, C. R. (2021). An ecological expansion of the adverse childhood experiences (ACEs) framework to include threat and deprivation associated with U.S. immigration policies and enforcement practices: An examination of the Latinx immigrant experience. Social Science & Medicine, 282, 114126.
  11. County of San Diego, Health and Human Services Agency, Public Health Services, Community Health Statistics Unit. (2022). Adverse Childhood Experiences (ACEs) in San Diego County, 2015-2019. Retrieved from https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/CHS/ACEs%20in%20San%20Diego%20County%20Brief.pdf.
  12. Ibid.
  13. Ibid.
  14. Barajas-Gonzalez, R. G., Ayón, C., Brabeck, K., Rojas-Flores, L., & Valdez, C. R. (2021). An ecological expansion of the adverse childhood experiences (ACEs) framework to include threat and deprivation associated with US immigration policies and enforcement practices: An examination of the Latinx immigrant experience. Social Science & Medicine, 282, 114126.
  15. Centers for Disease Control and Prevention. (2019). Preventing adverse childhood experiences: Leveraging the best available evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
  16. NumberStory.org. (n.d.). The story of your number is the story of your ACE history. Retrieved November 13, 2022, from https://numberstory.org/
  17. San Diego State University Social Policy Institute. (n.d.). ACEs aware. Retrieved November 13, 2022, from https://sdsusocialpolicyinstitute.org/work/aces-aware/
  18. County of San Diego Health and Human Services, Child Welfare Services, Behavioral Health Services, San Diego County Probation Department, San Diego County Office of Education, Foster Services Coordinating Program, San Diego Regional Center, Voices for Children, Special Education Local Plan Area, & Tribal Nations. (n.d.). San Diego County Children and Youth System of Care Memorandum of Understanding. Retrieved May 4, 2023, from https://www.chhs.ca.gov/wp-content/uploads/2022/08/SAN-DIEGO-COUNTY-SYSTEM-OF-CARE-MOU-Executed-03.15.2021.pdf
  19. San Diego County Office of Education. (n.d.). Trauma-Sensitive Schools. Retrieved May 4, 2023, from https://www.sdcoe.net/students/health-well-being/trauma-sensitive-schools
  20. Home | San Diego County ACEs Connection (CA) | PACEsConnection. (n.d.). Retrieved June 2, 2023, from https://www.pacesconnection.com/g/san-diego-county-aces-connection-group
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Updated January 17, 2024