Adverse childhood experiences and adult health
Population of interest has
and
Age
Sex
Race/Ethnicity
Education
Income
BRFSS changed its income question after 2020. Through 2020 the top bucket is an open-ended $75K+; from 2021 that range is split into four narrower ones. The two are never combined, so selecting $75K+ restricts the data to 2020 and earlier, and selecting any of the four restricts it to 2021 onward.
About the dashboard
How to read this map
This map shows geographic patterns in the percent (%) of adults. It is based on a population of adults that have an ACE score of 4 or more and any demographic profile.
Blue colored states have higher percent (%) of adults. Light green colored states have lower percent (%) of adults. Alaska, Colorado, Connecticut, and Illinois have no ACE module data in CDC's public BRFSS files and appear gray. Map cells shown in gray have no number to report: N/A where the state has no data, or -- where fewer than 30 respondents answered, which should be interpreted with caution.
ACE data are self-reported: adults answer survey questions about their own childhoods. A state with higher values has not necessarily had more ACEs. Differences between states can also reflect how readily adults recognize and report these experiences, which can vary with cultural factors and awareness of ACEs, among other reasons.
Indicator overview
Population has an ACE score of 4 or more
Every row is divided by the adults who answered that question, so each has its own denominator. Emotional neglect and physical neglect were asked only in 2021-2024, by 29 of the 49 states and territories with ACE module data, so those two sit on roughly a third of the sample the others do.
The rows also differ in what counts. Abuse and household rows count a single occurrence anywhere in childhood, while CDC scores the neglect rows only for the bottom two of five responses about how much of childhood a protective adult was present. Neglect is held to a much stricter test, so these heights measure different things and should not be ranked against each other.
Prevalence (%)
Asked only in 2021-2024
By 29 of 49 states and territories, so a smaller sample than the other rows.
Percent (%) of adults by age
Population has an ACE score of 4 or more
Percent (%)
18-24
23.9
25-34
25.4
35-44
21.4
45-54
19.1
55-64
14.9
65+
7.8
Percent (%) of adults by sex
Population has an ACE score of 4 or more
Percent (%)
Male
15.6
Female
19.5
Percent (%) of adults by race/ethnicity
Population has an ACE score of 4 or more
BRFSS changed its race variable after 2012, and three categories moved position on the scale: American Indian or Alaska Native, Asian, and Native Hawaiian or Pacific Islander. Each era is read on its own scale, so a category means the same thing in every year. Hispanic ethnicity is asked separately and takes precedence, so it never overlaps the others.
Adults who did not answer the question are dropped from the breakdown rather than shown as unknown, so the rows do not add up to the whole population.
Percent (%)
White, non-Hispanic
17.0
Black, non-Hispanic
18.9
American Indian/Alaska Native
30.1
Asian, non-Hispanic
8.2
Native Hawaiian/Pacific Islander
25.4
Other race
20.8
Multiracial
32.2
Hispanic
19.0
Percent (%) of adults by education
Population has an ACE score of 4 or more
Percent (%)
Never attended school
11.5
Elementary (Grades 1-8)
13.7
Some high school
26.3
High school graduate/GED
18.9
Some college
19.9
College graduate
12.7
Percent (%) of adults by income
Population has an ACE score of 4 or more
BRFSS changed its income question after 2020. Through 2020 the top bucket is an open-ended $75K+; from 2021 that range is split into four narrower ones. The two are never combined, so selecting $75K+ restricts the data to 2020 and earlier, and selecting any of the four restricts it to 2021 onward.
Adults who did not answer the question are dropped from the breakdown rather than shown as unknown, so the rows do not add up to the whole population.
Percent (%)
<$10K
26.0
$10-15K
24.4
$15-20K
22.9
$20-25K
21.1
$25-35K
20.9
$35-50K
19.0
$50-75K
18.0
$75K+
13.8
$75-100K
18.4
$100-150K
17.5
$150-200K
16.2
$200K+
13.5
The ACE score follows CDC's scoring of the BRFSS ACE module, collapsing 11 survey items into 8 categories: sexual abuse (3 items), physical abuse, substance abuse (2 items), emotional abuse, witnessed intimate partner violence, household mental illness, incarceration, and parental divorce. Only respondents with valid responses to all 11 survey items are scored. The average is weighted using BRFSS survey weights to be representative of each state's adult population.
Survey years 2009 through 2012 and 2019 onward are pooled. One caution about comparing across that gap: CDC changed the wording of the physical-abuse question between the two periods. Even in states that took part in both periods, the share of adults who reported it was about nine percentage points higher from 2019 onward than in 2009 through 2012. The question about adults hurting each other barely changed, and no other ACE question rose by more than about half as much. So physical abuse, and to a lesser degree the overall score, cannot be compared cleanly across the two periods.
Age matters when comparing states: older adults report fewer ACEs and have more long-term health conditions, and states differ in how old their adults are. Figures on the Explore page are not adjusted for age, so differences between states there partly reflect age. The Compare page adjusts for age by default (to the 2000 U.S. standard population), so every state is compared as if it had the same mix of ages, and it can be switched to show unadjusted figures.
Higher scores indicate more types of adversity experienced during childhood. Read more about adverse childhood experiences.
The ACE score follows CDC's scoring of the BRFSS ACE module, collapsing 11 survey items into 8 categories: sexual abuse (3 items), physical abuse, substance abuse (2 items), emotional abuse, witnessed intimate partner violence, household mental illness, incarceration, and parental divorce. Only respondents with valid responses to all 11 survey items are scored. The average is weighted using BRFSS survey weights to be representative of each state's adult population.
Survey years 2009 through 2012 and 2019 onward are pooled. One caution about comparing across that gap: CDC changed the wording of the physical-abuse question between the two periods. Even in states that took part in both periods, the share of adults who reported it was about nine percentage points higher from 2019 onward than in 2009 through 2012. The question about adults hurting each other barely changed, and no other ACE question rose by more than about half as much. So physical abuse, and to a lesser degree the overall score, cannot be compared cleanly across the two periods.
Age matters when comparing states: older adults report fewer ACEs and have more long-term health conditions, and states differ in how old their adults are. Figures on the Explore page are not adjusted for age, so differences between states there partly reflect age. The Compare page adjusts for age by default (to the 2000 U.S. standard population), so every state is compared as if it had the same mix of ages, and it can be switched to show unadjusted figures.
Higher scores indicate more types of adversity experienced during childhood. Read more about adverse childhood experiences.
The ACE-BRFSS dashboard is built around an interactive grid-map of the United States (plus territories). While exploring ACEs, choose a population of interest and a specific map display. Display options include average ACE score, percent of adults with ACEs, or prevalence of an ACE among the selected population.
The right-hand column starts with an overview of the prevalence of each ACE indicator. Additional bar charts show either the average ACE score or the percent/prevalence of adults/ACEs in major demographic categories. Values update to match the population and geography you've selected.