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Behavioral Risk Factor Surveillance System ACE Data
Many states are collecting information about adverse childhood experiences (ACEs) through the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is an annual, state-based, random-digit-dial telephone survey that collects data from non-institutionalized U.S. adults regarding health conditions and risk factors. Since 2009, all 50 states and the District of Columbia have included ACE questions for at least one year on their survey.
| 2021 | Alabama, Arkansas, Iowa, Kansas, Maine, Mississippi, Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, Oregon, South Carolina, Virginia, Wisconsin |
| 2020 | Alabama, Arizona, California, District of Columbia, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Mississippi, Missouri, Montana, Nevada, New Jersey, North Dakota, Oklahoma, Rhode Island, South Carolina, South Dakota, Texas, Utah, Virginia, Wisconsin, Wyoming |
| 2019 | Alabama, Delaware, Florida, Indiana, Iowa, Kansas, Michigan, Mississippi, Missouri, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia, Wisconsin |
| 2018 | Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Maryland, Nevada, New Jersey, Oklahoma, Oregon, South Carolina, South Dakota, Utah, Virginia, West Virginia, Wisconsin |
| 2017 | California, Connecticut, Illinois, Iowa, Oregon, South Carolina, South Dakota, Tennessee, Virginia, Wisconsin |
| 2016 | Arizona, Arkansas, Georgia, Hawaii, Iowa, Louisiana, Michigan, Nevada, New Hampshire, New York, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Virginia, Wisconsin |
| 2015 | Alaska, California, Iowa, Kansas, Kentucky, Louisiana, Maryland, Nebraska, Nevada, New Hampshire, Ohio, Oregon, South Carolina, Tennessee, Texas, Wisconsin |
| 2014 | Alaska, Arizona, Colorado, Florida, Iowa, Kansas, Louisiana, Nevada, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, West Virginia, Wisconsin |
| 2013 | California, Iowa, Michigan, Oregon, Utah, Wisconsin |
| 2012 | Iowa, North Carolina, Oklahoma, Tennessee, Wisconsin |
| 2011 | California, Maine, Minnesota, Montana, Nebraska, Nevada, Oregon, Vermont, Washington, Wisconsin |
| 2010 | District of Columbia, Florida, Hawaii, Maine, Nebraska, Nevada, Ohio, Pennsylvania, Utah, Vermont, Washington, Wisconsin |
| 2009 | Arkansas, California, Louisiana, New Mexico, Tennessee, Washington |
The BRFSS adverse childhood experiences (ACE) module was adapted from the original CDC-Kaiser ACE study and is used to collect information on child abuse and neglect and household challenges. The module is available in English and Spanish.
The questionnaires are not copyrighted, and there are no fees for their use. If you include the ACE study questionnaires in your research, a copy of the subsequent article(s) is requested (send to dvpinquiries@cdc.gov). Please note that while the questions used in the optional ACEs Module are provided below, these are subject to change. Please see the BRFSS Questionnaires website for the most updated information regarding what questions BRFSS used in the optional ACEs Module Survey.
ACEs are categorized into two groups on the BRFSS ACE module: abuse and household challenges. Each category is divided into multiple subcategories. Neglect items were not added to the BRFSS ACE module until 2019.
States that have added the ACE module using their own resources are not required to report ACE data back to CDC BRFSS. To access states’ ACE data please contact each state’s BRFSS coordinator. A list of state coordinators can be found on the BRFSS state coordinators web page.
ACEs Definitions
All ACE questions refer to the respondent’s first 18 years of life.
- Abuse1
- Emotional abuse: A parent or other adult in your home ever swore at you, insulted you, or put you down.
- Physical abuse: A parent or other adult in your home ever hit, beat, kicked or physically hurt you.
- Sexual abuse: An adult or person at least 5 years older ever touched you in a sexual way, or tried to make you touch their body in a sexual way, or attempted to have sex with you.
- Household Challenges
- Intimate partner violence:2 Parents or adults in home ever slapped, hit, kicked, punched or beat each other up.
- Substance abuse in the household: A household member was a problem drinker or alcoholic or used street drugs or abused prescription medications.
- Mental illness in the household: A household member was depressed or mentally ill or a household member attempted suicide.
- Parental separation or divorce: Parents were ever separated or divorced.
- Incarcerated household member: A household member went to prison.
- Neglect3
-
- Emotional neglect: An adult in the household never or very seldom made you feel safe and protected.
- Physical neglect: An adult in the household never or very seldom tried hard to make sure your basic needs were met.
1 Abuse Questions were modified from the original CDC-Kaiser ACE Study to make them more appropriate for a telephone survey.
2 In the original CDC-Kaiser ACE Study, the question pertained only to the mother being treated violently.
3 Neglect questions were added to BRFSS ACEs module in 2019.
Participant Demographics
Demographic Information for U.S Participants Completing the 2011-2020 BRFSS ACE Module |
||
|---|---|---|
| Demographic Information | Percent (N = 264,882) | |
| Gender | ||
| Female | 51.9% | |
| Male | 48.0% | |
| Race/Ethnicity | ||
| White, non-Hispanic | 63.1% | |
| Black, non-Hispanic | 10.9% | |
| Another race, non-Hispanic | 6.3% | |
| Multiracial, non-Hispanic | 1.3% | |
| Hispanic | 15.9% | |
| Age (years) | ||
| 18-24 | 11.9% | |
| 25-34 | 16.0% | |
| 35-44 | 16.0% | |
| 45-54 | 16.1% | |
| 55-64 | 17.0% | |
| 65+ | 22.0% | |
| Educational Attainment | ||
| Less than High School | 12.3% | |
| High School Diploma/GED | 27.7% | |
| Some College | 31.1% | |
| College Degree | 28.9% | |
Note: Reports and articles that use data from other years and/or states may contain different estimates.
Source: Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. MMWR Morb Mortal Wkly Rep 2023;72:707–715. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a2.
ACEs Prevalence
The prevalence estimates reported below are for all 50 states and DC, 2011-2020 BRFSS ACEs module (n=264,882).
Note: Reports and articles that use data from other years and/or other states may contain different estimates.
Prevalence of ACEs by Category among U.S. Adults, 2011-2020 BRFSS ACEs Module |
|||
|---|---|---|---|
| ACE Category | Women | Men | Total |
| Percent | Percent | Percent | |
| ABUSE | |||
| Emotional Abuse | 34.0% | 34.0% | 34.0% |
| Physical Abuse | 22.7% | 24.0% | 23.3% |
| Sexual Abuse | 17.7% | 7.0% | 12.6% |
| HOUSEHOLD CHALLENGES | |||
| Intimate Partner Violence | 18.1% | 16.3% | 17.2% |
| Substance Abuse | 27.9% | 25.0% | 26.5% |
| Mental Illness | 19.9% | 14.4% | 17.3% |
| Parental Separation or Divorce | 28.4% | 28.4% | 28.4% |
| Incarcerated Household Member | 8.1% | 9.3% | 8.6% |
Note: Reports and articles that use data from other years and/or other states may contain different estimates.
ACE Score Prevalence among U.S. Adults, 2001-2020 BRFSS ACEs Module |
|||
|---|---|---|---|
| Number of Adverse Childhood Experiences (ACE Score) | Women Percent |
Men Percent |
Total Percent |
| 0 | 36% | 36.3% | 36.1% |
| 1 | 22.1% | 24.2% | 23.1% |
| 2-3 | 22.7% | 24.2% | 23.5% |
| 4 or more | 19.2% | 15.2% | 17.3% |
Note: Reports and articles that use data from other years and/or other states may contain different estimates.
Source: Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. MMWR Morb Mortal Wkly Rep 2023;72:707–715. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a2.
The prevalence of ACEs from the BRFSS data was similar to that of the original ACE Study. Almost two-thirds of surveyed adults reported at least one ACE and more than one in four reported three or more ACEs.
ACEs are common across all populations. Some populations are more vulnerable to experiencing ACEs because of the social and economic conditions in which they live, learn, work and play.
The ACE score is the total sum of the different categories of ACEs reported by participants. Study findings show a graded dose-response relationship between ACEs and negative health and well-being outcomes. In other words, as the number of ACEs increases so does the risk for negative health outcomes. For an exhaustive list of outcomes, see selected journal publications.
Association between ACEs and Negative Outcomes
