About the CDC-Kaiser ACE Study
The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being.
The original ACE Study was conducted at Kaiser Permanente from 1995 to 1997 with two waves of data collection. Over 17,000 Health Maintenance Organization members from Southern California receiving physical exams completed confidential surveys regarding their childhood experiences and current health status and behaviors.
The CDC continues ongoing surveillance of ACEs by assessing the medical status of the study participants via periodic updates of morbidity and mortality data.
More detailed information about the study can be found in the links below or in “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults,” published in the American Journal of Preventive Medicine in 1998, Volume 14, pages 245–258.
The ACE Pyramid
The ACE Pyramid represents the conceptual framework for the ACE Study. The ACE Study has uncovered how ACEs are strongly related to development of risk factors for disease, and well-being throughout the life course.
The Family Health History and Health Appraisal questionnaires were used to collect information on child abuse and neglect, household challenges, and other socio-behavioral factors in the original CDC-Kaiser ACE Study.*
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 firstname.lastname@example.org).
- Family Health History Questionnaire
- Health Appraisal Questionnaire
*More detailed information about the ACE Study’s methodology, including survey development, can be found in “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults,” published in the American Journal of Preventive Medicine in 1998, Volume 14, pages 245–258.
Data and Statistics
Adverse Childhood Experiences (ACEs) are categorized into three groups: abuse, neglect, and family/household challenges. Each category is further divided into multiple subcategories. Participant demographic information is available by gender, race, age, and education. The prevalence of ACEs is organized by category.
All ACE questions refer to the respondent's first 18 years of life.
- Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt.
- Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured.
- Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you.
- Household Challenges
- Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother’s boyfriend.
- Household substance abuse: A household member was a problem drinker or alcoholic or a household member used street drugs.
- Mental illness in household: A household member was depressed or mentally ill or a household member attempted suicide.
- Parental separation or divorce: Your parents were ever separated or divorced.
- Criminal household member: A household member went to prison.
- Emotional neglect: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support.2
- Physical neglect: There was someone to take care of you, protect you, and take you to the doctor if you needed it2, you didn’t have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.
1Collected during Wave 2 only.
2 Items were reverse-scored to reflect the framing of the question.
Demographic information is from the entire ACE Study sample (n=17,337).
Demographic Information for CDC-Kaiser ACE Study Participants, Waves 1 and 2.
|Demographic Information||Percent (N = 17,337)|
|60 and over||46.4%|
|Not High School Graduate||7.2%|
|High School Graduate||17.6%|
|College Graduate or Higher||39.3%|
Note: Research papers that use Wave 1 and/or Wave 2 data may contain slightly different reports of participants’ demographic information.
The prevalence estimates reported below are from the entire ACE Study sample (n=17,337).
Prevalence of ACEs by Category for CDC-Kaiser ACE Study Participants by Sex, Waves 1 and 2.
|Percent (N = 9,367)||Percent (N = 7,970)||Percent (N = 17,337)|
|Mother Treated Violently||13.7%||11.5%||12.7%|
|Household Substance Abuse||29.5%||23.8%||26.9%|
|Household Mental Illness||23.3%||14.8%||19.4%|
|Parental Separation or Divorce||24.5%||21.8%||23.3%|
|Incarcerated Household Member||5.2%||4.1%||4.7%|
Note: 3Collected during Wave 2 only (N=8,629). Research papers that use Wave 1 and/or Wave 2 data may contain slightly different prevalence estimates.
ACE Score Prevalence for CDC-Kaiser ACE Study Participants by Sex, Waves 1 and 2.
|Number of Adverse Childhood Experiences (ACE Score)||Women
Percent(N = 9,367)
Percent (N = 7,970)
Percent (N = 17,337)
|4 or more||15.2%||9.2%||12.5%|
Note: Research papers that use Wave 1 and/or Wave 2 data may contain slightly different prevalence estimates.
Source: Centers for Disease Control and Prevention, Kaiser Permanente. The ACE Study Survey Data [Unpublished Data]. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2016.
Adverse Childhood Experiences (ACEs) are common. Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs.
The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course.
As the number of ACEs increases so does the risk for the following*:
Dose-response describes the change in an outcome (e.g., alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g. ACEs). A graded dose-response means that as the dose of the stressor increases the intensity of the outcome also increases.
- Alcoholism and alcohol abuse
- Chronic obstructive pulmonary disease
- Fetal death
- Health-related quality of life
- Illicit drug use
- Ischemic heart disease
- Liver disease
- Poor work performance
- Financial stress
- Risk for intimate partner violence
- Multiple sexual partners
- Sexually transmitted diseases
- Suicide attempts
- Unintended pregnancies
- Early initiation of smoking
- Early initiation of sexual activity
- Adolescent pregnancy
- Risk for sexual violence
- Poor academic achievement
*This list is not exhaustive. For more outcomes see selected journal publications.