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, 42 states plus the District of Columbia have included ACE questions for at least one year on their survey.

States Collecting BRFSS ACE Data by Year, 2009-2018.

ACEs Map BRFFS

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).

BRFSS ACE Module (English)pdf icon
BRFSS ACE Module (Spanish)pdf icon

ACEs are categorized into two groups on the BRFSS ACE module: abuse and household challenges. Each category is divided into multiple subcategories. Neglect items are not included on the BRFSS ACE module.

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.

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.

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.

Demographic information reported below is for 23 states that included the ACE module on the 2011-2014 BRFSS (n=214,157).

Demographic Information for Participants Completing the 2011-2014 BRFSS ACE Module.

Demographic Information Percent (N = 214,157)
Gender
Female 51.5%
Male 48.5%
Race/Ethnicity
White 68.1%
Black 8.4%
Other 6.3%
Multiracial 1.6%
Hispanic 15.6%
Age (years)
18-24 12.3%
25-34 17.3%
35-44 16.5%
45-54 18.3%
55-64 16.2%
65+ 19.4%
Educational Attainment
Less than High School 13.8%
High School Diploma/GED 28.1%
Some College 32.6%
College Degree 25.5%

Note: Reports and articles that use data from other years and/or states may contain different estimates.

Source: Merrick, M.T., Ford, D.C., Ports, K. A., Guinn, A. S. (In clearance2018). Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States. JAMA Pediatrics, 172(11), 1038-1044.

The prevalence estimates reported below are from 23 states that included the ACE module on the 2011-2014 BRFSS (n=214,157).

Prevalence of ACEs by Category for Participants Completing the ACE Module on the 2011-2014 BRFSS.

ACE Category Women Men Total
Percent Percent Percent
ABUSE
Emotional Abuse 33.9% 34.9% 34.4%
Physical Abuse 17.5% 18.4% 17.9%
Sexual Abuse 16.3% 6.7% 11.6%
HOUSEHOLD CHALLENGES
Intimate Partner Violence 18.2% 16.8% 17.5%
Substance Abuse 28.7% 26.3% 27.6%
Mental Illness 19.2% 13.7% 16.5%
Parental Separation or Divorce 27.8% 27.5% 27.6%
Incarcerated Household Member 7.3% 8.6% 7.9%

Note: Reports and articles that use data from other years and/or other states may contain different estimates.

ACE Score Prevalence for Participants Completing the ACE Module on the 2011-2014 BRFSS.

 

Number of Adverse Childhood Experiences (ACE Score) Women
Percent 
Men
Percent 
Total
Percent 
0 37.6% 39.3% 38.5%
1 22.7% 24.5% 23.5%
2 12.9% 13.9% 13.4%
3 9.0% 8.6% 8.8%
4 or more 17.8% 13.7% 15.8%

Note: Reports and articles that use data from other years and/or other states may contain different estimates.

Source: 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.

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 five 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

Association between ACEs and Negative Outcomes

Page last reviewed: April 9, 2019