Vital Signs/ACEs Report Talking Points & Other Resources


Link to Vital Signs/ACEs Report:

Vital Signs/ACEs Report Talking Points:

  • The CDC’s Vital Signs/ACEs report represents a milestone in our collective understanding of the overall health and socioeconomic impacts of ACEs in this country and what can be done to prevent them.
  • For this report data were collected between 2015 and 2017 through the BRFSS from more than 144,000 adults in 25 states.
  • Takeaway #1: ACEs are common—probably more common than you think—nearly 61% of all respondents experienced at least one type of ACEs.
  • Additionally, nearly one in six respondents (16%) reported four or more types of ACEs.
  • Females and American Indian/Alaskan Native Non-Hispanic, Black Non-Hispanic groups were more likely to experience 4 or more ACEs. Evidence supports that some children and families are at greater risk for ACEs due to the historical, social, structural, political, and economic environments in which they live.
  • Takeaway #2: The effects of ACEs add up over time and impact our health and life outcomes.
  • The more types of adversities you experience, the higher your risk of experiencing poor health outcomes, like depression, overweight/obesity, and cardiovascular disease.
  • Also, you are more likely to engage in health risk behaviors, such as smoking and heavy drinking, and to experience poor socioeconomic outcomes, such as unemployment.
  • For example, odds of depression were five times higher among adults with high levels of ACEs exposure v. those reporting no ACEs exposure.
  • Takeaway #3: Preventing ACEs could help prevent poor health and life outcomes.
  • At least five of the top ten leading causes of death are associated with ACEs
  • This study found that preventing ACEs could potentially result in a:
    • 44% reduction in depression
    • 26% reduction in COPD
    • 24% reduction in heavy drinking
    • Almost 13% reduction in coronary heart disease, the leading cause of death in the US
  • Applied to national estimates in 2017, this translates to up to 1.9 million cases of coronary heart disease…
    • 2.5 million cases of overweight or obesity
    • 1.5 million instances of high school noncompletion, and
    • 21 million cases of depression that would have been potentially avoided by preventing ACEs
  • Plus, reductions in socioeconomic challenges, including a nearly 15% reduction in unemployment.
  • Takeaway #4: ACEs are preventable.
  • Creating the conditions for safe, stable, nurturing relationships for children, families, and entire communities are fundamental to preventing ACEs.
  • There are many ways to achieve this:
    • Strengthening economic supports for families (EITC and family-friendly work policies)
    • Promoting social norms that protect against violence and adversity (public education campaigns);
    • Ensuring a strong start for children (high quality child care and home visiting programs, such as Healthy Families America);
    • Enhancing skills to help adults and youth handle stress, manage emotions and tackle everyday challenges;
    • Connecting youth to caring adults and activities (mentoring and programs)
    • Intervening to lessen immediate and long-term harms  (e.g., enhanced primary care to identify and address ACEs exposures through screenings, referrals, and supports)
  • We must approach ACEs prevention comprehensively and collaboratively…because prevention happens in partnership.
  • This means focusing on primary prevention and comprehensive approaches to prevention, working closely with our partners in the child abuse and neglect prevention field.
  • It also means engaging partners outside the field, such as the business sector, media, and national, state, and local legislators.
  • We all have a role to play in preventing early adversity and ACEs.
  • Together, we can prevent child abuse, America—because childhood lasts a lifetime.

Download the Vital Signs/ACEs Report Talking Points in PDF format here.

Additional ACEs Resources:

ACEs video:
ACEs webpage:
ACEs snapshot:
ACEs infographics:
ACEs prevention training:
ACEs prevention resource:
JAMA Pediatrics Viewpoint on ACEs:

ACEs Resources for Business:

Boost Your Competitive Edge:
Making the Case for Engaging Businesses:

FAQs about the Vital Signs/ACEs Report:

What was the impetus for this study?

Exposure to ACEs can have profound and lasting effects on a broad range of health and social outcomes, including health risk behaviors that contribute to preventable death and disease and chronic mental and physical health conditions. At least 5 leading causes of death have been associated with exposure to ACEs.

ACEs are common and, while everyone is at risk of experiencing ACEs, some people are at greater risk due to the historical, social, structural, political, and economic environments in which they live. Given the connection between ACEs and chronic health conditions and health risk behaviors, preventing ACEs is an important public health strategy for preventing many of the leading causes of adult morbidity and mortality.

To understand the potential benefits of preventing ACEs, this study sought to estimate population attributable fractions (PAFs) for health conditions, health risk behaviors, and socioeconomic impacts. These results provide an estimate of the possible percent reduction in the number of cases of each outcome that would be expected if ACE exposure were reduced or eliminated.

How was the current study conducted?

  • 2015 to 2017 Behavioral Risk Factor Surveillance System (BRFSS) data from 25 states that included ACE items were used for this analysis.
  • Each respondent was classified into one of the following ACE exposure categories based on the number of ACEs they reported: 0 (no ACE exposure), 1, 2–3, and 4+ (greatest ACE exposure).
  • 14 key outcomes were assessed for their association with ACE exposure.
  • Outcomes included the respondent’s self-reported status for coronary heart disease (CHD), stroke, asthma, chronic obstructive pulmonary disease (COPD), cancer (excluding skin), kidney disease, diabetes, depression, current smoking, heavy drinking (>14 alcoholic beverages per week for men and >7 alcoholic beverages per week for women), overweight/obesity (BMI of 25 or greater), less than a high school education, unemployment, and lacking health insurance.
  • Logistic regression modeling adjusting for age, race/ethnicity, and sex was used to calculate population attributable fractions (PAFs) representing the potential reduction in the outcomes associated with reductions in ACEs.
  • Population attributable fraction (PAF) is a metric that can help stakeholders understand the impact and cost savings of ACEs prevention on later health and wellbeing outcomes.
  • Population attributable fraction can also be defined as the number of cases avoided of various chronic diseases, mental health problems, health risk behaviors and socioeconomic challenges if ACEs are prevented.

 What is BRFSS?

The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based telephone survey of noninstitutionalized adults administered annually within each state, the District of Columbia, and US territories. Participants are asked questions covering a wide range of health conditions and health risk behaviors.

What is the BRFSS ACE module?

Since 2009, more than 40 states plus the District of Columbia have included ACE questions for at least one year on their survey. The BRFSS optional ACE module was adapted from the original CDC-Kaiser ACE Study and is used to collect information on child abuse and household challenges. However, neglect items are not included on the BRFSS ACE module, and there are some modifications to the questions. The ACE module can be found here: This 11-question module assesses exposure to abuse (physical, emotional, and sexual) and to 5 types of household challenges (household member substance use, incarceration, or mental illness, parental divorce, or witnessing intimate partner violence) prior to age 18.  Some of the BRFSS ACE data are available to the public. See CDC’s BRFSS website for more information about the BRFSS. States can add questions to the modules; state added questions are not available on the BRFSS website.

Why is the data limited to the years 2015–2017?

BRFSS ACEs data are continuously collected. The 2018 data are now available, but they were not available in time to clean, weight, and add to our dataset before doing the analysis for this study. ACEs data are collected retrospectively among adults on the Behavioral Risk Factor Surveillance System (BRFSS), and therefore, the estimates tend to stay relatively stable over time and across locations. The results observed are unlikely to change with the addition of the 2018 data. Data prior to 2015 have been used in previous publications (see Merrick et al., 2018), so this study focused on the data from 2015 to 2017.