Adverse Childhood Experiences in District of Columbia

District of Columbia

Adverse childhood experiences (ACEs) are stressful or traumatic events that can impact children’s health and well-being throughout their lifespan. Early experiences have a broad and profound impact on an individual’s development and subsequent emotional, cognitive, social and biological functioning. The relationship between ACEs and health was first described in a study published in 1998, which found a higher number of adverse childhood exposures was associated with a higher number of risk factors for leading causes of death in adults. A recent study found that having four or more ACEs (compared with none) was associated with a number of adverse health outcomes, including:

• Drug abuse and interpersonal and self-directed violence (very strong associations).
• Sexual risk-taking behaviors, poor mental health and alcohol abuse (strong associations).
• Smoking, heavy alcohol use, poor self-rated health, cancer, heart disease and respiratory disease (moderate associations).
• Physical inactivity, overweight or obesity and diabetes (weak or modest associations). 

There are also socioeconomic challenges associated with ACEs, including not graduating from high school, being unemployed and lacking health insurance. These negative experiences place a great economic burden on families, communities and society, costing an estimated $748 billion annually in North America.

The prevalence of ACEs is higher among:

• Children living in poverty compared with children living above the poverty level. 
• Non-Hispanic Black children compared with non-Hispanic white children. Hispanic children have the next-highest prevalence of ACEs. 

Prevention strategies to address ACEs include:

• Improving social and economic support for children and families.
• Promoting violence prevention.
• Ensuring children have a strong start in life.
• Teaching social-emotional and healthy relationship skills.
• Connecting youth to adults and activities through mentoring or after-school programs. 
• Intervening with services necessary to reduce short- and long-term harms of ACEs. 

Policy recommendations for addressing ACEs include: 

• Increasing awareness of ACEs and their impact on health in both the professional and public spheres.
• Increasing capacity of health care providers to assess the presence of ACEs and provide appropriate treatment options.
• Training health care providers in trauma-informed care.
• Supporting research for more sensitive assessment tools.
• Enhancing the capacity of communities to prevent and respond to ACEs through investments in evidence-based prevention programming and trauma interventions.
• Increasing access to needed mental health and substance abuse services.
• Encouraging nurturing home and classroom environments.

The Centers for Disease Control and Prevention’s (CDC) Division of Violence Prevention has a free online training module on ACEs prevention. The introductory module is appropriate for anyone interested in learning about ACEs regardless of education level or profession and is designed to help users understand, recognize and prevent ACEs. Additional modules for professionals working directly with and on behalf of kids and families are also available.

Healthy People 2030 has a developmental objective to reduce the number of young adults ages 18-25 who report three or more ACEs.

Bellis, Mark A., Karen Hughes, Kat Ford, Gabriela Ramos Rodriguez, Dinesh Sethi, and Jonathon Passmore. “Life Course Health Consequences and Associated Annual Costs of Adverse Childhood Experiences across Europe and North America: A Systematic Review and Meta-Analysis.” The Lancet Public Health 4, no. 10 (October 1, 2019): e517–28. https://doi.org/10.1016/S2468-2667(19)30145-8.

Bethell, Christina D., M.B. Davis, Narangerel Gombojav, Scott Stumbo, and Kathleen Powers. “A National and Across-State Profile on Adverse Childhood Experiences Among U.S. Children and Possibilities to Heal and Thrive.” Issue Brief. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, October 2017. https://www.cahmi.org/docs/default-source/resources/issue-brief-a-national-and-across-state-profile-on-adverse-childhood-experiences-among-children-and-possibilities-to-heal-and-thrive-(2017).pdf.

Felitti, Vincent J., Robert F. Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards, Mary P. Koss, and James S. Marks. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine 14, no. 4 (May 1998): 245–58. https://doi.org/10.1016/S0749-3797(98)00017-8.

Hughes, Karen, Mark A. Bellis, Katherine A. Hardcastle, Dinesh Sethi, Alexander Butchart, Christopher Mikton, Lisa Jones, and Michael P. Dunne. “The Effect of Multiple Adverse Childhood Experiences on Health: A Systematic Review and Meta-Analysis.” The Lancet Public Health 2, no. 8 (August 2017): e356–66. https://doi.org/10.1016/s2468-2667(17)30118-4.

Merrick, Melissa T., Derek C. Ford, Katie A. Ports, Angie S. Guinn, Jieru Chen, Joanne Klevens, Marilyn Metzler, et al. “Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017.” MMWR. Morbidity and Mortality Weekly Report 68, no. 44 (November 8, 2019): 999–1005. https://doi.org/10.15585/mmwr.mm6844e1.