{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:26:31Z","timestamp":1777508791970,"version":"3.51.4"},"reference-count":22,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Although preventable, adverse childhood experiences (ACEs) can result in lifelong health harms. Current surveillance data on adults\u2019 exposure to ACEs are either unavailable or incomplete for many U.S. states.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Current estimates of the proportion of U.S. adults with past ACEs exposures were obtained by analysing individual-level data from 2019 to 2020 Behavioural Risk Factor Surveillance System\u2015annual nationally representative survey of noninstitutionalized adults aged 18+years. Standardised questions measuring ACEs exposures (presence of household member with mental illness, substance abuse, or incarceration; parental separation; witnessing intimate partner violence; experiencing physical, emotional, or sexual abuse during childhood) were categorised into 0, 1, 2\u20133, or 4+ACEs\u2009and reported by sociodemographic group in each state. Missing ACEs responses (state did not offer ACEs questions or offered to only some respondents; respondent skipped questions) were modelled through multilevel mixed-effects logistic (MMEL) and jackknifed MMEL regressions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 2019\u20132020, an estimated 62.8% of U.S. adults had past exposure to 1+ACEs (range: 54.9% in Connecticut; 72.5% in Maine), including 22.4% of adults who were exposed to 4+ACEs (range: 11.9% in Connecticut; 32.8% in Nevada). At the national and state levels, exposure to 4+ACEs was highest among adults aged 18\u201334 years, those who did not graduate from high school, or adults who did not have a healthcare provider. Racial\/ethnic distribution of adults exposed to 4+ACEs varied by age and state.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>ACEs are common but not equally distributed. ACEs exposures estimated by state and sociodemographic group can help decisionmakers focus public health interventions on populations disproportionately impacted in their area.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/ip-2023-044935","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T13:25:14Z","timestamp":1705584314000},"page":"256-260","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Adults\u2019 exposure to adverse childhood experiences in the United States nationwide and in each state: modeled estimates from 2019-2020"],"prefix":"10.1136","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0036-3851","authenticated-orcid":false,"given":"Maria V","family":"Aslam","sequence":"first","affiliation":[{"name":"National Center for Injury Prevention and Control, CDC, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cora","family":"Peterson","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, CDC, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Swedo","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, CDC, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phyllis H","family":"Niolon","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, CDC, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Bacon","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, CDC, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Curtis","family":"Florence","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, CDC, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"2025092501303601000_30.3.256.1","unstructured":"Centers for Disease Control and Prevention . 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