Abstract
This survey study describes the prevalence of specific adverse childhood experiences and positive childhood experiences among US adolescents aged 12 to 17 years using data from the 2016-2023 National Survey of Children’s Health.
Adverse childhood experiences (ACEs) are potentially traumatic childhood events.1 Positive childhood experiences (PCEs), as defined in the Health Outcomes from Positive Experiences (HOPE) framework,2 are experiences that engage the parent or child to achieve positive health outcomes. Both ACEs and PCEs have been found to impact diverse health outcomes.1,3
Most Americans report experiencing at least 1 ACE (64%)1 and 4 or more PCEs (90%).3 However, few studies examine the prevalence of individual ACEs or PCEs at the population level, as they may change over time. Research has typically focused on cumulative scores (eg, count of ACEs experienced) and retrospective adult reports rather than data on current adolescents. The purpose of this study was to describe the prevalence of specific ACEs and PCEs among US adolescents aged 12 to 17 years using data from the 2016-2023 National Survey of Children’s Health (NSCH).
Methods
The NSCH is a nationally representative, parent-reported survey of noninstitutionalized US children aged 0 to 17 years, administered via web and mail.4 In this study, the 2016-2023 NSCH datasets were combined for analysis following technical recommendations and weighting guidelines from the NSCH.4 For the analysis, we report the number of adolescents aged 12 to 17 years (N = 125 564) experiencing each ACE and PCE from 2016 to 2023, with parents responding on their adolescent's behalf. Annual sample sizes ranged from 8909 to 20 708. Complete methodological details are available on the NSCH website.4
The ACEs analyzed followed the NSCH’s definitions and conceptualizations and included (1) economic hardship, (2) parental divorce or separation, (3) parental death, (4) parental incarceration, (5) domestic violence, (6) neighborhood violence, (7) household mental health concern, (8) household substance use, (9) racial discrimination, (10) gender- or sexuality-based discrimination, and (11) health- or disability-based discrimination.
The PCEs analyzed consisted of several variables organized into 7 items using the same methodology and reporting procedures as prior literature5 and included (1) adult mentorship, (2) family resilience, (3) organized activity participation, (4) service participation, (5) neighborhood support, (6) neighborhood safety, and (7) sharing ideas. Additional details outlining how NSCH items were created are available online.6
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines were followed in this study; however, the publication format limits inclusion of many of the details. This study was exempt from institutional review board approval, as it was a secondary analysis of public data. Full details are available from the corresponding author.
Results
Figure 1 and Figure 2 present the prevalence of ACEs and PCEs, respectively, from 2016 to 2023. Full prevalence data are available online.6 There was little variance in the proportion of adolescents experiencing individual ACEs over time. Specifically, the range of proportion values for 5 ACEs was 0.015 or less over the 8-year period, and 10 of 11 ACEs varied by less than 0.04.
Figure 1. Adverse Childhood Experiences (ACEs) Prevalence in Adolescents by Year.
APC indicates annual percentage change.
Figure 2. Positive Childhood Experiences (PCEs) Prevalence in Adolescents by Year.
APC indicates annual percentage change.
The variability in the proportion of adolescents experiencing individual PCEs was low, although there was more variability observed year to year in PCEs than ACEs. Specifically, the range of proportion values for 4 of the 7 PCEs was 0.065 or less, while the remaining 3 varied by less than 0.13.
Discussion
National prevalence rates remained relatively stable, with most ACEs varying by less than 2% and PCEs by less than 7% over the 7 years of data examined. Some ACEs and PCEs showed greater variability, highlighting the need to examine each individually. Unlike prior research, which analyzes cumulative counts, this study provides population-level estimates for each individual ACE or PCE. Limitations include parent report, no age control, exclusion of items related to abuse, ad hoc PCE definitions, and minor methodological changes in NSCH data collection over time.
The key implication of the stability in prevalence rates is that efforts to reduce ACEs and promote PCEs may not be leading to population-level change. These findings provide a vital baseline for evaluating the impacts of these initiatives based on data collected during and after multiple states have undergone efforts to understand and prevent ACEs and promote PCEs.
Data Sharing Statement
References
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Associated Data
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Supplementary Materials
Data Sharing Statement
