Prevalence of Adverse Childhood Experiences (Adult Retrospective), by Sexual Orientation

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Learn More About Childhood Adversity, Resilience, and Positive Experiences

Measures of Childhood Adversity, Resilience, and Positive Experiences on Kidsdata.org
Measures of childhood adversity, resilience, and positive experiences on kidsdata.org originate from four separate data sources and provide a rich and conceptually related perspective on childhood adversity. Taken together, they present a broad framework to look at child adversity across the lifespan and provide useful data to inform and facilitate interventions. However, due to differences in methodology, data from the three sources should not be compared. The data sources are:
Each of these data sources produces at least one overall index of childhood adversity. An overall index should be viewed as a more comprehensive measure than any of its individual items because it captures the cumulative magnitude of experiencing hardships.

NSCH data are collected by the U.S. Census Bureau on behalf of the Maternal and Child Health Bureau of the Department of Health and Human Services. Compared with more traditional methods of asking adults to recall their childhood experiences, NSCH asks parents about current adverse experiences to which their children (ages 0 to 17) have been exposed.

CHIS is conducted by the UCLA Center for Health Policy Research in collaboration with the California Department of Public Health and California Department of Health Care Services. CHIS surveys adolescents (ages 12 to 17) about their exposure to eight adverse experiences, five of which are included in an overall adversity index. This is the most direct population-based survey measure of adversity among California children because it asks respondents, while they are still children, about adversity they have experienced. CHIS also surveys adolescents about eight positive childhood experiences, and adults about both positive and adverse childhood experiences.

MIHA is a collaborative effort of the Center for Health Equity at UC San Francisco and the California Department of Public Health's Maternal, Child, and Adolescent Health Division and Women, Infant, and Children Division. MIHA asks postpartum women (ages 15 and older) who deliver a live birth about their own childhood hardships prior to age 14.

The BRFSS ACEs Module is adapted from the Adverse Childhood Experiences (ACEs) study by Kaiser Permanente and the Centers for Disease Control and Prevention. The data presented here were prepared by the California Department of Public Health's Injury and Violence Prevention Branch. They are based on adult recollections of their childhood experiences during the first 17 years of life and thus do not provide direct information about the current status of California's children.

NSCH, CHIS, MIHA, and BRFSS data together provide a comprehensive framework for understanding and addressing child adversity across the lifespan. Among these four data sources, NSCH and CHIS indicators are the most contemporary because they tap into children's current experiences, as viewed by parents and young people themselves. MIHA adds an intergenerational perspective by providing information about childhood hardships experienced by mothers of newborns. BRFSS provides a well-established standard measure of adult retrospective reports of adverse childhood experiences. Both NSCH and MIHA include a wider range of potentially adverse experiences, such as exposure to extreme poverty, community violence, and food and housing insecurity, whereas BRFSS and CHIS indices focus primarily on family dysfunction. Each source provides a unique but conceptually related perspective on childhood adversity.
Childhood Adversity, Resilience, and Positive Experiences
Characteristics of Children with Special Needs
Child Abuse and Neglect
Family Structure
Food Security
Housing Affordability and Resources
Foster Care
Intimate Partner Violence
Why This Topic Is Important
Both positive and negative childhood experiences influence outcomes over the life course (1, 2). Research shows that adverse childhood experiences (ACEs)—such as maltreatment, exposure to violence, and growing up with substance abuse or mental health problems at home—can be traumatic and disrupt healthy development (1, 2, 3). More than one third of children statewide and nationally have had at least one ACE (4). Early experiences—especially during the critical developmental periods of early childhood and adolescence—affect brain structure and function, which provide the foundation for lifelong learning, emotional development, behavior, and health (2, 5). The toxic stress associated with traumatic and often prolonged childhood adversity can lead to biological changes that have harmful short- and long-term behavioral, mental, and physical health consequences (2, 3). For example, adults with ACEs are more likely to experience poor mental health, substance use disorders, infectious or chronic diseases, negative maternal health outcomes, premature mortality, and other wide-ranging health problems when compared with adults not exposed to ACEs (3). The more ACEs a child accumulates, the greater the risk of poor outcomes, especially if they do not receive buffering supports (2, 3).

ACEs take an economic toll on society, as well, with annual costs of ACEs-related adult health problems estimated at $1.5 trillion in California and $14 trillion nationally (3). Conversely, positive childhood experiences (PCEs)—such as safe, supportive relationships with family and friends—are linked to better mental and physical health in adulthood (1, 6). Emerging research suggests that PCEs can strengthen resilience (i.e., the process of adapting well in the face of adversity), promote positive outcomes, and help offset the harmful effects of adversity (1, 2, 6). Fostering PCEs, providing young people access to resources and services, and supporting the development of their adaptive skills together make up key resilience factors. These assets, because they seldom occur in isolation, often accumulate and lead to multiple, intergenerational benefits—e.g., research suggests that PCEs may be transmitted from parents to their children (1, 2).
For more information, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  Han, D., et al. (2023). A systematic review of positive childhood experiences and adult outcomes: Promotive and protective processes for resilience in the context of childhood adversity. Child Abuse and Neglect, 144, 106346. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10528145

2.  Garner, A., et al. (2021). Preventing childhood toxic stress: Partnering with families and communities to promote relational health. Pediatrics, 148(2), e2021052582. Retrieved from: https://publications.aap.org/pediatrics/article/148/2/e2021052582/179805/Preventing-Childhood-Toxic-Stress-Partnering-With

3.  Peterson, C., et al. (2023). Economic burden of health conditions associated with adverse childhood experiences among U.S. adults. JAMA Network Open, 6(12), e2346323. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812583

4.  As cited on kidsdata.org, Children with adverse experiences (parent reported), by number. (2026). National Survey of Children's Health.

5.  Baker, A. E., et al. (2025). The connecting brain in context: How adolescent plasticity supports learning and development. Developmental Cognitive Neuroscience, 71, 101486. Retrieved from: https://www.sciencedirect.com/science/article/pii/S1878929324001476

6.  Huang, C. X., et al. (2023). Positive childhood experiences and adult health outcomes. Pediatrics, 152(1), e2022060951. Retrieved from: https://publications.aap.org/pediatrics/article/152/1/e2022060951/191565/Positive-Childhood-Experiences-and-Adult-Health
How Children Are Faring
Childhood adversity is common, and many children experience multiple adverse circumstances or events that can threaten their lifelong well being. One of the most timely assessments of childhood adversity comes from the National Survey of Children's Health (NSCH), in which parents report on the current status of their children ages 0-17. NSCH estimates from 2024 show that, from birth until the time of survey, 39% of U.S. children had been exposed to one or more adverse childhood experiences (ACEs). In California, more than 1 in 3 children (34%) had at least one ACE, around 1 in 8 (12%) had two or more ACEs, and 1 in 30 (3%) had four ACEs or more. Statewide and nationally, African American/Black and Hispanic/Latino children are more likely to have two or more ACEs than their white peers.

Positive childhood experiences (PCEs) also are common. According to estimates from the 2022 California Health Interview Survey (CHIS), a majority of California adolescents ages 12-17 had—always or most of the time—at least two adults other than their parents take genuine interest in them (58%), felt a sense of belonging at school (61%), felt supported by friends (72%), felt supported by family during difficult times (73%), and felt safe and protected by an adult at home (90%). Almost 2 in 5 adolescents (38%) had at least six of the seven PCEs asked about in the survey. These youth were less likely to have ACEs than their peers with five or fewer PCEs.
CHIS also measures PCEs among adults ages 18 and older, and ACEs among both adolescents and adults, using a related but distinct set of ACEs compared with NSCH. CHIS data for 2021 show nearly 1 in 5 adults statewide (19%) had experienced four or more types of childhood adversity by the time they reached age 18. Adults with at least a bachelor's degree or with annual income of at least $100,000 were less likely to have 4-8 ACEs than those with lower educational attainment or income, as were heterosexual adults (17%) when compared with homosexual and bisexual adults (26% and 39%, respectively).
Policy Implications
Increasingly, policymakers, researchers, and other leaders are focused on adverse and positive childhood experiences, recognizing their powerful impacts on lifelong outcomes (1). Exposure to multiple adverse childhood experiences (ACEs)—e.g., abuse, neglect, or caregiver substance abuse or mental illness—increases the likelihood that a child will develop serious health conditions in adulthood, such as depression, heart disease, and cancer (2, 3). By contrast, positive childhood experiences (PCEs)—e.g., feeling protected at home, supported by family and friends, and a sense of belonging at school—increase the likelihood of favorable mental, behavioral, and physical health over the life course (1, 4).

ACEs are largely preventable and their potential harms can be mitigated (2, 3, 5). If unaddressed, however, ACEs strain public systems and have been estimated to cost $1.5 trillion annually in California alone (2). Policymakers and leaders in multiple sectors have a role in helping to prevent ACEs, as well as in ensuring early identification and access to appropriate services for children and families affected by trauma (3, 6, 7). California has taken major steps to address childhood adversity, setting a goal to significantly reduce ACEs and toxic stress, passing legislation to support early identification and intervention, and making substantial investments in screening, research, and other efforts (7). Still, ACEs remain common statewide and nationally, with certain populations disproportionately impacted, including those living in poverty and American Indian/Alaska Native, African American/Black, Hispanic/Latino, and LGBTQ groups (5, 7).

Public policy shapes school, community, and economic conditions, as well as the availability of support services, which can steer young people's experiences in positive or negative directions (1, 3, 6). Given the powerful role of PCEs in influencing lifelong well being, leaders also should promote safe, nurturing relationships and environments for young people inside and outside of the home (1, 3, 6). Although California has a growing focus on advancing PCEs, continued efforts are needed to ensure that all children and youth have the support and opportunities they need to thrive (8).

Policy and program options to promote PCEs and help prevent, interrupt, and mitigate the effects of ACEs include continuing to:
  • Raise awareness about the lifelong impacts of ACEs and PCEs, and encourage positive social norms and actions that protect against adversity (4, 6, 8, 9)
  • Promote safe, supportive family relationships and environments by ensuring effective, resilience-building prevention services—such as home visiting, parenting skills training, and family relationship programs—are accessible and affordable (3, 6, 10)
  • Support policies that help reduce family stress and increase stability for children, e.g., improving the social safety net for families, strengthening family-friendly business practices, and increasing access to affordable housing and high-quality child care (3, 10)
  • Educate families about California's Earned Income Tax Credit, Young Child Tax Credit, Paid Family Leave, and other state programs and resources that support financial security (8, 10)
  • Cultivate children's sense of belonging in school and the community by providing protective, nurturing environments with access to caring adults, opportunities for social-emotional learning, accessible services that meet diverse needs, and high-quality afterschool and mentoring programs (3, 6, 10)
  • Promote strategies to ensure that all children and families have access to culturally responsive, trauma-informed mental health care, substance abuse treatment, survivor services, and other community resources designed specifically to address the consequences of trauma and facilitate resilience and healing (3, 6, 10)
  • Institutionalize trauma-informed policies, practices, and workforce education across public and private systems and organizations serving children and families (3, 6, 10)
  • Improve early identification and intervention for ACEs and toxic stress, strengthen pathways and connections to service systems, and build on child and family assets and PCEs in service settings (1, 5, 7)
  • Bolster collaboration across sectors to address community conditions and social determinants of health—such as environmental pollution, access to healthy foods, and safe housing—especially in communities where exposure to ACEs is highest (3, 10)
  • Advance equity-focused research on measuring ACEs and PCEs, preventing and mitigating toxic stress, promoting PCEs, and understanding how positive experiences buffer against adversity (1, 3, 5, 8)
  • Align funding and incentives for ACEs and PCEs initiatives across government levels and agencies, health systems, insurers, and philanthropy (2, 3, 8)
For more information, see kidsdata.org’s Research & Links section or visit ACEs Aware, PACEs Connection, and Safe and Sound. Also see Policy Implications in kidsdata.org’s Child and Youth Safety and Emotional and Behavioral Health topics.

Sources for this narrative:

1.  Han, D., et al. (2023). A systematic review of positive childhood experiences and adult outcomes: Promotive and protective processes for resilience in the context of childhood adversity. Child Abuse and Neglect, 144, 106346. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10528145

2.  Peterson, C., et al. (2023). Economic burden of health conditions associated with adverse childhood experiences among U.S. adults. JAMA Network Open, 6(12), e2346323. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812583

3.  Garner, A., et al. (2021). Preventing childhood toxic stress: Partnering with families and communities to promote relational health. Pediatrics, 148(2), e2021052582. Retrieved from: https://publications.aap.org/pediatrics/article/148/2/e2021052582/179805/Preventing-Childhood-Toxic-Stress-Partnering-With

4.  Huang, C. X., et al. (2023). Positive childhood experiences and adult health outcomes. Pediatrics, 152(1), e2022060951. Retrieved from: https://publications.aap.org/pediatrics/article/152/1/e2022060951/191565/Positive-Childhood-Experiences-and-Adult-Health

5.  Austin, A. E., et al. (2024). Screening for adverse childhood experiences: A critical appraisal. Pediatrics, 154(6), e2024067307. Retrieved from: https://publications.aap.org/pediatrics/article/154/6/e2024067307/199824/Screening-for-Adverse-Childhood-Experiences-A

6.  Hertz, M., et al. (2023). Adverse childhood experiences among U.S. adolescents over the course of the COVID-19 pandemic. Pediatrics, 151(6), e2022060799. Retrieved from: https://publications.aap.org/pediatrics/article/151/6/e2022060799/191245/Adverse-Childhood-Experiences-Among-US-Adolescents

7.  UCLA-UCSF ACEs Aware Family Resilience Network. (n.d.). ACEs Aware progress report: 2019-2023. California Department of Health Care Services, et al. Retrieved from: https://www.acesaware.org/progress-report-2023

8.  California Department of Public Health, Injury and Violence Prevention Branch. (2026). Positive and adverse childhood experiences (PACEs). Retrieved from: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/SACB/Pages/PACEs-resources.aspx

9.  Ottley, P. G., et al. (2022). Preventing childhood adversity through economic support and social norm strategies. American Journal of Preventive Medicine, 62(6), S16-S23. Retrieved from: https://www.ajpmonline.org/article/S0749-3797(22)00012-5/fulltext

10.  All Children Thrive - California, & California Essentials for Childhood Initiative. (2022). Reimagining child wellbeing: Local policy strategies to prevent and reduce adverse childhood experiences (ACEs) in California's communities. Retrieved from: https://www.pacesconnection.com/g/california-aces-action/fileSendAction/fcType/0/fcOid/527549497992392212/filePointer/527549497992392236/fodoid/527549497990271729/Reimagining%20Child%20Wellbeing_FINAL.pdf
Websites with Related Information
Key Reports and Research
County/Regional Reports
More Data Sources For Childhood Adversity, Resilience, and Positive Experiences