Adverse Childhood Experiences and Health Conditions and Risk Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2023

The authors suggest that preventing ACEs has considerable potential public health impacts in adolescence and beyond and might translate into sizable reductions in suicidal behaviors, substance use, sexual risk behaviors, violence, and persistent feelings of sadness and hopelessness when these children reach adolescence. 

This report presents the first lifetime national prevalence of self-reported individual and cumulative ACEs among U.S. high school students under 18 years of age, associations between cumulative ACE exposure and negative health conditions and risk behaviors in adolescence, and population-attributable fractions related to ACEs for each condition and behavior.

Findings include: 

• Students with four or more ACEs had significantly increased prevalence ratios for 15 of 16 measured negative health conditions and risk behaviors compared with students with zero ACEs, demonstrating the marked association between cumulative ACEs and negative outcomes. 
• The strongest associations were observed between experiencing four or more ACEs and attempted suicide (OR = 12.42), seriously considered attempting suicide (OR = 9.15), and current prescription opioid misuse (OR = 8.95).
• As the number of ACEs increased for most conditions and behaviors, adjusted prevalence ratios between cumulative ACEs count and health condition or risk behavior increased in magnitude, indicative of a dose-response relationship. 
• Three in four students (76.1%) experienced at least one ACE. Nearly one in five (18.5%) experienced four or more ACEs.
• The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%).