Adults' exposure to adverse childhood experiences in the United States nationwide and in each state: modeled estimates from 2019-2020.

Background: Although preventable, adverse childhood experiences (ACEs) can result in lifelong health harms. Current surveillance data on adults' exposure to ACEs are either unavailable or incomplete for many U.S. states.

Methods: 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-annual 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, 2-3, or 4+ACEs and 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.

Results: In 2019-2020, 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 18-34 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.

Conclusions: 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.