Division of Violence Prevention.
Office of Strategy and Innovation.
Pediatrics. 2024 Nov 1;154(5). doi: 10.1542/peds.2024-066633.
Adverse childhood experiences (ACEs) are preventable, potentially traumatic events with lifelong negative impacts. Population-level data on ACEs among adolescents have historically relied on parent reports and excluded abuse-related ACEs. We present the self-reported prevalence of ACEs among a large population-based sample of US high school students.
Using cross-sectional, state-representative data from 16 states that included core ACE questions on their 2021 Youth Risk Behavior Survey, we estimate the prevalence of 8 individual (lifetime emotional, physical, or sexual abuse, physical neglect, witnessed intimate partner violence, household substance use, household poor mental health, incarcerated parent or guardian) and cumulative ACEs (0, 1, 2-3, ≥4) among a large population-based sample of adolescents, overall and by demographic characteristics (sex, race and ethnicity, age, sexual orientation).
Emotional abuse (65.8%), household poor mental health (36.1%), and physical abuse (32.5%) had the highest prevalence. ACEs were very common, with 80.5% of adolescents experiencing at least 1 ACE and 22.4% experiencing ≥4 ACEs. Experiencing ≥4 ACEs was highest among adolescents who were female (27.7%), non-Hispanic multiracial (33.7%), non-Hispanic American Indian or Alaska Native (27.1%), gay or lesbian (36.5%), bisexual (42.1%), or who described their sexual identity some other way or were not sure of their sexual identity (questioning) (36.5%).
Self-reported ACE estimates among adolescents exceed previously published parent-reported estimates. ACEs are not equally distributed, with important differences in individual and cumulative ACEs by demographic characteristics. Collecting ACE data directly from adolescents at the state level provides actionable data for prevention and mitigation.
童年逆境经历（ACEs）是可预防的、具有潜在创伤性的事件，会对人的一生造成负面影响。以往关于青少年 ACEs 的人群数据依赖于父母报告，且排除了与虐待相关的 ACEs。我们呈现了一项基于大量美国高中生人群样本的 ACEs 自我报告患病率。
我们使用了来自 16 个州的横断面、具有代表性的州数据，这些州在其 2021 年青少年风险行为调查中包含了 ACE 核心问题，我们估计了在一个基于人群的大样本青少年中，8 种个体 ACE（一生中的情感、身体或性虐待、身体忽视、目睹亲密伴侣暴力、家庭物质使用、家庭心理健康不良、父母或监护人被监禁）和累积 ACE（0、1、2-3、≥4）的患病率，总体以及按人口统计学特征（性别、种族和民族、年龄、性取向）进行了估计。
情感虐待（65.8%）、家庭心理健康不良（36.1%）和身体虐待（32.5%）的患病率最高。ACEs 非常普遍，80.5%的青少年至少经历过 1 种 ACE，22.4%的青少年经历过≥4 种 ACE。经历≥4 种 ACE 的青少年中，女性（27.7%）、非西班牙裔多种族（33.7%）、非西班牙裔美洲印第安人或阿拉斯加原住民（27.1%）、同性恋（36.5%）、双性恋（42.1%）或其他方式描述自己的性身份或对自己的性身份不确定（质疑）（36.5%）的青少年比例最高。
青少年的自我报告 ACE 估计值高于之前发表的父母报告估计值。ACEs 的分布不均，按人口统计学特征在个体 ACE 和累积 ACE 方面存在显著差异。在州一级直接从青少年收集 ACE 数据，为预防和缓解提供了可操作的数据。
