Survey Results

Survey Items: ACE9

Denominator: Children age 0-17 years

Numerator: Yes, Child experienced the Adverse Family Experience; No, Child did not experience Adverse Family Experience

Revisions and Changes: New in the 2011/12 NSCH.

Additional Notes: In 2011/12 NSCH, Adverse Family Experiences were included to capture psychosocial risk factors that affect children. In the original Adverse Childhood Experience (ACE) Study found, there were significant associations between childhood abuse, neglect and exposure to violence with adult health problems (Felitti et al, 1998). A modified version of nine adverse childhood experiences list was developed for this survey: (1) socioeconomic hardship, (2) divorce/separation of parent, (3) death of parent, (4) parent served time in jail, (5) witness to domestic violence, (6) victim of neighborhood violence, (7) lived with someone who was mentally ill or suicidal, (8) lived with someone with alcohol/drug problem, (9) treated or judged unfairly due to race/ethnicity. These nine items were based initially on the BRFSS ACE Module, which includes items 2, 4, 5, 7, and 8. The additional four items were developed based on a review of life course stressors in children’s lives by a Technical Expert Panel. This TEP includes a representative group of experts in the field of survey methodology, children's health, community organizations, and family leaders. Additionally, there was a public comment period. From the collection of input from the Technical Expert Panel and Public Comment, items on perceived discrimination, death of a parent, witness/victim of neighborhood violence, and socioeconomic hardship were included in the list of Adverse Family Experiences.

Treatment of Unknown Values: Unknown values (responses coded as 'refused', 'don't know', or system missing) are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the data query results table. In nearly every case, the proportion of unknown values is less than 1% and the exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Weighted Est.). Exceptions are noted in the form of a “Data Alert” at the bottom of a results table.

History and Development: The Maternal and Child Health Bureau leads the development of the NSCH survey and indicators, in collaboration with the National Center for Health Statistics (NCHS) and a national technical expert panel. The expert panel includes representatives from other federal agencies, state Title V leaders, family organizations, and child health researchers. Previously validated questions and scales are used when available. Respondents’ cognitive understanding of the survey questions is assessed during the pretest phase and revisions made as required. All final data components are verified by NCHS and DRC/CAHMI staff prior to public release. The samples in 2003 and 2007 were drawn by random digit dial telephone sampling. The 2011/12 survey included the addition of cell phones to the sample. This has implications for the comparability of items between 2007 and 2011/12. More information can be found in the “Learn About the Surveys” section of this website.