How Do We Protect Future Generations from Adverse Childhood Experiences?

November 05, 2019|10:50 a.m.| Debra Houry, MD, MPH, director of the National Center for Injury Prevention and Control, CDC

As a physician, I know firsthand the importance of preventing injuries and violence. While working in the emergency department, I often saw patients after an acute traumatic event, but just as frequently would see patients with longer term health issues from prior trauma. This helped me better understand the consequences of adverse childhood experiences (ACEs) and childhood trauma as well as the importance of primary prevention. ACEs are traumatic events that occur in childhood. Examples include witnessing or experiencing violence, having a family member attempt or die by suicide, and growing up in a household with substance abuse. ACEs can lead to risky behaviors, chronic health problems, and diminished life opportunities.

I believe we all have a role to play, and here at the Centers for Disease Control and Prevention (CDC), we work to understand how injury and violence impact us all and what we can do to prevent it. I am incredibly proud that CDC released a Vital Signs on ACEs on Nov. 5, our first on this topic. The report provides comprehensive estimates of the potential to improve Americans’ health by supporting protective factors that can prevent ACEs from occuring in the first place or reduce the number of ACEs a child experiences.

Scope of the Problem

In our recent MMWR and Vital Signs, CDC scientists report that about 62 percent of adults surveyed across 25 states reported they had experienced at least one ACE and 16 percent had experienced four or more ACEs.

The prevalence of ACEs is striking, particularly because ACEs have negative and lasting effects on health and opportunity. ACEs increase the risk of many health conditions such as obesity, diabetes, drug overdose, suicide attempts, heart disease, and cancer.

Besides influencing a child’s physical and mental health, ACEs also affect life potential. Low graduation rates and lost time from work are just a few of the lasting socioeconomic problems linked to ACEs. The effects of ACEs cost society hundreds of billions of dollars annually.

Primary Prevention

There are things we can do to prevent ACEs from happening in the first place. We know that all children and families face challenges. We can shift the focus from individual responsibility to community solutions by strengthening economic supports to families and promoting social norms that protect against violence and adversity, such as those that support positive parenting and those that foster connectedness and healthy relationships.

We can also work to ensure a strong start for children to build a foundation for future learning and opportunity. We can teach skills to parents and youth to help them handle stress and tackle everyday challenges. We can also connect youth to caring adults and activities to improve their future outcomes.

ACEs Intersect With Opioid Use and Suicide

Increasing rates of suicide and opioid overdose have raised concerns about how ACEs intersect with these public health problems. Childhood adversity, opioid overdose, and suicide are urgent and interrelated public health challenges that have consequences for all of us. These challenges are preventable if we adopt a coordinated approach that focuses on addressing today’s crises while preventing tomorrow’s.

These three public health concerns cause a ripple effect that impacts families across multiple generations:

  1. ACEs increase the risk of opioid overdose and suicide later in life.
  2. A child who witnesses opioid overdose or losing a loved one to suicide can find this experience traumatic.
  3. A child who experiences one or both of these traumatic events is at risk of future opioid overdose or suicide in their later life.

Starting a conversation about the connections between ACEs, opioids, and suicide is a necessary first step. Engaging people as champions for prevention within their communities and adopting a comprehensive public health approach, which focuses on prevention, early treatment, and long-term support, are also critical to the prevention of ACEs. Investing in research and evaluation can help identify ways to prevent ACEs, opioid overdose, and suicide.

State and Community Resources

CDC offers a preventing ACEs resource to help states and communities leverage the best available evidence in their work. This resource is designed to help prioritize prevention activities with the greatest potential for impact.

It is my hope that leaders from multiple sectors of society, including public health officials, will use this resource and findings from the Vital Signs to join efforts to prevent ACEs. States and territorial health departments can play an important role in preventing ACEs by placing prevention at the forefront of efforts and convening leadership and resources to create broad population-level impact.

If you have additional questions about ACEs, please email