www bidenschool udel edu Timeline Tuesday Data Snapshot

www. bidenschool. udel. edu Timeline Tuesday Data Snapshot: Adverse Childhood Experiences (ACEs) Sharon Merriman-Nai Annie Slease La. Wanda Burgoyne Kier Berkel Joseph R. Biden, Jr. School of Public Policy & Administration

1 Biden School of Public Policy & Administration www. bidenschool. udel. edu

Data Overview Sharon Merriman-Nai Community Perspective Panelists Annie Slease La. Wanda Burgoyne Kier Berkel 2 Biden School of Public Policy & Administration www. bidenschool. udel. edu

The State Epidemiological Outcomes Workgroup (SEOW) 4 Goals of the SEOW Identify, Analyze, and Share Data Create Data Products Train Communities in Understanding and Using Data Build State and Local Level Monitoring Systems 3

4 Biden School of Public Policy & Administration www. bidenschool. udel. edu

Executive Order 24, Progress Report and Action Plan https: //governor. delaware. gov/wp-content/uploads/sites/24/2018/10/Executive-Order-Number-24 -Trauma-Informed-State. pdf https: //governor. delaware. gov/wp-content/uploads/sites/24/2019/11/DE-TIC-Progress-Report-and-Action-Plan. pdf 5 Biden School of Public Policy & Administration www. bidenschool. udel. edu

What are ACEs? Original Kaiser study included 10 adverse childhood experiences including abuse, neglect, and household/family dysfunction. Broader issues such as poverty, racism, and exposure to community violence are now considered ACEs create toxic stress which can lead to changes in brain structure and function, and poorer health and social outcomes throughout the lifespan – the more ACEs experienced, the greater the impact. 6 Biden School of Public Policy & Administration www. bidenschool. udel. edu

How Prevalent are ACEs? Findings from 25 states asking ACE questions in the CDC Behavioral Risk Factor Surveillance System (BRFSS, 2015 -2017): • Almost 2 in 3 adults report at least 1 ACE • Nearly 16% of adults report 4 or more ACEs • Higher rates of being overweight and obese, heavy drinking, COPD, and depression are associated with higher numbers of reported ACEs • Among these respondents, greater ACE scores are also associated with greater socio-economic challenges (Merrick et al. , 2019) 7 Biden School of Public Policy & Administration www. bidenschool. udel. edu

How Prevalent are ACEs in Delaware? 14% 44% 19% 23% 0 ACEs 1 ACE 2 -3 ACEs 4 or more Aces Source: Delaware Household Health Survey, 2015 8 Biden School of Public Policy & Administration www. bidenschool. udel. edu

National Survey of Children’s Health U. S. 53, 7 51, 7 2016 56, 2 60, 1 56, 7 57, 2 2017 Unexposed 2018 Delaware 24, 6 24, 5 22, 0 21, 7 19, 3 17, 8 25, 7 22, 0 23, 2 22, 6 21, 3 19, 6 2017 2018 2016 2017 2018 One adverse childhood experience Two or more adverse childhood experie Source: Hussaini, K. DE Dept. of Health and Social Services, Div. of Public Health, Preliminary Analysis, National Survey of Children’s Health, 2016 -2018. 9 Biden School of Public Policy & Administration www. bidenschool. udel. edu

NSCH 2016 -2018 – ACEs and Poverty 0 -199% FPL 200 -299% FPL 300 -399% FPL 400% FPL or more 76, 6 40, 3 46, 8 59, 4 Unexposed 25, 4 29, 4 24, 9 34, 3 17, 7 One adverse childhood experience 23, 8 15, 7 Two or more adverse childhood experiences Source: Hussaini, K. DE Dept. of Health and Social Services, Div. of Public Health, Preliminary Analysis, National Survey of Children’s Health, 2016 -2018. 10 Biden School of Public Policy & Administration www. bidenschool. udel. edu

NSCH 2016 -2018 – ACEs and Race Non-Hispanic White 62, 1 41, 0 African American Hispanic/Latino(a) Other races 55, 3 54, 6 Unexposed 21, 8 25, 8 24, 6 26, 7 One adverse childhood experience 33, 2 16, 1 20 18, 6 Two or more adverse childhood experiences Source: Hussaini, K. DE Dept. of Health and Social Services, Div. of Public Health, Preliminary Analysis, National Survey of Children’s Health, 2016 -2018. 11 Biden School of Public Policy & Administration www. bidenschool. udel. edu

NSCH 2016 -2018 ACEs and Parent Place of Birth All parents born in the US (3 rd or higher generation HH) Any parent born outside of the US (1 st and 2 nd generation HH) Other (child born in United States, parents are not listed) 56, 3 61, 4 51, 2 27, 5 Unexposed 22, 7 27, 9 21 21, 3 One adverse childhood experience 10, 7 Two or more adverse childhood experiences Source: Hussaini, K. DE Dept. of Health and Social Services, Div. of Public Health, Preliminary Analysis, National Survey of Children’s Health, 2016 -2018. 12 Biden School of Public Policy & Administration www. bidenschool. udel. edu

NSCH 2016 -2018 - ACEs in Special Health Needs SHCN Non-SHCN 60, 7 36, 2 Unexposed 25, 1 38, 8 23, 2 One adverse childhood experience 16, 1 Two or more adverse childhood experiences Source: Hussaini, K. DE Dept. of Health and Social Services, Div. of Public Health, Preliminary Analysis, National Survey of Children’s Health, 2016 -2018. 13 Biden School of Public Policy & Administration www. bidenschool. udel. edu

2019 Delaware High School Youth Risk Behavior Survey (YRBS) – ACE Indicators (%) Been in a fight 20 Bullied at school 15 Emotional Dating Violence 14 Forced sexual contact or intercourse in past year 8 Incarcerated Parent 8 Raped in lifetime 7 Sexual Dating Violence 6 Physical Dating Violence 5 Threatened with a weapon 5 Homeless 4 Source: Center for Drug & Health Studies. (2019). Youth Risk Behavior Survey: High School [Biennial Survey]. 14 Biden School of Public Policy & Administration www. bidenschool. udel. edu

2019 Delaware High School YRBS Prevalence of ACEs (%) 21 56 23 0 ACEs 1 ACE 2+ ACEs Source: Center for Drug & Health Studies. (2019). Youth Risk Behavior Survey: High School [Biennial Survey]. 15 Biden School of Public Policy & Administration www. bidenschool. udel. edu

2019 Delaware High School YRBS ACEs and Gender* (%) 58 54 25 0 ACES 22 17 1 ACE Male 24 2+ ACEs Female Source: Center for Drug & Health Studies. (2019). Youth Risk Behavior Survey: High School [Biennial Survey]. 16 Biden School of Public Policy & Administration www. bidenschool. udel. edu

2019 Delaware High School YRBS ACEs and Race and Ethnicity (%) 53 58 58 26 0 ACEs Non-Hispanic Black* 22 22 1 ACE Non-Hispanic White* 22 20 21 2+ ACEs Hispanic or Latino/a/x* Source: Center for Drug & Health Studies. (2019). Youth Risk Behavior Survey: High School [Biennial Survey]. 17 Biden School of Public Policy & Administration www. bidenschool. udel. edu

2019 Delaware High School YRBS ACEs and Substance Use (past month, %) 46 48 44 35 26 29 25 17 18 15 14 8 Alcohol Binge drinking Marijuana 0 ACEs 1 ACE Vaping 2+ ACEs Source: Center for Drug & Health Studies. (2019). Youth Risk Behavior Survey: High School [Biennial Survey]. 18 Biden School of Public Policy & Administration www. bidenschool. udel. edu

2019 Delaware High School YRBS ACEs and Mental Health (past year, %) 57 42 34 25 20 14 7 Sad/hopeless for most days, 2 wks in a row 0 ACEs 3 Self-Harm 1 ACE 6 Attempt Suicide 2 or more ACEs Source: Center for Drug & Health Studies. (2019). Youth Risk Behavior Survey: High School [Biennial Survey]. 19 Biden School of Public Policy & Administration www. bidenschool. udel. edu

Protective factors at the family, school, community, and societal levels can help to prevent ACEs and reduce their impact. 20 Biden School of Public Policy & Administration www. bidenschool. udel. edu

References Data highlights are from the 2020 Delaware State Epidemiological Profile, a product of the State Epidemiological Outcomes Workgroup (SEOW) which is supported by the Delaware Department of Health and Social Services, Division of Substance Abuse and Mental Health. To access the report and infographics on this and related prevention topics, visit: https: //www. cdhs. udel. edu/seow/reports-and-products. The SEOW is grateful for Dr. Khaleel Hussaini for the preliminary analysis of the National Survey of Children’s Health data. For more on the Delaware Youth Risk Behavior Survey, please visit the UD Center of Drug and Health Studies at: https: //www. cdhs. udel. edu/seow/school-surveys. Centers for Disease Control and Prevention. (n. d. ). Adverse childhood experiences (ACEs), https: //www. cdc. gov/violenceprevention/acestudy/. Fink, A. (2016, Dec. 16). Adverse childhood experiences and behavioral health. [Presentation to the State Epidemiological Outcomes Workgroup, New Castle, Delaware]. https: //bit. ly/3 l 4 XTZx Hussaini, K. S. (2020). [Presentation]. Preliminary Analysis of the National Survey of Children’s Health, adverse childhood experience in the U. S. and in Delaware, 2016 -2018. Delaware Department of Health and Social Services, Division of Public Health. Merrick, M. , et al. (2019). Vital Signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention – United States, 2015 -2017. Morbidity and Mortality Weekly Report, 68(44), 999 -1005, www. cdc. gov/mmwr/volumes/68/wr/mm 6844 e 1. htm. 21 Biden School of Public Policy & Administration www. bidenschool. udel. edu

Sharon Merriman-Nai smnai@udel. edu Center for Drug and Health Studies at the University of Delaware www. dekidscount. org 22 Biden School of Public Policy & Administration www. bidenschool. udel. edu