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State PACEs Action

States Collecting ACE Data in the BRFSS through 2020


The US Department of Health and Human Services Centers for Disease Control and Prevention (CDC) has listed the ACE questions as an “Optional Module” for states and territories to administer through the Behavioral Risk Factor Surveillance System (BRFSS) since 2009. In April 2019, the CDC updated information about the states' inclusion of the ACE module in the BRFSS and reported that “…since 2009, 42 states plus the District of Columbia have included ACE questions for at least one year on their survey.” By the end of 2019, only two states—Massachusetts and Wyoming—have not included the ACEs module.  In 2019, 22 states* added the module—6 for the first time (Alabama, Delaware, Mississippi, Missouri, North Dakota, and Rhode Island).

The BRFSS is an ongoing data collection program designed to measure behavioral risk factors for the adult population (18 years of age or older) living in households. The original Kaiser Permanente-CDC ACE Study began in 1995 and completed in 1997, but participants were followed for 20 years. New data on the more than 17,000 participants continued to be collected until the end of 2015.

In 2018 alone, 17 states included the ACE module in the BRFSS, four of them (Idaho, Indiana, New Jersey, and West Virginia) for the first time. Of the remaining eight states that had never included the ACE module in 2018 (Alabama, Delaware, Massachusetts, Mississippi, Missouri, North Dakota, Rhode Island, and Wyoming), only two remain at the end of 2019. Here is a state-by-state spreadsheet that records the year(s) when states included the ACEs module.

Many states, but not all, produce reports that provide analysis and context for the ACEs data. The development of these reports may take two or more years to produce once the survey data is collected. If you are aware of a report of any kind (they range from multi-page reports to single page infographics), please respond to this post in the comment section. With information from you and other sources, this post on state reports on BRFSS ACE module data will be updated.

Many other ACE studies have been done in the last few years, including by the Crittenton Foundation, the National Survey of Children's Health, Washington State University’s survey of elementary schoolchildren, of people living in Philadelphia, and of populations in England and other countries. To see a list, go to this section of the Resources Center on ACEs Connection.

Below are slides showing the states that administered the ACE Optional Module on their BRFSS questionnaire from 2009 through 2020.


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Robert, here is a link to a fact sheet from the NH Department of Health and Human Services on the BRFSS survey.  If you have time, it would be great if you could call the number at the end of the fact sheet and express your concern that the ACEs Module is not included in the state BRFSS survey.  If you recall, Jane Stevens sent a description of how states decide whether to include the ACEs module ( --- see comment section). The staff at ACEs Connection Network as well as our members would be interested in what you find out from the state.  Thanks for bringing this to our attention.  Elizabeth 

I received a call from the [private contractor] folks conducting my state's (N.H.) BRFSS. They asked if I would participate. I asked if there would be any ACEs related questions on it, and they asked what ACEs were. I endeavored to explain it. Since they were not asking any ACEs related questions, I declined to participate in the BRFSS phone interview. I attempted to follow-up on getting further information on who decides which state's BRFSS will include ACEs questions. When I tried querying at the CDC website, I ended up with an e-mail from the CDC's private contractor from Northrup-Grumman....

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