Wisconsin Adverse Childhood Experiences (ACE) Data Findings from 2011-2015 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) The following figures are from the Behavioral Risk Factor Surveillance System. These can be used in presentations. You can copy and paste entire slides into your own powerpoints based on what is most applicable to your audience and change up colors and fonts as you would like.

Overall ACE prevalence in Wisconsin 4-6 Content Slides ACEs overview 3 Overall ACE prevalence in Wisconsin 4-6 ACE prevalence by household income 7-12 ACE prevalence by race/ethnicity 13-15 ACEs and health outcomes 16-19 ACEs and smoking 20-26 You can copy and paste entire slides into your own powerpoints based on what is most applicable to your audience

ACE overview Adverse childhood experiences (ACEs) are negative life events or experiences which occur during childhood and have the potential to impede healthy child development. Wisconsin includes the ACE module in the state's annual Behavioral Risk Factor Surveillance System (BRFSS). To assess the occurrence of ACEs among Wisconsin adults, the BRFSS asks if they experienced any of the following events or circumstances prior to the age of 18: Recurrent physical abuse Recurrent emotional abuse Sexual abuse An alcohol or other drug abuser in the household An incarcerated family member A household member who was chronically depressed, mentally ill, institutionalized or suicidal Violence between adults in the home Parental separation or divorce Poverty/neglect (questions added to ACE module in 2014) Adverse childhood experiences (ACEs) are negative life events or experiences which occur during childhood and have the potential to impede healthy child development. An ACE score is a measure of the cumulative exposure to adverse childhood experiences.  Exposure to any one of the criteria is counted as one point; points are tallied and totaled for a final score. An ACE score does not capture the severity or frequency of an adverse experience; instead it illuminates the number of ACE categories experienced. ACEs can have long-term, damaging consequences, such as higher risk behaviors and poor health outcomes, and are a leading determinant of public health spending. The Centers for Disease Control and Prevention (CDC) and its partners sponsor an annual survey to collect data within all 50 states, including Wisconsin. Survey questions focus on a range of health behaviors and conditions, as well as a host of health-related risk factors. Early research on adverse childhood experiences led the CDC to develop a specific survey module of ACE-related questions. Wisconsin includes this module in the state's annual Behavioral Risk Factor Surveillance System (BRFSS). To assess the occurrence of ACEs among Wisconsin adults, the BRFSS asks if they experienced any of the following events or circumstances prior to the age of 181: Recurrent physical abuse Recurrent emotional abuse Sexual abuse An alcohol or other drug abuser in the household An incarcerated family member A household member who was chronically depressed, mentally ill, institutionalized or suicidal Violence between adults in the home Parental separation or divorce Poverty/neglect

57% of Wisconsin Residents have at least 1 ACE Prevalence of Individual ACEs in Wisconsin 57% of Wisconsin Residents have at least 1 ACE Over half of all Wisconsin residents have at least 1 ACE. Findings from the 2011-2015 Behavioral Risk Factor Survey

Household Dysfunction 26% of Wisconsin residents grew up with someone who struggled with substance abuse Feel free to build on any of these categories depending on what you want to highlight Findings from the 2011-2015 Behavioral Risk Factor Survey

Abuse 28% of Wisconsin residents grew up experiencing emotional abuse Feel free to build on any of these categories depending on what you want to highlight – For example: even though sexual abuse percentage looks so much smaller in relation to emotional abuse you could always highlight that 1 in 10 Wisconsin adults have been sexually abused, which helps to tell a story and doesn’t have people just focusing on the numbers in the graphs Findings from the 2011-2015 Behavioral Risk Factor Survey

ACE Distribution by Current Household Income 0 ACEs 1 ACEs 2-3 ACEs 4+ACEs <$20,000 31% 22% 24% $20,000-$34,999 40% 21% 17% $35,000-$49,999 45% 14% $50,000 46% 23% 10% The following slides are focused on Wisconsin ACE prevalence by income level. This table (and following tables) are provided in case you would like to present the information in a different way. Findings from the 2011-2015 Behavioral Risk Factor Survey

ACEs are more prevalent among those with lower income The main point should be the title of the figure, with color used to distinguish the difference <$20,000 <$20,000-$34,999 $35,000-$49,999 >$50,000 Findings from the 2011-2015 Behavioral Risk Factor Survey

ACEs are more prevalent among those with lower income <$20,000 Any ACE <$20,000-$34,999 $35,000-$49,999 The main point should be the title of the figure, with color used to distinguish the difference >$50,000 Findings from the 2011-2015 Behavioral Risk Factor Survey

ACEs are more prevalent among those with lower income Any ACE <$20,000 <$20,000-$34,999 $35,000-$49,999 This is a third way to present the same data. >$50,000 Findings from the 2011-2015 Behavioral Risk Factor Survey

Households with lower incomes are more likely to have 4 or more ACEs Another way to present income and ACE data Findings from the 2011-2015 Behavioral Risk Factor Survey

Nearly 1 out of 4 individuals with <$20,000 household income have 4 or more ACEs You can highlight one bar if you want to call out – but this may change your heading Findings from the 2011-2015 Behavioral Risk Factor Survey

ACE Distribution by Race/Ethnicity 0 ACEs 1 ACEs 2-3 ACEs 4+ACEs Black 20% 26% 28% Native American 23% 19% 27% 31% Hispanic/Latin@ 33% 16% White 45% 22% 13% Asian* 58% 15% 4% The following slides are focused on Wisconsin ACE prevalence by income level. This table is provided in case you would like to present the information in a different way. *Statistically insignificant due to low sample size Findings from the 2011-2015 Behavioral Risk Factor Survey

Blacks and Native Americans have higher rates of ACEs than Whites, Hispanic/Latinos, and Asians Any ACE Black Native American Hispanic/Latin@ This is one way to present ACEs and their correlation with race information, and the following slide is another White Asian* *Statistically insignificant due to low sample size Findings from the 2011-2015 Behavioral Risk Factor Survey

Blacks and Native Americans have higher rates of ACEs than Whites Hispanic/Latinos, and Asians Any ACE Black 0 ACEs Native American Hispanic/Latin@ White Another slide that presents ACEs and their correlation with race Asian* *Statistically insignificant due to low sample size Findings from the 2011-2015 Behavioral Risk Factor Survey

ACEs and Health Outcomes Asthma 9% 12% 15% 22% Poor/Fair general health 11% 13% 18% 23% Ever diagnosed with depression 8% 36% Frequent mental distress (14+ bad mental health days in past 30 days) 4% 24% The correlation between ACEs and negative health outcomes is not surprising as people who have ACEs are more likely to participate in risk behaviors (like smoking) which increases their chances for negative health outcomes. Findings from the 2011-2015 Behavioral Risk Factor Survey

Both asthma and fair to poor general health are correlated with more ACEs More ACEs are correlated with negative health outcomes Findings from the 2011-2015 Behavioral Risk Factor Survey

Both asthma and fair to poor general health are correlated with more ACEs Fair/Poor General Health Current Asthma Same as last slide with a different look Findings from the 2011-2015 Behavioral Risk Factor Survey

Both depression and frequent mental distress are correlated with more ACEs Findings from the 2011-2015 Behavioral Risk Factor Survey

Individual ACEs and Smoking Rates Household Dysfunction Smoking Rate Incarcerated 44% Drug abuse 36% Divorce 31% Violence between adults 30% Problem drinker 29% Depression/suicidal/mentally ill 28% The following slides are focused on Wisconsin ACE prevalence by income level. This table is provided in case you would like to present the information in a different way. Findings from the 2011-2015 Behavioral Risk Factor Survey

Individual ACEs and Smoking Rates Abuse Smoking Rate Sexual abuse – forced to have sex 40% Sexual abuse – victim forced to touch perpetrator 36% Sexual abuse – victim touched 31% Physical abuse 30% Emotional abuse 26% The following slides are focused on Wisconsin ACE prevalence by income level. This table is provided in case you would like to present the information in a different way. Findings from the 2011-2015 Behavioral Risk Factor Survey

Smoking rates increase as ACE scores increase You can call out main points specific to smoking in Wisconsin data Findings from the 2011-2015 Behavioral Risk Factor Survey

Individuals with 4 or more ACEs smoke at rates double that of the Wisconsin average (19%) You may not need to change your color scheme based on the main point. Findings from the 2011-2015 Behavioral Risk Factor Survey

All household dysfunction ACEs have higher rates of smoking than the overall Wisconsin average 19% ALL individual ACEs are correlated with a higher smoking rates than that of the general population Findings from the 2011-2015 Behavioral Risk Factor Survey

All abuse ACEs have higher rates of smoking than the overall Wisconsin average 19% Sexual abuse – Forced to have sex Sexual abuse – Victim forced to touch perpetrator Sexual abuse – Victim touched Physical abuse ALL individual ACEs are correlated with a higher smoking rates than that of the general population Emotional abuse Findings from the 2011-2015 Behavioral Risk Factor Survey

All poverty ACEs have higher rates of smoking than the overall Wisconsin average 17% Homeless when growing up Hungry because family couldn’t afford food Wisconsin poverty data related to ACEs only started getting collected in 2014. You will note that the 17% overall Wisconsin smoking rate is smaller than the two previous slides due to them having multiple years of data. Findings from the 2011-2015 Behavioral Risk Factor Survey *Wisconsin started collecting this data in 2014