Over the last dozen years (2009-2020), every state and the District of Columbia have included the ACEs module in the Behavioral Risk Factor Surveillance System (BRFSS) Survey at least once—many multiple times—achieving a significant milestone in the PACEs (ACEs/trauma/resilience) movement. In 2009, the first year that the ACEs module was available for inclusion in the BRFSS, only Arkansas, California, Louisiana, New Mexico, Tennessee, and Washington participated.

Since 2009, the US Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (CDC) has offered to states the ACEs questions in an “Optional Module” in the BRFSS, an ongoing data collection program designed to measure behavioral risk factors for the adult population (18 years of age or older) living in households. (Click here for CDC’s ACEs BRFSS page).

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.

States must secure funding for the inclusion of the ACEs module, which varies depending on a number of factors, including sample size.  

A whopping 32 states and the District of Columbia* included the module in 2020, compared to 2019, another banner year when 22 states** added the module—6 for the first time (Alabama, Delaware, Mississippi, Missouri, North Dakota, and Rhode Island). Numerous states continue to add the module in 2021. Click here for a spreadsheet of the tally for each year between 2009-2020. Attached is a PowerPoint slide deck showing the states that administered the ACE Optional Module in the BRFSS questionnaire from 2009 through 2020. Click here for a pdf version.

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.

*32 states plus DC included the ACEs module in 2020: AL, AZ, CA, CO, DC, FL, HI, ID, IL, IA, KS, KY, ME, MD, MA, MN, MS, MO, MT, NV, NJ, NM, NY, ND, OK, OR, RI, SC, TN, TX, UT, WI, WY

**22 states included the ACEs module in 2019: AL, DE, FL, IN, IA, KS, MI, MS, MO, NJ, NM, NY, ND, OH, OK, PA, RI, SC, TN, VA, WV, WI