New Data Analysis Shows Impact of Childhood Experiences on Health


A new study published by the Rhode Island Department of Health (RIDOH) underscores the effects of adverse childhood experiences on health outcomes in adulthood among Rhode Islanders.


“Health does not start in the doctor’s office. Health starts in the places where we live, learn, work, and play. For this reason, our approach to public health at RIDOH focuses on the conditions and structures in our communities that have the greatest impact on the health of children and adults,” said Director of Health Nicole Alexander-Scott, MD, MPH. “Adverse childhood experiences, and ultimately their impacts on health outcomes among adults, are entirely preventable. Through our Health Equity Zone initiative and numerous other community partnerships, we are working to address these underlying factors and give all Rhode Islanders in all ZIP codes throughout the state an equal opportunity to be healthy and thrive.”


Adverse childhood experiences are stressful or traumatic events that can undermine a child’s sense of safety and well-being. They can include emotional abuse, exposure to substance use, sexual abuse, having a member of the household be incarcerated, and having separated or divorced parents. The prevalence of adverse childhood experiences among Rhode Island adults is similar to the national prevalence.


Researchers scored the number of adverse childhood experiences reported by a group of adult survey respondents, then reviewed the health data they self-reported. Respondents with higher numbers of adverse childhood experiences had negative health outcomes at significantly higher rates in a range of areas. For example, 45% of respondents with a high score for adverse childhood experiences reported a history of depression, compared to 9% of those with no adverse childhood experiences. Nearly 30% of those with higher adverse childhood experience scores were cigarette smokers, compared to 7% of those with no adverse childhood experiences. Similar patterns were seen in the areas of arthritis, chronic obstructive pulmonary disease (COPD), frequent mental distress, and heavy drinking.


This new analysis was conducted on data collected through RIDOH’s 2020 Behavioral Risk Factor Surveillance System (BRFSS). BRFSS is a self-report survey of adults conducted by RIDOH with assistance from the Centers for Disease Control and Prevention (CDC). Data collected include information on health, health risk behaviors, preventive practices, and healthcare access. The data allow RIDOH to understand patterns in health risks, identify emerging problems, prevent disease, and improve treatment.


The new analysis of BRFSS data, titled Adverse Childhood Experiences and Long-Term Health among Adults in Rhode Island, was published in the Rhode Island Medical Journal. The authors of the study were Tracy Jackson, PhD, MPH and Karine Monteiro, MPH, from RIDOH’s Center for Health Data and Analysis.


According to the BRFSS data, most Rhode Island adults (63%) have experienced at least one adverse childhood experience, and 16% experienced four or more types of adverse events during childhood. 61% of U.S. adults reporting at least one adverse event and 16% reporting four or more types of adverse childhood experiences.


RIDOH has a variety of programs and partnerships that are aimed at preventing adverse childhood experiences through support for communities, parents, and families and improving health outcomes in adults.


  • Rhode Island’s Health Equity Zone (HEZ) initiative is a health equity-centered approach to prevention that leverages place-based, community-led solutions to address the social determinants of health. The initiative is grounded in research that shows up to 85% of health outcomes are determined by factors outside clinical settings, such as access to affordable, healthy foods; high-quality education; employment opportunities; and safe neighborhoods. Each HEZ is led by a community-based collaborative that conducts an assessment to identify, describe, and prioritize inequities of importance to the community and develops and implements an action plan informed by the assessment to address root causes of health inequities. There are currently 15 Health Equity Zones in Rhode Island.
  • Families with a child under four years old or who are pregnant can enroll in the voluntary, no-cost Family Visiting program that offers support and resources to thousands of families in Rhode Island each year.
  • People who currently smoke cigarettes, vape, or use other tobacco products can access free, confidential, safe, and effective quit support for nicotine addiction through the Rhode Island Nicotine Helpline at 1-800-QUIT-NOW (1-800-784-8669). Learn more about quit journey resources at Teens can also get free help to quit vaping by phone, text, and online chat by visiting or simply texting "Start my quit" to 36072.
  • People feeling overwhelmed by issues related to mental health or struggling with alcohol or drug use should know help is available. BH Link ( provides immediate assistance to a person in crisis by providing intervention services and connecting people to ongoing treatment and care.


More information about BRFSS is available online. People can also view BRFSS data online directly.


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