Service provided: Analysis of state BRFSS ACE surveys
As of January 2012, eighteen states have completed ACE surveys as part of their Behavioral Risk Factor Surveillance System (BRFSS). Among the first was Washington State, in 2009. The state was also the first to contract to do a thorough analysis of their ACE Study, in 2010. The information was distributed across the state — to legislators, child welfare agencies, juvenile justice departments, community councils, and schools. This has resulted in a state-wide effort to incorporate ACE concepts into all aspects of state services.
Dr. Robert Anda and Dr. David Brown analyzed the Washington State data. We have contracted to do a similar analysis for Iowa. We are interested in talking with other states about analyzing their BRFSS ACE data.
If you are interested in having us work with you on your BRFSS ACE data please contact Rob Anda at email@example.com.
The Washington State analysis can be found here: ACEs in Washington BRFSS Final Report
What is the BRFSS?
The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based system of health surveys focused on collecting uniform, state-speciﬁc data on many of the health risk behaviors and conditions that place adults at risk for chronic, non-communicable disease as well as data on clinical preventive health practices and health care access that are associated with the leading causes of morbidity and mortality in the United States (Mokdad, 2009). Data are collected monthly from a representative sample in each of 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam, and the sampling is designed to provide national estimates when all state data are combined. For most states, the BRFSS is the only source for this type of information. The BRFSS is not only a unique source of health risk behavior data for states, but is also useful to measure progress toward the U.S. Healthy People 2020 objectives (Mokdad, 2009; Brown, 2009). Detailed information on the BRFSS can be found at www.cdc.gov/brfss or from your state’s BRFSS coordinator (www.cdc.gov/brfss/stateinfo.htm).
Viewing child trauma and related experiences as a set of exposures that have broad implications for human development and prevention of public health problems is a relatively new concept (Anda et al, 2010). Nonetheless, the emergence of ACEs as topic of interest in public health is a natural evolution in the fıeld of health promotion and disease prevention following on the seminal work of McGinnis and Foege (1993) to quantify the contribution of alcohol, smoking, and other health risk behaviors to mortality in the United States and the growth in popularity of the BRFSS as a tool to monitor the prevalence of health risk behaviors. The details of this story are available in Anda and colleagues paper “Building a Framework for Global Surveillance of the Public Health Implications of Adverse Childhood Experiences” (Anda et al, 2010).
Beginning in 2008, the U.S. Centers for Disease Control and Prevention developed questions similar to those used in the ACE Study conducted in San Diego, California for incorporation into the BRFSS. Findings from the ACE BRFSS data have begun to emerge and more importantly have begun to shape programs and policy in public health and beyond. Perhaps one of the most shining examples of the latter is found in the State of Washington where the Washington State Family Policy Council (http://www.fpc.wa.gov/about.html) and its partners have incorporated the prevention of ACEs into their scope of work and have developed a course entitled Reducing Adverse Childhood Experiences (http://www.fpc.wa.gov/acecourse.html).
Dr. Anda and Dr. Brown have extensive experience working with the CDC-state BRFSS system. During his career at CDC, Dr. Anda was the supervisory epidemiologist for the BRFSS and contributed to the development of new content for the surveys, including the newly introduced ACE questions. Dr. Brown was assigned to the BRFSS for several years and also has extensive knowledge of the survey system and proper analysis and use of the data it provides. Drs. Anda and Brown have produced numerous reports and publications using the data from this system.
Anda RF, Butchart A, Felitti VJ, Brown DW. Building a framework for global surveillance of the public health implications of adverse childhood experiences. Am J Prev Med. 2010;39:93-98.
Brown DW. The dawn of Healthy People 2020: a brief look back at its beginnings. Prev Med. 2009;48:94-95.
McGinnis JM, Foege WH. Actual causes of death in the U.S. JAMA 1993;270:2207–2212.
Mokdad AH. The Behavioral Risk Factors Surveillance System: past, present, and future. Ann Rev Public Health. 2009;30:43-54.