Public Opinion In Tennessee About Adverse Childhood Experiences (ACEs)
Public Opinion in Tennessee aboutAdverse Childhood Experiences (ACEs)forJune 2017BYLINDA M. DAUGHERTY, MPAPRAGYA G. POUDEL, MPH
The University of Tennessee–KnoxvilleCollege of Social Work Office of Research and Public ServiceKaren Sowers, DeanMaryanne Cunningham, Interim DirectorThe University of Tennessee, Knoxville, is an EEO/AA/Title VI/Title IX/Section504/ADA/ADEA institution in the provision of its education and employment programs andservices. All qualified applicants will receive equal consideration without regard to race,color, national origin, religion, sex, pregnancy, marital status, sexual orientation, genderidentity, age, physical or mental disability, or covered veteran status.This project was funded through a contract with the University of Tennessee College of Social Work.Project #17013i
Table of ContentsPurpose and Methodology . 1Findings and Discussion . 2Who experiences ACEs?.3Impact on Health and Well-being .5Impact on mental health.5Impact on brain development .5Impact on physical health .5Social impact .7Lower High School graduation rates .7Higher divorce rates .7Reliance on public assistance .7Prevention of Adverse Childhood Experiences (ACEs) .9Impact of stable relationship.9Providing supports .9Responsibility of government and public agencies.9Identifying ACEs . 11Efforts to increase awareness of Adverse Childhood Experiences (ACEs) . 12Universal Parenting Place . 13Building Strong Brains. 13Conclusion. 15APPENDIX . A1Tables of Results . A2Survey Instrument . A30ii
List of Tables and FiguresFigure 1: Familiarity with ACEs. 2Table 1: First heard of ACEs . 2Figure 2: Who experiences ACEs and who does it impact . 4Figure 3: ACEs impact on physical and mental health . 6Figure 4: Impact of trauma on brain development . 6Figure 5: Social impact of ACEs . 8Figure 6: Prevention of ACEs . 10Figure 7: Experiences defined as ACEs. 11Table 2: Sources of information about raising children. 12Figure 8: Effectiveness of UPP . 14Figure 9: Familiarity with Building Strong Brains . 14Figure 10: Support for Building Strong Brains .14iii
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)Purpose and MethodologyBuilding Strong Brains: Tennessee ACEsInitiative was established in 2015 with theexpressed mission of raising the awarenessabout the potential long-term and damagingeffects of Adverse Childhood Experiences(ACEs). Moreover, the mission includes effortsto promote policies and practices that increasesuccessful intervention and prevention of theseexperiences.The University of Tennessee College of SocialWork Office of Research and Public Service(SWORPS) was contracted by the ACEAwareness Foundation to conduct a statewidepublic opinion survey to establish a baselineabout the public’s level of awareness aboutACEs and support for the Initiative’s goal toincrease prevention and mitigation of theimpact of adverse childhood experiences inTennessee. A mixed-mode survey wasconducted with 922 Tennessee residentsbetween February 15 and February 24, 2017.The margin of error for the results of the surveyis /- 3.2%.Surveys were administered by telephone usingcell phone and landline sample and by webutilizing a web panel. The web panel ofTennessee residents under the age of 56 waspurchased from Survey Sampling, Inc. (SSI) forthe completion of complete 484 surveys. Arandom digit dial (RDD) landline sample, alsopurchased from SSI, resulted in the completionof 241 surveys. A random sample of cell phonenumbers of Tennessee residents was purchasedfrom Marketing Systems Group, Inc. and wasused to complete 178 surveys. A 5 gift cardwas offered to those who completed the surveyon a cell phone to offset expense incurred fordata usage. All potential survey respondentswere screened to confirm they were Tennesseeresidents and were 18 years of age or older.The goal of survey research is to validlyrepresent the population through input from asubstantially smaller segment, or sample, ofthat population. Particular attention must bemade to ensure the sample is representative ofthe population on known characteristics toreduce bias that may be introduced by overrepresenting groups whose opinions differsignificantly from the overall population.Despite efforts to achieve proportionalrepresentation by gender, age group, andregion of the state, younger males andresidents in West Tennessee were slightlyunderrepresented. Weights were calculated foreach record to adjust for the underrepresentation. All findings discussed andpresented in this report are from weighteddata. A full reporting of the results of the surveycan be found in the Appendix.The survey instrument was designed tomeasure the level of familiarity with the term“Adverse Childhood Experiences”; when andhow people first learned about ACEs; level ofawareness about the sources and potentialimpact of ACEs; and support for efforts to focuson prevention and mitigation of the effects ofACEs. A copy of the survey instrument is locatedin the Appendix.Prepared by College of Social Work Office of Research and Public ServicePage 1
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)Findings and DiscussionA core purpose for conducting this survey wasto measure the level of awareness the publicabout Adverse Childhood Experiences (ACEs). Inan effort to measure awareness, surveyrespondents were asked to indicate theirfamiliarity with the term.The level of familiarity was reported to be low.A majority (55.6%) indicated they were not atall familiar and less than one out of tenrespondents (9.0%) stated they were very orextremely familiar with the term (see Figure 1).How Familiar Are You With The Term ACEs?(n 922)A little familiar16.4%Somewhat familiar13.6%Very familiar5.8%Extremely familiar3.2%Not sure5.3%Not at all familiar55.6%Figure 1: Familiarity with ACEsThose who were at least somewhat familiarwith the term were asked to identify wherethey had first heard the term or about theconcept. The most frequently cited sourceswere news articles, discussion on the radio, oritems on the internet. Almost half of those whoreported some familiarity with the concept(46.7%) reported they had heard it from one ofthese sources. About one out of three (28.7%)indicated they heard about it in school or byattending a training course. Other sourcesshared by the respondents were discussionswith family and friends (9.5%) or with medicalprofessionals (5.3%).Others reported they became familiar with theterm when they attended child advocacy ormeetings to discuss issues about childhooddevelopment (see Table 1).Source%(n 145)News/radio/internetSchool or trainingFamily or friendsWorkMental health or medicalprofessionalChild advocacy/childhooddevelopment meeting46.728.39.56.55.33.7Table 1: First heard of ACEsPrepared by College of Social Work Office of Research and Public ServicePage 2
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)Survey respondents were presented with anumber of statements about Adverse ChildhoodExperiences and asked to indicate how muchthey agreed or disagreed with the statement.They were also provided with an option ofstating they were “Not Sure”. Inclusion of thisresponse was particularly important becausethe level of awareness about the topic wasrelatively low. These statements addressedthree broad aspects of ACEs: who is exposed;what are the impacts; and whose responsibilityit is to prevent or reduce the experiences.statistically significant, some differences didemerge.Who experiences ACEs?Respondents also reported they agreed – eithersomewhat or strongly – that the impact of ACEsmight be greater on some children than onothers. Almost 9 out of 10 respondents (88.1%)agreed that some children are more resilientthan others and may not suffer theconsequences of adverse experiences.An area of interest for this research was todetermine public perception about whether ornot certain groups of children have moreexposure to adverse experiences and if somesuffer from more serious long term impactsthan others. Respondents were presented withtwo questions about how household incomeand individual characteristics influenceexposure and impact of adverse experiences.The overwhelming majority of respondentsindicated that exposure to adverse experiencesis not restricted to low-income children.Furthermore, it was found that most hold thebelief that some children are impacted moresignificantly than others by these experiences(see Figure 3).A large majority of the respondents (80.4%)indicated they somewhat or strongly disagreedwith the statement that only low-incomechildren were victims of ACEs. While not Black or African Americans were morelikely than others (23.0%) to report theystrongly or somewhat agreed that ACEswere only experienced by low-incomechildren. Only 11.3% of respondentswho identified themselves as White orCaucasian agreed.Respondents under 35 and those withannual household incomes below 15,000 were more likely to report theywere unsure about this statement(11.3% and 18.8%, respectively).Those who were younger and reside inlower income households were againmore likely to be uncertain about howto respond to this statement (11.7%and 15.3%, respectively).Older respondents –those over 65 –were more likely to agree that somechildren are impacted more thanothers by their experiences (92.4%).Younger respondents – those between18 and 34 – were less likely to agreethat the effects of ACEs weredependent upon the individual (79.0%).Prepared by College of Social Work Office of Research and Public ServicePage 3
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)How much do you agree or disagreewith this statement?(n 3%2.5%3.0%0%Only low-income children experience adversechildhood experiencesStrongly agreeSomewhat agreeAdverse experiences have a greater impact onsome children than others.Somewhat disagreeStrongly disagreeNot sureFigure 2: Who experiences ACEs and who does it impactPrepared by College of Social Work Office of Research and Public ServicePage 4
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)Impact on Health and Well-beingAnother area of focus for this survey was todetermine how much public awareness there isabout the effects of ACEs on the physical andmental well-being of individuals and thedevelopment of young children.Impact on mental healthThere was almost unanimous agreement thathow a child is reared – regardless of adversity –affects their mental health in adulthood. Almost9 out of 10 respondents (87.8%) indicated theyagreed that mental health in adulthood isinfluenced by childhood experiences (see Figure3). While little variation emerged betweengroups, it is worth noting that two trendsmaterialized. Women were significantly more likelythan men to strongly agree that how achild is reared has an impact on his orher mental health in adulthood. Sevenout of ten women (70.8%) stronglyagreed compared to 58.8% of men.Older respondents were also morelikely to strongly agree with thiscompared to their youngercounterparts. Three out of four ofthose 65 years of age and older (74.8%)strongly agreed compared to 54.7% ofthose between the ages of 18 and 34.Impact on brain developmentThere was less agreement with statementsregarding the impact of ACEs on braindevelopment and long term effects on physicalhealth. While almost 3 out 4 respondentsagreed that brain development was differentfor children with ACEs (72.2%), there wassignificant variation reported between groups. Those who reported being morefamiliar with ACEs were also more likelyto agree that children’s brain development is affected. More than 6out of 10 of those who were veryfamiliar with ACEs (62.1%) also stronglyagreed with the statement while lessthan half of those who were not at allfamiliar with ACEs (44.1%) reported thesame response.Similar to previous trends, females andolder respondents were more likely tostrongly agree. However, thedifferences were not statisticallysignificant.The impact of adverse experiences on a child’sbrain development was explored further.Respondents were asked their opinion aboutthe level of impact trauma before the age ofthree had on a child’s brain development. Lessthan half (42.5%) reported it had a greatamount of impact while 37.0% felt that it hadsome impact (see Figure 4). Females were significantly more likelyto indicate that brain development wasgreatly impacted by trauma. Almosthalf of females (49.5%) thought traumahad a “great amount” of impactcompared to 34.9% of males.About half of those under 35 (47.7%)thought it had great amount of impact.Those who expressed this opinionsteadily declined among olderrespondents with 35.4% of those 65and older expressing the same opinion.Impact on physical healthThe level of agreement continued to declinewhen respondents were asked about the effectsof how a child is raised on the prevalence ofcancer or heart disease in adulthood. Only twoout of three respondents (67.2%) agreed withthis statement (see Figure 3). None of thevariations that emerged for the other questionsabout the effects on mental and physicaldevelopment were found for this question.Prepared by College of Social Work Office of Research and Public ServicePage 5
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)How much do you agree or disagreewith this statement?(n 922)44.6%Brain development for children who are exposedto trauma is different from those who do notexperience trauma.27.6%6.9%5.5%15.3%36.3%How a child is raised affects their physical healthas an adult including increased chances to getcancer or heart disease.30.9%8.6%9.2%15.0%64.8%23.0%How a child is reared affects their mental health asan adult.3.0%3.4%5.8%0%Strongly agreeSomewhat agree20%Somewhat disagree40%Strongly disagree60%80%Not sureFigure 3: ACEs impact on physical and mental healthImpact of Trauma Before Age 3on Brain Development(n 922)Great amount42.5%Some37.0%Not sure11.2%None2.0%Very little7.2%Figure 4: Impact of trauma on brain developmentPrepared by College of Social Work Office of Research and Public ServicePage 6
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)Social impactIn addition to the impact on brain developmentand physical and mental health, ACEs impose asocial cost. These costs may include fewerpeople graduating from high school, inability tosustain a marriage, and more reliance on publicassistance in adulthood.significantly between racial groups and incomelevels. Lower High School graduation ratesOverall, more than half of the surveyrespondents (57.2%) indicated they eithersomewhat or strongly agreed that experiencingtrauma during childhood reduced the likelihoodof graduating from high school (see Figure 5).However, there were differences in opinionsabout this topic that are worthy of discussion. Black or African-American respondentswere significantly more likely tostrongly disagree with the statementthat the ability to graduate from highschool was diminished because ofchildhood trauma. Almost one-third ofBlack respondents (32.1%) stated theystrongly disagreed compared to 10.6%of White or Caucasian respondents.Additionally, those with lowerhousehold incomes were also morelikely to strongly disagree with thecorrelation of trauma and high schoolgraduation. Almost 1 out of 3 with ahousehold income below 15,000(28.3%) strongly disagreed whereas9.9% of those with a household incomeabove 100,000 disagreed with thestatement.Higher divorce ratesRespondents were also asked whether theythought adults who had experienced trauma asa child were more likely to be divorced. Similarto the question about the impact on graduationrates, more than half of overall respondentssomewhat or strongly agreed (56.9%) with thisstatement (see Figure 5). Again, opinions varied Respondents who identified themselvesas Black or African were significantlymore likely to strongly disagree thatdivorce rates are higher for those whoexperience trauma in childhood. One infour Black or African-Americanrespondents (24.7%) strongly disagreedcompared to 8.1% of respondents whoidentified themselves as White orCaucasian.Respondents living in households withan annual income below 15,000 werealso significantly more likely to voicestrong disagreement with thestatement linking childhood trauma tohigher divorce rates. Almost 1 out of 5respondents in this income category(19.4%) strongly disagreed whereas lessthan 1 out 20 respondents in thehighest income bracket (6.6%)expressed a similar opinion.Reliance on public assistanceIn addition to the impact on high schoolgraduation rates and divorce rates, respondentswere asked how childhood experiences mightaffect the likelihood of relying on publicassistance in adulthood. While there was lessagreement on this topic than on others, a smallmajority (51.0%) agreed that reliance on publicassistance was higher among those whoexperienced childhood trauma (see Figure 5).Trends discussed above regarding attitudesabout the social costs of childhood trauma alsoemerged for this question. One out of three Black or AfricanAmerican respondents (30.5%) stronglydisagreed that childhood traumaincreased the likelihood of relying onpublic assistance in adulthood. White orCaucasian respondents werePrepared by College of Social Work Office of Research and Public ServicePage 7
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs) significantly less likely to disagree withonly 1 out 10 (11.5%) expressing strongdisagreement with the statement.Again, those whose annual householdincome was below 15,000 were alsosignificantly more likely to stronglydisagree with the linkage betweentrauma and public assistance. Morethan one-fourth of low incomerespondents (27.3%) strongly disagreedcompared to only 7.4% of those whosehousehold income exceeded 100,000.How much do you agree or disagreewith this statement?(n 922)24.0%32.9%Adults who experience trauma as a child are morelikely to be divorced.12.7%9.8%20.6%22.4%34.8%Children who experience trauma are less likely tograduate from high school.17.5%12.8%12.5%20.1%30.9%Those who experience trauma as a child are morelikely to rely on public assistance as an adult.19.8%13.4%15.7%0%Strongly agreeSomewhat agree10%Somewhat disagree20%Strongly disagree30%40%Not sureFigure 5: Social impact of ACEsPrepared by College of Social Work Office of Research and Public ServicePage 8
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)and 79.9% of the oldest respondentssomewhat or strongly agreed with thisquestion. Additionally, more than oneout of ten stated they were not certainabout the impact of supports – 12.8% ofthe youngest group and 15.1% of theoldest group.Prevention of Adverse ChildhoodExperiences (ACEs)An additional focus of the survey was tomeasure attitudes and perceptions aboutstrategies to prevent and mitigate the effects ofACEs and who should shoulder theresponsibility for these efforts.Impact of stable relationshipParticipants were asked to indicate their level ofagreement with the statement that a stablerelationship with an adult can reduce thedamage incurred from childhood trauma. A highlevel of agreement was expressed (89.5%) thata stable relationship with an adult mightmitigate that negative impact of childhoodtrauma (see Figure 6). Little variation of opinionwas expressed on this topic.Responsibility of government and publicagenciesThere was less agreement expressed about therole of government and public agencies inreducing trauma for children than otherquestions included in the survey. When askedwhether government shares a role with parentsand the community to reduce trauma, less than3 out of 4 respondents (72.8%) indicated theyagreed with the statement (see Figure 6). Providing supportsSurvey participants were also asked to expresstheir level of agreement or disagreement aboutthe possible results of providing supports tochildren and their families on negating theimpact of adversity. While there was lessagreement with this statement than the impactof a stable relationship discussed above, a largemajority did voice some level of agreement(81.8%) (see Figure 6). The youngest and oldest respondents,those under 35 years old and those 65and older, were less likely to agree andwere more likely to voice uncertaintyabout the impact of providing supportsto children and their families. Three outof four younger respondents (75.2%) While the overall agreement did notdiffer between racial groups, the levelof intensity in agreement with thestatement did. African-Americanrespondents were significantly morelikely to “strongly agree” thatgovernment should play a role inreducing trauma. More than half(51.0%) expressed strong agreementwhile 36.0% of White respondentschose the same response.Females were also more likely thantheir male counterparts to agree thatgovernment shared a responsibility inlowering traumatic incidences. Morethan 3 out of 4 females (78.2%)somewhat or strongly agreed while67.0% of males agreed.Prepared by College of Social Work Office of Research and Public ServicePage 9
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)How much do you agree or disagreewith this statement?(n 922)65.5%24.0%A stable relationship with an adult can reducethe damaging effects of childhood trauma.1.9%3.3%5.4%51.7%30.1%Providing supports to children and their familiescan reduce the impact of adversity.4.4%3.8%9.9%37.4%35.4%Government and public agencies share aresponsibility with parents and the communityto reduce trauma for children.10.5%8.3%8.4%0%Strongly agreeSomewhat agree20%Somewhat disagree40%Strongly disagree60%80%Not sureFigure 6: Prevention of ACEsPrepared by College of Social Work Office of Research and Public ServicePage 10
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)However, some differences were reported forother experiences.Identifying ACEsAnother focus area for the survey was todetermine the public’s ability to accuratelyidentify experiences that might be consideredan adverse childhood experience with lifelongeffects on a person’s well-being. Respondentswere presented with a list of ten experiences achild might encounter during childhood andasked to indicate if they believed thisexperience might be considered an ACE. Therewas a high degree of consensus on what couldbe considered an adverse childhood experience.More than 9 out of 10 respondents agreed thatabuse, violence in the home, and substanceabuse in the home is an ACE. Fewer, but still anoverwhelming majority reported thatmalnourishment (89.2%), being separated fromparents (84.5%), and racial or culturaldiscrimination would be considered an ACE.Starting a new school (35.0%) was reported bythe fewest respondents to be an ACE (seeFigure 7. Females were significantly more likelythan males to state that being exposedto bullying would be considered anadverse childhood experience. Almost 9out of 10 females (87.4%) selectedexposure to bullying as an ACE while77.6% of males did the same.Differences in opinion about twoexperiences emerged between racialcategories. Nearly 9 out of 10 Blackrespondents (88.5%) identified povertyas an ACE while 73.7% of Whiterespondents indicated it was an ACE.Additionally, more than one-third ofAfrican American respondents (36.5%)reported that breaking a bone shouldbe considered an ACE while less than 1out of 5 White respondents (19.0%)made the same choice.Identified as an Adverse Childhood Experience(n 922)Physical or sexual abuse93.6%Violence in the home93.2%Substance abuse in the home92.0%Malnourishment89.2%Being separated from parents84.5%Being exposed to bullying82.6%Racial or cultural discrimination81.6%Poverty74.6%Starting a new school35.0%Breaking a bone21.6%0%20%40%60%80%100%Figure 7: Experiences defined as ACEsPrepared by College of Social Work Office of Research and Public ServicePage 11
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)Efforts to increase awareness of Adverse Childhood Experiences (ACEs)A final area of interest addressed in the surveywas to learn the public’s attitudes and opinionsabout raising children and current efforts toraise awareness about and reduce AdverseChildhood Experiences in Tennessee.Respondents were asked about theirparticipation in parenting classes andworkshops and whose opinion they would trustwith questions about raising children.One-fourth of respondents (25.3%) reportedthey had attended a parenting class orworkshop in the past. The level of reportedparticipation grew with household income.Less than 1 out of 10 of those whose householdincome fell below 15,000 (9.1%) indicated theyhad attended a workshop whereas 42.3% ofthose whose income exceeded 100,000 hadattended a parenting class.Respondents were also asked about trustedsources for parenting information andto whom they would reach out withquestions about raising their children.The respondents’ parents wereidentified as the most widely trusted(72.2%) followed by their physician.Other frequently cited sources werefriends (36.3%) and ministerial orspiritual leaders (35.0%) (see Table 2).Sources for information about raising children(n Social workerMinister/spiritual leader35.0%Childcare provider23.4%23.1%20.7%20.1%Table 2: Sources of information about raising childrenPrepared by College of Social Work Office of Research and Public ServicePage 12
Public Opinion in Tennessee about Adverse Childhood Experiences (ACEs)Universal Parenting PlaceBuilding Strong BrainsA Universal Parenting Place (UPP) is a sitewhere parents can get information and helpwith raising their children in a safe and healthyenvironment. Respondents were asked toreport their level of familiarity with a UPP andto voice their opinion on its effectiveness forimproving conditions for vulnerable families.Respondents were also asked about theirfamiliarity with Tennessee’s ACEs initiative,Building Strong Brains, and their level ofsupport for the initiative. Awareness of theinitiative was reported to be low, however,support was quite high. The majority ofrespondents (74.8%) indicated they were not atall familiar with the initiative but a largemajority (81.5%) indicated they somewhat orstrongly favored it (see Figure 9). Support fo
Prepared by College of Social Work Office of Research and Public Service Page 2 Findings and Discussion A core purpose for conducting this survey was to measure the level of awareness the public about Adverse Childhood Experiences (ACEs). In an effort to measure awareness, survey respondents were asked to indicate their familiarity with the term.
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