Adverse Childhood Experiences (ACEs): Health Impact of ACEs in Ohio

There are many organizations working to improve child well-being in Ohio at the state and local levels. Across these entities, the impact of adverse childhood experiences (ACEs) has surfaced as a common challenge that must be addressed.

Exposure to ACEs is a pervasive problem affecting many children in Ohio and across the country. National data and analysis provide clear evidence that ACEs exposure is linked to poor health and well-being through adulthood, including disrupted neurodevelopment, social problems, disease, disability and premature death. In addition, ACEs exposure has severe long-term cost implications at the individual and societal levels, including increased medical, child welfare, criminal justice and special education expenditures, as well as productivity losses.

This brief:

  • Summarizes current research on how ACEs impact health and well-being
  • Provides new data and analysis on the prevalence of ACEs in Ohio and the impact of ACEs on the health of Ohioans

More specifically, this brief expands on what we know from national research by exploring these questions:

  • To what extent could Ohio’s health outcomes be improved by preventing ACEs?
  • Which ACEs have the most significant impact on the health of Ohioans?

Preventing and mitigating the impact of ACEs are critical components of any plan to advance the health and well-being of Ohioans. Ohio Governor Mike DeWine and other policymakers have already taken significant strides to improve the health and well-being of Ohio’s children, including the creation of the Governor’s Office of Children’s Initiatives and improvements to the state’s child welfare and home visiting systems. In addition, the 2020-2022 State Health Improvement Plan (SHIP) includes reduction of ACEs as a priority.

Policymakers and other stakeholders can use the Ohio-specific data and analyses provided in this brief to inform future approaches to reduce ACEs exposure in Ohio.



3 Key findings for policymakers

  • Exposure to ACEs is a pervasive problem. Nearly two-thirds of Ohioans have been exposed to ACEs. Ohioans of color and Ohioans with low incomes, disabilities and/ or who are residents of urban and Appalachian counties are more likely to experience multiple ACEs.
  • Preventing ACEs can improve health. For example, if exposure to ACEs were eliminated in Ohio, an estimated 36% of depression diagnoses could be prevented.
  • Focusing action on specific ACEs may yield more significant health impacts. Data analysis suggests that preventing and mitigating the impacts of emotional and sexual abuse and living in a household with someone who has a substance use disorder, mental health problem or who is incarcerated are likely to have the largest effects on the health of Ohioans.

Ohio ACEs Impact project

Led by the Health Policy Institute of Ohio and informed by a multi-sector advisory group, this project includes a series of three policy briefs and a resource page to build on and amplify current efforts to address ACEs in Ohio.

In August 2020, HPIO released the first brief, Adverse Childhood Experiences (ACEs): Health impact of ACEs in Ohio. This brief, the second in the series, focuses on the economic impact of ACEs in Ohio. The third brief builds on the previous two by identifying evidence-informed and cost-effective strategies to prevent and mitigate the impacts of ACEs.

This project is funded by the Ohio Department of Mental Health and Addiction Services (OhioMHAS) supported by Ohio’s 2020-2021 SAMHSA Community Mental Health Block Grant, the Harmony Project, the Ohio Children’s Hospital Association and HPIO’s core funders.