Survey Results

Survey Items: Survey instrument item number for children 0-5 years: I12a-h; for children 6-11 years: I13a-h; for children 12-17 years: I13a-h
Variables in public use data file: ACE1; ACE3; ACE4; ACE5; ACE6; ACE7; ACE8; ACE9; ACE10

Denominator: Children age 0-17 years

Numerator: Children with no adverse childhood experiences; Children with 1 adverse childhood experience; Children with 2 or more adverse childhood experiences

Revisions and Changes: In 2018, there were changes to the wording of the item that asks about whether the child's family experienced economic hardship to cover the basics, like food or housing (ACE1).
Though data for this item is not comparable with the 2017 NSCH due to the change, the overall measure of ACEs did not change significantly; therefore, the results of the composite measure may be compared. For more information about the changes, click here.

Additional Notes: In the 2017 and 2018 combined NSCH data query, 2 versions of ACEs measure are presented: (a) including all 9 items asked in the survey and (b) excluding the "economic hardship" item". This version of ACEs measure was constructed based on all 9 ACEs questions asked in the 2017 and 2018 NSCH: hard to cover basics on family's income (ACE1); parent or guardian divorced or separated (ACE3); parent or guardian died (ACE4); parent or guardian served time in jail (ACE5); saw or heard parents or adults slap, hit, kick, punch one another in the home (ACE6); was a victim of violence or witnessed violence in neighborhood (ACE7); lived with anyone who was mentally ill, suicidal, or severely depressed (ACE8); lived with anyone who had a problem with alcohol or drugs (ACE9); and treated or judged unfairly due to race/ethnicity (ACE 10). A response of 'somewhat often' or 'very often' to the question "Since this child was born, how often has it been very hard to cover the basics, like food or housing, on your family's income?" (ACE1) was coded as an adverse childhood experience. The remaining survey items ACE3-ACE10 are dichotomous with 'Yes/No' response options.
This ACEs measure is different than the ACEs measure presented in the https://mchb.hrsa.gov/sites/default/files/mchb/Data/NSCH/NSCH-2018-factsheet.pdf"target=_blank>fact sheet by HRSA's Maternal and Child Health Bureau which did not include the "economic hardship" item (ACE1).

Treatment of Unknown Values: Missing values may be due to non-response (i.e. a skipped item) or a “don’t know” response. The way these items are handled can vary by measure. For NPMs and NOMs, having missing values for all items in an indicator will lead to the case being given a missing value on the overall measure. For some other measures, if there is a missing value on any of the items, the case will be set to missing. How missing values are handled is documented in the "Additional notes" field above when required.
Missing values are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the Interactive Data Query results table. In the majority of cases, the proportion of missing values is less than 2%. Exceptions are noted in the form of a Data Alert at the bottom of a results table. The exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Pop. Est.). To learn about the impact of the missing values on the population count estimates, click here.

History and Development: The Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau (MCHB) funds and directs the National Survey of Children's Health (NSCH), and develops survey content in collaboration with the U.S. Census Bureau and a Technical Expert Panel. The Technical Expert Panel consists of experts in survey methodology and children's health, federal and state stakeholders, clinicians and researchers. The U.S. Census Bureau conducts the survey, oversees the sampling, and produces a final data set of survey results. Respondents' cognitive understanding of the survey questions was assessed during the pretest phase of the survey redesign (in 2015) and reassessed after the 2016 survey; subsequent revisions were made. Previously validated questions and scales are used when available. The manuscript "The Design and Implementation of the 2016 National Survey of Children's Health" provides detailed information about the redesign of the NSCH, administration of the first redesigned survey (2016), and the sampling and administration changes for the 2017 and 2018 NSCH.
Prior to 2016, the NSCH and the National Survey of Children with Special Health Care Needs were each conducted three times as interviewer-assisted telephone surveys using random digit dial sampling. In 2016, the two surveys were combined into a single annual self-administered questionnaire. Due to decline in the number of households with landline telephones, the NSCH now utilizes an addressed based sampling method to select participating households, thus all invitations are sent by mail. Participants may choose to complete the survey either online using a secure website or a mailed paper version of the survey. All final data components are verified by the Census Bureau, HRSA/MCHB and CAHMI/DRC staff prior to public release. More information about the survey can be found in the "About the National Survey of Children's Health" section of this website and HRSA's MCHB website.