Open Access Highly Accessed Research article

National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England

Mark A Bellis12*, Karen Hughes1, Nicola Leckenby3, Clare Perkins4 and Helen Lowey5

Author Affiliations

1 Centre for Public Health, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK

2 Public Health Wales, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK

3 Department of Academic Neonatal Medicine, Chelsea and Westminster Campus, Imperial College London, Fulham Road, London SW10 9NH, UK

4 Knowledge and Intelligence Team (North West), Public Health England, 15-21 Webster Street, Liverpool L3 2ET, UK

5 Blackburn with Darwen Borough Council, Specialist Public Health Directorate, 6th floor, 10 Duke Street, Blackburn BB2 1DH, UK

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BMC Medicine 2014, 12:72  doi:10.1186/1741-7015-12-72

Published: 2 May 2014



Epidemiological and biomedical evidence link adverse childhood experiences (ACEs) with health-harming behaviors and the development of non-communicable disease in adults. Investment in interventions to improve early life experiences requires empirical evidence on levels of childhood adversity and the proportion of HHBs potentially avoided should such adversity be addressed.


A nationally representative survey of English residents aged 18 to 69 (n = 3,885) was undertaken during the period April to July 2013. Individuals were categorized according to the number of ACEs experienced. Modeling identified the proportions of HHBs (early sexual initiation, unintended teenage pregnancy, smoking, binge drinking, drug use, violence victimization, violence perpetration, incarceration, poor diet, low levels of physical exercise) independently associated with ACEs at national population levels.


Almost half (47%) of individuals experienced at least one of the nine ACEs. Prevalence of childhood sexual, physical, and verbal abuse was 6.3%, 14.8%, and 18.2% respectively (population-adjusted). After correcting for sociodemographics, ACE counts predicted all HHBs, e.g. (0 versus 4+ ACEs, adjusted odds ratios (95% confidence intervals)): smoking 3.29 (2.54 to 4.27); violence perpetration 7.71 (4.90 to 12.14); unintended teenage pregnancy 5.86 (3.93 to 8.74). Modeling suggested that 11.9% of binge drinking, 13.6% of poor diet, 22.7% of smoking, 52.0% of violence perpetration, 58.7% of heroin/crack cocaine use, and 37.6% of unintended teenage pregnancy prevalence nationally could be attributed to ACEs.


Stable and protective childhoods are critical factors in the development of resilience to health-harming behaviors in England. Interventions to reduce ACEs are available and sustainable, with nurturing childhoods supporting the adoption of health-benefiting behaviors and ultimately the provision of positive childhood environments for future generations.

Child abuse; Childhood; Alcohol; Smoking; Violence