Why are Adverse Childhood Experiences Important?
Chronic stressful or traumatic childhood experiences can alter brain development and the immune system leading to lasting physiological and cognitive changes.
A large and growing body of evidence shows that ACE’s have a significant negative effect on a broad range of cognitive, socio-emotional, and health outcomes over the lifespan, including risk of chronic disease, mental illness, violence, and being a victim of violence.
Population Experiencing Four or More ACEs, 2010 and 2018
Source: WNC Healthy Impact Community Health Survey, 2018 and US BRFSS, 2010
What do the Numbers Say about Adverse Childhood Experiences?
Western North Carolina (WNC) Data:
Approximately 16% of adults in WNC report that they have experienced 4 or more ACEs. The following adult populations were significantly more likely to report high ACE score in 2018:
- Adults aged 18-39 years (27%)
- Very low income (23%) or low income (21%)
- Those identifying American Indian/Alaska Native, Indigenous (33%)
(WNCHN- WNC Healthy Impact Community Health Survey, 2021)
Differences in health outcomes across social groups, economic status, and racial/ethnic identity are closely linked with disparities in social determinants of health, which disproportionately burden individuals and communities who experience systemic disadvantage and/or discrimination. See our data story on the Social Determinants of Health to learn more about how the conditions in which people are born, live, work, play, learn, worship, and age can influence their ability to achieve good health for themselves and their families.
WNC Regional ACEs with Other Issues, 2018
Source: WNC Healthy Impact Community Health Survey, 2018
Experienced ACEs Before 18 Years of Age, 2018
Source: WNC Healthy Impact Community Health Survey, 2018
Risk Factors for Adverse Childhood Experiences:
- High rates of poverty
- Food Insecurity
- Unstable Housing
- High Unemployment rates
- Easy access to drugs and alcohol
What does WNC say is the story behind adverse childhood experiences?
Source: WNCHN- Online Key Informant Survey, 2021

The items below are paraphrased themes that emerged from a 2021 regional survey of key informants. These responses do not:
- Necessarily reflect accurate or scientifically validated information about health determinants, outcomes, and/or strategies for change,
- Represent an exhaustive list of factors that can help or hurt efforts to address this key regional health issue.
The information in this section should be interpreted and used with care. It should be used only to help local health departments and agencies begin to understand community perceptions about local health issues. Communities are strongly encouraged to collect their own, local-level data to inform local planning and evaluation activities.
What’s Helping?
- Increased awareness
- Education/training
- Outside mentors
- School systems
What’s Hurting?
- Lack of parent education
- Substance use
- Health professionals lack adequate training
- Lack of resources to assist those with high ACES
- Poverty
- Generational trauma
- Denial/stigma
What we are hearing:
“We have a community that is ready to help in any way possible once a need has been identified. Various different providers/professionals in the community have also been trained and educated on the impact of ACES. We have a grassroots level of professionals that are ready and willing to really make lasting changes in our community regarding ACES so that we have a healthier community.”
“Many clinics, doctor offices, and advocacy groups support individual, family’s health and wellbeing.”
“The local public schools and the community college support the health and wellbeing of our community. Having key officials that focus on removing barriers helps both entities in serving the community.”
“We work with a lot of young children through our early childhood programs. Preventing trauma and helping vulnerable families and children deal with trauma is an important part of what we do.”
How is the region prioritizing social determinants of health?
The western North Carolina region includes 17 communities: 16 counties and Eastern Band of Cherokee Indians (EBCI)



