A sweeping new analysis suggests that the United States has made little headway in changing the mix of experiences that shape teen adolescents’ long-term health.
Despite years of programs aimed at lifting up families and buffering kids from hardship, the prevalence of both adverse and positive childhood experiences (ACEs and PCEs) reported by parents of teens has stayed largely flat since 2016.
The study tracked 11 adverse and seven positive experiences among 125,564 adolescents ages 12 to 17, using data from the National Survey of Children’s Health.
The period spans eight years of social and economic shifts, including the COVID-19 lockdowns – a natural experiment the research team expected might alter the numbers.
The researchers examined a familiar roster of ACEs – parental divorce, death, or incarceration; witnessing violence; experiencing discrimination; and economic hardship. They then combined them with other PCEs.
These include having a non-parent adult mentor, demonstrating family resilience during tough times, joining organized or service activities, and feeling neighborhood safety and support.
Senior author Susie Breitenstein, a professor of nursing at Ohio State University who designs parent-training programs to strengthen social and emotional health, said the results hit close to home.
“I do early intervention parenting work, and the goal really is to decrease the incidence of adverse childhood experiences and increase the incidence of positive childhood experiences,” she said.
“I think at a local level we have had some success, but at a national level it doesn’t seem like we’ve really moved the needle on some of these experiences. This was kind of surprising to us.”
Across the eight-year window, adverse experiences generally did not surge or collapse. One clear bright spot: economic hardship fell sharply – about 25 percent – from 2016 to 2023.
This change reflects a gradual recovery from the lingering effects of the 2008 financial crisis and, potentially, policy support during the pandemic.
The most common adverse experience remained parental divorce, affecting at least 30 percent of teens. Yet, even there, prevalence ticked down about one percentage point over the study period.
The steepest rise among the adverse measures was racial discrimination, up to roughly six percent. This increase warrants urgent attention given its well-documented links to stress, mental health challenges, and long-term disease risk.
On the positive side, PCEs were consistently more prevalent than ACEs. Depending on the measure, between 40 and 90 percent of parents reported that their teens experienced key positives, compared with less than 35 percent reporting any single adverse experience.
One notable dip did appear: teen participation in organized activities fell in 2021, precisely when after-school programs, sports, clubs, and service opportunities were disrupted by COVID-19.
“Directly following COVID in 2021, we saw a decrease in participation in activities, which is thought to be a positive childhood experience,” said lead statistician Nathan Helsabeck from Ohio State.
Some might interpret “no big change” as good news, especially given pandemic-related turmoil. The authors see it differently.
Because ACEs are tied to higher risks of adult disease, mental illness, and substance misuse, shifting these rates is a public health imperative. Flat lines suggest that national efforts haven’t yet translated into population-scale gains.
“There are complex dynamics across experiences that intersect across family, community, and the broader society,” Breitenstein said.
“And in our work, we constantly talk about strength-based approaches and the importance of propping those up, and how to do that. Because sometimes you can’t avoid these adverse experiences, especially when we talk about something like divorce.”
The stability also underscores a core insight. ACEs and PCEs aren’t simply opposites on a single dial. Positive experiences don’t always erase harm, but they can buffer its effects.
That nuance, the authors argue, should inform program design and policy – protecting families from known risks while actively building up the supports that help kids thrive.
Most prior research has aimed to count total ACEs or PCEs or identify high risk subgroups. This study flips the lens, reporting the share of teens experiencing specific events or supports year by year.
That approach, the authors say, creates a practical yardstick for evaluating whether new programs actually move the numbers.
“This is a really clear, straightforward baseline that other researchers or policymakers could use to build a case for an intervention or other work,” Helsabeck said.
For Breitenstein and colleagues – whose work spans youth experiencing homelessness and those receiving psychiatric care – the next step is making the findings concrete.
“There are a lot of things that help strengthen children’s experiences, but they don’t always cross paths or build on each other,” she said. “We know these things matter, so we’ll use the data to shore up the resources we can to help support others.”
The study’s headline is sobering: at the national level, the mix of positive and adverse experiences reported by parents of teens hasn’t shifted much since 2016, despite sweeping social change and targeted interventions.
There are modest wins – less economic hardship – and worrying trends, especially rising reports of racial discrimination and a pandemic-related dip in organized activities.
Overall, the stubborn stability suggests that the systems designed to protect kids and build resilience are not yet delivering population-wide change.
If there’s a silver lining, it’s clarity. By mapping specific experiences over time, the research provides policymakers, schools, health systems, and community groups with a shared baseline.
Moving the needle won’t come from any single program, the authors argue, but from sustained, integrated efforts that reduce harm and expand everyday positives in the places kids actually live – homes, neighborhoods, classrooms, and after-school spaces.
The study is published in the journal JAMA Pediatrics.
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