The analysis was conducted from September 10, 2021, to November 29, 2022, in a series of steps that incorporated multiple data sources. First, combined 2019-2020 BRFSS data including modeled small area estimates as described in a previous study provided each state’s estimated prevalence of 8 ACEs (physical, emotional, or sexual abuse; household member substance use disorder, incarceration, or mental illness; parental divorce; or witnessing intimate partner violence) in terms of ACE count (0, 1, 2-3, ≥4) per US adult (≥18 years) (unpublished study by M.V.A. et al). Because just 37 jurisdictions included BRFSS ACE module questions during 2019-2020 and in each state 14% to 33% of the respondents skipped 1 or more ACE survey question, the small area estimates approach (a statistical process that used actual survey responses to generate modeled responses if data were missing20) from the unpublished study provided a way to use the most recent BRFSS ACEs data to analyze all states and include more respondents. There was further support for this approach in a recent analysis of state-level BRFSS ACEs data spanning 2011-2020 (the minimum timeline
