Nationally, nearly 25 percent of children aged 17 and under have experienced at least one traumatic event, whether it be physical abuse, neglect or living with a family member who has struggled with alcoholism or drug use, recent federal data shows.

Among Black youth, however, 30 percent have suffered a traumatic event, with another 35 percent suffering two or more adverse childhood experiences, also known as “ACEs.”

The stats are the findings of a state-by-state poll released last year from the 2016 National Survey of Children’s Health, a survey aimed at providing data on the health and well-being of children by studying factors that affect their physical and emotional health. This includes everything from access to health care, family interactions and neighborhood characteristics, according to the Health Resources & Services Administration, which helped fund the annual survey.

The data also offers an inside look at the rate of children and teens impacted by adverse events, which several studies have shown put them at higher risk for developing chronic ailments like heart disease, asthma and even depression. Now, public health proponents are hoping to use the findings to influence policies aimed at counteracting said traumatic childhood experiences.

“These numbers tell a story about what is happening nationally to children,” Martha Davis, senior program officer of the Robert Wood Johnson Foundation, which supports policies to combat childhood adversity, told The Washington Post. “They have implications for schools and families and communities and health care.”

According to the survey, nearly a quarter of youth in the United States have endured a traumatic event by the time they turned 18 years old. New York topped the list with an ACEs rate of 30.3 percent, while Arizona had the lowest rate at 19 percent. The top five states with the highest rates of childhood adversity were also located in the Northeast, Western and Southern regions of the United States.

The idea that such negative episodes can have a long-term impact has only recently been popularized, however, with the federal government first inquiring about them in the 2010/ 2011 survey, WaPo reported. The term “ACEs” gained steam after a 1998 landmark study from Kaiser Permanente and the Centers for Disease Control and Prevention, which found that traumatic childhood experiences were incredibly common and linked to poor health outcomes.

A growing body of research around brain science and biology has helped to explain this connection, showing just how high “doses” of stress, and adversity can negatively affect the developing brains and bodies of young children. Nearly two–thirds of those polled for the Kaiser study reported experiencing at least one traumatic childhood event. Compared to those who reported no trauma, participants who suffered four or more adverse events were twice as likely to be diagnosed with heart disease, six times as likely to suffer from depression and were more likely to engage in risky behaviors.

“I went to medical school; I never heard about this,” pediatrician Nadine Burke Harris said of the groundbreaking research. “When I did, I wanted to shout it from the rooftops.”

Harris now runs her own practice, the Center for Youth Wellness in San Francisco, Calif., where her staff utilizes a method that not only examines a patient’s medical history but their social history, too. Every child that walks through the center’s doors is screened for ACEs that might cause toxic stress and lead to chronic health issues in the future.

“We heal children’s brains and bodies by piloting treatments for toxic stress and sharing our findings nationally,” according to the Center. “We prevent toxic stress by raising awareness among those who can make a difference — from parents and pediatricians to policymakers. Our mission is to improve the health of children and adolescents exposed to [ACEs].”

Health advocates define adverse childhood events as stressful or traumatic episodes youth experience before age 18, including violence at home, substance abuse, neglect and living with a parent who has mental illness. Repeated or high exposure to said events without the preventative support of a loving adult can disrupt children’s stress response, making it that much harder to deal with toxic stress, research shows.

Like Harris, teachers, practitioners, the courts and others in the medical community have begun to adapt and respond to the startling research behind these adverse episodes. ACE Response, an organization born out of a partnership between Prevent Child Abuse America and the University at Albany (SUNY) School of Social Welfare suggests that ACE prevention begins with the integration of brain science and policy. For instance, Davis and colleagues over at the RWJF have pushed for policies to help counter childhood adversity, such as paid family leave, home visiting programs and other resources to give parents the time they need to better support their children.

Meanwhile, sites like ACE Response serve as an online resource connecting policymakers, program directors and researchers involved with the implementation of other ACE prevention measures in the United States and beyond. This way, both doctors and decision-makers have a common understanding on the ramifications of childhood trauma and the importance of buffering it.

Child health advocates in Iowa are now working to do just that. In 2011, the state began collecting ACEs data from within its borders, prompting leaders with Prevent Child Abuse–Iowa to launch the Connections Matter campaign, an initiative aimed at promoting the importance of care, trusting relationships and reducing the impact of childhood trauma. The goal, according to PCA-Iowa director Liz Cox, is to build “thriving communities that foster resilience and reduce the intergenerational transmission of abuse and neglect.”

While the idea that children should grow up in loving environments free from abuse and neglect is nothing new, the connection between childhood trauma and long-term health issues is. Now cities and states are working to keep kids healthy from the get-go.

In a piece for the National Resilience Institute, Cox cited the notable progress Washington state has made in decreasing childhood adversity, resulting in billions of dollars saved to its state budget, reduced high school dropout rates, teen pregnancy and even suicide attempts among children. She and other child advocates across the state are now pushing to achieve similar results by utilizing strategies to help foster conversations around ACEs, create policy centered on prevention and promote funding of evidence-based trauma intervention, such as after-school programs.

“Reducing ACEs requires collaborative [social] work further upstream in prevention,” Cox wrote. “Proportionate funding of evidence-based prevention, like parenting classes, sexual abuse prevention training for teachers, respite care, home visits and community capacity building — is an investment that strengthens families and reduces the demands on foster care systems.”

“Support from community foundations, corporations, and private donors can help leverage investments from the state and federal governments to create better access to prevention services for youth,” she added.

The Substance Abuse and Mental Health Services Administration, or SAMHSA, has offered similar suggestions for buffering ACEs, which include keeping local decision-makers in the  loop on current state and county-level ACEs data and taking into account the primary risk and protective factors when mapping out prevention planning efforts. Like Harris, some family doctors have even started questioning patients on urban-related stressors, such as how safe their neighborhoods are or if they’ve witnessed any violence.

As research continues to grow around adverse childhood experiences, it’s hoped that efforts aimed at reducing childhood trauma will flourish as well.