Comment from Hong, Audrey

As a current family nurse practitioner student, I am writing in full support of continuing information collection for the CDC’s Essentials for Childhood (EfC) program, as such data is crucial to further expanding efforts to reduce adverse childhood experiences (ACE). This program is critical in that a history of ACEs – such as household dysfunction, neglect, and abuse – has been overwhelmingly associated with a multitude of risk factors for many leading causes of death in adults (Felitti et al., 1998). These are not limited to but include cancer and heart disease. Furthermore, those who have reported a minimum of four ACEs face a significantly higher risk of various poor health outcomes compared to those without any; the strongest association being tied to self-directed violence and problematic drug use (Hughes et al., 2017). As a future primary care provider, screening children and families for these influential ACEs is not only within my scope of practice, but is also widely supported by various guidelines and frameworks – with perhaps the most notable being the American Academy of Pediatrics’s Bright Future Guidelines (2024). When needed, I will be referring them to community resources; the utility of these referrals will depend directly on the quality of the prevention infrastructure behind it (Centers for Disease Control and Prevention [CDC], 2026). I therefore strongly believe in the importance behind sustained data collection; this is essentially how the CDC evaluates the effectiveness of the prevention infrastructure it funds, with these evaluations holding the power to shape future funding opportunities (CDC, 2026). Furthermore, to circumvent situations where frontline clinicians end up relying on questionably effective referral pathways lacking real evidence behind them, I ask that a portion of the collected evaluation and performance data circle back to the primary care providers conducting the ACE screens themselves. This would help ensure that the referrals made lead to a resource that has been shown to actually work, rather than just exist on paper. References: American Academy of Pediatrics. (2024, February 26). Bright Futures Toolkit: Links to commonly used screening instruments and tools. https://publications.aap.org/toolkits/resources/15625/Bright-Futures-Toolkit-Links-to-Commonly-Used?autologincheck=redirected Centers for Disease Control and Prevention. (2026, June 18). Reporting of the Essentials for Childhood (EfC): Preventing adverse childhood experiences through data to action program (Docket No. CDC-2026-1091). Federal Register, 91(117), 36838–36839. https://www.regulations.gov/document/CDC-2026-1091-0001 Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8 Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), E356–E366. https://doi.org/10.1016/s2468-2667(17)30118-4