Adverse childhood experiences are potentially traumatic events that occur before the age of 18. For this report, the authors evaluated Live Beyond, a statewide public awareness campaign sponsored by the California Office of the California Surgeon General. The report details their findings related to campaign outcomes for California youth and caregivers.

Evaluation of “Live Beyond”

A Public Awareness Campaign to Address Adverse Childhood Experiences and Toxic Stress in California

Graham DiGuiseppi, Dana Schultz, Rebecca L. Collins, Elizabeth Roth, Nicole K. Eberhart

ResearchPublished Oct 21, 2025

Adverse childhood experiences (ACEs) are potentially traumatic events, such as abuse, neglect, and household stress, that occur before the age of 18. ACEs are common: Almost two-thirds of U.S. adults report at least one ACE, and nearly one-fifth report four or more. ACEs can have wide-ranging effects on mental and physical health and social relationships. These negative health outcomes come about through a process known as toxic stress, a condition characterized by heightened and prolonged physiological and psychological changes that can persist into adulthood.

Given the substantial cost of ACEs to society and their potential to affect future generations, broad population-level interventions are needed. For this report, the authors evaluated Live Beyond, a public awareness campaign funded by the Office of the California Surgeon General and carried out by Civilian, a social marketing and communications agency. Civilian used social marketing to reach two priority populations: youth and young adults ages 16 to 25, and caregivers of youth ages 8 to 16 in California.

The report presents findings of a process evaluation that used document review to detail the planning, development, and implementation of the campaign, and an outcome evaluation that used surveys precampaign and ten months postimplementation to examine the campaign’s impact on transition-age youth’s and caregivers’ ACE-related knowledge and awareness, attitudes and beliefs, skills and actions, and well-being. The authors concluded that, if continued for a longer time, Live Beyond could make headway in addressing the high prevalence and cost of ACEs and toxic stress in California.

Key Findings

  • Live Beyond was grounded in the science of adverse childhood experiences (ACEs), communication, and behavior change and informed by data identifying precampaign gaps in Californians’ ACE-related knowledge, attitudes, and skills.
  • Experts, youth and adults affected by ACEs, and community partners helped determine priority populations and ensure that messages and materials matched those populations’ needs and were perceived positively.
  • Communication, media, and outreach plans were strategically developed to ensure effective reach and engagement across multiple advertising channels.
  • The campaign reached just over one in four members of each population prioritized by Live Beyond (youths ages 16 to 25 and caregivers of youths ages 8 to 16) in its first ten months.
  • Of the priority populations, 60 to 70 percent reported that the Live Beyond ads made them want to learn more about ACEs, to protect their children from ACEs, and to take steps to reduce the negative effects of ACEs and toxic stress.
  • From pre- to postcampaign, caregivers’ reported basic ACE knowledge and awareness increased by more than 50 percent.
  • After Live Beyond was implemented, an additional 276,000 California caregivers indicated that self-care strategies (stress busters) effectively mitigate the negative effects of ACEs.
  • The fraction of caregivers and youth who reported regular use of stress busters increased by 7 and 10 percent, respectively, from before to ten months after Live Beyond implementation.
  • If continued for an extended period, Live Beyond could make headway in addressing the high prevalence of ACEs and toxic stress in California.

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DiGuiseppi, Graham, Dana Schultz, Rebecca L. Collins, Elizabeth Roth, and Nicole K. Eberhart, Evaluation of “Live Beyond”: A Public Awareness Campaign to Address Adverse Childhood Experiences and Toxic Stress in California. Santa Monica, CA: RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA3039-1.html.
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This research was funded by the California Health and Human Services Agency and carried out within the Access and Delivery Program in RAND Health Care.

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