1. A Qualitative Study of Adverse Childhood Experiences of Low-
Income Youth in Philadelphia
Roy Wade Jr. MD PhD MPH, Judy A. Shea PhD, David M. Rubin MD MSCE,
Joanne N. Wood MD MSHP
Table 1: Participant Demographics
 We completed focus groups with young adults ages
18 to 26 who grew up in Philadelphia for at least half
of their childhood.
 Using the Nominal Group Technique, participants
generated a list of adverse childhood experiences
arranged in order of perceived significance.
Methods
 We held 19 focus groups with 119 young adults in
Philadelphia (see Table 1).
 Participants cited stressors in ten domains: family
relationships, community stressors, personal
victimization, economic hardship, peer relationships,
discrimination, school, health, child welfare/juvenile
justice, media/technology (see Table 2).
Results
 Participants endorsed broader experiences of
adversity than listed in the initial ACE Study.
 The most commonly cited childhood exposures
were family relationships, community stressors,
personal victimization, and economic hardship.
 Family relationships included the ACE measures
of household dysfunction but focused on a lack
of love and support in families.
 Community stressors and personal victimization
created a general sense of lack of safety for
participants.
 A surprisingly low number of respondents
endorsed discrimination & corporal punishment
as stressors.
Discussion
 Future research must incorporate a community
perspective into the conceptualization of childhood
adversity.
 As our understanding of adversity
evolves, researchers must incorporate these broader
experiences into an ACE framework to understand
their impact on health outcomes.
Conclusions
 Background: The Adverse Childhood Experiences
(ACE) study associated childhood experiences of
abuse, neglect, and household dysfunction with
poor health outcomes. These experiences may not
be representative of all populations, particularly
urban economically disadvantaged children.
 Methods: We performed a qualitative study of
childhood adversity among adults who grew up in
Philadelphia.
 Results: Participants endorsed a broad range of
adversities summarized in ten domains.
 Conclusions: Participants cited numerous
childhood adverse experiences including stressors
not included in the initial ACE studies. Future work
will focus on determining the significance of these
broader adversities in contributing to adult health
outcomes.
Abstract
 Prior research has established a strong link
between ACEs and poor health outcomes including
psychiatric illness, chronic illness, and even early
death.
 The ACE study measured these experiences in
three domains: abuse, neglect, and family
dysfunction.
 These childhood experiences are found more
commonly in economically distressed settings, but
may not capture the broader experiences of
adversity that low-income urban children face.
Background
 To identify and characterize the range of adverse
events experienced by low-income urban children.
Objectives
Table 2: Participant Responses
Domains Number of Responses
Family Relationships 195
Community Stressors 119
Personal Victimization 72
Economic Hardship 67
Peer Relationships 35
Discrimination 23
School 22
Health 17
Child Welfare/Juvenile
Justice
8
Media/Technology 5
Demographics
Percent of
Individuals
Sex
Male 55
Female 45
Race/Ethnicity
Non-Hispanic
Caucasian
5
Hispanic Caucasian 5
Non-Hispanic Black 71
Hispanic Black 5
Native American
Black
1
Hispanic 8
Native American 2
Asian 3
Neighborhood
Poverty Level
(100% FPL)
Less than 10% 5
10% to 20% 11
20% to 40% 51
Greater than 40% 33