Transcript of "A Qualitative Study of Adverse Childhood Experiences of Low-Income Youth in Philadelphia_Roy Wade 5_3_13"
A Qualitative Study of Adverse Childhood Experiences of Low-Income Youth in PhiladelphiaRoy Wade Jr. MD PhD MPH, Judy A. Shea PhD, David M. Rubin MD MSCE,Joanne N. Wood MD MSHPTable 1: Participant Demographics We completed focus groups with young adults ages18 to 26 who grew up in Philadelphia for at least halfof their childhood. Using the Nominal Group Technique, participantsgenerated a list of adverse childhood experiencesarranged in order of perceived significance.Methods We held 19 focus groups with 119 young adults inPhiladelphia (see Table 1). Participants cited stressors in ten domains: familyrelationships, community stressors, personalvictimization, economic hardship, peer relationships,discrimination, school, health, child welfare/juvenilejustice, media/technology (see Table 2).Results Participants endorsed broader experiences ofadversity than listed in the initial ACE Study. The most commonly cited childhood exposureswere family relationships, community stressors,personal victimization, and economic hardship. Family relationships included the ACE measuresof household dysfunction but focused on a lackof love and support in families. Community stressors and personal victimizationcreated a general sense of lack of safety forparticipants. A surprisingly low number of respondentsendorsed discrimination & corporal punishmentas stressors.Discussion Future research must incorporate a communityperspective into the conceptualization of childhoodadversity. As our understanding of adversityevolves, researchers must incorporate these broaderexperiences into an ACE framework to understandtheir impact on health outcomes.Conclusions Background: The Adverse Childhood Experiences(ACE) study associated childhood experiences ofabuse, neglect, and household dysfunction withpoor health outcomes. These experiences may notbe representative of all populations, particularlyurban economically disadvantaged children. Methods: We performed a qualitative study ofchildhood adversity among adults who grew up inPhiladelphia. Results: Participants endorsed a broad range ofadversities summarized in ten domains. Conclusions: Participants cited numerouschildhood adverse experiences including stressorsnot included in the initial ACE studies. Future workwill focus on determining the significance of thesebroader adversities in contributing to adult healthoutcomes.Abstract Prior research has established a strong linkbetween ACEs and poor health outcomes includingpsychiatric illness, chronic illness, and even earlydeath. The ACE study measured these experiences inthree domains: abuse, neglect, and familydysfunction. These childhood experiences are found morecommonly in economically distressed settings, butmay not capture the broader experiences ofadversity that low-income urban children face.Background To identify and characterize the range of adverseevents experienced by low-income urban children.ObjectivesTable 2: Participant ResponsesDomains Number of ResponsesFamily Relationships 195Community Stressors 119Personal Victimization 72Economic Hardship 67Peer Relationships 35Discrimination 23School 22Health 17Child Welfare/JuvenileJustice8Media/Technology 5DemographicsPercent ofIndividualsSexMale 55Female 45Race/EthnicityNon-HispanicCaucasian5Hispanic Caucasian 5Non-Hispanic Black 71Hispanic Black 5Native AmericanBlack1Hispanic 8Native American 2Asian 3NeighborhoodPoverty Level(100% FPL)Less than 10% 510% to 20% 1120% to 40% 51Greater than 40% 33