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A Qualitative Study of Adverse Childhood Experiences of Low-Income Youth in Philadelphia_Roy Wade 5_3_13


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A Qualitative Study of Adverse Childhood Experiences of Low-Income Youth in Philadelphia_Roy Wade 5_3_13

  1. 1. 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