title: Adverse childhood experiences of low-income urban youth.
abstract: OBJECTIVE
  Current assessments of adverse childhood experiences (ACEs) may not adequately encompass the breadth of adversity to which low-income urban children are exposed. The purpose of this study was to identify and characterize the range of adverse childhood experiences faced by young adults who grew up in a low-income urban area.
  
  
  METHODS
  Focus groups were conducted with young adults who grew up in low-income Philadelphia neighborhoods. Using the nominal group technique, participants generated a list of adverse childhood experiences and then identified the 5 most stressful experiences on the group list. The most stressful experiences identified by participants were grouped into a ranked list of domains and subdomains.
  
  
  RESULTS
  Participants identified a range of experiences, grouped into 10 domains: family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, child welfare/juvenile justice, and media/technology. Included in these domains were many but not all of the experiences from the initial ACEs studies; parental divorce/separation and mental illness were absent. Additional experiences not included in the initial ACEs but endorsed by our participants included single-parent homes; exposure to violence, adult themes, and criminal behavior; personal victimization; bullying; economic hardship; and discrimination.
  
  
  CONCLUSIONS
  Gathering youth perspectives on childhood adversity broadens our understanding of the experience of stress and trauma in childhood. Future work is needed to determine the significance of this broader set of adverse experiences in predisposing children to poor health outcomes as adults.
authors.affiliation: Department of General Pediatrics, and wader2@email.chop.edu.
authors.forename: Roy
authors.initials: R
authors.lastname: Wade
authors.affiliation: Division of General Internal Medicine, Department of Medicine, and.
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
authors.affiliation: Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaPolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: David
authors.initials: D
authors.lastname: Rubin
authors.affiliation: Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaPolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Joanne
authors.initials: J
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D015143:Philadelphia; D011203:Poverty; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology*; D014505:Urban Population; D055815:Young Adult
keywords: child abuse; children of impaired parents; domestic violence; nominal group technique; poverty; sexual abuse; spouse abuse; substance abuse; urban