title: Adverse Childhood Experiences: Expanding the Concept of Adversity.
abstract: BACKGROUND
  Current knowledge of Adverse Childhood Experiences (ACEs) relies on data predominantly collected from white, middle- / upper-middle-class participants and focuses on experiences within the home. Using a more socioeconomically and racially diverse urban population, Conventional and Expanded (community-level) ACEs were measured to help understand whether Conventional ACEs alone can sufficiently measure adversity, particularly among various subgroups.
  
  
  METHODS
  Participants from a previous large, representative, community-based health survey in Southeast Pennsylvania who were aged ≥18 years were contacted between November 2012 and January 2013 to complete another phone survey measuring ACEs. Ordinal logistic regression models were used to test associations between Conventional and Expanded ACEs scores and demographic characteristics. Analysis was conducted in 2013 and 2014.
  
  
  RESULTS
  Of 1,784 respondents, 72.9% had at least one Conventional ACE, 63.4% at least one Expanded ACE, and 49.3% experienced both. A total of 13.9% experienced only Expanded ACEs and would have gone unrecognized if only Conventional ACEs were assessed. Certain demographic characteristics were associated with higher risk for Conventional ACEs but were not predictive of Expanded ACEs, and vice versa. Few adversities were associated with both Conventional and Expanded ACEs.
  
  
  CONCLUSIONS
  To more accurately represent the level of adversity experienced across various sociodemographic groups, these data support extending the Conventional ACEs measure.
authors: Department of Family Medicine and Community Health, University of Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania. Electronic address: peter.cronholm@uphs.upenn.edu.
authors: Peter F
authors: PF
authors: Cronholm
authors: Department of Epidemiology and Biostatistics, University of Pennsylvania; Violence Prevention Initiative, Center for Injury Research Prevention.
authors: Christine M
authors: CM
authors: Forke
authors: Department of Pediatrics, The Children's Hospital of Philadelphia.
authors: Roy
authors: R
authors: Wade
authors: Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
authors: Megan H
authors: MH
authors: Bair-Merritt
authors: Robert Wood Johnson Foundation, Princeton, New Jersey.
authors: Martha
authors: M
authors: Davis
authors: Philadelphia Health Management Corporation, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
authors: Mary
authors: M
authors: Harkins-Schwarz
authors: Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
authors: Lee M
authors: LM
authors: Pachter
authors: Violence Prevention Initiative, Center for Injury Research Prevention; Department of Emergency Medicine, The Children's Hospital of Philadelphia.
authors: Joel A
authors: JA
authors: Fein
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000706:statistics & numerical data*; D000069586:Adult Survivors of Child Adverse Events / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D044469:Racial Groups / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult