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 Philadelphia_Roy Wade 5_3_13

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  A Qualitative Studyof 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