1. In low-income, urban young adults, family relationships, community stressors, and personal victimization were ranked as the 3 most stressful adverse childhood experiences (ACEs).
2. In this population, parental divorce/separation and mental illness were not identified as ACEs, while single-parent homes, exposure to violence, adult themes and criminal behavior, personal victimization, bullying, economic hardship and discrimination were ACEs that were not previously identified.
Study Rundown: Adverse childhood experiences have been linked to negative adult health outcomes including adult risk-taking behaviors, chronic illness, disability and early death, as well as poor academic achievement, incarceration, unemployment and poverty. While low-income, urban youth have increased exposure to adversities, ACEs have largely been established by interviews with white, middle to upper class youth who live in rural and suburban communities. This study used focus groups of low-income, urban young adults from Philadelphia to identify adverse childhood experiences. Family relationships, community stressors, and personal victimization were the three most commonly cited domains. Single-parent homes, exposure to violence, adult themes and criminal behavior, personal victimization, bullying, economic hardship and discrimination had not been identified in previous ACE studies, while parental divorce/separation and mental illness were initial ACEs that were absent in this population. Though this study was limited by recall bias and generalizability, it identifies unique stressors in the low-income, urban population. Early recognition of these stressors may help physicians prevent or mitigate poor health outcomes.
Relevant Reading: Improving the adverse childhood experiences study scale
In-Depth [qualitative study]: Young adults aged 18 to 26 from Philadelphia neighborhoods, in which 20% of residents lived at or below the Federal Poverty Level, were recruited into 17 focus groups. Of the 119 participants, 55% were male and 71% were non-Hispanic blacks. The nominal group technique was used to generate a list of adverse experiences and participants identified the 5 most stressful experiences on the group list. Adverse experiences were grouped into 10 domains (most cited to least): family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, child welfare/juvenile justice and media/technology. Family relationships included substance abuse in the home, death and illness of family members, violence between family members and single-parent homes, which was an adverse experience not identified in previous ACE studies. Community stressors included neighborhood violence, crime and death. Exposure to violence was a recurrent theme across domains that had not previously been identified as an ACE. Additional adverse experiences newly identified in this population included adult themes and criminal behavior, personal victimization, bullying, economic hardship, and discrimination, though study authors were surprised to note that discrimination was cited by only a few participants.
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