The impact of adverse childhood experiences on an urban pediatric population
Open accessAbstract
Objective The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community. Study design Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were coded and each ACE criterion endorsed by a traumatic event received a score of 1 (range=0-9). This study reports on the prevalence of various ACE categories in this population, as well as the association between ACE score and two pediatric problems: learning/behavior problems and body mass index (BMI)≥85% (i.e., overweight or obese). Results The majority of subjects (67.2%, N=471) had experienced 1 or more categories of adverse childhood experiences (ACE≥1) and 12.0% (N=84) had experienced 4 or more ACEs (ACE≥4). Increased ACE scores correlated with increased risk of learning/behavior problems and obesity. Conclusions There was a significant prevalence of endorsed ACE categories in this urban population. Exposure to 4 or greater ACE categories was associated with increased risk for learning/behavior problems, as well as obesity. Practice implications Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models.
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“However, research has demonstrated that children who experience multiple childhood adversities fare poorly academically, including exhibiting learning problems and lower achievement (Burke et al., 2011; Holt, Finkelhor, & Kantor, 2007).”
BackgroundSatterfield, D., Debruyn, L., Santos, M., Alonso, L., & Frank, M. (2016) · MMWR Supplements · doi:10.15585/mmwr.su6501a3 · Cited by 73 · see citing works
Zettler, H., Wolff, K. T., Baglivio, M. T., Craig, J. M., & Epps, N. (2018) · Youth Violence and Juvenile Justice · doi:10.1177/1541204017698213 · Cited by 71 · see citing works
Zhang, H.-P., Liu, M., & Long, H. (2020) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-020-00679-z · Cited by 70 · see citing works
Beyond Boys’ Bad Behavior: Paternal Incarceration and Cognitive Development in Middle Childhood
Haskins, A. R. (2016) · Social forces; a scientific medium of social study and interpretation · doi:10.1093/sf/sow066 · Cited by 70 · see citing works
“Relatedly, recent work in the areas of public health and epigenetics (e.g., Burke et al. 2011; Shonkoff et al. 2012) has shed light on how exposure to chronic stressors and accumulated adversity (toxic stress), such as homelessness, extended exposure to violence, poverty, and the incarceration of a…”
BackgroundMeasuring Childhood Adversity in Life Course Cardiovascular Research: A Systematic Review
Appleton, A. A., Holdsworth, E. A., Ryan, M., & Tracy, M. (2016) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000430 · Cited by 81 · see citing works
“Eighteen studies we reviewed adopted this strategy, of which four used the adverse childhood experiences (ACEs) questionnaire (14,15,22,27) and”
MethodRethinking flourishing: Critical insights and qualitative perspectives from the U.S. Midwest
Willen, S. S., Williamson, A. F., Walsh, C. C., Hyman, M. S., & Tootle, W. (2021) · SSM - Mental Health · doi:10.1016/j.ssmmh.2021.100057 · Cited by 81 · see citing works
The evolving neurobiology of early-life stress
Birnie, M. T., & Baram, T. Z. (2025) · Neuron · doi:10.1016/j.neuron.2025.02.016 · Cited by 65 · see citing works
Inequity in child health: The importance of early childhood development
Woolfenden, S. R., Goldfeld, S. R., Raman, S., Eapen, V., Kemp, L., & Williams, K. J. (2013) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.12171 · Cited by 65 · see citing works
Iguacel, I., Gasch‐Gallén, À., Ayala‐Marín, A. M., Miguel‐Etayo, P. D., & Moreno, L. A. (2020) · International Journal of Obesity · doi:10.1038/s41366-020-00697-y · Cited by 67 · see citing works
ATTACHMENT AND BIOBEHAVIORAL CATCH‐UP: A SYSTEMATIC REVIEW
Grube, W. A., & Liming, K. W. (2018) · Infant Mental Health Journal · doi:10.1002/imhj.21745 · Cited by 69 · see citing works
Childhood stress, life history, psychopathy, and sociosexuality
Patch, E. A., & Figueredo, A. J. (2016) · Personality and Individual Differences · doi:10.1016/j.paid.2016.04.023 · Cited by 60 · see citing works
Child Abuse, Resting Blood Pressure, and Blood Pressure Reactivity to Psychosocial Stress
Gooding, H. C., Milliren, C. E., Austin, S. B., Sheridan, M. A., & McLaughlin, K. A. (2015) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsv040 · Cited by 56 · see citing works
Patterns of adversity and pathways to health among White, Black, and Latinx youth.
Liu, S. R., Kia-Keating, M., & Nylund-Gibson, K. (2018) · International Journal of Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.09.007 · Cited by 57 · see citing works
Exposure to violence in childhood is associated with higher body mass index in adolescence
Gooding, H., Milliren, C., Austin, S., Sheridan, M., & McLaughlin, K. (2015) · International Journal of Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.08.005 · Cited by 57 · see citing works
Goldenson, J., Kitollari, I., & Lehman, F. (2020) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-020-00308-y · Cited by 61 · see citing works
Zarei, K., Xu, G., Zimmerman, B., Giannotti, M., & Strathearn, L. (2021) · Children · doi:10.3390/children8090761 · Cited by 55 · see citing works
“Similar associations have been reported previously for developmental delay [25], ID [26], learning problems [6], severe or frequent headaches (including migraines) [27,28], ADHD [29–31], and anxiety [7–10].”
BackgroundSelvaraj, K., Ruiz, M. J., Aschkenasy, J. R., Chang, J. D., Heard, A., Minier, M., Osta, A. D., Pavelack, M., Samelson, M., Schwartz, A., et al. (2018) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.09.004 · Cited by 60 · see citing works
The Interrelation of Adverse Childhood Experiences within an At-Risk Pediatric Sample
Scott, B. G., Burke, N. J., Weems, C., Hellman, J. L., & Carrion, V. (2013) · Journal of Child & Adolescent Trauma · doi:10.1080/19361521.2013.811459 · Cited by 55 · see citing works
“This study represents secondary data analysis on a subsample of at-risk urban youth reported in Burke et al. (2011) and additional details of the full sample (N = 701; range = 0–20 years) can be found in that report.”
MethodSelf-citationLogan-Greene, P., Tennyson, R. L., Nurius, P., & Borja, S. (2017) · Child and Youth Care Forum · doi:10.1007/s10566-017-9413-2 · Cited by 53 · see citing works
“8% had experienced no ACEs of any kind (Burke et al. 2011); examining all ACE items included here showed that only 6.”
BackgroundAdverse childhood experiences, health, and employment: A study of men seeking job services
Topitzes, J., Pate, D. J., Berman, N. D., & Medina-Kirchner, C. (2016) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2016.09.012 · Cited by 48 · see citing works
Medical Students' Perspectives on Trauma-Informed Care Training.
Goldstein, E., Murray-García, J., Sciolla, A., & Topitzes, J. (2018) · The Permanente Journal · doi:10.7812/tpp/17-126 · Cited by 53 · see citing works
Integrating and synthesizing adversity and resilience knowledge and action: The ICARE model.
Hays-Grudo, J., Morris, A. S., Beasley, L. O., Ciciolla, L. M., Shreffler, K. M., & Croff, J. M. (2021) · American Psychologist · doi:10.1037/amp0000766 · Cited by 65 · see citing works
Neurodisability among Children at the Nexus of the Child Welfare and Youth Justice System
Baidawi, S., & Piquero, A. (2020) · Journal of Youth and Adolescence · doi:10.1007/s10964-020-01234-w · Cited by 52 · see citing works
“disorder, as well as intellectual disability and conduct disorder) are at increased risk of childhood maltreatment and protective services involvement (Maclean et al. 2017; Lange et al. 2013; Hibbard and Desch 2007; Sullivan and Knutson 1998; Clayton et al. 2018; Burke et al. 2011; Jones et al. 2012).”
BackgroundAdverse Childhood Experiences and Weight Status among Adolescents
Davis, L., Barnes, A. J., Gross, A. C., Ryder, J., & Shlafer, R. J. (2019) · Jornal de Pediatria · doi:10.1016/j.jpeds.2018.08.071 · Cited by 52 · see citing works
Saleem, F. T., Howard, T. C., & Langley, A. K. (2022) · Psychology in the Schools · doi:10.1002/pits.22615 · Cited by 51 · see citing works
Health and adverse childhood experiences among homeless youth
Barnes, A. C., Gower, A. L., Sajady, M., & Lingras, K. A. (2020) · BMC Pediatrics · doi:10.1186/s12887-021-02620-4 · Cited by 51 · see citing works
Early adverse childhood experiences and exclusionary discipline in high school.
Pierce, H., Jones, M. S., & Gibbs, B. G. (2021) · Social Science Research · doi:10.1016/j.ssresearch.2021.102621 · Cited by 48 · see citing works
Adverse Childhood Experiences (ACEs): Translation into Action in K12 Education Settings
Chafouleas, S. M., Pickens, I. B., & Gherardi, S. A. (2021) · School Mental Health · doi:10.1007/s12310-021-09427-9 · Cited by 48 · see citing works
Scott, B. G., Sanders, A. F. P., Graham, R. A., Banks, D. M., Russell, J. D., Berman, S. L., & Weems, C. F. (2014) · Identity · doi:10.1080/15283488.2014.944697 · Cited by 48 · see citing works
Self-citationKowalski, M. A., Kowalski, A., Hamilton, Z. K., Stohr, M. K., Pedneault, A., Baglivio, M. T., Hamilton, Z. K., Stohr, M. K., & Cerutti, D. (2019) · A to Z of Classroom Behaviour · doi:10.4135/9781526482990.n21 · Cited by 48
“…are exposed to trauma (Anda et al., 2006; Copeland, Keeler, Angold, & Costello, 2007), certain subsets of children are at a higher risk for experiencing adverse events, including justice-involved youth (Burke et al., 2011; Baglivio et al., 2014; Cronholm et al., 2015; Flaherty et al., 2009).”
BackgroundLinking systemic arterial stiffness among adolescents to adverse childhood experiences
Klassen, S. A., Chirico, D., O’Leary, D. D., Cairney, J., & Wade, T. J. (2016) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2016.04.002 · Cited by 48 · see citing works
The biopsychosociotechnical model: a systems-based framework for human-centered health improvement
Card, A. J. (2022) · Health Systems · doi:10.1080/20476965.2022.2029584 · Cited by 66 · see citing works
“…determinants of health, helping pave the way for fields of inquiry such as the impact of adverse childhood experiences (ACEs) on health (Boullier & Blair, 2018; Burke et al., 2011; Dube et al., 2002; Felitti, 2009; Felitti et al., 1998; Hughes et al., 2017; Oh et al., 2018; Schilling et al., 2007).”
Background
- Authors
- Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G.
- Affiliations
- California Pacific Medical Center (US)
- LSU New Orleans (US)
- Venue
- Child Abuse & Neglect
- Publisher
- Elsevier BV
- Published
- 2011-06
- Volume
- 35
- Issue
- 6
- Pages
- 408-413
- ISSN
- 0145-2134 (ISSN-L)
- PMC
- PMC3119733
- OpenAlex
- W2079494095
- Cited by
- 594
- References
- 26
- Citations by year
- 2026: 16 · 2025: 34 · 2024: 40 · 2023: 44 · 2022: 71 · 2021: 106 · 2020: 58 · 2019: 57 · 2018: 38 · 2017: 35 · 2016: 36 · 2015: 21 · 2014: 10 · 2013: 17 · 2012: 10
- FWCI
- 12.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Child Abuse & Neglect (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K23MH063893, MH 63893)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child Abuse and Related Trauma
- Keywords
- adverse childhood experiences, low-income youth, childhood obesity, body mass index, ACE score, ACE screening, primary prevention
- MeSH terms
- Adolescent, Child, Child Abuse, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Learning Disabilities, Male, Medical Records, Obesity, Parent-Child Relations, Poverty, Retrospective Studies, Risk Factors, San Francisco, Urban Population, Logistic Models, Young Adult
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