Cited by 594Child Abuse and TraumaChild Welfare and AdoptionChild Abuse and Related Trauma

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The impact of adverse childhood experiences on an urban pediatric population

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Burke, Nadine J., Hellman, Julia L., Scott, Brandon G., Weems, Carl F., Carrion, Victor G.·2011·Child Abuse & Neglect

DOI 10.1016/j.chiabu.2011.02.006PMC PMC3119733

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Abstract

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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“Strong evidence connects ACE scores to adult health problems (Felitti et al., 1998), highlighting the need for enhanced ACEs detection, interpretation, and treatment in healthcare settings (Burke et al., 2011; Weinreb et al., 2010).”
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“Procedures Focus groups were conducted with providers/staff and patients as part of a comprehensive trauma-informed care implementation, including the preparation for a practice wide childhood adversity screening initiative using the ACEs-Q [8], Protective and Compensatory Experiences (PACES) screen [31], and the Safe…”
BackgroundMethodResultInfluential
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“, [3,6,7]), the present study is different in that the examination took place in a clinical sample of children that are already exhibiting a host of socioemotional difficulties.”
BackgroundResult
Adverse childhood experiences and adult employment outcomes: Unpacking mechanisms across the life course
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Parent-Child Nativity, Race, Ethnicity, and Adverse Childhood Experiences Among U.S. Children
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“We also measured adverse childhood experiences that occurred before quarantine, as accumulation of risks facilitates later mental problems [22,23].”
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The Protective Role of Trauma Informed Attitudes on Perceived Stress Among Teachers and School Staff
Minne, E. P., & Gorelik, G. (2021) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-021-00389-3 · Cited by 14
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“Meta-analyses have shown that ACEs are associated with both childhood obesity [25–27] and underweight [31, 32].”
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Trauma-Informed
Rosa, W. E. (2023) · Annals of Internal Medicine · doi:10.7326/m23-2275 · Cited by 10
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Trauma-Informed Care Training for Educators: Some Preliminary Evidence
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“Scores of 4 were considered indicative of a level of adverse childhood experiences that is linked to trauma, which in turn is linked to developmental issues (Burke et al., 2011; Hambrick et al., 2019; Sciolla et al., 2019) (Table 1).”
Background
Spiral Model of Phronesis Development: Social-emotional and character development in low-resourced urban schools
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“In addition, existing studies are generally focused on the development of obesity (Burke et al., 2011; Schneiderman et al., 2013) to the exclusion of other relevant CVD risk factors (i.e., diabetes, smoking, and hypertension).”
Background
Navigating in Seclusion: The Complicated Terrain of Children’s Spirituality in Trauma, Grief and Loss
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“Child maltreatment and other ACEs are non-specific risk factors for multiple disorders [3–5] and numerous health risk behaviours throughout the lifecourse [1,2,6,7].”
Background
A Qualitative Study Identifying a Rural Community’s Barriers and Facilitators to Addressing Adverse Childhood Experiences in Families with Young Children
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“Burke et al. [45] noted the need for efective early identifcation of ACEs because it could lead to identifying children who are at risk for chronic diseases and/or psychological problems later in adolescence and adulthood and allow for the implementation of early prevention and treatment programs.”
Background
Examining adverse childhood experiences and attention deficit/hyperactivity disorder: A systematic review
Wojtara, M. S., Syeda, Y., Singh, H., Rana, E., & Sabeer, S. (2023) · Mental Health Science · doi:10.1002/mhs2.26 · Cited by 14
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“A sample size of 17 was deemed sufficient to compare findings from the original study, which used the EMDR Blind 2 Therapist protocol with participants from Northern Iraq (Bennett-Levy and Lee, 2014; Chigwedere et al., 2020; Collard and Clarke, 2020; Farrell et al., 2020; Scott et al., 2021).”
Method
The Preventing Relational Aggression in Schools Everyday (PRAISE) Program: Adaptations to Overcome Subgroup Differences in Program Benefits
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“They are exposed to acute and chronic stressors, such as community violence, poverty, and limited access to quality education (Burke et al., 2011; Esposito, 1999).”
Background
Residentially-Placed Youth and the Adverse Childhood Experiences-Recidivism Relationship: Considering Racial/Ethnic and Sex Differences
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“Historically the ACEs literature has failed to examine the impact of ACEs on lowincome, urban, and minority samples (Burke et al., 2011).”
Background
More than therapy: The link between adverse childhood experiences, social support, and therapeutic services
Ronnenberg, M., Conrad, A. R., Wojciak, A., & Menninga, E. J. (2020) · Child & Family Social Work · doi:10.1111/cfs.12745 · Cited by 8
The Consistency of Maternal Childhood Abuse Reporting in Pregnancy and the Postpartum Period
Racine, N., Plamondon, A., McDonald, S., Tough, S., & Madigan, S. (2019) · Journal of Women's Health · doi:10.1089/jwh.2019.7795 · Cited by 8
“3,4 7–11 Preliminary feasibility and acceptability of the ACEs questionnaire in a prenatal care setting have been demonstrated 12 ; however, the consistency of responses across contexts has been repeatedly called into question.”
Youth and Adult Perspectives on Violence Prevention Strategies: A Community-Based Participatory Study.
Dodington, J., Mollen, C., Woodlock, J., Hausman, A., Richmond, T., & Fein, J. (2012) · doi:10.1002/jcop.21513 · Cited by 8
Two Adverse Early Life Events Induce Differential Changes in Brain CRH and Serotonin Systems in Rats along with Hyperphagia and Depression
Alcántara‐Alonso, V., García-Luna, C., Soberanes-Chávez, P., Estrada-Camarena, E. M., & de Gortari, P. (2024) · Journal of Integrative Neuroscience · doi:10.31083/j.jin2302041 · Cited by 9
“The association between an impaired development of neuroendocrine axis and obesity has also been observed in humans [38,42–47], and explains the 17% prevalence of obesity among adults experiencing early-life stress.”
Background
Potential challenges and future implications for trauma-informed approaches in schools
Phung, B. (2022) · Frontiers in Education · doi:10.3389/feduc.2022.1040980 · Cited by 7
“These same young individuals are 3 times more likely to repeat a grade and have a 10-fold increased risk for developing a learning deficit/disorder in the future (Burke et al., 2011).”
Background
Childhood Adversity and Illness Appraisals as Predictors of Health Anxiety in Emerging Adults with a Chronic Illness
Traino, K., Espeleta, H. C., Dattilo, T. M., Fisher, R. S., & Mullins, L. (2022) · Journal of clinical psychology in medical settings · doi:10.1007/s10880-022-09870-z · Cited by 7
“, 2018), with recent research suggesting that this increased risk can begin as early as adolescence (Burke et al., 2011; Flaherty et al., 2009, 2013; Thompson et al., 2015).”
Background
Prevalence and Impact of Adverse Childhood Experiences in an Interdisciplinary, School-Based Pediatric Clinic.
Gaylord, N. M., Bland, T., Muñoz, L., Ross, R. A., & Olson, C. (2022) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2021.09.003 · Cited by 7
Trauma Informed Strategies for Human Trafficking Education in Urban Schools: An Attachment Theory Perspective
Albert, L. S. (2021) · Education and Urban Society · doi:10.1177/00131245211048427 · Cited by 18
“These adverse and traumatic experiences have been linked with learning challenges, behavioral problems and negative health and well-being outcomes (Burke et al., 2011).”
Background
Understanding emotion as a strategy in policing
Sweeney, K. (2021) · The Police Journal Theory Practice and Principles · doi:10.1177/0032258x211018496 · Cited by 23
“…in children, as well as obesity, it can be so potent that it may be responsible in adulthood for tripling the risk of heart disease, quadrupling the risk of depression and other mental illnesses as well as reducing life expectancy by up to 20 years (Burke et al., 2011; Felitti et al., 1998).”
Background
Adverse Childhood Experiences Among Children with Neurodevelopmental Delays: Relations to Diagnoses, Behavioral Health, and Clinical Severity
Mehari, K., Iyengar, S., Schneider, M., Berg, K., & Bennett, A. E. (2021) · Journal of clinical psychology in medical settings · doi:10.1007/s10880-021-09769-1 · Cited by 7
Human Trafficking in Adolescents: Adopting a Youth-centered Approach to Identification and Services.
Einbond, J., Diaz, A., Cossette, A., Scriven, R., Blaustein, S., & Arden, M. (2020) · Primary Care · doi:10.1016/j.pop.2020.02.008 · Cited by 7
It Can Be Done: How One Charter School Combats the School-to-Prison Pipeline
Basford, L., Lewis, J., & Trout, M. (2020) · The Urban review · doi:10.1007/s11256-020-00583-x · Cited by 7
Child maltreatment and body mass index over time: The roles of social support and stress responses
Sokol, R. L., Ennett, S. T., Gottfredson, N. C., Shanahan, M. E., Poti, J. M., Halpern, C. T., & Fisher, E. B. (2019) · Children and Youth Services Review · doi:10.1016/j.childyouth.2019.03.006 · Cited by 12
Childhood Trauma Management in Primary Care
Forkey, H. C., & Conn, A. (2018) · Advances in Pediatrics · doi:10.1016/j.yapd.2018.04.004 · Cited by 6
Differences in Recruiting and Engaging Rural and Urban Families in Home-Based Parenting Programs
Heidari, Z., Gissandaner, T., & Silovsky, J. F. (2018) · doi:10.1037/rmh0000096 · Cited by 7
Association between Adverse Childhood Experiences (ACEs) and Developmental Delay of Preschool Children in a Rural Area of Colombia
von Sneidern, E., Cabrera, K. P., Galeano, N., Plaza, M., & Barrios, M. (2017) · Journal of Child and Adolescent Trauma · doi:10.1007/s40653-017-0179-3 · Cited by 7
“A study conducted in an area of Northern California characterized for its high rates of violence and poverty reported four or more ACEs in 12% of the population studied (Burke et al. 2011), which is very similar to the prevalence of four of more ACEs observed in Barú.”
BackgroundMethodResult
A prospective study on the association between caregiver psychological symptomatology and symptom clusters of pediatric posttraumatic stress disorder.
Wong, S., Kletter, H., Wong, Y., & Carrion, V. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21816 · Cited by 7
Self-citation
Increased cardiometabolic risk in healthy young adults with early life stress
Kulak, M. J., los Angeles, W. L.-D., Daniels, T. E., Mathis, K. J., Gobin, A. P., Laumann, L. E., Beck, Q., & Tyrka, A. R. (2024) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001273 · Cited by 6
Parenting Education to Improve Relational Health Through Pediatric Primary Care: A Scoping Review
Marie-Mitchell, A., Delgado, C., & Gilgoff, R. (2024) · Journal of Primary Care & Community Health · doi:10.1177/21501319241306302 · Cited by 5
“It’s like you’re not even there…”: Gambling harm experienced by children of gambling parents
Suomi, A., Bailey, M., Lucas, N., Dowling, N. A., & Delfabbro, P. (2022) · Children and Youth Services Review · doi:10.1016/j.childyouth.2022.106800 · Cited by 7
Trauma-informed behavior support with youth in flexible learning and vocational education settings: Exploring the acceptability of an online trauma-informed education program
Gavin, T., Krishnamoorthy, G., Ayre, K., Bryce, I., & Trimmer, K. (2022) · Preventing School Failure Alternative Education for Children and Youth · doi:10.1080/1045988x.2022.2132197 · Cited by 8
“…& Lanigan, 2018; Sciaraffa et al., 2018) have found that students experiencing symptoms linked to developmental trauma, including compromised neurodevelopment (Bick & Nelson, 2016; Hambrick et al., 2021), social–emotional, and behavioral difficulties (Burke et al., 2011; Van der Kolk et al., 2005).”
Background
Improving outcomes for trauma-experienced individuals through the delivery of trauma awareness training for multi-organisational public sector workers
Richmond, E., McColm, R., McCaig, M., & Binnie, V. (2021) · Journal of Mental Health Training, Education and Practice · doi:10.1108/jmhtep-04-2021-0038 · Cited by 6
Executive Function After Prenatal Alcohol Exposure in Children in a South African Population: Cross-sectional Study
Louw, J. G., van Heerden, A. C., Olivier, L., Lambrechts, T., Broodryk, M., Bunge, L., Vosloo, M., & Tomlinson, M. (2021) · JMIR Formative Research · doi:10.2196/20658 · Cited by 7
Knowledge of Trauma-Informed Care Among Graduate Students in School Psychology
Gubi, A. A., Denicola, G., Kosecki, O., Bocanegra, J. O., Strait, J., Wycoff, K. L., & Giordano, K. (2021) · Contemporary School Psychology · doi:10.1007/s40688-020-00342-5 · Cited by 6
The impact and measure of adverse childhood experiences: reflections of undergraduates and graduates in England
Martin‐Denham, S., & Donaghue, J. (2020) · Journal of Public Health · doi:10.1007/s10389-020-01359-z · Cited by 7
“This is important because, unlike in the UK, screening in the USA is expected to drive disease prevention in future generations (Burke et al. 2011; Machtinger et al. 2015; Marsac et al. 2016; Murphy et al. 2016; Oral et al. 2016).”
Background
The Association Between Adverse Childhood Experiences (ACEs) and Postoperative Bariatric Surgery Weight Loss Outcomes
Shinagawa, A., Ahrendt, A. J., Epstein, E. M., Lambin, J.-H., Lambin, R., Cox, M., Gevorkian, J., Shoenberger, D., & Sasse, K. C. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04779-8 · Cited by 7
Addressing adults with adverse childhood experiences requires a team approach
Valeras, A., Cobb, E. L., Prodger, M., Hochberg, E., Allosso, L., & VandenHazel, H. (2019) · International Journal of Psychiatry in Medicine · doi:10.1177/0091217419860359 · Cited by 6
Relationships Between Caregiver Violence Exposure, Caregiver Depression, and Youth Behavioral Health Among Homeless Families
McGuire-Schwartz, M., Small, L. A., Parker, G., Kim, P., & McKay, M. (2014) · Research on Social Work Practice · doi:10.1177/1049731514553921 · Cited by 3
The Potential for Communication Scholars to Set Priorities That Curb Health Disparities
Len-Ríos, M. (2012) · Howard Journal of Communications · doi:10.1080/10646175.2012.667732 · Cited by 6
“Similarly, Burke and colleagues (Burke et al., 2011) have furthered this line of research by studying how early abuse and family dysfunction affects the health of low-income urban children.”
Background
Webs of Supportive Relationships: A Positive Youth Development Approach to Career and Workforce Development with Risk-Immersed Youth
Flanagan, S. K., Zaff, J. F., Varga, S. M., & Margolius, M. (2020) · Advancing inclusive and special education in the Asia-Pacific · doi:10.1007/978-981-15-4443-9_4 · Cited by 11
Influence of Childhood Adversity on Students’ Delinquent Activities: Interplay with Neighborhood Context and Delinquent Peer Association
Khan, M. B. U., & Tang, Y. (2023) · New Directions for Child and Adolescent Development · doi:10.1155/2023/6677530 · Cited by 5
Reporting, Forgetting, or Reimagining: A Developmental Theory of Traumatic and Adverse Childhood Memories
Weems, C. F. (2025) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-025-00528-4 · Cited by 5
Self-citation
Typologies of childhood maltreatment and associations with internalizing symptoms among university students in Singapore: A latent class analysis
Lee, J., Munisamy, Y., Ai, T., Yoon, S., Kim, J., & Pon, A. K. L. (2025) · PLoS ONE · doi:10.1371/journal.pone.0320851 · Cited by 5
“…abuse, physical neglect, emotional neglect, as well as experiences of indirect exposure to household dysfunction during childhood, such as household substance abuse, mental illness, witnessing violence towards one’s mother, history of incarceration and parental separation or divorce [15,16].”
Adverse Childhood Experiences and Risk of Abnormal Body Mass Index: A Global Systematic Review and Meta-Analysis
Amiri, S., Mahmood, N., Yusuf, R., Ghenimi, N., Javaid, S. F., & Khan, M. A. (2024) · Children · doi:10.3390/children11081015 · Cited by 8
The Value of Student Voice and Choice: A Guide for Trauma-Informed Participatory Action Research in the University Setting
Hargrove, S., Schuette, S., Zerubavel, N., Holton, J., & Kinghorn, W. A. (2024) · Journal of Participatory Research Methods · doi:10.35844/001c.94139 · Cited by 9
What is Common Becomes Normal; Black-White Variation in the Effects of Adversities on Subsequent Initiation of Tobacco and Marijuana During Transitioning into Adolescence
Assari, S., Najand, B., & Sheikhattari, P. (2024) · JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY · doi:10.29245/2578-2959/2024/1.1300 · Cited by 6
“…that indicated the negative effect of the adverse life experience on the child (0 = Not at All; 1 = A Little; 2 = Some; 3 = A lot), we had a variable as a continuous measure with higher scores indicating higher exposure to adverse life experience impact during the transition to adolescence 67 .”
Background
Relationship Between Psychological Trauma and Irritable Bowel Syndrome and Functional Dyspepsia in a Joint Hypermobility Syndrome/Ehlers–Danlos Syndrome Patient Population
Silvernale, C. J., Garcia‐Fischer, I., & Staller, K. D. (2023) · Digestive Diseases and Sciences · doi:10.1007/s10620-023-08201-y · Cited by 9
“History of adverse childhood experiences (ACEs) and trauma is highly correlated with increased incidence of chronic disease and IBS specifically [6].”
Risk and Resilience Focusing on Depression and Conduct Disorder: A Comprehensive Literature Review
Park, Y., Thor, P., & Yang, S. (2023) · Adversity and Resilience Science · doi:10.1007/s42844-023-00116-x · Cited by 6
“Roughly 67% of youth experienced at least one incident of ACEs, and those exposed to four or more types of aces were at a high level of risk of experiencing behavioral problems (Burke et al., 2011).”
Adverse Child Events (ACES) and their Negative, Long-Term
Hoffman, K. A. (2022) · Sílex · doi:10.53870/silex.2022121196 · Cited by 5
“ACES exposure has been associated with a number of neurodevelopmental and behavioral health conditions, including learning disability (Burke et al., 2011) and anxiety (Briggs & Price, 2009; Kessler et al., 2010; Mersky et al., 2013; Schilling et al., 2007).”
Background
Managing health in inequitable contexts: Health capacities as integral to life course health development
Joseph, P. L. (2022) · New Directions for Child and Adolescent Development · doi:10.1002/cad.20464 · Cited by 6
Conduct Problems As a Pathway From Childhood Adversity to Community Violence Exposure: The Protective Roles of Caregiver Knowledge and Involvement
Evans, M. C., Duong, J. B., Morelli, N. M., Hong, K., Voss, C., Mendez, L., Garcia, J., Elzie, X., & Villodas, M. T. (2022) · Journal of Interpersonal Violence · doi:10.1177/08862605221081932 · Cited by 7
“The present study sought to address gaps in the extant literature regarding the association between ACEs and indirect ECV (Burke et al., 2011).”
Background
Ecological Predictors of Parental Beliefs about Infant Crying in a Randomized Clinical Trial of ABC
Thorpe, D., Silver, J., Perrone, L., DeSantis, N., Dash, A., Rodríguez, M. M. D., Beras-Monticciolo, E., & Bernard, K. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1916939 · Cited by 7
“Exposure to adverse childhood experiences was assessed using the Adverse Childhood Experiences scale (ACE) and a cutoff point of 4 or more was used to classify caregiver risk (Burke et al., 2011).”
Method

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)
ORCID: Scott, Brandon G.
Weems, Carl F.
Venue: Child Abuse & Neglect
Publisher: Elsevier BV
Published: 2011-06
Volume: 35
Issue: 6
Pages: 408-413
ISSN: 0145-2134 (ISSN-L)
DOI: 10.1016/j.chiabu.2011.02.006
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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 › Sociology and Political Science › 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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The impact of adverse childhood experiences on an urban pediatric population

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