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Intergenerational Effects of Childhood Adversities

Intergenerational Associations Between Adult Past Exposure to Adverse Childhood Experiences and Offspring Child Health Outcomes: The Philadelphia ACE Study

Child walking with parent


Adverse Childhood Experiences (ACEs) are specific psychosocial stressors and traumas experienced by children that have been strongly linked with health and wellbeing throughout life. This project examines possible intergenerational effects of parents’ past exposure to ACEs and their children’s health, health behaviors, and health care access and utilization. This is one of the first studies looking at ACEs from an intergenerational perspective. We also examine whether associations between current neighborhood disadvantage and child health differ depending on parents’ past ACE exposure. This project uses expanded ACEs measurements developed by the Philadelphia ACE Project that reflect not only family-level dysfunction, but also community-level stressors prominent in urban areas, such as witnessing community violence. The results demonstrate that parental ACEs are associated with worse child health outcomes, suggesting parental ACEs as an additional social context factor contributing to child health inequality, especially in urban communities.

Research Methods

This is a cross-sectional study using a population-based sample of Philadelphia parents and children combining data from the 2012 Southeastern Pennsylvania Household Health Survey (HHS) and the 2012-2013 Philadelphia ACE Survey. The sample includes 371 children under 18 years old 1) for whom an adult completed an HHS survey regarding their health information and 2) who had a household member who participated in the Philadelphia ACE Survey. Parents reported about their ACEs exposure including nine individual- and household-level adversities: emotional abuse, physical abuse, sexual abuse, physical neglect, emotional neglect, household substance abuse, household mental illness, domestic violence, and incarcerated care provider. Parents also reported on five community-level stressors: violence, racial discrimination, unsafe neighborhood, bullying and living in foster care.

Child health outcomes were reported by the child's main caregiver and consist of 10 measures in three domains: health status (overall health status, ever diagnosed with asthma, obesity), health behaviors (servings of fruits and vegetables per day, past-month sugary beverage consumption, past-month physical activity, TV watching time per day), and health care (health insurance, usual source of health care, dentist visit). Results from multivariable logistic regression models showed that parental high ACE scores were associated with worse child overall health status, higher prevalence of child asthma, and longer TV-watching time among children. The findings suggest that parental ACEs exposure might contribute to worse child health in this racially and socially diverse urban population. The findings can be found here:

Next Steps: We are currently investigating how parental ACEs and current neighborhood socioeconomic disadvantage may impact children’s health together, and whether families with parental ACE exposure may be more vulnerable to effects of neighborhood disadvantage. 

We are also investigating this topic using data from the Philadelphia site of Children’s Healthwatch, a multi-site study that includes ongoing collection and analysis of “sentinel” survey data in urban hospitals across the country on infants and toddlers from families facing economic hardship, with the goal of informing policy decisions that can give all children equal opportunities for healthy, successful lives. In Philadelphia, surveys are conducted at St. Christopher’s Hospital for Children. Past studies by Children’s HealthWatch colleagues have linked maternal ACE exposure to household food insecurity. We are investigating how maternal ACEs relate to other child health outcomes. We are also conducting a validation study of a short, 2-item measure of ACEs among mothers of young children.


The project team acknowledges the Public Health Management Corporation, the Philadelphia ACEs Task Force and the Drexel Urban Health Collaborative.

Research Team


This research was supported by Urban Health Collaborative pilot funding in 2016.The Philadelphia Urban ACE Study was supported by the Robert Wood Johnson Foundation. Additional support for the Philadelphia ACE Task Force efforts has been provided by the CHG Charitable Trust, the First Hospital Foundation, the Stoneleigh Foundation, and the Scattergood Foundation.