Join the #ChildrenCanThrive Campaign so all children grow up happy and healthy.

The #ChildrenCanThrive  campaign seeks to transform our response to the public health crisis of Adverse Childhood Experiences (ACEs) and their long term effects.

Join the #ChildrenCanThrive Campaign so all children grow up happy and healthy.

San Francisco teens study adversity among their peers

June 28, 2016   |   Sukhdip K. Purewal

Over the past two years, the Center for Youth Wellness and H2O productions, (based at Leadership High School in San Francisco) have worked in partnership to implement a research study on Adverse Childhood Experiences (ACEs) that utilizes principles of community based participatory research (CBPR). CBPR is a framework of research that emphasizes collaboration among partners and highlights the voice of community in identifying research topics of interest and solutions to resolve identified concerns (Israel, Schulz, Parker, Becker, 1998; Minkler & Wallerstein, 2003).

The CYW-H2O/LHS partnership highlights the voice of local high school students in the Bayview and Excelsior districts of San Francisco in understanding the prevalence of adversities and the relationship between adversities, socio-demographic factors, and academic performance.  

In the summer of 2014, when the original 10 ACEs identified by Drs. Vincent Felitti and Robert Anda were presented to student researchers, they immediately recognized that the ACEs were largely reflective of the home environment (i.e. incarceration of a household member, family member treated violently) (Felitti et al, 1998).

“What about the community environment? What about the school environment?” they asked. It came to light that these additional environments are where adolescents increasingly spent their time and where they are strongly influenced by their peers. Our research partners proposed to add a number of ACEs to the list – school bullying, harassment by a police officer, discrimination, and so on. In total, with the insights of LHS students, we generated a list of 27 total adversities to study.  Many of the youth proposed adversities were added to the Center for Youth Wellness Adverse Childhood Experiences Questionnaire (CYW ACE-Q), which is currently being utilized at the Bayview Child Health Center and other pediatric primary care clinics to screen children and adolescents for adversity.

The research study, which recruited and surveyed 9th-12th grade high school students from Leadership High School during the 2015-2016 academic school year presented us with lessons that further emphasize the need for immediate action to address the problem of ACEs, particularly for youth living in marginalized communities. From study findings, we learned of the high prevalence of all adversities, especially those that our youth experts identified to be important. We also learned how disproportionately greater the prevalence of adversities were for our youth when compared to what adults in the original ACE Study reported (as much as 10x times greater), and in comparison to national data on youth (as much as 6x times greater).

LHS student researchers provided contextual narratives to the ACEs they experienced for CYW staff at a recent presentation. Youth shared their personal stories of losing friends to violence, of experiencing discrimination and other daily struggles. Despite these challenges, the themes of resilience and hope were also present – this cohort of new high school graduates looks forward to attending universities around California where they hope to share their stories and to empower others with knowledge about ACEs.

The next step in this project, and in alignment with the philosophy of CBPR, is to take action and to create real change based on lessons learned. The true experts and stakeholders – the Leadership High School youth – will help us to understand, identify and implement next steps so that our efforts to reduce the impacts of ACEs and toxic stress for our future generations are meaningful and effective. Throughout the summer and fall of this year, we hope to continue sharing findings from this work, and put research to action. More to come!


Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health, 19(1), 173-202.

Minkler, M., & Wallerstein, N. (2003). Introduction to community based participatory research. Community-Based Participatory Research for Health, 3-26.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine14(4), 245-258.