Finished in 2013, this study from across South Eastern Pennsylvania was built on the foundation of the original Kaiser Permanente sample. Since ACEs are more prevalent in Philadelphia, it identified new elements that would result from living in an urban environment.
5 newly identified Urban ACE indicators:
Witnessing abject violence of any kind
Living in an unsafe neighborhood
Living in foster care
Since the initial Kaiser Permanente study was conducted primarily on educated middle class caucasian families, it also was hugely beneficial as one of the first studies to examine ACEs with a racially and socio-economically diverse urban population. And in doing so, it created a new score.