experiencing adversity during childhood can disrupt typical developmental pathways and consequently affect health outcomes throughout the lifespan (norman et al., 2012), particularly for indigenous populations in canada as they tend to experience greater health disparities when compared to non-indigenous populations (statistics canada, 2018a). to better understand these relationships within indigenous populations, the first nations ace study examined adverse childhood experiences (aces) in a first nations population seeking substance use treatment, including participant-reported aces and health outcomes of parents and grandparents using a community-based participatory approach. regression models assessed the relationship among ace scores and subsequent health outcomes reported by 141 individuals in an on-reserve residential treatment program. higher reported ace scores were significantly associated with an increased number of health concerns. some study hypotheses were not supported despite being supported with prior literature. odds ratios of increased prevalence of specific diseases were not significant, however trended in expected directions. parent and grandparent aces and residential school attendance were not significantly related to increased health concerns by participants, although were associated with parenting difficulties. future research with a larger sample size may increase the power of analyses to detect clinically and statistically-relevant relationships among these groups. when participant and staff experiences with first nations ace study were examined, participants generally reported positive experiences with the study, and staff members reporting satisfaction with the cbpr practices embedded within the study.