Rural‐Urban Differences in Adverse Childhood Experiences Across a National Sample of Children

• Published in: The Journal of rural health Vol. 36; no. 1; pp. 55 - 64
• Main Authors: Crouch, Elizabeth, Radcliff, Elizabeth, Probst, Janice C., Bennett, Kevin J., McKinney, Selina Hunt
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 2020
• Subjects: Adolescent; Adverse childhood experiences; Adverse Childhood Experiences - psychology; Adverse Childhood Experiences - statistics & numerical data; Aggression; Bivariate analysis; Child; Child abuse & neglect; child health; Child poverty; Child, Preschool; Childhood; Childhood experiences; Childhood factors; Children; Children & youth; Childrens health; Cross-Sectional Studies; Divorce; Domestic violence; Drug abuse; Economic analysis; Economic hardship; Exposure; Female; health disparities; Households; Humans; Illnesses; Imprisonment; Infant; Male; Marital separation; Mental disorders; Mental health; Parental death; Parents & parenting; Planners; Policy making; Polls & surveys; Poverty; Poverty - statistics & numerical data; Prevalence; Public use; Regression analysis; Regression models; Residence; rural; Rural areas; Rural communities; Rural Population - statistics & numerical data; Rural Population - trends; Rural urban differences; Substance abuse; Surveys and Questionnaires; United States; Urban areas; Urban population; Urban Population - statistics & numerical data; Urban Population - trends; Urban poverty; Violence; United States; United States > US; health disparities; child health; poverty; rural; adverse childhood experiences
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12366

Purpose: The purpose of this study was to examine the prevalence of adverse childhood experiences (ACEs) exposure in 34 states and the District of Columbia, and whether exposure differs between rural and urban residents.
Methods: This cross‐sectional study used data from the 2016 National Survey of Children's Health (NSCH), restricted to states in which rural versus urban residence was indicated in the public use data (n = 25,977 respondents). Bivariate analyses were used to estimate unadjusted associations. Multivariable regression models were run to examine the association between residence (rural or urban) and ACE counts of 4 or more.
Findings: Compared to urban children, rural children had higher rates of exposure to the majority of the ACEs examined: parental separation/divorce, parental death, household incarceration, household violence, household mental illness, household substance abuse, and economic hardship. In adjusted analysis, there was no significant difference for rural children compared to urban children. The odds of 4 or more ACEs decrease as poverty levels decline, with children residing 0%‐99% below the federal poverty line more likely to have reported 4 or more ACEs, compared to children residing 400% or above the federal poverty line (aOR 4.02; CI: 2.65‐6.11).
Conclusions: Our findings suggest that poverty is a key policy lever that may mitigate the burden of ACE exposure. The findings of this study may be instructive for policymakers and program planners as they develop interventions to stop, reduce, or mitigate ACE exposure and the long‐term impact of ACEs among children in rural America.