Abstract
Exposure to adverse childhood experiences (ACEs) is associated with increased odds of high‐risk behaviors and adverse health outcomes. This study examined whether ACE exposure among individuals living in rural areas of the United States is associated with adult activity limitations, self‐reported general poor health status, chronic diseases, and poor mental health. Data from the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS) (N=79,810) from nine states were used to calculate the prevalence of ACEs in rural and urban areas. ACE scores were determined by summing 11 survey items. Multiple logistic regression was used to examine the association between ACE scores and health outcomes, including self‐reported general health status, chronic diseases, and health‐related quality of life. Approximately 55.4% of rural respondents aged ≥18 years reported at least one ACE and 14.7% reported experiencing ≥4 ACEs in their childhood, compared to 59.5% of urban residents who reported at least one ACE and 15.5% reporting ≥4 ACEs. After adjusting for sociodemographic covariates, compared to rural respondents who never reported an ACE, rural respondents who experienced ≥1 ACEs had increased odds of reporting fair/poor general health, activity limitations, and heart disease, which is consistent with previous studies. The odds of experiencing a heart attack were higher for rural residents reporting 2 and ≥4 ACEs; the odds of diabetes were higher for those with 3 ACEs; and the odds of ever having asthma or poor mental health was higher for those with ≥3 ACEs. Although individuals in rural areas are less likely to experience ACEs, over half of rural respondents reported experiencing an ACE in childhood. Programs aimed at preventing ACEs, including child maltreatment, can benefit rural areas by reducing adult morbidity and increasing quality of life.
Highlights
Adverse childhood experiences (ACEs) are childhood abuses and household disruptions experienced before the age of 18 that includes exposure to mental illness, substance abuse, imprisonment, separation or divorce, adult violence, physical abuse, and sexual abuse [1,2,3]
Activity limitation, fair/poor general health status, ever being diagnosed with diabetes, ever having a stroke, ever having a heart attack, ever having angina or coronary heart disease, ever having asthma, and poor mental health were all significantly associated with ≥4 ACEs (Table 3)
The results indicate that a greater dose of ACE exposure corresponds to increased odds of an adverse health outcome after controlling for a number of sociodemographic variables
Summary
Adverse childhood experiences (ACEs) are childhood abuses and household disruptions experienced before the age of 18 that includes exposure to mental illness, substance abuse, imprisonment, separation or divorce, adult violence, physical abuse, and sexual abuse [1,2,3]. Studies have shown that, compared to individuals who have never reported an ACE, individuals who experienced ACEs are at increased odds of high-risk behaviors such as binge drinking, risky sexual behavior, and smoking as well as adverse health outcomes such as premature death, diabetes, stroke, depression, fair/poor health, myocardial infarction, asthma, disability, severe obesity, mental distress, and ever having a sexually transmitted disease [1, 3,4,5]. The objective of this study is to determine whether ACE exposure among individuals living in rural areas is associated with increased odds of adult activity limitations, self-reported general poor health status, chronic diseases, and poor mental health. This study contributes to the existing literature on health effects of ACEs by conducting research among a large sample of rural and urban residents from nine US states
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