Research / Rural Health

Rural-Urban Differences in Adverse and Positive Childhood Experiences: Results from the National Survey of Children’s Health

Adverse childhood experiences (ACEs) are potentially traumatic events of abuse, household dysfunction, and neglect that children may experience between birth and 17 years of age. Prior research has found ACEs to be associated with risky behaviors and poor physical and mental wellbeing outcomes during childhood and into adulthood. Conversely, positive childhood experiences (PCEs) such as a nurturing, safe, and supportive environment allow for healthy development and overall wellness. PCEs help to mitigate the effects of ACEs and other negative events.

Research has found that the total number of ACEs that burden an individual can affect subsequent outcomes into adulthood. Individuals who have experienced multiple ACEs are more likely to experience poorer physical and mental health into adulthood, and are more likely to engage in risky behaviors, such as binge drinking. Children who lived in a rural area were less likely to have no ACE exposures (44.1%) than children residing in urban areas (52.5%).

Continued monitoring of rural children’s ACEs exposure will be needed, both to monitor the effectiveness of community interventions and, unfortunately, to assess the effect of the current public health emergency. Estimates of family disruption due to COVID-19 vary, and no studies specifically examining rural children’s experience of family disruption have yet been published. At the national level, researchers have estimated that for every 100 COVID deaths, 7.8 children experience parental death, with an estimated 43,000 parental deaths through February 2021.

A different research group, studying loss of a primary caregiver, whether parent or grandparent, estimated that 120,630 children faced this loss across the 15-month period from April 2020 through June 2021, with the burden falling more heavily on non-white children, due to the racial/ethnic disparities seen with COVID morbidity and mortality. Given the trajectory of the epidemic over time, the COVID-19 pandemic may have placed rural children at increased risk for parental loss, as rural vaccination rates have been lower, and rural death rates higher, for this disease.

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