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.
PurposeThis study's purpose was to determine the prevalence of physical, mental, and developmental health conditions among US children and assess the association with urban versus rural residence.MethodsBivariate/multivariable analyses were conducted with cross‐sectional data for children aged 0‐17 years (N = 71,811) from the 2016‐2017 National Survey of Children's Health. Prevalence estimates of excellent/very good health were derived from parents’ qualitative judgments. Parent‐reported health conditions were aggregated by condition type (physical, mental, developmental). Prevalence was determined for condition type and severity. Adjusted risk ratios assessed the effect of residence on having physical, mental, or developmental conditions.ResultsAmong rural children in the general population, we found lower crude rates of excellent/very good overall health and higher rates of ≥1 physical condition(s) and ≥1 mental condition(s), as well as these 2 conditions in combination with ≥1 developmental condition(s). Rural children in the general population were also more likely to have physical and mental conditions that parents rated as moderate/severe in unadjusted analyses. To a lesser extent, these differences held true for the children with special health care needs. Risk ratios for rural residence were largely nonsignificant in adjusted analyses.ConclusionsWhile rural children had lower crude rates of parent‐reported excellent/very good health and higher crude rates of parent‐reported or doctor‐diagnosed physical and mental health conditions compared to urban children, the same pattern of urban‐rural differentials was not evident in the adjusted analyses. Compositional and contextual differences in the urban/rural populations suggest that social determinants of health may have accounted for rate disparities in child health conditions.
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