Adverse Childhood Experiences (ACEs)
Adverse childhood experiences (ACEs) are
frequent or prolonged exposures to psychosocial
stressors early in life. ACEs can influence one's emotional
and physical health throughout
life. The greater the number of incidents or more prolonged the exposure, the greater the negative
the child's development. Early childhood health promotion programs may use a trauma-informed approach when
implementing initiatives in the community to help lessen the impact of ACEs and improve the likelihood of
ACEs can include traumatic
experiences such as:
- Abuse (including physical, emotional, or sexual)
- Other types of violence or trauma, including domestic violence in the home
- Separation of parents from their children
- Parental mental illness or substance use
When a person experiences psychological stress, their body may release stress hormones including cortisol, epinephrine (adrenaline), and dopamine.
With recurrent stressful experiences, a person may begin to feel
chronically endangered. In these cases, stress hormones may never return to normal levels, which can
result in chronic pain, mental health concerns, and increased vulnerability to addiction. This extended exposure
to stress hormones is known as toxic stress.
ACEs and toxic stress may have lasting impacts beginning early on. When pregnant individuals experience toxic stress, it can
affect fetal development. This increases the
likelihood of preterm birth, low birthweight, and poor health outcomes in the infant. Similarly, when young
children experience toxic stress, their cognitive development can be impaired. Chronic exposure to
alter children's brains, which can lead to an increased risk of stress-related conditions including
An analysis of the National Survey of Children's Health identified five ACEs that
are more common among children in rural communities compared to those in urban areas. The ACEs that are
more frequent in children in rural areas were:
Divorce or separation of parent or guardian (27.8% small rural, 26.9% large rural, 22.9% urban)
Living with someone with an alcohol or substance use disorder (11.5% small rural, 10.8% large rural, 7.6%
Parent or guardian served time in jail or prison (10.9% small rural, 11.7% large rural, 6.9% urban)
Living with someone with a mental illness (9.3% small rural, 10.0% large rural, 6.9% urban)
Saw or heard domestic violence (8.5% small rural, 7.6% large rural, 5.0% urban)
More information on ACEs can be found in Confronting
Adverse Childhood Experiences to Improve Rural Kids' Lifelong Health in RHIhub's Rural Monitor.
Resources to Learn More
Childhood Experiences in Rural and Urban Contexts
Reports on a study analyzing the rural prevalence of individual ACEs, the level of exposure to ACEs in rural
regions, and the rural-urban differences of exposure to ACEs by adults using data from the Behavioral Risk
Factor Surveillance System (BRFSS).
Author(s): Talbot, J.A., Szlosek, D., & Miller, E.C.
Organization(s): Maine Rural Health Research Center
Coping with Trauma, Stress
Presents resources, tools, and articles on how adults can help children cope with violence, disasters, and other
Organization(s): National Association for the Education of Young Children
the Rural Context for Adverse Childhood Experiences (ACEs): Policy Brief and Recommendations
Examines the impact of adverse childhood experiences (ACEs) on rural communities and explores how health and
human services can help lessen the influence on long-term outcomes.
Organization(s): U.S. Department of Health and Human Services, National Advisory Committee on Rural Health and
How Childhood Trauma Affects Health
Defines ACEs and discusses the physical effects it can have throughout the lifecourse.
Author(s): Burke Harris, N.
Sesame Street in Communities
Provides resources, information, and tools for caregivers and healthcare providers working with at-risk children
to minimize exposure to ACEs. Includes research-driven videos, storybooks, and digital activities created to
promote healthy childhood development, brain development, and address trauma.
Organization(s): Sesame Street, Robert Wood Johnson Foundation