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Rural Health Information Hub

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 influence on 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 success.

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
  • Neglect
  • 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 stress can permanently alter children's brains, which can lead to an increased risk of stress-related conditions including obesity.

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% urban)
  • 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

Adverse 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
Date: 4/2016

Coping with Trauma, Stress and Violence
Presents resources, tools, and articles on how adults can help children cope with violence, disasters, and other stressors.
Organization(s): National Association for the Education of Young Children

Exploring 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 Human Services
Date: 8/2018

How Childhood Trauma Affects Health Across a Lifetime
Defines ACEs and discusses the physical effects it can have throughout the lifecourse.
Author(s): Burke Harris, N.
Organization(s): TEDTalks
Date: 2/2015

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