Adverse childhood experiences (ACEs) are disturbances in family relationships that deprive children of the security and emotional support they need for healthy development. Although a recent report by the Health Resources and Service Administration indicated that rural children have higher rates of ACEs than their urban peers, we know of no studies examining rural-urban differences in adults' exposure to ACEs. This study was designed to address this research gap and to inform health system initiatives geared toward mitigating the impacts of ACEs on rural populations.

Key Findings:

• Past research has shown that ACEs have long-term, negative implications for health and well-being: as the number of ACEs increases, the risk for health problems in adulthood rises.
• ACEs are a significant problem among rural adults. Over half of rural residents reported some ACE exposure, and over one in ten reported high levels of exposure (four or more ACEs).
• After adjustment for demographics, rural and urban populations showed similar odds of experiencing high-level ACE exposure.
• Rural primary care providers can play a leadership role in forging community partnerships to raise public awareness about ACEs, conduct ACE-focused community needs assessments, and launch initiatives to create new services geared toward building resilience in families.