Social
Adverse Childhood Experiences and Utilization of Preventive Healthcare among Children in Rural Communities in the United States (NHIS 2022) Mary Labuhn* Mary Labuhn Andrew Williams
Background. Children residing in rural communities have increased risk for Adverse Childhood Experiences (ACEs), and children in rural communities are less likely to receive preventive healthcare. Additionally, the associations between ACEs and health behaviors may be sex specific. Given rural-urban disparities in chronic health conditions, examination of drivers of these disparities is needed.
Methods. Data for children between the ages of 9 and 17 (weighted n=3,949,102) were collected from the 2022 National Health Interview Survey. Sample included those identified as residing in “nonmetropolitan” areas according to the 2013 NCHS Urban-Rural Classification. Physician visit in the past 12 months (yes/no) and dental visit in the past 12 months (yes/no) were self-reported. Participants self-reported (yes/no) to 8 ACEs (high ACEs ≥1). Logistic regression estimated odds ratios and 95% confidence intervals for associations between ACEs and doctor visit and dental visit, adjusted for demographic and healthcare factors.
Results. Children with ≥1 ACE were 28% less likely (OR=0.71,95%CI:0.78,0.79) to visit a doctor and 48% less likely (OR=0.52,95%CI0.51,0.52) to visit a dentist, compared to children with 0 ACEs. Further, boys had decreased odds (OR=0.23,95%CI0.23,0.23) while girls had increased odds (OR=1.23,95%CI:1.22,1.25) of visiting a doctor within 1 year. Both boys (OR=0.22,95%CI:0.22,0.23) and girls (OR=0.87,95%CI 0.86,0.88) had decreased odds of visiting a dentist.
Discussion. For children living in rural communities, those with ≥1 ACE were less likely to have a recent doctor or dentist visit. We observed sex differences, such that boys with ≥1 ACE were significantly less likely to have had a recent doctor or dentist visit than girls with ≥1 ACE. A higher prevalence of particular ACES, such as “lacking basic needs” among boys may explain the observed differences by sex. Further research is warranted to best inform prevention efforts in rural communities.