Thursday, October 12, 2017

Childhood trauma can cause long-lasting harm to rural adults; help less available in rural areas

People living in rural areas are more likely to deal with poor physical and mental health; the reasons are a complicated web of interconnected factors such as smoking or drug use, workplace hazards, lack of access to physical or mental health care, poverty, and despair. But another reason for poor health is adverse childhood experiences, which are "significant disturbances in a child’s life that affect their security and ability to function in healthy ways. ACEs include all forms of child abuse (emotional, physical, or sexual), neglect (physical or emotional), or household dysfunction (divorce, violence, incarceration, substance abuse, or mental illness)," Jenn Lukens reports for the Rural Health Information Hub. ACEs can cause a self-perpetuating cycle of poor life outcomes that in turn create more ACEs for the next generation.

ACE exposure in rural adults. (Source)
According to a 1998 study by insurer Kaiser Permanente and the Centers for Disease Control and Prevention, the more ACEs a child experiences, the more likely he or she is to experience chronic health conditions, anxiety disorders, a lack of accomplishment in life (career, etc.) and even early death. Subsequent studies confirmed that research and found that "because the central nervous system closely interacts with the body’s immune, hormone, and clotting systems, adverse experiences in a child’s life, especially repeated ones, can change how the organ systems function later on. This process is known as 'biological embedding' and could take years or even decades before symptoms start to show," Lukens reports. And rural children are more likely to experience certain ACEs such as poverty, living with a mentally ill person, and living with a person who abuses drugs or alcohol.

Dr. Jean Talbot of the Maine Rural Health Research Center led research for a 2016 study that looked at how ACEs affect adults in both rural and urban areas. "ACEs cluster together. People who report having an ACE are more likely to have more than one," Talbot told Lukens. "It’s easy to think of ways that this could happen. For example, if a parent experiences incarceration or mental illness, this in itself is an ACE for the children in the family, but it can also impair the adult’s ability to care for kids. So it may open up the fault line exposing children to other types of adversity."

Helping kids deal with ACEs could have a big impact on rural health. "We know that ACEs are linked to high-risk health behaviors like smoking and alcohol abuse," Talbot said. "These, in turn, contribute to health outcomes like heart disease, lung cancer, and diabetes – some of the major causes of the widening rural-urban mortality gap. So, if we want to close this gap, we may need to address rural ACEs as part of that effort."

Some rural community clinics and school districts are trying to address ACEs with programs that train teachers to watch for kids facing adverse conditions, and other programs that help children process trauma. Pediatricians are often the first professionals to see that a rural child has had an adverse experience, so the CDC and some nonprofit groups are raising awareness with doctors about the importance of keeping an eye out for them.

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