Adverse Childhood Experiences of Urban and Rural Preschool Children in Poverty.

Adverse childhood experiences (ACEs) have long-term health consequences. Young children in the southern part of the United States (US) are at greater risk than children in other parts of the US. This study assessed preschool children ACEs using a family-friendly tool, the Family Map (FMI), and compared children living in rural/urban areas while examining the potential moderation of race. The FMI-ACE score was examined as a total and two sub-scores. We found that race did not moderate the FMI-ACE score but that Black children (Cohen's d = 0.52) and children in urban and large rural areas were at highest risk (Cohen's d = 0.38). However, the subscale FMI-ACEs parenting risk was moderated by race such as that Black children were less at risk in rural areas than urban (Cohen's d = 0.62). For FMI-ACEs environmental risk, race moderated risk such that Black children were most at risk in large rural areas but less so in small rural areas (Cohen's d = 0.21). Hispanic children were most at risk in small rural areas and least in large rural environments. Findings from this study suggest that targeting the most at-risk children for interventions should consider the context including race and location.