Authors assessed the association between adverse childhood experiences (ACEs) and fair/poor self-rated health (SRH), and whether citizenship modifies it among Latinos aged ≥50 years. 2021–2022 California Health Interview Survey (CHIS) were used. Weighted log-binomial generalized linear models estimated prevalence ratios (PRs) of the associations between ACEs, citizenship, and fair/poor self-rated health (SRH), including interaction terms to assess effect modification on multiplicative and additive scales.

Findings: High ACE exposure (≥4) was associated with a higher fair/poor SRH prevalence relative to low ACEs. Immigrant Latinos had higher fair/poor SRH prevalence than U.S.-born Latinos, strongest among noncitizens. Multiplicative interaction by citizenship was statistically significant; however, the relative association between high ACEs and fair/poor SRH was smaller among immigrant Latinos than U.S.-born Latinos. On the additive scale, high ACEs corresponded to meaningful absolute increases in fair/poor SRH across all groups (U.S.-born: +14 percentage points; naturalized: +6; noncitizens: +12).

High ACE exposure is consistently associated with poorer SRH among Latinos aged ≥50, but citizenship shapes how this risk is expressed. Evaluating both additive and multiplicative scales clarifies that smaller relative effects among noncitizens coexist with substantial absolute health burdens.