NC_old1171: Interactions of individual, family, community, and policy contexts on the mental and physical health of diverse rural low-income families

(Multistate Research Project)

Status: Inactive/Terminating

Project Menu

SAES-422 Reports

Annual/Termination Reports:

[12/15/2014] [02/23/2016] [01/30/2017] [12/08/2017] [12/21/2018]

Date of Annual Report: 12/15/2014

Report Information

Annual Meeting Dates: 10/21/2014 - 10/22/2014
Period the Report Covers: 10/01/2013 - 09/01/2014

Participants

Brief Summary of Minutes

Please click on the "Copy of Minutes" link below for NC1171's 2013/2014 annual meeting.

Minutes Attachment:

Attachment

Accomplishments

Publications

Impact Statements

Date of Annual Report: 02/23/2016

Report Information

Annual Meeting Dates: 10/19/2015 - 10/21/2015
Period the Report Covers: 10/01/2014 - 09/30/2015

Participants

State representatives present:
Barnett, Melissa (barnettm@arizona.edu )--University of Arizona;
Berry, Ann (aaberry@utk.edu)--University of Tennessee;
Bird, Carolyn (Carolyn_Bird@ncsu.edu)--North Carolina State University;
Cancel-Tirado , Doris (canceltd@wou.edu)--Western Oregton University;
Greder, Kimberly (kgreder@iastate.edu)--Iowa State University;
Hyjer Dyk, Patricia (pdyk@uky.edu)--University of Kentucky;
Katras, Mary Jo (mkatras@umn.edu)--University of Minnesota Extension
Mammen, Sheila (smammen@resecon.umass.edu)--University of Massachusetts Amherst;
Ontai , Lenna (lontai@ucdavis.edu)--University of California, Davis;
Sano, Yoshie (yoshie_sano@wsu.edu)Washington State Univeristy Vancovuer;
Wiles, Bradford (bwiles@k-state.edu)--Kansa State Univeristy
Wilmoth, Joe (joe.wilmoth@msstate.edu )--Mississippi State University;
Yancura , Loriena (loriena@hawaii.edu)--University of Hawaii
Zvonkovic, Anisa (anisaz@vt.edu)Virginia Tech University

Other persons present:
Curran , Melissa (barnettm@arizona.edu)--University of Arizona;
Greer, Betty (bgreer@utk.edu)--University of Tennessee;
Oliver, Brittney (bdo36@msstate.edu)--Mississippi State University;
Routh, Brianna (brouth@iastate.edu)--Iowa State University;
Shirer, Karen (shire008@umn.edu)--University of Minnesota Extension;
Smith, Suzanne (smithsu@vancouver.wsu.edu)--Washington State Univeristy Vancovuer

Brief Summary of Minutes

Please see the attachment.

Minutes Attachment:

00_RFSH Annual Meeting Minutes 2015.docx

Accomplishments

The overall objectives of this project are: Objective 1: To conduct extensive higher order analyses in all waves of quantitative and qualitative data to further explore factors that create barriers or enhance the physical and mental health of diverse rural low-income families. Objective 2: To understand the impact of the Affordable Care Act (ACA) on rural low-income families. Objective 3: To disseminate findings, based on the proposed analyses, in order to further the empirical knowledge base and increase understanding among family serving professionals and policy makers regarding factors that contribute to or create barriers to the physical and mental health of diverse rural low-income families. To achieve the objectives above, we set our milestones in each year. The 2015 milestones and their activities, outputs, and short-term outcomes are described below: 2015 milestones: Objective 1: Develop comprehensive historical data set of compatible health and well-being variables from parallel populations collected at different points in time. Provide input into case study protocols. <ul> <li>The Executive Board committee assigned a contact person who takes a leadership role to achieve this goal. After consulting a statistical consultants, we found that merging different datasets is not practical for our project. According to Tom Scoffield at Iowa State who looked at the datasets, we do not have a critical mass of data to construct a meaningful combined dataset. The only way to do this would be census tract data (i.e., addresses). However, due to change in group membership this is not possible. His opinion was that we were better off running parallel analyses in data sets from two time points to effectively address questions about time. This decision was not made lightly.</li> </ul> Objective 2: Purposely select rural, low-income families and stakeholders for case studies. Develop interview protocol, finalize strategies and other procedures for case study interviews. <ul> <li>The Case Study committee was formed at the 2014 annual meeting which identified the impact of the ACA on rural, low-income families as a topic that needed to be assessed. The committee recommended the target populations, sampling method, and potential interview questions. Based on the recommendations, we further created case study sub-committee which developed draft of interview protocol for rural, low-income mothers, and draft of survey for community healthcare providers. At the 2015 meeting, however, the group decided to focus on collecting information from individual mothers by postponing the survey for community healthcare providers. Currently, the group is finalizing the interview protocol and pilot tests of the protocol is been conducted.</li> </ul> Objective 3: For this objective, we have 2 milestones; <ol> <li>a) Assemble welfare policies for each state. Compile multi-state findings and policy points of interest for the similarities and differences, and</li> <li>b) Peer-reviewed publications and presentations representing multiple disciplines targeting diverse audiences (practitioners, researchers, policy makers).</li> </ol> To achieve Objective 3-a), a project member completed a databook which lists health-related information of our participating counties. Mammen, S., Shepherd, A. & Miccio, E. (2015). A Guide to the Affordable Care Act (ACA) Coverage In RFSH States. Unpublished document. Additionally, policy briefs about the impact of ACA on rural, low-income families are published to inform policymakers and community stakeholders. The titles of the briefs can be found under “Publication” section. In addition of various journal articles, conference proceedings, book chapters, and other outputs, we also submitted two grant proposals to secure findings: 1) NCFR innovative grant proposal submitted by Dr. Kimberly Greder, Iowa State University, in order to conduct additional interviews with Latina mothers in Iowa, and 2) Robert Wood John Foundation grant by Dr. Doris Tirado-Cancel, Western Oregon University, to analyze NC1171 data more in depth. Finally, the NC1171 data were used to enhance undergraduate students’ learning outcomes. Dr. Suzanne Smith, Washington State University Vancouver, used case studies in her conflict management class; and Dr. Sheila Mammen, University of Massachusetts, used local level data in her economics class. The 2016 milestones are set as follows: Objective 1: Analyze health and well-being of rural low-income families based on two waves of qualitative and quantitative data from the NC1171 project. Examine changes and stabilities of families and communities based on the historical data set created in Year 1. Objective 2: Collect, code and clean data from selected case study families. Collect, code, and clean data from community stakeholders. Objective 3: Distribution of selected policy briefs. Peer-reviewed publications and presentations representing multiple disciplines targeting diverse audiences (practitioners, researchers, policy makers). Begin development of educational materials for elected officials, program administrators, students, consumers.

Publications

The list below only shows published work and publications in preparation are not included in the list. Peer reviewed manuscripts--Published: Mammen, S., Dolan, E., & Seiling, S.B. (2015) Explaining the poverty dynamics of rural families using an economic well-being continuum.  Journal of Family and Economic Issues. doi: 10.1007/s10834-014-9405-4. Manoogian, M. M., Jurich, J., Sano, Y., & Ko Ju-Lien. (2015). “My kids are more important than money:” Parenting expectations and commitment among Appalachian, low-income mothers. Journal of Family Issues. 36(3), 326-350. doi: 10.1177/0192513X13490402. Valluri, S., Mammen, S., & Lass, D. (2015) Health care use among rural, low-income women and children: Results from a 2-stage negative binomial model.  Journal of Family and Economic Issues, 36:154-164. Doi: 10.0007/s10834-014-9424-1. Peer reviewed manuscripts—Under Review: Barnett, M., Yancura, L.A., Wilmoth, J., & Sano, Y. (under review). Wellbeing Among Rural Grandfamilies in Two Multigenerational Household Structures. Submitted to Grandfamilies: The Contemporary Journal of Research, Practice, and Policy. Greder, K., Doudna, K., and Sarver, S. (under review). Food Insecurity, Maternal Depression, and Child Behaviors in Rural, Low-income Families”. Submitted to Family Relations. Izenstark, D., Oswald, R.F., Holman, E.G., Mendez, S.N, and Greder, K. (under review). Rural, Low-Income Mothers’ Use of Family-Based Nature Activities to Promote Family Health. Submitted to Journal of Leisure Research. Mammen, S., Sano, Y. & Gay, M (under review). Degree of privation among rural, low-income families: Differences by race and ethnicity. Submitted to Journal of Rural Sociology. Reina, A. and Greder, K. (under review). Meanings and strategies for good health: Perspectives of Latina immigrant mothers in the rural Midwest”. Submitted to Hispanic Journal of Behavioral Sciences. Yancura, L. Sano, Y., & Ontai, L. (under review). The association between multigenerational household structure and overweight and obesity in rural families. Submitted to Child: Care, Health & Development. Book Chapters Downey, J. and Greder, K. (2014) “Depressive Symptomology among rural low-income Latina and non-Latina White mothers”. In Blair, S.L. and McCormick, J.H. (Eds.), Family and Health: Evolving Needs, Responsibilities, and Experiences (Contemporary Perspectives in Family Research, Volume 8B. (pp.247 – 269). Emerald Group Publishing Limited. Greder, K., Ihmels, M., Burney, J., Doudna, K. (2014). Obesity in Rural America. In J. Warren and B. K. Smalley (Eds.). In Rural Public Health: Best Practices and Preventive Models. Springer Publishing Company.  Technical Report Mammen, S., Shepherd, A. & Miccio, E. (2015). A Guide to the Affordable Care Act (ACA) Coverage In RFSH States. Unpublished document. Policy Briefs Byrne, M. and Greder, K. (2014). Obesity Risks for Latino Immigrant Families in Rural Iowa. Iowa State University Extension and Outreach Research Brief, HS 0012, Iowa State University. [Available online]. <a href="http://store.extension.iastate.edu/Product/HS12">http://store.extension.iastate.edu/Product/HS12</a> Byrne, M., Greder, K., and Routh, B. (2014). Healthcare Literacy, Access, and Resources in Iowa’s Rural Latino Communities. Iowa State University Extension and Outreach Research Brief, HS 0013, Iowa State University. [Available online]. <a href="http://store.extension.iastate.edu/Product/HS13">http://store.extension.iastate.edu/Product/HS13</a> Conference Presentations Bao, J., and Greder, K. (2015) “Relationship Between Family Routines and Rural Latino Child Health.” Poster at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Burney, J., Routh, B., Greder, K., and Greer, B. (2015) “Associations between Maternal Depression and Family Eating and Physical Activity Behaviors.” Poster Symposium at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Dyk, P., Routh, B., Katras, M., Greder, K., Mammen, S., and Alvarez, S. (2015) “Barriers and Enablers to Good Health Experienced by Low-Income Rural Mothers.” Poster Symposium at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Greder, K., Katras, M.J., and Routh, B. (2015). “Rural Low-Income Mothers Using Internet for Health Information”. Workshop presentation at the 20th Rural Multiracial and Multicultural Health Conference, Philadelphia, PA. Greder, K., Sano, Y., Mammen, S. and Doudna, K. (2015). “Relationship between health and rural low-income mothers’ Internet use.” Poster Symposium at the National Council on Family Relations 76th Annual Conference, Baltimore, Maryland. Izenstark, D., Oswald, R.F., Holman, E.G., Mendez, S.N., and Greder, K. (2015). “Using Family-Based Nature Activities to Promote Rural, Low-income Families' Health", Paper presentation at the National Recreation and Park Association (NRPA) Research Conference, Las Vegas, NV. Awarded Pillars of NRPA Award for Best Research Abstract in Health and Wellness, National Recreation and Park Association. Mammen, Berry, Bird, & Burney. (2015) Empowering Marginalized Rural Families through Health Security ”  Poster Symposium at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Mammen, Varcoe, & Lawrence. (2015) Impact of EITC status of RFSH Mothers. The annual meeting on the American Council for Consumer Interests, Clearwater Beach, FL. Ontai, L., Sano, Y., Greder, K., McGuire, J., Radunovich, H., and Barnett, M. (2015) “Relationship Between Negative Family Dynamics and Child Health.” Paper at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Radunovich, H., & Smith, S.R. (July-August 2015). NC 1171 Research Collaborative: Mental Health Results for Poor, Rural Families. National Association for Rural Mental Health, Honolulu, Hawaii. Rodriguez, G. and Greder, K. (2015). “Relationship Between Families’ Health Insurance Status and Children’s Dental Health”. Poster presentation at the Annual Cambio de Colores (Change of Colors) Conference, Kansas City, MO. Routh, B., Doudna, K., and Greder, K. (2015) “Maternal Depression and BMI among Rural Low-Income Latina Immigrant Mothers.” Paper Symposium at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Routh, B., Doudna, K., and Greder, K. (2015). Parenting Alliance and Health Behaviors among Rural Latinos. Poster presentation at the 38th Annual Rural Health Conference, Philadelphia, PA. Sano, Y., Greder, K., and McGuire (2015) “Relationship between Food Insecurity and Child Behavior Among Rural Families.” Poster Symposium at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Non-refereed Manuscripts for Professional Organization Bulletins and Newsletters Routh, B. and Greder, K. (2014). Health Disparities Facing Latinos in Rural Iowa. Public Health Matters, Iowa Public Health Association.[Available online]. http://www.iowapha.org/Resources/Documents/IPHA%20PHM-Winter2014.pdf

Impact Statements

Our activities in the 2014-2015 project year made intended impact on scholars, policy makers, community stakeholders, and college students. Our findings were disseminated in academic community through 3 published peer-reviewed journal articles, 6 manuscripts which are currently under review and dozens of other manuscripts which are in progress. In addition to academic journals, our outputs were diverse: 2 book chapters, a technical report, 2 policy briefs, 14 conference presentations, and 1 newsletter. Collectively, these outputs deepened our knowledge regarding factors that create barriers or enhance physical and mental health of diverse rural low-income families. We are also beginning to understand the impact of the Affordable Care Act on this population. The information of this project additionally enhanced learning of undergraduate students as a few project members utilized the information in their classroom.

Date of Annual Report: 01/30/2017

Report Information

Annual Meeting Dates: 10/16/2016 - 10/18/2016
Period the Report Covers: 10/01/2015 - 09/30/2016

Participants

Barnett, Melissa (barnettm@arizona.edu )--University of Arizona; Berry, Ann (aaberry@utk.edu)--University of Tennessee; Bird, Carolyn (Carolyn_Bird@ncsu.edu)--North Carolina State University; Cancel-Tirado , Doris (canceltd@wou.edu)--Western Oregton University; Greder, Kimberly (kgreder@iastate.edu)--Iowa State University; Davis, Kelly (Kelly.Davis@oregonstate.edu)--Oregon State University, Dyk, Patricia (pdyk@uky.edu)--University of Kentucky; Mammen, Sheila (smammen@resecon.umass.edu)--University of Massachusetts Amherst; Ontai , Lenna (lontai@ucdavis.edu)--University of California, Davis; Peek, Gina (Gina.peek@okstate.edu)--Oklahoma State University, Radunovitch, Heidi (hliss@ufl.edu)--University of Florida, Sano, Yoshie (yoshie_sano@wsu.edu) Washington State University Vancovuer; Shipley, Ahlishia (ashipley@nifa.usda.gov)--USDA-NIFA; Wiles, Bradford (bwiles@k-state.edu)--Kansa State Univeristy; Wilmoth, Joe (joe.wilmoth@msstate.edu )--Mississippi State University; Yancura , Loriena (loriena@hawaii.edu)--University of Hawaii; Other persons present: Bao Juan (jbao@iastate.edu)--Iowa State University, Curran , Melissa (barnettm@arizona.edu)--University of Arizona; Oliver, Brittney (bdo36@msstate.edu)--Mississippi State University; Routh, Brianna (brouth@iastate.edu)--Iowa State University; Shirer, Karen (shire008@umn.edu)--University of Minnesota Extension; Smith, Suzanne (smithsu@vancouver.wsu.edu)--Washington State Univeristy Vancovuer

Brief Summary of Minutes

Please see the attached meeting minutes.

Minutes Attachment:

NC1171 Annual Meeting_Minutes.docx

Accomplishments

The overall objective of this project are: Objective 1: To conduct extensive higher order analyses in all waves of quantitative and qualitative data to further explore factors that create barriers or enhance the physical and mental health of diverse rural low-income families. Objective 2: To understand the impact of the Affordable Care Act (ACA) on rural low-income families. Objective 3: To disseminate findings, based on the proposed analyses, in order to further the empirical knowledge base and increase understanding among family serving professionals and policy makers regarding factors that contribute to or create barriers to the physical and mental health of diverse rural low-income families. To achieve the objectives above, we set our milestones in each year. The 2016 milestones and their activities, outputs, and short-term outcomes are described below: Objective 1: Analyze health and well-being of rural low-income families based on two waves of qualitative and quantitative data from the NC1171 project. Examine changes and stabilities of families and communities based on the historical data set created in Year 1. Analyze health and well-being of rural low-income families based on two waves of qualitative and quantitative data from the NC1171 project. We have working groups to analyze data in four topical areas: Economic Well-being, Family and Child Wellbeing, Food/nutrition/health, Multi-generational workgroups. Each group produced peer-reviewed publications, conference presentations, research briefs, e.t.c. Please see ‘Publications’ for details. Examine changes and stabilities of families and communities based on the historical data set created in Year 1. As we reported in the 2015-2016 project year, the group decided not to create a historical data set. Objective 2: Collect, code and clean data from selected case study families. Collect, code, and clean data from community stakeholders. Building on our previous work, we continued to revise interview protocol which examines the impact of healthcare reform on the lives of rural, low-income families. A pilot data collection was conducted in North Carolina team and the feedback from them was incorporated in revising the protocol. The revised protocol was then translated to Spanish so that low-income Latino families can be included in the study. Information and language for the Institutional Review Board were shared among project members and many states obtained and/or are in process of obtaining approval from their universities’ IRB. One state—University of Kentucky completed their interviews with mothers and their experiences were also shared with the group. The challenges shared by the UK team and UNC team included: difficulty identifying target mothers, participants’ not showing up for the interviews, lack of resource, and so on. Finally, Kansas State University volunteered to be a data manager for the Case Study and proposed budget plan. Objective 3: Distribution of selected policy briefs. Peer-reviewed publications and presentations representing multiple disciplines targeting diverse audiences (practitioners, researchers, policy makers). To achieve this goal, we have created research briefs for all data collecting states. The brief include information about health status of rural families, access to healthcare, and challenged faced by rural communities. This “state reports” were created by University of Massachusetts team and shared with the project members. Each states will modify the research briefs according to their own interests. A research brief titled Family Influence on Rural Child Health and Well-being has been created by a collaborative effort by Iowa State University and University of California, Davis. We plan to produce more topic-based research briefs in the 2016-2017 year. Finally, the group members started to brainstorm various ideas on development of educational materials for elected officials, program administrators, students, and consumers.

Publications

Grants: Cancel-Tirado, D. – Robert Wood Johnson Foundation New Connections Grant. $100,000 Gilligan, M., & Greder, K. The Contributions of Adult Sibling Relations to Health and Well-Being in Hispanic Families. Untenured Faculty Seed Grant, College of Human Sciences, Iowa State University, 2015-2016. $10,000. Greder, K., Rosmann Manatt Outreach Award. Latina immigrant mothers. College of Human Sciences, Iowa State University. $8,000. Sano, Y., & Smith, S.  Understanding rural low-income families through the Patient Protection and Affordable Care Act. Vancouver mini-grant, Washington State University Vancouver, 2016-20017. $4,000.   Publications: Bao, J., Pang, Y., Arellanes, J., Greder, K., & Smith, S. (2016). Mediating effects of family rituals and child behavior on food insecurity and rural mothers’ mental health. Poster presentation, Iowa State University. Barnett, M. A., Yancura, L., Wilmoth, J., & Sano, Y. (2016). Wellbeing Among Rural Grandfamilies in Two Multigenerational Household Structures. GrandFamilies: The Contemporary Journal of Research, Practice and Policy, 3(1), 4. Izenstark, D., Oswald, R.F., Holman, E.G., Mendez, S.N, and Greder, K. (2016). Rural, Low-Income Mothers’Use of Family-Based Nature Activities to Promote Family Health. Journal of Leisure Research, 48(2), 134–155. Mammen, S., & Sano, Y. (under review). Degree of Privation among Rural Low-Income Families: Difference by Race and Ethnicity. Journal of Family and Economic Issues. Mammen, S., Sano, Y., Braun, B., & Maring, L. (in preparation). Core Health Messages shaped by rural, low-income mothers: A result of participatory action research. Journal of Health Communications. Routh, B., Greder, K., Lohman, B. & Neppl, T. (2016) Associations between Mental Health and Obesity. Report, National Council on Family Relations, Vol. 61.2, pp., F14-F16. Minneapolis, MN. Sano, Y., Bolkan, C., & Glessing, J. (in preparation). Maternal depression and family comorbidity: Tracking depression trajectories of rural, low-income mothers. Journal of Health Care for the Poor and Underserved. Sano, Y., Greder, K., & Mammen, S. (in press). Relationship between Rural, Low-Income Mothers’ Health Literacy and Depressive Symptoms in the Family Context. Medical Research Archives. Wilmoth, J., Yancura, L., Barnett, M., & Oliver, B. (in preparation). The Contributions of Religiosity, Doubt, and Raising Grandchildren to Well-Being in Older Adults. Journal for the Scientific Study of Religion. Yancura, L., Barnett, M., Mammen, S. & Sano, Y., (in preparation). Grandparents Help In Unexpected Ways: Complementary Analyses Of Grandparent Contributions To Low Income Rural Families. Journal of Family Issues.   Research/Policy Briefs: Greder, K., Bao, J., Ontai, L. (2016).  Rural families speak about health project; Family influences on health and well-being of rural children in low-income households. Research Brief. Bird, C., Mammen, S., Berry, A. & Dyk, T. (2016). Conducted the analyses and drafted the findings for four policy briefs, as follows: <ol> <li>Financial and other barriers to being insured</li> <li>Mothers health care coverage and wait time to coverage</li> <li>Mothers reported status in relation to health conditions</li> <li>Work and family: Working all the time and no paid time off.</li> </ol>   Conference Presentations: Bao, J., and Greder, K. (2015). Relationship between Family Routines and Rural Latino Child Health.” Poster at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Bao, J., Gudmunson, C.G., Greder, K., & Smith, S.R. (November 2016). The Impact of Family Rituals and Maternal Depressive Symptomology on Delinquency among Children: A Rural-Urban Comparison. National Council on Family Relations, Minneapolis, Minnesota. Bao, J., Pang, Y.C., Arellanes, J., Greder, K., & Smith, S.R. (March 2016). The Mediating Effects of Family Rituals and Child Behaviors on Food Insecurity and Rural Mothers’ Mental Health. Society for Research in Human Development, Denver, Colorado. Bao, J., Pang, Y.C., Arellanes,J., & Greder, K. (2016). Family Rituals, a Buffer for the Negative Effects of Food Insecurity on Rural Mothers’ Mental Health.” Poster presentation at the 2016 Society for Research in Human Development 20th Biennial Conference. Denver, CO. Berry, A. & Bird, C., Mammen, S. & Burney, J. (March 11, 2016). Rural families and health security. Family Economics and Resource Management Association, New Orleans, LA Berry, A. (August 24, 2016). FCS and Rural Development: Rural Families Speak Project. Southern Region Program Leaders Network, Nashville, TN Burney, J., Routh, B., Greder, K., and Greer, B. (2015, November). Associations between Maternal Depression and Family Eating and Physical Activity Behaviors.” Poster Symposium at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Dyk, P., Routh, B., Katras, M., Greder, K., Mammen, S., and Alvarez, S. (2015, November). Barriers and Enablers to Good Health Experienced by Low-Income Rural Mothers.” Poster Symposium at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Greder, K., Routh, B., Mammen, S., & Sano, Y. (November, 2016). The effects of rural low-income mothers’ understanding of health information on obesogenic behaviors and mothers’ body weight. National Council on Family Relations, Minneapolis, MN. Lovely, S. & Dyk, P. H. (February 7, 2016). Low-Income Rural Women’s Health Perceptions. Southern Rural Sociological Association, San Antonio, TX. Mammen, S., Berry, A., Bird, C., Burney, J. & Sano, Y. (November 2015). Empowering marginalized rural families through health security. Poster symposium at the annual meeting of the National Council on Family Relations, Vancouver, B.C. Ontai, L., Hollis, N., Barnett, M. Greder, K., McGuire, J., Radunovich, H., & Sano, Y. (November 2015). Psycho-social risk and hilc obesity in low-income, rural families. Paper presentation at the annual meeting of the National Council on Family Relations, Vancouver, B.C. Rodriguez, G. and Greder, K. (2016). Relationship between health insurance status of Latino children and their overall and dental health. Poster session presented at the Fourteenth Annual Cambio de Colores (Change of Colors) - Latinos in the Heartland Conference, Kansas City, Missouri. Routh, B., Doudna, K., and Greder, K. (2015, November). Maternal Depression and BMI among Rural Low-Income Latina Immigrant Mothers.” Paper Symposium at the National Council on Family Relations 77th Annual Conference, Vancouver, BC. Routh, B., Greder, K., Lohman, B., Neppl, T. (2016). Associations between mental health and obesity. Paper presented at Iowa State University. Sano, Y. & Mammen, S. (June, 2016). A strategy to improve the health and well-being of rural, low-income families. Poster presentation at the annual meeting of the Society for Prevention Science, San Francisco, CA. Sano, Y., Mammen, S., & Greder, K. (November, 2016). Degree of privation among rural Hispanic families. Poster presentation at the annual meeting of the National Council on Family Relations, Minneapolis, MN. Sano, Y., McGuire, J., Greder, K., & Greer, B. (November 2015). Food insecurity, family environment and child health outcomes of rural families. Poster symposium at the annual meeting of the National Council on Family Relations, Vancouver, B.C. Weisz, D., Ontai, L., Sutter, C., Taylor, J. (May 2016). Family Dinnertime Routines as a Moderator of Internalizing Problems in Food-Insecure Children. Poster presented at the University of California Undergraduate Research Conference, Davis, CA.   Community Presentations: Greder, K. & Routh, B. (2016). Health and nutrition of Latino mothers. Presented to Iowa Nutrition Professionals. Des Moines, IA. Wiles, B. B. (February 2016). Are You Research Ready?. Presented to Kansas State Research and Extension FCS Agents February Update, Manhattan, KS. Wiles, B. B. (August 2016) Are You Research Ready?. Presented to Kansas State Research and Extension FCS Agents, August Update, Manhattan, KS. Wiles, B. B. (September 2016). Health Disparities in Southwest Kansas. Presented to Southwest Kansas Live Well Consortium, Garden City, KS.   Teaching: Smith, S. (2016). Case studies used in conflict theory course. Washington State University Vancouver. Dyke, T. (2016) Use of protocol and consent form for research methods course for graduate students. University of Kentucky.   Others: Bird, C. & Mammen, S. (2016). Drafted initial revision to case study protocol based on pilot study. Bird, C. (2016). Pilot tested the participant screener and interview protocol for Affordable Care Act data collection. Bird, C. (2016). Pilot tested IRB application for qualitative data collection to examine impacts of the Affordable Care Act. Provided the multistate project with language to use to address IRB concerns regarding issues including potential civil liability, participant exposure to fines due to insurance status, and procedures to encrypt audio files. Dyke, T. (2016) Conducted Case Study interviews with Kentucky mothers.

Impact Statements

Our activities in the 2015-2016 project year made intended impact on scholars, policy makers, community stakeholders, and college students. Our findings were disseminated in academic community through 4 published peer-reviewed journal articles, 1 manuscript which was in press, and dozens of other manuscripts which are in progress. In addition to academic journals, our outputs were diverse: producing a few research/policy briefs, multiple conference presentations, community presentations, teaching outputs. Collectively, these outputs deepened our knowledge regarding factors that create barriers or enhance physical and mental health of diverse rural low-income families. We are also beginning to understand the impact of the Affordable Care Act on this population by starting to interview rural, low-income mothers as Case Studies. The information of this project additionally enhanced learning of undergraduate students as a few project members utilized the information in their classroom. Finally, we have applied and received a few grants from universities and a private Foundation.

Date of Annual Report: 12/08/2017

Report Information

Annual Meeting Dates: 10/23/2017 - 10/24/2017
Period the Report Covers: 10/01/2016 - 09/30/2017

Participants

Barnett, Melissa (barnettm@email.arizona.edu) - University of Arizona; Berry, Ann (aberry9@utk.edu) - University of Tennessee; Bird, Carolyn (carolyn_bird@ncsu.edu) - North Carolina State University; Cancel-Tirado, Doris (canceltd@mail.wou.edu) – Western Oregon University; Curran, Melissa (macurran@email.arizona.edu) - University of Arizona; Davis, Kelly (Kelly.Davis@oregonstate.edu) - Oregon State University; Dyk, Patricia (pdyk@uky.edu) - University of Kentucky; Greder, Kimberly (kgreder@iastate.edu) - Iowa State University; Ontai, Lenna (lontai@ucdavis.edu) – University of California, Davis; Radunovich, Heidi (hliss@ufl.edu) - University of Florida; Wiles, Bradford (bwiles@ksu.edu) - Kansas State University; Wilmoth, Joe (joe.wilmoth@msstate.edu) - Mississippi State University; Oliver, Brittney (bdo36@msstate.edu) - Mississippi State University; Smith, Suzanne (smithsu@vancouver.wsu.edu) – Washington State University, Vancouver; Sano, Yoshie (yoshie_sano@wsu.edu) - Washington State University, Vancouver; Peek, Gina (gina.peek@okstate.edu) - Oklahoma State University; Mammen, Sheila (smammen@resecon.umass.edu) - University of Massachusetts

Brief Summary of Minutes

Annual meeting objectives were to: a) Review progress toward meeting defined project aims; b) Identify scope of work and goals for 2017-18 year; c) Provide relevant updates to membership; d) Provide time for workgroups to move forward on work in progress.

The group made several decisions related to project objectives as follows:

Objective 1: Individuals will work with overlapping variables in 1011 and 1171 to pursue potential manuscripts that can help to advance understanding of stability and change in these associations over time. All agreed that there are opportunities to continue to pursue work that will lead to publications toward this objective.

Objective 2: An overview of the existing data was given to the group and the data made available via the group share site; Data collection deadline for family case studies was extended to March 2018; Data collection process was outlined and updated requirements for sharing transcribed data with Kansas State was shared; Group decided to not move forward with stakeholder case studies due to timeline and perceived limitations of potential benefit at this time.

The group will continue to work on data collection efforts, with the first round of data to be made available to the data collecting states once 50% of the transcripts have been coded. Given the timely nature of the data relating to health insurance coverage, the team agreed that quick turnaround of the results to key stakeholders in each state will be key. Kentucky offered an example of a fact booklet put together and released based on their data collection, which was done a year ago as a pilot.

In lieu of conducting stakeholder interviews, the group decided to use existing datasets to collect community-level data of interest to the objective (e.g. employment rates, health indicators, etc.). County Health Rankings and Census data were identified as two likely sources that could be utilized. A subcommittee was identified to work on locating and extracting this data related to the counties where data were collected for the NC1171-ACA (Affordable Care Act) project.

Objective 3: A review of objective 3 was given and the group was encouraged to take on projects that will contribute to the progress toward this objective.

An additional major topic of discussion and decision making concerned the Governance Document which had not been updated in three years. Given the evolution of the group due to retirements and new states joining the project, bringing with it a number of assistant level faculty in need of publications, the group voted to approve a provision to allow a pathway for securing access to the existing data generated for NC1171. The change will require an application that documents how the individual has contributed to the collaborative work of the project. Applications will be reviewed by the Board at their regularly occurring monthly meetings. Additionally, sections documenting agreements for the ACA portion of the project (NC1171-ACA) were added and approved by vote of the membership.

Time was also spent on general updates to the group. A presentation was done by the group to the NC1011 Alumni to share what we have done since their work, and to seek input and guidance in how to operate effectively to move the work forward based on their experiences working collaboratively on the original project. Alishia Shipley from NIFA gave an update on topics of relevance related to NIFA and National efforts. An affiliate was nominated and voted in by the group. The 2017-18 Board members were nominated and the slate was voted to be approved. A working group was identified to begin work outlining a potential proposal to continue the work of the group after the end of the current project period.

Accomplishments

The proposed objectives of this project are: 1) To conduct extensive higher order analyses in all waves of quantitative and qualitative data to further explore factors that create barriers or enhance the physical and mental health of diverse rural low-income families. 2) To understand the impact of the Affordable Care Act (ACA) on rural low-income families. 3) To disseminate findings, based on the proposed analyses, in order to further the empirical knowledge base and increase understanding among family serving professionals and policy makers regarding factors that contribute to or create barriers to the physical and mental health of diverse rural low-income families. To achieve these objectives, we set yearly milestones to achieve. The 2017 milestones and the related activities, outputs, and short-term outcomes are describe for each objective below. Obj 1 milestone: Analyze results of family & contextual data. Update contextual data for counties so that it coincides with data from families selected for case studies. Outputs: In the past year, NC1171 team members have collaborated on multiple manuscripts for peer review in scholarly journals and professional society presentations that represent a range of scholarly disciplines. Kentucky Policies & Participants booklet containing contextual county data, was produced by Kentucky to distribute to key stakeholders to educate them about rural, low-income mothers’ experiences with the ACA. Piloting of the family case study in Kentucky and Massachusetts generated qualitative data indicating diversity in the accessibility and perceived utility of the ACA among low-income, rural mothers’. Findings from Kentucky revealed confusion exists between federal (ACA/Obamacare) and state policies. These findings suggest the need to move beyond distributing enrollment information by including informing about where benefits are coming from and how they can be accessed.   Activities: Team members continue to analyze the family and contextual data for publications. Work continues on adding the county-level contextual data for inclusion in analyses. Obj2 milestone: Collect, code and clean data from selected case study families. Collect, code, and clean data from community stakeholders. Seek additional funding to further examine changes that result from the ACA over time in low-income, rural families. Outputs: The team developed a common set of data collection tools that will be used across the multi-state project. The use of a common set of tools will allow the project to aggregate the data for identification of themes, issues, and conditions with a pervasive pattern. Washington received funding through a grant from the Washington State University, Vancouver. Activities:  Eight participating states (CA, FL, KS, KY, NC, OR, TN, WA) are in the process of collecting data for the family case studies.  To date, 28 transcripts have been generated. The group decided to move the collection of community level data across all states to the 2018 year. Obj 3 milestones: Write and distribute selected policy briefs. Peer-reviewed publications and presentations representing multiple disciplines targeting diverse audiences (practitioners, researchers, policy makers). Development of educational materials for elected officials, program administrators, students, consumers. Outputs: Yoshie Sano (WA) and Sheila Mammen (MA) served as co-editors of a Special Issue for the Family Science Review Journal, for which team members from across the participating states (AZ, CA, FL, HI, IA, KS, KY, MA, MS, NC, OR, TN, WA) contributed to one of five reviews communicating the findings across the last 20 years of the project. The issue has been peer reviewed and the resubmission is currently under consideration for final publication.   A team of project team members led by Lori Yancura (HI), including Yoshie Sano (WA), Lenna Ontai (CA), Melissa Barnett (AZ), Kelly Davis (OR), & Brittney Oliver (MS), developed a successful grant proposal to utilize case studies generated from the NC1171 data to develop lesson plans to be used in undergraduate family science-related courses. Kentucky distributed the Kentucky Policies & Participants booklet to educate stakeholders them about rural, low-income mothers’ experiences with the ACA. Activities: Team members continue to work toward publications and presentations to professional groups and key stakeholder groups. The group shared ideas for reaching policy makers with the informaiton generated from the family case study data in a timely manner.

Publications

Grants. Sano, Y. (PI) - Understanding rural low-income families through the Patient Protection and Affordable Care Act. Vancouver mini-grant, Washington State University Vancouver, 2016-20017. $4,000. (Co-PI: Smith, S.) Yancura, L. (PI) - Association of Public and Land-grant Universities. “Rural Families in Real Life:Case Study Lessons from Interviews with Low-Income Rural Mothers”  Association of Public and Land-grant Universities. $3,000.00 (+ 2,000 match fro UH Manoa) (Co-I: Sano, Y., Ontai, L., Barnett, M., Davis, K., Oliver, B.) Publications Refereed Journal Articles Radunovich, H.L., Smith, S., Ontai, L., Hunter, R., & Cannella, R. (in press). The role of partner support in the physical and mental health of poor, rural mothers. Journal of Rural Mental Health. Sano, Y., Greder, K., & Mammen, S. (2017). Relationship between Rural, Low-Income Mothers’ Health Literacy and Depressive Symptoms in the Family Context. Medical Research Archives, 5(1). doi: <a href="http://dx.doi.org/10.18103/mra.v5i1.948">http://dx.doi.org/10.18103/mra.v5i1.948</a> Barnett, M. A., Yancura, L., Wilmoth, J., & Sano, Y. (2016). Wellbeing among Rural Grandfamilies in Two Multigenerational Household Structures. GrandFamilies: The Contemporary Journal of Research, Practice and Policy, 3 (1). Available at: <a href="http://scholarworks.wmich.edu/grandfamilies/vol3/iss1/4">http://scholarworks.wmich.edu/grandfamilies/vol3/iss1/4</a> Scientific and Outreach Oral Presentations. Symposium Proceedings Berry, A.A., Bird, C. L., Mammen, S., & Burney, J. 2016.  Rural families and health security.  Family Economics and Resource Management Association, New Orleans, LA.  Dyk, P. H. & Lovely, S. 2017. Navigating the Uncertain Healthcare Terrain: Voices of Kentucky Low-Income Rural Women.  Southern Rural Sociological Society annual meeting, Mobile, AL. Greder, K., Routh, B., Mammen, S., & Sano, Y. 2016. The effects of rural low-income mothers’ understanding of health information on obesogenic behaviors and mothers’ body weight. National Council on Family Relations, Minneapolis, MN. Poster Presentations Sano, Y., Mammen, S., & Greder, K. 2016. Degree of privation among rural Hispanic families. National Council on Family Relations, Minneapolis, MN.   Other Creative Works The NC1171 project proposal was used as an exemplar in a graduate Research Design course.  Not only were the mechanics of the proposal discussed, but the importance of exploring the topics of RFSH. Kentucky Policies & Participants booklet was produced and distributed at the NC1171 annual meeting in Tucson as a template for summarizing data and providing policy comparisons for the participating states.

Impact Statements

Activities: Our activities in the 2017 year were focused on coordination of collection of the family case studies and analyzing the existing family level data. Impacts of these activities were the generation of several publications that are in progress and under review and professional conference presentations given across a variety of disciplines, as well as 3 peer-reviewed publications and 3 conference presentations in the 2017 year. These efforts contribute to the base of knowledge regarding key factors that create barriers as well as those that enhance the physical and mental health of rural, low-income families. Early findings from the piloting of the family case studies project in Kentucky resulted in learning that confusion exists between federal (ACA/Obamacare) and state policies. Such information helps us advance the understanding of how to effectively communicate key information regarding health care access and coverage by including informing about where benefits are coming from and how they can be accessed. To disseminate this information, Kentucky produced the Kentucky Policies & Participants booklet to educate stakeholders them about rural, low-income mothers’ experiences with the ACA. Fund leveraging: We had two successful grants from project team collaborations. Indicators for 2018: Number of peer reviewed manuscripts and presentations given. Adoption of the case studies course materials by undergraduate professors teaching family science courses. Number of policy briefs distributed to policy makers in target counties included in the family case studies project.

Date of Annual Report: 12/21/2018

Report Information

Annual Meeting Dates: 10/22/2018 - 10/24/2018
Period the Report Covers: 10/01/2017 - 09/30/2018

Participants

Berry, Ann (aberry9@utk.edu) - University of Tennessee; Bird, Carolyn (carolyn_bird@ncsu.edu) - North Carolina State University; Burney, Janie (jburney@utk.edu) – University of Tennessee; Cancel-Tirado, Doris (canceltd@mail.wou.edu) – Western Oregon University; Chandler, Kelly (Kelly.Davis@oregonstate.edu) - Oregon State University; Contreras, Dawn – Michigan State University; Dyk, Patricia (pdyk@uky.edu) - University of Kentucky; Greder, Kimberly (kgreder@iastate.edu) - Iowa State University; Ontai, Lenna (lontai@ucdavis.edu) – University of California, Davis; Radunovich, Heidi (hliss@ufl.edu) - University of Florida; Wiles, Bradford (bwiles@ksu.edu) - Kansas State University; Wilmoth, Joe (joe.wilmoth@msstate.edu) - Mississippi State University; Smith, Suzanne (suzanne.smith@gsw.edu) – Washington State University, Vancouver; Sano, Yoshie (yoshie_sano@wsu.edu) - Washington State University, Vancouver; Peek, Gina (gina.peek@okstate.edu) - Oklahoma State University; Mammen, Sheila (smammen@resecon.umass.edu) - University of Massachusetts; Wallace, Heather (heather.wallace@utk.edu) – University of Tennessee. Listserve: rfs@lists.ncsu.edu

Brief Summary of Minutes

National updates were provided by Christina Hamilton via Skype and Alishia Shipley who was in attendance.

State updates were provided related to project objectives.

Progress toward objectives was reviewed. A presentation on the data for the Stakeholder Interviews was made informing the membership of the availability of the data for analysis. Workgroups were identified for 3 specific research questions to analyze with the newly available data.

Project renewal was discussed and break-out sessions provided opportunities for groups to work on sections of the proposal. Objectives were identified and procedures were discussed. A writing team was identified to move forward with the proposal to finalize it for submission

The Governance Document and Bylaws were reviewed. Updates were made to the document and voted on by the membership. It was noted that the document needs a more thorough review to bring it up to date with the current operations of the group and the Executive Board was charged with the review in the coming year.

Affiliates and new state PIs were nominated and voted on by the membership.

Executive Board nominations were made and the 2018-19 Board was voted in.

Accomplishments

Rural communities and families continue to experience health inequalities when compared to their urban and suburban counterparts. Despite efforts to improve health care quality, access, and affordability among rural areas, there has been an increase in rural health disparities. The NC1171 multistate team is working to understand family and community level factors that contribute to these health disparities, and to understand how recent legislative changes (i.e. Affordable Care Act) impact individual families’ access to health care in rural communities. The team is also developing educational tools to foster undergraduates’ understanding of factors that impact rural low-income families’ health and well-being. Short-term Outcomes: No outcomes to report at this time. Outputs: <ul> <li>Special issue of Family Science Review: To showcase the lessons learned from the past two decades of the multistate project, the team reviewed the published work across the three multistate projects (NC223, NC1011, NC1171) to produce a special issue of the journal Family Science Review. The issue features an overview of the projects and the participants, followed by five individual papers focused on the aspects of everyday experiences that have been identified from the 20 years of the multistate project to be critical to family health and well-being.</li> <li>Publications and presentations: In addition to the special issue, the team has published three peer reviewed articles and five juried national presentations.</li> <li>Qualitative dataset on ACA access and usage: This dataset is comprised of interviews of low-income mothers from the participating states regarding their access and use of ACA health-care coverage in their community. The team will use the dataset over the next year to understand barriers to access and usage, as well as general variability in individual understanding of the ACA options available to them.</li> <li>Undergraduate lesson plans: A multistate team created animated videos and accompanying lesson plans for use in undergraduate family science courses. The lessons are designed to depict the primary barriers to health that have been identified via the multistate efforts across the three projects: nutrition and family health behaviors, family relationships and supports, and work-family balance.</li> <li>Healthcare Coverage and Access Profiles: A template was created by Kentucky and shared to create a profile of healthcare access from the state data. The template can be used by all states to share the data with policy makers and community stakeholders.</li> </ul>  Activities: <ul> <li>Undergraduate lesson plans were created to utilize the animated vignettes in lessons related to health in rural families. First, interviews with mothers from the NC1171 qualitative data were reviewed for relevant content related to the relevant content identified for the lessons. Each team used the participants’ words to create scripts which aim to depict the reality of the lived experience related to the focal construct for low-income mothers in rural communities. The scripts were then set to animation using a software package. Lesson plans for each video were created tying the focal construct to an underlying theory, and activities that can be used for students to interact with the subject matter in an active manner.</li> <li>The undergraduate lesson plans were pilot tested in one course and used a centralized evaluation assessment. Feedback from the evaluations will be used to adjust the videos and lesson plans for further pilot testing and evaluation over the next year.</li> <li>Qualitative data for the ACA access and usage project were coded for primary and secondary themes.</li> <li>A special issue submission was organized and drafts written focused on the lessons learned relevant to cooperative extension and outreach from across the three multistate projects (NC223, NC1011, NC1171). It is expected that this publication will be completed and available in the coming year.</li> <li>Analyses of data by multistate teams to understand multigenerational households, nutrition and physical activity behaviors, community resources, and health care in relation to health in rural low-income populations. Currently there are seven manuscripts undergoing peer review at family science journals.</li> <li>Two graduate students were trained in analysis of the quantitative and qualitative data from NC1171.</li> <li>One undergraduate was trained to analyze NC1171 data and create a poster for University hosted scholar events.</li> </ul> Milestones: In Year 4 (2017-18) of this 5-year project, efforts were focused on analyzing the quantitative data and completing the processing of the qualitative data in order to fully process the information that can be gained for dissemination to further understanding of barriers that contribute to health disparities in low-income, rural populations. To date, the quantitative data has been analyzed for all major aims of the project. The full qualitative data set is ready and available for analysis in the coming year.

Publications

<ul style="list-style-type: disc;"> <li>Mammen, S., Berry, A. A., Bird, C., Chandler, K. D. (2018).  Rural low-income families’ quest for economic security: It takes more than a paycheck.  Family Science Review, 22(1), 9-25.</li> <li>Cancel-Tirado, D., Greder, K., & Wiles, B. (2018). Risk and resilience of rural Latino families: 20 years of research. Family Science Review, 22(1), 70-90</li> <li>Ontai, L., *Barnett, M.A., Smith, S., Wilmoth, J. & Yancura, L. (2018). Understanding FamilyWell-Being in the context of rural poverty: Lessons from the Rural Families Speak Project. Family Science Review, 22(1), 39-53. (*authors listed alphabetically)</li> <li>Sano, Y., Mammen, S., & Oliver, B. (2018). Food insecurity among rural, low-income families. Family Science Review, 22(1).</li> <li>Mammen, S., & Sano, Y. (2018). Rural, low-income families and their well-being: Findings from 20 years of research. Family Science Review, 22(1).</li> <li>Dyk, P. D., Radunovich, H., Sano, Y. (2018). Health challenges faced by rural, low-income families: Insights into health disparities. Family Science Review, 22(1).</li> <li>Mammen, S., Berry, A., Bird, C., & Davis, K. (2018) Rural, Low-Income Families’ Quest for Economic Security: It Takes More than a Pay Check. Family Science Review, 22:1.</li> <li>Cancel-Tirado, D. I., Feeney, S. L., Washburn, I. J., Greder, K. A., & Sano, Y. (2018). Health, wellbeing, and health care access in rural communities: Comparing Latino and non-Latino White low-income families. Family and Community Health, 41(2), 73-82. doi: 10.1097/FCH.0000000000000193</li> <li>Wilmoth, J., Yancura, L., Barnett, M., & Oliver, B. (2018). The Contributions of Religiosity, Doubt, and Raising Grandchildren to Well-Being in Older Adults. Journal of Religion, Spirituality & Aging, 1-22.</li> <li>Mammen, S., Sano, Y., Braun, B., & Maring, E.F. (2018). Shaping Core Health Messages: Rural, Low-Income Mothers Speak Through Participatory Action Research. Health Communication. Published online first.</li> <li>Radunovich, H.L., Smith, S.R., Ontai, L., Hunter, C., & Cannella, R. (2017).  The role of partner support in the health and mental health of poor, rural mothers. Journal of Rural Mental Health, 41(4), 237-247.</li> </ul> Juried national presentations: <ul style="list-style-type: disc;"> <li>Cancel-Tirado, D., Feeney, S., Sano, Y., & Greder, K. (2018). Comparing barriers and enablers to health among rural low-income Latino and White families. Paper presented at the 2018 Annual Meeting of the Rural Sociological Society in July, Portland, OR.</li> <li>Cancel-Tirado, D., Feeney, S., Washburn, I., Greder, K., & Sano, Y. (November, 2017). Rural Latino and non‐Latino White families’ health outcomes and healthcare access. Poster presentation at the National Council on Family Relations 79th Annual Conference in November, Orlando, FL.</li> <li>Pang, Y., Bao, J.*, Greder, K., & Smith, K. (November, 2017). Effects of family rituals, child behaviors, and food security on rural maternal depressive symptoms. Poster presentation at the National Council on Family Relations 79th Annual Conference in November, Orlando, FL.</li> <li>Bao, J.*, & Greder, K. (November, 2017). Family rituals and mothers’ mental health in rural low‐income families. Poster presentation at the National Council on Family Relations 79th Annual Conference in November, Orlando, FL.</li> <li>Davis, L., Cancel-Tirado, D., Sano, Y., & Greder, K. (2017). Addressing child care Deserts in Oregon: Eliminating upstream barriers to promoting maternal and child well-being. Paper presented at the Oregon Public Health Association Annual Meeting in October, Corvalis, OR.</li> <li>Davis, L., Cancel-Tirado, D., Feeney, S., Sano, Y., & Greder, K. (October, 2017). Addressing child care deserts in Oregon: Eliminating upstream barriers to promoting maternal and child well-being. Presented at the annual conference of the Oregon Public Health Association conference, Corvallis, OR.</li> <li>Sano, Y., Routh, B., & Lanigan, J. (November, 2017). Understanding the Food Environment of Rural Low-Income Families. Poster presented at the annual meeting of the National Council on Family Relations, Orlando, FL.</li> <li>Cancel-Tirado, D., Feeney, S., Washburn, I., Sano, Y., & Greder, K. (November, 2017). Rural Latino and Non-Latino White Families’ Health Outcomes and Healthcare Access. Poster presented at the annual meeting of the National Council on Family Relations, Orlando, FL.</li> <li>Radunovich, H., Wiles, B., Dyk, P., Sano, Y., Smith, S., Berry, A., Ferraro, A., & Piper, J. (August, 2018). Rural mothers’ understanding of the Affordable Care Act and implications for health and mental health. Presentation at the National Association for Rural Mental Health 44thannual conference, New Orleans, LA.</li> <li>Chandler, K., Barrett-Rivera, B., Sano, Y., Smith, S., & Bird C. (July, 2018). A duel or a dance? Rural, low-income mothers’ experiences managing work and family time. Paper presented at the annual meeting of the Rural Sociological Society conference, Portland, OR.</li> <li>Radunovich, H.L., Smith, S., Ontai, L., Hunter, C., & Cannella, R. (November, 2017). Does partner support affect the physical and mental health of poor, rural mothers? Paper presentation for the National Council on Family Relations Annual Conference, Orlando, FL</li> <li>Routh, B. and Greder, K. (2017, November) Home and community influences on obesity-related behaviors among rural low-income families. National Council on Family Relations annual conference, Orlando, FL.</li> </ul>

Impact Statements

Impacts: Rural communities and families continue to experience health inequalities when compared to their urban and suburban counterparts. Additionally, the prevalence of high-poverty counties and the proportion of the poverty population residing in high-poverty counties have been higher in rural areas than in urban areas. The higher poverty rates in rural communities contribute to the health inequalities. To overcome these barriers to health, a greater understanding of the everyday experiences of families living in rural poverty is necessary in order to facilitate effective supports to address the unique needs of the population. This project adds to that understanding through the collection of unique quantitative and qualitative datasets capturing the everyday lived experiences of families living in rural poverty. The knowledge generated from this project has direct implications for informing family-focused and community level programs intended to address health Indicators: • The data has been used to generate publications that are distributed widely to reach family science researchers and practitioners. The publication of the special issue of Family Science Review is published by the Family Science Association and reaches family science researchers and professionals in the field. • We have successfully combined community level data to provide context to the individual experiences. This has resulted in six presentations and a publication furthering understanding of community level factors that contribute to health inequities in the context of rural poverty. • Individual states (KY, WA) have distributed briefs to local policy makers outlining health care coverage and access issues learned from the interviews conducted. disparities in low-income, rural communities.