Brief Summary of Minutes of Annual Meeting

• 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.

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:

• 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.
• Publications and presentations: In addition to the special issue, the team has published three peer reviewed articles and five juried national presentations.
• 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.
• 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.
• 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.

 Activities:

• 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.
• 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.
• Qualitative data for the ACA access and usage project were coded for primary and secondary themes.
• 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.
• 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.
• Two graduate students were trained in analysis of the quantitative and qualitative data from NC1171.
• One undergraduate was trained to analyze NC1171 data and create a poster for University hosted scholar events.

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.

• 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.
• 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
• 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)
• Sano, Y., Mammen, S., & Oliver, B. (2018). Food insecurity among rural, low-income families. Family Science Review, 22(1).
• Mammen, S., & Sano, Y. (2018). Rural, low-income families and their well-being: Findings from 20 years of research. Family Science Review, 22(1).
• 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).
• 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.
• 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
• 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.
• 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.
• 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.

Juried national presentations:

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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
• 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.