The Power of Older Women and Men in Egyptian and Tunisian Families

The passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996 represented one of the most profound developments in American social policy since the Great Society programs of the mid- 1960s and has the potential to affect the health of millions of American children. The overall purpose of the legislation, commonly referred to as welfare reform, was to decrease reliance on welfare and increase the economic independence of poor families. Its impact has been far-reaching, affecting many determinants of child health and well-being, such as family resources, reproductive choices, maternal employment, parental supervision, childcare, and access to health insurance.The implementation of PRWORA has been associated with unprecedented declines in the number of children receiving public benefits. In the first 2 years after welfare reform, the number of children receiving welfare benefits fell by 28%.1,2 In addition, the number of children enrolled in Medicaid, the principal public health insurance program for poor children in the United States, also fell, despite provisions in the legislation to extend Medicaid coverage to all children who lose welfare benefits.3 Similarly, the number of children receiving food stamps has dropped by 20% between 1996 and 1998.4–6 Although there is consensus that both growth in the economy and welfare policies themselves have contributed to these declines, the exact proportion attributable to each factor remains unclear.7–9This discussion considers how these major shifts in public support for poor children and their families are likely to affect patterns of child health and the provision of clinical services to children. It addresses these concerns by exploring 4 related issues: the elements of the welfare legislation most likely to affect child health, the impact of this legislation on enrollment in public programs for children, the potential health effects of welfare reform, and the role of pediatric and other child health practitioners in addressing these health effects through clinical practice and public advocacy.The PRWORA legislation ended the federal guarantee of income support to poor families by replacing the longstanding entitlement program Aid to Families With Dependent Children (AFDC) with limited block grants to the states under the new Temporary Assistance for Needy Families (TANF) program. Through these block grants, the states were given substantial power over many aspects of welfare policy and implementation, which has led to unprecedented variation in state welfare programs. Among the many changes in welfare that PRWORA imposed, there are 6 key elements of the new welfare law that have implications for child health: time limits, work requirements, family caps, the uncoupling of TANF and Medicaid, sanctions, and changes in related social programs.The federal law mandates a 5-year lifetime limit for cash benefits. Once families reach their time limit, benefits are terminated regardless of their social or economic situation. States can institute shorter limits and 23 states have done so; several states have time limits of 2 years or less (Table 1).10 Exemptions and extensions are permitted for factors such as domestic violence, parent disability, or caring for a young child; however, 18 states do not allow extensions in any circumstance.The federal law also mandates that single parents receiving TANF must seek work (Table 1).11 In many states, educational activities such as pursuing high school diploma equivalency, job training, or college, no longer fulfill work requirements. Although 28 states have adopted the federal guideline that exempts parents of children younger than 1 year of age from work, 12 states have set the age for exemption much lower at 3 months of age (Table 1). Although states can provide exemptions to women with chronically ill children, most states have adopted highly restrictive criteria. For example, in Massachusetts work exemptions are limited to only those women whose children meet SSI disability standards, a practice that has recently been challenged in court.12 Similarly, state exemptions for when a parent is disabled or a victim of domestic violence have been highly restrictive.13 Failure to comply with work requirements can result in reduction or termination of benefits (Table 1).Although there was no specific federal requirement to eliminate benefits for children born to women already on welfare, states were allowed to do so and 23 states have chosen to restrict cash assistance to such family cap children to provide a disincentive for childbearing while on welfare.10 Nineteen of these states provide no additional assistance, 2 provide partial increases in cash benefits, 1 provides additional assistance as vouchers rather than cash, and 1 provides additional assistance to a third party rather than to the parent (Table 1). For families who have an additional child while on welfare, the family cap restrictions do not reduce total benefits to the family, but effectively result in a decrease in household income per family member. In an additional effort to discourage childbearing while on welfare, 4 states have provisions that require mothers who have children while receiving TANF to work soon after birth.10,13Before 1996, welfare and Medicaid were administratively linked. The PRWORA legislation created different eligibility requirements and funding mechanisms for the 2 programs. Families found ineligible for TANF could still qualify for Medicaid, which remains an entitlement program. PRWORA maintained Medicaid eligibility guidelines similar to those of the former AFDC program and specified that Medicaid benefits could continue for a transitional year after families leave TANF for employment (Table 1). This provision was intended to address the likelihood that the jobs available to this population may not provide health insurance. The State Child Health Insurance Plan (SCHIP) was also established in 1997 to reduce the number of uninsured low-income children. By the beginning of fiscal year 1999, the majority of states had begun implementing their SCHIP enrollment plans, although the pace of enrollment has varied across states.14The welfare law mandated that cash benefits must be reduced if parents fail to comply with work requirements, a practice that many states had implemented even before this legislation.13States vary regarding the causes, severity, and duration of sanctions. For example, some states will impose sanctions if immunization or routine pediatric health care is not appropriately documented (Table 1).The welfare legislation also included changes in 2 other important programs that benefit low-income children—food stamps and the Supplemental Security Income (SSI) programs. New restrictions were imposed in the food stamps program, including a reduction of benefit levels and allowances for reductions in food stamp benefits if families were penalized under TANF rules.4,15 Welfare reform tightened SSI eligibility by eliminating the Individualized Functional Assessment as a basis for evaluating disability in children and by requiring eligibility redeterminations.16,17 These individualized assessments allowed children to be considered disabled if their conditions were of comparable severity to those of an adult or if they had a combination of impairments that did not individually meet disability criteria.18Since the enactment of PRWORA, there have been substantial declines in enrollment of children in important programs that serve as the safety net for poor children—TANF, Medicaid, food stamps, and SSI. The difference between states in the size of enrollment decreases is likely caused by differences in their specific welfare policies as well as their overall economic situation.7,8,19 There is evidence that there is persistent need for these programs despite a strong economy, which has implications for future periods of economic slowdown.20,21Since the enactment of welfare reform, the number of children receiving welfare benefits decreased by 28%, from 8.6 million in 1996 to 6.2 million in 1998 (Table 2).1,2 During this same period, the rate of child poverty decreased by 1.6%. However, this decrease reflected overall poverty trends and did not necessarily represent the experiences of children leaving welfare.22An even more striking decline occurred among adults, with the total number of people receiving TANF falling by 43% from 12.2 million in August 1996 to 6.9 million in June of 1999.23 Although the welfare caseload began to decline from its peak of 14.2 million in 1994, before passage of welfare reform, 61% of the decrease since 1994 occurred in the last 2 years. The size of the drop varies from 12% in Rhode Island and Nebraska to over 80% in Idaho, Wisconsin, and Wyoming.23,24One problem with evaluating Medicaid enrollment trends is the significant time lag in reporting these data.25 Fiscal year 1998 data are only now becoming available and have yet to be verified. Medicaid enrollment data compiled from a recent survey of 21 states are available but do not include information for children.26 However, the data that are available for the period between 1996 and 1997 indicate that the number of children enrolled in Medicaid fell by 1 million, from 16.3 to 15.3 million, a 6% decrease (Table 2).3,27 This reduction occurred while the child uninsurance rate remained stable at 15%, translating to 11 million uninsured children.21 As with the TANF decline, the reason for the decreases in Medicaid enrollment are understood to be multifactorial but are likely to include practical administrative barriers resulting from the uncoupling of Medicaid and TANF, as well as improvements in local economic conditions.7,28 In addition, part of the decline in Medicaid enrollment is attributable to a decrease in the participation rate in the program among poor children from 63% in 1996 to 58% in 1998.29The effort to expand coverage to a larger proportion of poor children through SCHIP has only offset a portion of the Medicaid declines. A recent survey of the 12 states with the most uninsured children demonstrated that increases in SCHIP enrollment were overshadowed by even larger decreases in Medicaid enrollment, resulting in substantially fewer children enrolled in federally funded health insurance programs 3 years after welfare reform.30 Indeed, evidence indicates that there are at least 2.6 million uninsured children eligible for SCHIP and 4.7 million uninsured children eligible for Medicaid.31,32 SCHIP enrollment data suggest that although enrollment increased by over 50% from 833 000 to 1.3 million between December 1998 and June 1999 this only accounted for 50% of those predicted to be eligible.33 As SCHIP enrollment proceeds, information must be gathered on how many of these uninsured yet eligible children are captured.Food stamps are an important resource for low-income families regardless of whether they receive welfare benefits. Concurrent with the dramatic decrease in the total number of TANF recipients from 1996 to 1998, there has been a comparable 24% decrease in overall food stamp enrollment from 24.9 million to 18.9 million participants, the lowest number since 1979.4 In the face of this decline, the increased need for food assistance was documented in a 1999 survey of 26 major cities that found requests for food assistance by families with children increased by 15% in the previous year and that two thirds of those requesting food assistance were working.20This evidence suggests that food stamp enrollment cannot be explained only by a decreased need for food assistance. Rather, the overall decline is likely to be attributable to a combination of overall economic conditions, specific tightening of food stamp eligibility requirements under PRWORA and to spillover effects of other welfare reform policies geared to reducing caseloads.4Studies have indicated sharp declines in the use of food stamps by families who leave welfare. Former welfare recipients left the food stamp program at greater rates than other families, but those with the lowest incomes were especially likely to stop receiving food stamps.15 These declines are not caused by ineligibility because most families are still eligible because their incomes have remained low after leaving welfare.4,34–38Not surprisingly, the number of children receiving food stamps also decreased, falling 20% from 13.2 million in 1996 to 10.5 million in 1998 (Table 2).39 This drop accounts for nearly one half of the total decline in food stamp enrollment. In addition, the rate of participation of poor children decreased from 94% to 84% between 1995 and 1997, despite rising rates of demand for subsidized school lunches and emergency food assistance.4The SSI program is one of the most important programs providing supplemental income support for families with disabled children. After the stricter eligibility standards for SSI went into effect, eliminating the Individualized Assessment Plan and requiring eligibility redeterminations, the overall enrollment dropped by 11%, from 955 000 to 847 000 between December 1996 and December 1999.40 Children who lost their SSI benefits through redeterminations also lost their Medicaid coverage until this was reinstated by the 1997 Balanced Budget Act.18,40Although there are many potential ways welfare reform can influence the well-being of poor children and their families, we consider the principal pathways to be: changes in family resources, influences on parental supervision, and alterations in access to health care.Although PRWORA has many complex components, its primary impact will depend on whether it serves to increase or decrease resources for families who leave and those who remain on welfare. Despite the centrality of this issue, there are limited data on the long-term economic status of families after they leave the welfare rolls. Recent studies of different states have shown that one half to two thirds of people who left welfare were employed when surveyed 3 to 12 months later.34–38 However, all of these welfare leaver studies are limited by relatively short follow-up periods. These studies also indicate that although many former recipients are working, their earnings do not raise them above the poverty level, because most are employed in low-wage, entry-level work.34,41This concentration in low-wage work is consistent with the evidence that families who leave welfare for work face significant barriers to employment, including inadequate education, training, and previous work experience.42–44 Former recipients also tend to be young single parents with young children.34 Child health is often cited as a barrier to parental employment among welfare recipients.42–44 This is not surprising because recent studies indicate that children of welfare recipients have a higher burden of illness than do other poor children—20% to 40% of families receiving AFDC had children with chronic illnesses, compared with 10% of all poor families.45–47Because it may be difficult for women with chronically ill children to meet the new work requirements, they will be more vulnerable to sanctions or benefit terminations for noncompliance. Although states can provide exemptions to work requirements because of child illness, many base such exemptions on strict criteria such as SSI disability designation. Such exemptions, however, will not affect mothers of chronically ill children who have significant health needs and require parental participation in their medical care, but who may not meet SSI disability standards. For example, chronically ill children with respiratory diseases have 3 times the number of physician visits and 4 times the rate of hospitalizations of healthy children.47Although the dramatic declines in TANF rolls may well reflect improved social conditions for some families previously reliant on public assistance, a portion of poor families will likely experience significant hardship, particularly during difficult economic times. Taken together, the barriers to employment, sanctions, and the termination of benefits outlined above will cause some families to experience declines in available income. There is much evidence to indicate that decreases in family resources, including food stamps, resulting from welfare policies have the potential to cause predictable and substantial adverse child health effects.48–55The impact of the substantial declines in food stamp participation on the nutritional status of poor children must also be considered. Poor children are 5 times more likely to experience food insecurity and hunger, and they have significantly lower intake of calories, iron, folate, and other nutrients, compared with nonpoor children.56,57 Undernutrition is associated with numerous adverse health outcomes, including poor growth, iron deficiency, lead poisoning, and impaired cognitive development.53,55,57–59In contrast, food stamp use is associated with a lower risk of inadequate food intake and improved nutritional status.Parental work requirements included in welfare reform raise important questions regarding childcare arrangements while parents are working. Inadequate or substandard childcare poses a variety of risks, including injuries, communicable diseases, and noncompliance with prescribed medical regimens.60 In the case of chronically ill children, flexibility in parental employment as well as appropriate child care are essential to maintaining reasonable health. For example, children with asthma who adhere to their medical regimens are more likely to have their disease well-controlled.61–63Depending on the age of the child, parental time and supervision are needed for the recognition of symptoms, administration of appropriate treatments, and attendance at medical visits.64–67Former welfare recipients are unlikely to find jobs that provide the flexibility needed to care for a chronically ill child, because most find low-wage work in industries characterized by limited parental benefits or leave policies.41,68 National data suggest that employed poor mothers and mothers of chronically ill children have less sick leave than do other mothers.60 In particular, a substantial proportion of former welfare recipients lacked sick leave or vacation leave or a flexible schedule that might allow them to care for a sick child.41,46 This disparity between the amount of illness poor families experience and the degree of work flexibility available to them suggests that these parents will be faced with the difficult decision of what to do when their child is sick or needs to go to the doctor and they are unable to take time off from work.The problem of inadequate day care for current and former TANF recipients was underscored by recent data suggesting a shortage of affordable day care, especially for infants and toddlers.69,70 The gap in available care is particularly striking for poor families who work nonday schedules because most child care providers are unavailable during these off hours.69–71 For many families, this means that they will have to rely on unregulated day care, which is more available during nonstandard hours. This contributes to the use of lower quality day care by poor families, a factor that increases the risk of deleterious child health and developmental outcomes.71–73 PRWORA provided additional funding for child care subsidies, which are critical in assisting former recipients to obtain affordable quality day care.69 However, most states are unable to provide child care subsidies to all families who meet the eligibility criteria, resulting in waiting lists and copayments to restrict access to limited child care funds.69,74The primary means of providing health insurance to children on welfare has been the Medicaid program. The reduction in Medicaid enrollment since the passage of PRWORA raises concerns about uninsured children in families leaving welfare. Despite provisions for continued coverage, several studies provide consistent evidence that up to one half of children in the examined states were not enrolled in Medicaid 6 months after leaving welfare and that there was limited use of available transitional Medicaid coverage.34,36,75,76Medicaid dropout of eligible children is at least partly caused by administrative barriers and the lack of coordination between Medicaid and welfare agencies.19,25,28 Overall, 40% of former recipients and 25% of their children were uninsured.75Recipients uninsured by Medicaid are unlikely to have employer-based private insurance because the proportion who found jobs providing such insurance varies considerably, from 10% to 60% and even those who have access to employer insurance may not be able to afford the cost of the premiums.27,28,36 The fact that a substantial proportion of children who leave welfare become uninsured is of concern because research has repeatedly shown that poor children without health insurance experience impaired access to health care. They are less likely to have a regular source of care and are more likely to have difficulty obtaining prescription medications and to delay seeking care because of cost concerns.77,78 Moreover, uninsured children with a chronic illness are more likely to have had no physician visit in the previous 12 months.79,80 Thus, welfare policies that unintentionally result in higher rates of uninsured children can be expected to result in a variety of adverse health outcomes and a growing burden on the financial well-being of clinical practices and institutions that care for poor children in the United States.The nature and scale of welfare reform will create new challenges and opportunities for clinicians who care for poor children in the United States. The persistence of continued high rates of uninsurance in the face of a decline in Medicaid enrollment represents a serious barrier to improved child health and will generate new financial burdens for clinical practices and institutions serving poor families. The extent to which uninsurance remains a problem depends on how successful individual states are in enrolling eligible children in their Medicaid and SCHIP programs. Early evidence suggests that there is considerable variation in how effective states have been in their outreach efforts and in overcoming important administrative barriers to enrollment, such as frequent eligibility redeterminations and complicated applications.25,28,81 In addition, hospitals and clinics that are confronted with higher rates of uncompensated care because of uninsured children will have a strong financial incentive to address this problem.From a policy perspective, there is an urgent need to understand what portion of the declines noted in Medicaid, food stamps, and SSI is attributable to economic growth or welfare policies. This will be key in determining whether more attention should be focused on program policies or on policies in for an economic The pediatric could to raise public of these trends and to seek including those by the American of Although the data on enrollment trends in these programs are from a relatively short time these are the only data and more information on child health and well-being to a more regarding PRWORA as it its in must consider the that if some families are unable to leave welfare and poverty during the current economy, it is likely that the potential for adverse will increase during an economic enrollment efforts greater attention should be to population that are such is children of who for Medicaid because of that Medicaid will be as evidence of a public and will affect their for will need to a of the problem of uninsured children and institute outreach such as those by the American of the by the and the by the of Health and and the National caring for low-income families may need to patterns of practice and new to meet the different welfare reform may generate for their limits will new economic burdens on families. work requirements may require greater by with day care providers to health care regimens and practice to parents with limited work will also need to serve as of information and assistance for families who may be eligible for Medicaid, food stamps, and transitional child care subsidies even after welfare benefits should be that in many states, medical may to be a critical for TANF time limits, maternal work requirements, and maintaining health insurance for children with health care provide assistance for their clinicians caring for poor children should have a of local welfare policies and should with social and For example, one pediatric has a of routine regarding health food and welfare by a and follow-up to families in obtaining needed clinical could also serve as an essential source of data on the impact of welfare reform on children. particularly those focused on children with chronic illness, could provide information on the health of children who changes in their welfare Health care providers could also an important role in families who more into poverty under welfare reform provisions even if the overall experience of the population Such can use the power of to set research and policy can to welfare reform policy by providing regarding to effectively or and Although we data from such as the National of American Families as well as the of the of data on child health in these studies will be are in a to significant to the health and well-being of children during the implementation of welfare reform by the experience of clinical practice and research to the of child health over welfare has to the states, health care providers are in a to influence local policy through their Through the pediatric can that the health of children is included in the of the effects of social welfare Through clinical we can that the discussion of welfare reform is by a of the experience that the research was in part by funding from the the the National of National of and the Health and the and the for the Children of the who previous of this and and who in the of the

Using data from a 2012–2013 empirical study, this article examines financial practices and attitudes toward accumulation of assets among low-income rural families in a county in Mississippi. It dissects “asset accumulation” as an often-ignored facet of the financial component of the Community Capitals Framework. The analysis also examines financial capital creation strategies used by local institutions. The article presents a new theoretical framework for understanding and predicting asset accumulation processes among low-income rural families and resulting community progress. Findings show asset accumulation among low-income rural women and families is hindered by a number of individual and institutional factors. However, a culture of fiscal household responsibility and asset accumulation can be created among women and low-income families. When this occurs, community financial capital as a multiplier effect can be anticipated, which will temporally increase other forms of community capital and progress community.

The present study examined homeownership among rural, low-income families. Previous literature was examined to understand the financial, psychological and social benefits of and barriers to homeownership among this population. Although most lowincome families appear to prefer to own their homes, limitations can prevent them from buying their ‘dream home’ and risks can diminish the positive effects of homeownership. Recent public policy has attempted to extend opportunities for homeownership to households heretofore under served. Attaining and sustaining homeownership among low-income families has become an important area of research. In addition to a review of previous literature, this research examined the role of family socio-demographic, economic, housing and housing market characteristics and health characteristics in predicting tenure status among low-income, rural families. Quantitative data were utilized from a multi-state longitudinal study of the effects of welfare reform on rural low-income families, North Central Regional research project #NC1011. Logistical binomial regression analyses revealed that for low-income families in rural areas seven variables were significantly related to tenure status; e.g. participant education level, partner status, Latino, family monthly income, family food security score, utility costs and county housing wage. A second analysis revealed that those with partners had five significant variables; education level, monthly income, food security score, monthly utilities, and county housing wage. Taken together, the review of literature demonstrates the importance of homeownership while the analyses contribute to understanding low-income households’ tenure status.

Many nonprofits and government entities model the standard for housing affordability set by the United States Department of Housing and Urban Development (HUD, which states that housing costs in excess of 30% of gross household income are unaffordable. Families require a minimum level of basic consumption after housing costs are made which must then be purchased with the remaining 70% of their gross income. Hence, an increasing number of studies have examined how these competing needs factor into the government equation for housing affordability using national datasets. This study uses data from the Rural Families Speak project, a multi-state research project focused on rural, low-income families with children. The percent of income families spent on housing is compared to their ability to fulfill basic needs to answer the question: Do low-income rural families that are not housing cost burdened perceive themselves to be able to meet more basic needs than families that are housing cost burdened according to the government standard? By incorporating measures of perceived fulfillment of basic needs, the understanding of affordability can be broadened to include the challenging circumstances of rural areas.

Childhood obesity rates appear to be more pronounced among youth in rural areas of the USA. The availability of retail food outlets in rural communities that sell quality, affordable, nutritious foods may be an important factor for encouraging rural families to select a healthy diet and potentially reduce obesity rates. Researchers use the term 'food desert' to describe communities where access to healthy and affordable food is limited. Understanding the ways in which the food environment and food deserts impact childhood obesity may be a key component to designing interventions that increase the availability of healthy and affordable foods, thus improving the health of rural communities. The food environment was investigated in 6 rural low-income Maine communities to assess how food environments affect eating behaviors and obesity rates of rural children enrolled in Medicaid/State Children's Health Insurance Program in Maine ('MaineCare'). Focus groups were conducted with low-income parents of children enrolled in MaineCare to ask them about their food shopping habits, barriers faced when trying to obtain food, where they get their food, and what they perceive as healthy food. Cost, travel distance, and food quality were all factors that emerged as influential in rural low-income family's efforts to get food. Parents described patterns of thoughtful and creative shopping habits that involve coupons and sales. Grocery shopping is often supplemented with food that is harvested, hunted, and bartered. The use of large freezers for storing bulk items was reported as necessary for survival in 'tough' times. Families often travel up to 128.8 km (80 miles) to purchase good quality, affordable food, recognizing that in rural communities travelling these distances is a reality of rural life. Parents appeared to know what qualities describe 'healthy food'. Rural families may have greater flexibility and opportunity to be methodical in their food shopping than urban families since many have access to cars and large freezers. This creates a buffer around these rural communities that might otherwise be considered food deserts. Although the meaning of food desert may be different in rural areas than in urban, it does not negate the fact that low-income rural families are struggling. The combination of challenges that rural low-income families face call for more rigorous study to identify promising interventions for increasing food access and quality in these communities. Participants have developed creative skills for getting food on the table and they know what healthy food is. Despite having acquired this knowledge and these skills, rural families are struggling. With these struggles in mind, policy-makers should consider the shopping patterns reported in this study when thinking about how to help rural residents better access affordable, healthy and quality foods. Customary approaches to remedying the problem of food deserts in urban areas, such as building more grocery stores, may not be necessary in rural areas. More creative approaches for food-access policy changes, subsidies and incentives are needed to match the complex and multi-faceted strategies that low-income residents utilize to feed their families.

Recreation is an important resource that can support residents’ capacity to cope with stress and deal with community crisis, such as a pandemic. However, rural low-income families often experience inequitable access to recreation provisions. COVID-19 pandemic forced municipal recreation departments across Canada to re-evaluate and adapt their provisions, of particular importance for rural low-income families. Through the lens of social liberalism, this study examined the role of a municipal recreation department's response to community crisis and the implications of its provisions on rural low-income mothers and their families’ capacity to facilitate leisure during the pandemic. Through 29 interviews with low-income mothers and a focus group with the recreation department, we illuminate how provisions were designed and delivered to address income inequality, geographic isolation, social exclusion and childcare. Considering these findings, we discuss the department's approach to redesigning and delivering provisions and the implications to supporting low-income families’ access to recreation.

What is the anti-poverty effect of solar PV poverty alleviation projects? Evidence from rural China

This study was a secondary analysis of wave one data of the Rural Families Speak project, a multi-state longitudinal Agricultural Experiment Station project that focused on assessing changes in the well-being and functioning of rural low-income families in the context of welfare reform. Quantitative analysis was conducted to determine the housing situations of the families and the relationships of these factors with the family economic and cognitive well-being and employment circumstances of study participants. Discriminant analysis was used to develop a model to predict the employment circumstances (employed, not employed) of the participants. Housing costs usually take the first and largest portion of a family's budget, leaving the rest of the income to purchase food, clothing, health care needs, school fees, etc. Without supplemental assistance from family, friends, and government agencies, the housing costs for many of the families would be a burden to the family budget, limiting the funds available for human capital needs. Most participants in this wave of the study did not have housing costs greater than the government standard of 30% of monthly income. However, the majority of the families could not have afforded to pay fair market rents for housing in their geographic areas with their current monthly incomes. Variables included in the final model to predict the participant's employment status were the housing income adequacy of the family (fair market rent divided by monthly income), transportation assistance, child care assistance, Medicaid, TANF, and marital status. The model correctly classified over 70% of the cases. Family economic and cognitive well-being for rural low-income families was studied with housing tenure as the independent variable. Homeownership was found to increase the participant's level of family economic well-being, as measured by the perception of income adequacy and the family's total monthly income. Housing tenure was found to be independent of participant's health, community awareness, and life satisfaction. By tracking these families over time, the changes in their family economic well-being and their employment circumstances can be examined. Housing costs and circumstances can be monitored and analyzed for relationships to employment and family economic situations.

This study was undertaken to explore how rural low-income families with children process health information following a nurse-delivered intervention designed to reduce environmental risks in their homes. Grounded theory methodology with a constructivist approach was used to conduct the study. Semistructured interviews of 10 primary child caregivers in rural low-income families who had participated in an environmental risk reduction intervention were completed from 2009 to 2011. Data were categorized using comparative analysis, theoretical sampling, and coding techniques. The three phases-(a) visiting my perception, (b) weighing the evidence, and (c) making a new meaning-explained the core process of the grounded theory of Re-Forming the Risk Message. Rural low-income families at risk for environmental hazards in their homes determined what health information and needed subsequent actions regarding their risks were important by changing the meanings of nurse-delivered messages. Nursing interventions designed to improve health behaviors and reduce risks are often based on stage theories that explain how change occurs through steps leading to positive actions through delivery of risk messages. However, the risk message delivered in an intervention designed to engage action is not always the risk message people decide to use. To understand whether people are ready to engage in positive behaviors through interventions, or if needed changes to the information must be made, nurses need to discover and explore reasons for the re-formed risk messages.

This chapter provides an overview of social support in sustaining rural low-income families. Social support is defined and relevant theoretical perspectives are presented. Literature is included to help in understanding how informal networks function when needs are high and resources are few, with the amount and types of support varying by context and time. The Rural Families Speak (RFS) project mothers’ narratives help demonstrate the types, strengths, and constraints of the support networks that emerged for the families. Further research needs and strategies for aiding positive employment and family well-being outcomes for rural low-income families are presented.

The economic volatility faced by rural low-income families is explained with an Economic Well-Being Continuum (EWC), a comprehensive measure which describes the circumstances of low-income families in eight specific dimensions and establishes their level of economic functioning. Using the Rural Families Speak longitudinal dataset and a case study approach, we analyzed the poverty spells of five rural, low-income families, including a migrant family. Life circumstances and trigger events that contribute to families’ entry into and exit from poverty were examined with the EWC. Health issues and relationship changes were significant trigger events that established or altered the economic functioning of the families while support networks helped mitigate their hardships. Policies to alleviate poverty spells among the rural poor are discussed.

Longitudinal studies of food insecurity have not considered the unique circumstances of rural families. This study identified factors predictive of discontinuous and persistent food insecurity over three years among low-income families with children in rural counties in 13 U.S. states. Respondents reported substantial knowledge of community resources, food and finance skills, and use of formal public food assistance, yet 24% had persistent food insecurity, and another 41% were food insecure for one or two years. Multivariate multinomial regression models tested relationships between human capital, social support, financial resources, expenses, and food insecurity. Enduring chronic health conditions increased the risk of both discontinuous and persistent food insecurity. Lasting risk for depression predicted only persistent food insecurity. Education beyond high school was the only factor found protective against persistent food insecurity. Access to quality physical and mental health care services are essential to ameliorate persistent food insecurity among rural, low-income families.

Much of the research on low-income families, welfare, and self-sufficiency has focused on urban populations. Further, many of the studies on informal or social support available to and accessed by low-income families addressed needs such as childcare, transportation, money, or housing and did not focus on food issues. This paper focuses on how formal government food assistance programs and informal supports are utilized by rural low-income families as they work to meet their food needs. Drawing on interviews from the multi-state “Rural Families Speak” project, we examine food security in relation to the use of formal and informal supports. Additional analyses address how mothers view and describe their use of support to meet food needs.

Authors examine the lives of rural low-income mothers, highlighting the conditions that, for most families, contribute to a work–child care compromise. An overview of child care in the United States is presented as well as program and policy contexts to help the reader understand the choices made by rural families as they balance employment and child care commitments. The authors examine child care from the experiences of Rural Families Speak (RFS) rural low-income families, and present the benefits and relationship costs that informal care providers have for families. Further research needs and recommendations are included.

The Earned Income Tax Credit and Rural Families: Differences between Participants and Non-Participants