Maryland Rural Families Speak: About Health

Introduction What is the current status of health for low-income families in rural Maryland? Do they have health insurance? Are their health needs being met? What is the state of mental health among low-income mothers? And how does health affect the ability of families to work, earn income, and make ends meet? In order to explore these issues, interviews were conducted in 2000 with 35 mothers from low-income families residing in rural Maryland ¹. These families live in Dorchester County on the Eastern Shore, and in the mountains of Garrett County. Both of these counties rank at or near the lowest of the state's counties on economic indicators. The stories of these women paint a picture of rural Maryland as experienced by them and their families.

Maryland Mothers Interviewed

Average age: 28
Average # of children: 2
Married or living with partner: 60%
Education-

Some high school or less: 31%
High school or GED: 20%
Beyond high school: 49%
Race/Ethnicity-
White, Non-Hispanic: 54%
African American: 34%
Native American: 9%
Multiracial: 3%

Physical Health These Maryland families deal with numerous health-related problems. Mothers completed a survey about their own physical health, the health of their partners, and the health of their children in the past year. They reported the following:

Mothers (35 total)
An average of 5 health problems per mother in the past year; range 0-19.
Most common health problems -
Migraines/headaches (46%)
Allergies (46%)
Back problems (37%)
Anemia (37%)

Partners (21 total)
An average of 3 health problems per partner in the past year; range 0-9.
Most common health problems -
Tobacco use (48%)
Allergies (33%)
Back problems (24%)

Children (74 total)
An average of 3 health problems per child in the past year; range 0-15.
Most common health problems -
Allergies (37%)
Ear infections (28%)
Eye or vision problems (22%)

Overall, each family dealt with an average of 14 health problems in the past year. Mental Health Mothers completed a standardized survey assessing the incidence of depressive symptoms.² Mothers' total scores on this survey indicated their risk for clinical depression. Based on scores from this survey, 43% of the mothers interviewed were at risk for clinical depression. These numbers are consistent with levels of depressive symptoms among low-income women, who are more likely to be depressed than women from high-income groups. Women are 2-3 times more likely to be depressed than men.³ When asked if they experienced depression or anxiety in the past year, only 29% of mothers said yes. The discrepancy between this number and the number of mothers showing depressive symptoms on the standardized measure suggests that more needs to be learned about the mothers' knowledge, perceptions, and reporting of depression. Health Insurance 60% of the mothers and 62% of their partners had health insurance; about 40% did not. Nearly all of their children (94%) had health insurance. Only one mother received health insurance for her children as an employment benefit. Most of the children were covered under the state health plan or Medicaid. At times, the mothers indicated that it was a challenge to find health services that were both convenient and covered under their or their children's health plans:

"?And the only reason I was on Free State anyhow is because the dentists up here accepted Free State. Well?I don't know of any dentist in Garrett County that accepts Maryland Physician's Care?so I'm gonna have to be travelin' to Cumberland and with one income and the price of gas, the way it is right now, I mean you almost need a bank loan to get gas. You know, I'm gonna have to travel to Cumberland to take my kids to the dentist and then there's no guarantee that the dentist is going to be able to see all four of them?"

Mothers do know how to find health care. At least 90% of mothers reported knowing how to find a family doctor or dentist, find family planning services, get their children immunized, and apply for Medicaid. Some of the mothers reported having difficulty paying for health-related expenses. 23% of mothers reported that both medical care and medicines were difficult to pay for, while 29% of mothers reported having difficulty paying for dental care. For these mothers, the cost of health insurance is often what prevented them from having it. Whether or not a family had health insurance was an important factor in deciding whether or not to seek help for health problems. Those without, did without. Health and Employment Mothers often reported that health played a role in their ability to secure and maintain employment. 17% of the mothers cited a time or times when their health resulted in them leaving or being fired from a job. Many mothers spoke about health problems and challenges to employment and family living. One mother, referring to her child's asthma, said:

"September to February we're in the hospital at least three times a month?I can't hold a job because I've got to be in the hospital with her."

Two others, speaking about themselves said:

"I tried to work full time, but I was in the hospital more than I worked." "I left that job because of health problems. I was sick one day and I couldn't call in so I told my husband to call in. And they tried to say he didn't call in. And when I came back to work that day, they wouldn't be seeing me, and they said they'd have to release me."

Health and Food Security According to the USDA, food security is the ability to access at all times enough food to meet the nutritional requirements of a healthy life. Using a standardized survey instrument⁴, the level of food security for families was assessed. Food-insecure families reported twice as many health problems as food-secure families.⁵

Avg. Number of Health Problems Food-Secure: 4 Food-Insecure: 8

A similar trend was seen in the area of mental health, although the differences were not as great. Mothers from food-secure families were less likely to be at risk for depressive symptoms than mothers from food-insecure families.

% At Risk For Depression Food-Secure: 40% Food-Insecure: 60%

Summary Physical and mental health problems are both a part of these Maryland families' lives. In addition to the numbers of health problems reported and high proportion of mothers at risk for depression, mothers reported having difficulties with paying for health care and maintaining employment. Food security also appears to be related to family health. These issues, combined with the challenges of living in a rural area, such as accessibility and transportation, make it more difficult for mothers to seek preventive health care for themselves and their families.

Research Study Description: This Maryland study is part of the USDA multi-state, longitudinal research study NC223: "Tracking the Well-being of Rural Low-Income Families in the Context of Welfare Reform." Funding from the USDA National Research Initiative; the University of Maryland Agricultural Experiment Station and Cooperative Extension, the Department of Family Studies, the Graduate Research Board; the USDA-MD Department of Human Resources Food Stamp Nutrition Education Program and the American Association of Family Consumer Sciences. Cooperating study states include: California, Colorado, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New York, Ohio, Oregon and Wyoming. Data were also collected in Virginia. This study began in l998 and continues through 2003. Its intent is to contribute to the debate about welfare reform and public assistance and to fill a void in information about rural families. In year one, 448 families in 28 counties in 15 states provided demographic, economic, mental and physical health, housing, childcare, transportation, food security, and family support information. The same families will be interviewed for three years to track their well-being over time. For more information contact:
Bonnie Braun, Ph.D.
1204 Marie Mount Hall
College Park, MD 20742
301-405-3581
BB157@umail.umd.edu

This fact sheet created by: Bonnie Braun, Ph.D., Study Leader
Extension Family Life Specialist
Department of Family Studies
Melissa Rudd
Graduate Research Assistant Reviewed by: Orv Grimes
Graduate Research Assistant
Donna E. Howard, Ph.D.
Department of Public and Community Health
Irmgard Koscielniak
Extension Educator, Garrett County
Connie Barnett
Extension Educator,
Dorchester County

Thanks to Maryland Mothers The authors want to thank the mothers who gave their time and allowed us to learn about their lives. Without their participation, this study would not be possible. We pledge to share the information and their words with policymakers and program directors, with the intent of improving the well-being of low-income, rural families.

This fact sheet is third in a series released as findings become available.

¹ Families will be interviewed three times over three years: 2000,2001, and 2002.
² Center for Epidemiological Studies Depression Scale (Radloff, 1977).
³ Lennon, Blome, & English (2001).
⁴ USDA Core Food Security Module (Bickel, Nord, Price, Hamilton, & Cook, 2000).
⁵This difference was significant at the p<.05 level.

For more information, contact Dr. Bonnie Braun

Last updated: 03/23/2006