Sheila Mammen

A Case Study in Creating Oral Health Messages for Rural Low-Income Families: A Comparison to the Cultural Appropriateness Framework

Culturally appropriate oral health messages are found to be an effective tool to improve oral health among rural, low-income families. Yet knowledge on how to best achieve such messages is lacking. Based on participatory, learner-based approach, this study examined various oral health messages (varied length, detail, and voice) among 75 rural, low-income mothers in nine states in the theoretical framework of cultural appropriateness model. Specifically, we compared the process of our message creation to the differential effects of linguistic, peripheral, evidential, and sociocultural approaches. Results of qualitative analysis showed that low-income mothers, who represent a “rural culture,” prefer messages that (a) have a clear and concise connection between recommendations presented in the message and future economic consequences of inaction, with sufficient explanation; (b) mention problem-specific economic struggles and inaccessibility of resources; (c) include the sources of fluoride, community barriers, availability of professional resources, and the quality of local water; and (d) contain the voice of a dental authority over the voice of other mothers. The applicability of cultural appropriateness framework and policy implications are discussed.

The Earned Income Tax Credit: An Incentive to Rural Employment

This chapter describes the federal Earned Income Tax Credit (EITC) enacted in 1975 to help offset Social Security taxes for low-income families with children. The EITC was also meant to provide those taxpayers with an increased incentive to work. The tax credit provides significant benefits to low-income working families and the communities in which they live. Eligibility for the EITC is discussed in relation to rural families. Past research on EITC is reviewed and framed within the behavioral life-cycle theory. The inclusion of self-control, mental accounting, and life-cycle saving is discussed. Findings from the Rural Families Speak (RFS) project are included.

Shaping Core Health Messages: Rural, Low-Income Mothers Speak Through Participatory Action Research

ABSTRACT Rural, low-income families are disproportionately impacted by health problems owing to structural barriers (e.g., transportation, health insurance coverage) and personal barriers (e.g., health literacy). This paper presents a Participatory Action Research (PAR) model of co-created Core Health Messages (CHMs) in the areas of dental health, food security, health insurance, and physical activity. The research project engaged a multi-disciplinary team of experts to design initial health messages; rural, low-income mothers to respond to, and co-create, health messages; and stakeholders who work with families to share their insights. Findings reveal the perceptions of mothers and community stakeholders regarding messages and channels of message dissemination. By using PAR, a learner engagement approach, the researchers intend to increase the likelihood that the CHMs are culturally appropriate and relevant to specific populations. The CHM-PAR model visually illustrates an interactive, iterative process of health message generation and testing. The paper concludes with implications for future research and outreach in a technological landscape where dissemination channels are dynamic. This paper provides a model for researchers and health educators to co-create messages in a desired format (e.g., length, voice, level of empathy, tone) preferred by their audiences and to examine dissemination methods that will best reach those audiences.

Labor Supply Decisions of Rural Low-Income Mothers

Labor force participation is crucial to the economic well-being of low-income rural families. This study identified the factors that influence two decisions that low-income rural mothers make regarding their employment: labor force entry and number of hours supplied to employment. The sample consisted of 412 rural low-income mothers who participated in a multi-state study. The logistic regression model correctly predicted 80 percent of their work participation decisions. Employed rural mothers appeared to be older, better educated, and less likely to suffer from depression compared to those not working. Additionally, they were more likely to have an employed partner, a driver’s license, child care assistance, and Earned Income Tax Credit from the previous year. The estimated labor supply function explained 33 percent of the variation in hours worked by the 208 employed rural mothers. Higher wages, availability of health insurance, and overtime benefits predicted the number of hours that these employed mothers were willing to work.