Focus on Research
Penn State Intercom......November 14, 2002

Physical, mental illnesses
hinder low-income families

By Vicki Fong
Public Information

In a study of 254 low-income families in three U.S. cities, 52 percent report concurrent physical and mental health problems in both the primary caregiver and at least one of the children in the household. In addition, the separation of welfare assistance, Medicaid and health insurance programs have created major challenges for recipients to obtain and keep a lasting job — a key goal of welfare reform, researchers said.

“The physical and mental health problems of these adults and children are substantial and significantly hinder a family’s attempts to transition from welfare to permanent work and economic security,” said co-author Linda Burton, professor of human development and family studies and sociology. “Our data suggest that the health problems of parents and children are integrally linked and solutions developed by state and federal policymakers should comprehensively address both economic and health issues of families.”

The ethnographic study by Burton; Debra Skinner, research scientist, University of North Carolina, Chapel Hill; Stephen Matthews, senior research associate in social sciences at Penn State; and William Lachicotte, UNC-Chapel Hill; is part of a larger ongoing project, “Welfare, Children and Families: A Three-City Study,” where researchers at eight universities are monitoring the consequences of welfare reform on the lives of 2,400 families in Boston, Chicago and San Antonio.
Ethnographic research teams observed families’ day-to-day activities and the influences impacting their interactions with school, work, family and government and health-care agencies. Forty-nine percent were receiving welfare assistance benefits; of that subgroup, 16 percent were working, following welfare work requirements. The other 51 percent not receiving welfare were working poor or unemployed.

Approximately 83 percent of the caregivers — usually a biological mother — were 39 years old or younger; and nearly all had at least one child 2 to 4 years of age. For primary caregivers, common physical health conditions included diabetes, heart disease, severe obesity and arthritis accompanied by mental health concerns such as depression, anxiety or stress. For children, the researchers also found a range of serious conditions such as severe chronic asthma, seizures or lead poisoning coupled with depression, autism or attention deficit hyperactivity disorder, for example.

“The fact that many of these caregivers face health problems usually associated with older, frail individuals, is very troubling,” Burton noted. “Also, we found that most of these caregivers tended to neglect their own health needs to meet the economic and health-care needs of their children and extended family.”

The 254 families in the study included 42 families selected specifically because they had children with moderate to severe disabilities. Co-author Skinner, who directed the disability component, found similar challenges with 83 percent reporting concurrent physical and mental health problems in both the primary caregiver and at least one child.

The researchers also studied how all the families coped with seeking employment, fulfilling welfare work requirements and trying to maintain their family’s health. Caregivers worked despite having serious health problems, but frequently, they reported having lost or resigned from jobs because of health-related responsibilities.

Insurance coverage was uneven across the non-disability families with 40 percent fully insured by Medicaid, private insurance or some combination of the two; 60 percent were partially or uninsured. Of the disability families, 74 percent were fully insured and 26 percent were partially inured.

While Medicaid is working for many people, there are gaps in coverage and access to services, the researchers said. Complicating factors affecting private and public insurance coverage included grandparents without legal custody of the children; caregivers working low-wage jobs with no health benefits; caregivers’ inability to pay deductible and co-insurance costs; and job schedules and transportation difficulties when traveling to appropriate offices to apply for Medicaid or other types of health insurance.

“There is no single reason for why families are failing to receive the proper assistance,” Burton and Skinner noted. “It’s the convergence of all these forces that create unworkable situations for families. These early findings highlight several key points that should be considered in the current welfare reform reauthorization debate and any further reforms in welfare assistance, Medicaid and employee health insurance benefits.”

Full reports of “Welfare, Children and Families: A Three-City Study” are posted at http://www.jhu.edu/~welfare/.

Labels do not
encourage overeating

Labels listing energy density -- the number of calories per ounce -- do not encourage overeating the way "low fat" labels are suspected of doing, a University study says.

In the study, 40 normal weight women ate the same amount of food when their meals differed in calories by as much as 29 percent -- even when they were given la-bels that told them there were fewer calor-ies per portion. Tanja Kral, who conducted the study as her master's thesis, said, "Some studies have shown that people take larger portions of foods labeled 'low fat‚' using the label as a license to eat more. This study shows that energy density labels are unlikely to undermine the benefits of of-fering foods with fewer calories per ounce."

Kral conducted the study under the direction of Barbara Rolls, who holds the Guthrie chair of nutrition in the College of Health and Human Development.

Rolls said, "This tendency of people to take the same size serving of less energy-dense foods, even when they know the portion contains fewer calories, offers food manufacturers and restaurants a way to de-crease the fat and calories in their products, making them healthier and satisfying."

In the study, 40 healthy, normal weight women ages 18 to 32, ate breakfast, lunch and dinner in the University's Laboratory for the Study of Human Ingestive Behavior on three days each a week apart. Analysis showed that the pattern of food intake across the different levels of energy density was similar in the two groups when nutrition information was provided and when it was not.

Grant to enable study
of union structures

The organization of union locals may influence the way health-care workers view their unions, according to a University researcher.

The National Science Foundation awarded Paul Durrenberger, professor of anthropology, a grant to investigate how the structure of union organization, whether it is top-down or participatory, affects the way union members think and feel about their unions. The two-year grant is for about $200,000.

Durrenberger will investigate locals of health-care unions in Chicago and Pennsylvania to see how the organizational structures influence patterns of thought among union members.

"The findings will be important for all kinds of organizations, including management organization of work teams and quality circles, not just unions, because it will show us how organization affects how people think," the researcher said.

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