Journal of Family and Economic Issues

, Volume 36, Issue 1, pp 154–164 | Cite as

Health Care Use Among Rural, Low-Income Women and Children: Results from a 2-Stage Negative Binomial Model

  • Swetha ValluriEmail author
  • Sheila Mammen
  • Daniel Lass
Original Paper


Determinants of healthcare use among rural, low-income mothers and children were assessed using a 2-stage negative binomial model of joint mother/child choices and data from a multi-state, longitudinal study, Rural Families Speak. Maternal healthcare use increased with higher depression scores, chronic conditions, new medical conditions, number of children, pediatric visits, prenatal/post-partum needs, and health insurance coverage. Maternal visits decreased with lower income, age, child’s chronic conditions, and child’s private health insurance. Pediatric visits increased with new medical conditions, greater number of chronic conditions, and maternal health visits. Pediatric visits decreased with maternal depression, pregnancy, Latina and African American mothers, more children, and private health insurance coverage. The 2-stage model shows mothers simultaneously choose healthcare visits for themselves and their child.


Rural health care Pediatric health care utilization Maternal health care utilization Behavioral Model of Health Services Utilization 



This research was supported in part by USDA/CSREES/NRICGP Grant Numbers 2001-35401-10215 & 2002-35401-11591, 2004-35401-14938. Data were collected in conjunction with the cooperative multi-state research project, NC-223/NC-1011, “Rural Low–Income Families: Monitoring Their Well-being and Functioning in the Context of Welfare Reform.” Cooperating states are California, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New York, Ohio, and Oregon.The authors gratefully acknowledge the assistance of Megan Gay, undergraduate research assistant, University of Massachusetts Amherst.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of BiostatisticsGeorge Washington UniversityWashingtonUSA
  2. 2.Department of Resource EconomicsUniversity of Massachusetts AmherstAmherstUSA
  3. 3.Department of Resource EconomicsUniversity of Massachusetts AmherstAmherstUSA

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