Race, Place, and Material Hardship: Rurality As a Protective Factor

Background: Material hardship occurs when a household’s consumption of goods and services falls below an acceptable standard (e.g. lack of food, healthcare, transportation, or adequate housing), and is associated with negative outcomes including poor mental and physical health. Recent studies suggest that material hardship is more frequent among people of color, households with children, and residents in urban communities. While prevalence in urban areas suggests that rurality may be a protective factor against material hardship, few researchers, if any, have examined whether all rural households are protected. That is, we have not observed whether people of color fare better in rural areas compared to urban considering material hardship. In response, we examined the association between race, place, and material hardship in a unique sample from a predominantly rural state.

Method: In this descriptive study, we examined associations between race, place, and material hardship using data from a statewide evaluation of healthcare innovations in Iowa, the State Innovation Model (SIM) Statewide Consumer Survey (SCS) (weighted N = 2,371,739). Iowans ages 18 years and older participated in a telephone survey between September 2016 and April 2017. We estimated a linear regression (OLS) to examine the effect of race and community size place on the number of material hardships reported by a respondent. We included 14 material hardships including indicators for housing instability, food insecurity, difficulty paying bills, inability to access healthcare, lack of transportation, and difficulty affording childcare.

We hypothesized that rural households would have less material hardships compared to urban households, and that the relationship between rurality and material hardship would depend on respondent race. More specifically, we hypothesized that respondents who were Black, Indigenous, or other people of color (BIPOC) living in rural areas would experience less material hardship compared to counterparts living in urban areas. We fit a linear regression model, including an interaction between race and rurality, controlling for income, financial stress, household size, education, employment, and gender.

Results: The overall model was statistically significant and explained approximately 30% of the variance in number of material hardships. Rural respondents and residents of small towns experienced less material hardship compared to those living in urban areas, while those living in large towns experienced slightly more material hardship. BIPOC respondents experienced more material hardship overall compared to white respondents. However, BIPOC respondents living in rural areas, small towns, and large towns all experienced less material hardship compared to BIPOC respondents in urban areas.

Conclusion: Although people of color in our sample were more likely to report material hardship overall, results suggest that living in rural areas or small towns may shield some people of color from material hardship. With limitations of the data in mind (e.g., small sample size for people of color in Iowa), more research is needed to understand the relationship between race, place, and material hardship. Future research should also explore the mechanisms that might buffer material hardship for people of color in rural areas.