Exploring Links Between Perceived Health, Social Exclusion & Social Assistance Recipiency in Saskatchewan Single Mothers Randy Johner, University of Regina George Maslany, University of Regina Bonnie Jeffery, University of Regina Paul Gingrich, University of Regina KEY WORDS: SOCIAL EXCLUSION, SINGLE MOTHERS, HEALTH, SOCIAL ASSISTANCE, ABORIGINAL IDENTITY The understanding of the construct of social exclusion is intrinsically linked to social and economic inequalities. In Canada, single mothers are vulnerable to social exclusion and poor health outcomes. Using a population health approach, an exploratory study in Saskatchewan (Canada) examined links between sociodemographic characteristics, social exclusion factors and perceived health in single mothers. A stratified random sample of 375 single mothers (non-social assistant recipients- 202; social assistant recipients-163) responded to a self-administered survey (summer, 2007). Multivariate findings suggested that social and economic factors of exclusion may be linked to single mother’s poor perceived health. A significant association was found between whether or not a single mother was a social assistant recipient and perceived health. Study findings suggest public social programs may not adequately support the inclusion of single mothers in Canadian society. In Canada, the single mother population is vulnerable to social exclusion and poor health outcomes (Curtis, 2001; Kapsalis & Tourigny, 2002). In the province of Saskatchewan, 13% of families are single mother families (Community Health Profiles from the 2006 Census). The poorest Saskatchewan children live in single mother families, with a poverty rate of 47.5% (19,000); the Canadian poverty rate for these families is 42.6% (Hunter, Douglas, & Pedersen, 2008). Given the current policy environment in Canada of cuts to social programs, the movement away from state support for individuals in times of need, and the promotion of individual self-sufficiency through increased human capital and welfare- to-work programs, policy-makers should be concerned about the health status of vulnerable population groups like single mothers. Although current research indicates that the factor of poverty-level income or
Transcript
Exploring Links Between Perceived Health, Social Exclusion & Social Assistance Recipiency in
Saskatchewan Single Mothers
Randy Johner, University of Regina George Maslany, University of Regina Bonnie Jeffery, University of Regina Paul Gingrich, University of Regina
KEY WORDS: SOCIAL EXCLUSION, SINGLE MOTHERS, HEALTH,
SOCIAL ASSISTANCE, ABORIGINAL IDENTITY
The understanding of the construct of social exclusion is intrinsically
linked to social and economic inequalities. In Canada, single mothers are vulnerable to social exclusion and poor health outcomes. Using a population health approach, an exploratory study in Saskatchewan (Canada) examined links between sociodemographic characteristics, social exclusion factors and perceived health in single mothers. A stratified random sample of 375 single mothers (non-social assistant recipients- 202; social assistant recipients-163) responded to a self-administered survey (summer, 2007). Multivariate findings suggested that social and economic factors of exclusion may be linked to single mother’s poor perceived health. A significant association was found between whether or not a single mother was a social assistant recipient and perceived health. Study findings suggest public social programs may not adequately support the inclusion of single mothers in Canadian society.
In Canada, the single mother population is vulnerable to social
exclusion and poor health outcomes (Curtis, 2001; Kapsalis & Tourigny, 2002). In the province of Saskatchewan, 13% of families are single mother families (Community Health Profiles from the 2006 Census). The poorest Saskatchewan children live in single mother families, with a poverty rate of 47.5% (19,000); the Canadian poverty rate for these families is 42.6% (Hunter, Douglas, & Pedersen, 2008). Given the current policy environment in Canada of cuts to social programs, the movement away from state support for individuals in times of need, and the promotion of individual self-sufficiency through increased human capital and welfare-to-work programs, policy-makers should be concerned about the health status of vulnerable population groups like single mothers. Although current research indicates that the factor of poverty-level income or
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social assistance recipiency is most often linked to social exclusion (Silver, 2007) and to poor health outcomes (Marmot, 2004; Wilkinson, 2005), the negative link between social exclusion and poor health status has also been recognized (Bryne, 2005; Berkman & Melchior, 2006; Galabuzi, 2004; Stewart, Makwarimba, Barnfarther, Letourneau, & Neufeld, 2008; Raphael, 2007).
Using a population health approach, this cross-sectional study asked the question: Is social exclusion linked to perceived health in Saskatchewan single mothers, social assistance recipients and non-social assistance recipients? The overall goal of this study was to enhance the theoretical understanding of the construct of social exclusion. This paper will present a brief review of the literature as it pertains to the construct of social exclusion as well as a description of a population health approach which lends theoretical support to this study’s hypotheses, followed by the methods, data analysis and results sections. A discussion of the study results, and further study questions will conclude this paper. The Construct of Social Exclusion
Researchers in Canada, Europe and the UK have just begun to unravel the complex relationships of multiple factors which are intrinsic to the construct of social exclusion (Silver, 2007). In its broadest sense, social exclusion is defined as “the process through which individuals or groups are wholly or partially excluded from the society in which they live” (De Haan & Maxwell, 1998, p.2). Definitions of social exclusion are often linked to welfare problems such as low-income or social assistance or poor health and generally seen as “a situation in which a single individual is suffering from several different welfare problems at the same time” (Hallerod & Larsson, 2007, p. 15). Reid (2004) who has linked social exclusion to poor perceived health status in Canadian low-income single mothers, defined social exclusion as a “disintegration from common cultural processes, lack of participation in social activities, alienation from decision-making and civic participation, and barriers to employment and material resources” (p. 3). In our study which also linked social exclusion to perceived health status, social exclusion was conceptually defined as, ‘the excluded are those who experience economic vulnerability (i.e. have low educational levels) and lack of support in times of need (low social supports and networks, low sense of control/isolation).’
Studies that examine social exclusion typically include economic (e.g. low income, inadequate education) and social relations (e.g. lack of social supports and networks/ feelings of aloneness or isolation) dimensions of exclusion, but may also include other dimensions such as political (e.g. do not vote) (Burchardt, Le Grand, & Piachaud, 2002), or
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environmental (e.g. housing, access to services for the disabled, social security) (White, 1998, as cited in Galabuzi, 2004, p.176), or physical health and psychological well-being ( e.g. have a disability)(Barnes, 2005, as cited in Silver, 2007, p.5).
According to Silver (2007), “social characteristics that reflect the distribution of honour, respect, and social distance, not just the distribution of material and non-material resources” are central to unraveling and understanding social exclusion (p. 2). In other words, examining aspects of social and economic disadvantage is as intrinsic to the ‘unraveling’ of the construct of social exclusion as is considering mechanisms such as discrimination or devaluation which limit individual capacity to pursue personal goals. Are individuals treated equally, with dignity and respect? Do individuals feel valued, and are able to enjoy good health (i.e. holistically in the sense of being able to pursue personal goals)?
Social exclusion is context –specific. An analysis of social exclusion in Canada would necessitate an analysis of what it means for example to be a Saskatchewan single mother receiving social assistance (Silver, 2007). Within each country, dominant social and cultural institutions through ‘socially-enforced’ boundaries which either include or exclude groups and/or individuals in their respective societies give different meanings to exclusion or being left out of society. Exclusion is not always construed as the complete opposite of inclusion as individuals can be considered both included and excluded, such as social assistance recipients who are included, or regarded as part of society, but “excluded as a means of reinforcing work ethics among the majority” (Silver, p.1).
Although the population of single mothers, particularly those who have a low-income or receive social assistance, is usually linked to social exclusion (Kapsalis & Tourigny, 2002), the factor of low-income or poverty itself is not coterminous with exclusion (Silver, 2007). Poverty does not mean that individuals or groups will experience exclusion in other spheres of life (Paugam & Russell, 2000); for example, low-income single mothers may experience labour-market exclusion, but not feel excluded in society if family and community connectedness are more highly valued than income levels.
In Canada, attaining an adequate education is highly valued (Frideres, 1998), particularly in terms of access to employment opportunities, potential income levels, and well-being. Higher educational levels are usually correlated with higher incomes and adequate employment (Women in Canada: A Gender-Based Statistical Report, 2006). In his longitudinal analysis of Canadian population groups most at risk of social exclusion which included single mothers, Fleury (2002) suggests that adequate educational levels decrease the risk
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to exclusion. European cross-sectional data support Fleury’s finding that links low educational levels with social exclusion (Robila, 2006; Tsakloglou & Papadopoulos, 2002). However, across all educational levels, age groups and occupational status, Canadian women are paid less than their male counterparts. In 2002, women when compared to men, had hourly wages that were “82 % those of men’s” (Cooke-Reynolds & Zukewich, 2004, p.26). In addition, Morissette and Picot (2005) found that 23 % of single mothers were low-paid workers (i.e. earned less than $375.00/week in 2000 dollars) compared to 10 % of single fathers.
According to Sen and Ostlin (2007), women in almost all societies, “may have less land, wealth and properties: yet have higher burdens of work in the economy of ‘care’- ensuring the survival, reproduction and security of people, including young and old” (p. xiii). The gendered structural causes of women’s economic inequalities in Canadian society in conjunction with their care giving loads must be considered or women in general and single mothers in particular, will continue to be vulnerable to social exclusion and to poor health.
For example, support (or lack of) from public social programs play a pivotal role in Canadian women's lives because their lives and various forms of care giving which include children, men, and/or elderly people, are intrinsically linked (Armstrong & Armstrong, 2008). According to Armstrong and Armstrong, eldercare and childcare responsibilities for women have both economic and social costs because of “days lost at paid employment and declining social networks” (p.132). In addition, women report having difficulties with their physical and emotional health as a result of their care giving loads (Armstrong & Armstrong).
Linking a Population Health Approach & Social Exclusion
A population health approach which theoretically supports the understanding of the construct of social exclusion (Guildford, 2000) examines many factors or determinants and their interrelationships which are known to determine population health (Taking Action on Population Health, 1998). Economic and social aspects of exclusion are also well-known determinants of health such as education and income levels, social supports, networks, and sense of control (proxy for coping skills). In addition, socioeconomic characteristics such as gender and culture (Tsakloglou & Papadopoulos, 2002) are also well-known determinants of health and are linked to social exclusion.
Gender is recognized as a social determinant of health and “is a function of the status of women in society and culture (e.g. probability of single parenthood status and its economic consequences or poverty resulting from under/unemployment)” that currently garners limited
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attention from Canadian policy-makers (Public Health Agency of Canada, 2001, p.12). Gender has been linked to social exclusion and poor health outcomes in Canadian society (Reid, 2004). In her longitudinal study, Fortin (2008) found that working-age Canadians (18-54 years) who are persistently poor or under/unemployed are much more likely to be a woman, a single parent, to have less education, and to have far worse health outcomes than those with higher incomes or more stable employment. According to Fleury (2002), a Canadian single parent who is of Aboriginal identity (off-reserve Aboriginal Peoples), and/or has a work-limiting illness or disability, and/or is a high school dropout or student, is at great risk for exclusion.
Economic dimensions of exclusion, such as low education and income levels have been linked to morbidity and mortality rates (Kosteniuk & Dickenson, 2003; Santana, 2002). In addition, economic disadvantage has been linked to perceived health (Bobak et al., 2000; Deaton, 2001). For example, many individuals who have higher educational levels most often have jobs with higher incomes; these fortunate individuals can purchase adequate food with necessary nutritional value for better health (Murrell & Meeks, 2002). Social dimensions of exclusion such as social supports and networks are linked to health outcomes (Berkman et al. 2004) as well as low control beliefs which are also an important consequence of socioeconomic status (Marmot, 2004). The link between Aboriginal identity and social exclusion has been found to be a reflection of “poor quality factors” or determinants of health (Raphael, 2007, p. 215).
When examining social exclusion, like a population health approach, a range of determinants (and their interactions) which link exclusion and health status, would be considered when developing policy responses. Effective policy responses to social exclusion, like a population health approach, would emphasize a collective policy environment in order to achieve its goals: to reduce exclusion and improve the health of all Canadians, as well as to reduce inequities in health outcomes between population groups, such as single mothers.
Using a population health approach, this cross-sectional study only examines associations between sociodemographic characteristics, social exclusion and perceived health and cannot determine causality. Rather than social exclusion leading to poor health, reverse causation is possible: poor health may lead to social exclusion. Authors (Berkman & Melchior, 2006; Bryne, 2005) suggest that the processes of exclusion may negatively influence the health of populations: therefore in our study, we anticipated that a reduction in social exclusion would result in better health. In this study we explored whether or not social exclusion (educational attainment, social supports and networks, perceived sense of control) was linked to perceived health in Saskatchewan single
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mothers, social assistant recipients (Transitional Employment Assistance-TEA) and non-social assistant recipients (Non-TEA).
In 1997, Saskatchewan restructured its social assistance programming with its ‘Building Independence’ program. A new social assistance program called Transitional Employment Assistance (TEA) was developed specifically for applicants who were deemed employable or who would be collecting social assistance for short periods of time until they found employment. Generally, after two or three months, if TEA individuals had not found employment, these individuals were then transferred to the Social Assistance Plan (SAP). Recipients in the SAP program receive higher social assistance benefits than the TEA recipients, and are not required to work. In May 2005, the program was again restructured so that now most applicants for social assistance ‘qualified’ for TEA and could remain on TEA for six months or longer before possible transfer to the SAP program. Most social assistance applicants were now deemed employable, and attachment/re-attachment to the labour market was seen as a priority.
Although, there is currently is no ‘politically-sanctioned consensus’ on what equates a poverty line (ability to purchase basic means) in Canada (Kerr & Michalski, 2005), the most cited ‘poverty line’ in Canadian literature appears to be Statistics Canada’s low-income cutoffs (LICOs). In determining the LICO, income is considered to be money that is acquired by all household members (ages 15 years and over). Although LICOs do not account for territorial or provincial differences in costs of living (i.e. variation in housing rents), they do attempt to account for the differences in the cost of living by site of urban centre and family size. A Saskatchewan single parent with one child in receipt of social assistance (TEA) could receive up to$13, 235.00 per year; the before-taxes Low Income Cut-Offs (LICO) or poverty line was $22, 276.00 per year (National Council of Welfare, 2006). Hypotheses for this study were
Hypothesis 1: TEA mothers will have lower educational levels, a lower sense of control, fewer perceived social supports and networks and poorer perceived health than Non-TEA single mothers. Hypothesis 2: Educational levels, sense of control, perceived social supports and networks will contribute to positive self-rated health in both groups of TEA/Non-TEA single mothers (after controlling for monthly income (before taxes), age in years, Aboriginal identity, children 5 years and under and disability). Data & Methods
In our study, we operationally defined a single mother as ‘an adult female (18 to 59 years) who does not have a current partner (either
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marital or common law), and who lives with at least one dependent child under the age of 18 years (Kapsalis & Tourigny, 2002, p.8). Our study did not omit single mothers who live with their parents. During the study time frame, May, 2005 through February, 2007, there were 30, 846 Saskatchewan single mothers who lived with at least 1 child under the age of 18 years. According to Saskatchewan Community Resources personnel, there were 5, 064 single mothers, who had received social assistance or Temporary Employment Assistance (TEA) for at least 3 months during the study time frame which left 25, 782 Saskatchewan single mothers who had not received TEA (Non-TEA) or any other form of social assistance. Please note, for the remainder of this paper, TEA/Non-TEA single mothers will be referred to as TEA/NON-TEA mothers. In order to assure adequate representation of TEA mothers for this study, we used a stratified (by region) proportionate sampling design. The sample consisted of 2500 respondents: 1250 TEA and 1250 Non-TEA respondents. Each stratum sample size for both TEA and Non-TEA mothers was proportional to the strata population size of TEA mothers who resided within one of Saskatchewan’s’ three major cities, Prince Albert, Regina, or Saskatoon, or in other areas of the province. Out of the total population of 5,064 TEA mothers, Community resources personnel determined that 1,023 or 20% of the total TEA mother population resided in Regina, 1, 305 or 25% resided in Saskatoon, 700 or 15% resided in Prince Albert, and 2,036 or 40% resided in towns, villages or farms. Out of the total population of 25,782 Non-TEA mothers, Department of Health personnel determined that 1,730 or 15% resided in Prince Albert, 4, 944 or 20% resided in Regina, 4,999 or 25% resided in Saskatoon, and 14,109 or 40% resided in towns, villages or farms. Community Resources personnel conducted a simple random sampling method utilizing SPSS 14.0 for the TEA sub-sample (1250 mothers). A dataset of the last TEA payment (with last known address) made to each single mother with at least one child less than 18 years of age was saved and from this dataset, four separate files were created. From these four files, the TEA recipients were randomly selected (Prince Albert (190 households), Regina (250 households), Saskatoon (310 households), and ‘other’ (500 households). A systematic sampling method was used to select the Non-TEA sub-sample (1250 mothers) from the total population of 25,782 single mothers utilizing the provincial health registry (PHR) database. Department of Health personnel selected names from active Health Services Numbers (HSN) which is randomly assigned by computer with the inclusion criteria consisting of single mothers with at least one child less than 18 years of age, and holding regular (no extended benefit i.e. social assistance) coverage. Strata were selected as follows: Prince Albert
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(190 households –every 9th HSN), Regina (250 households-every 19th HSN), Saskatoon (310 households-every 16th HSN) and ‘other’ (500 households-every 28th HSN to all other). A pilot study (Johner, Maslany, & Jeffery, 2007) was conducted prior to data collection in order to ascertain the survey instrument’s readability, completion time and anticipated response rate. Prior to conducting the pilot study and this study that followed, we received research ethics approval from the University of Regina, Research Ethics Board. For ethical reasons, there were only two mail outs of the survey instrument: June 11th and 12th, 2007 and July 11th and 12th, 2007 because Government personnel were concerned about the anticipated ‘burden’ of the ‘captive’ audience of TEA mothers who would be asked to participate in future research. In the first mail out, we received less than 60 TEA respondents. Our TEA response rate more than doubled after the second mail out. The final overall response rate for this study (after accounting for returned undelivered questionnaires-440) received a 19% response rate (404-29 excluded questionnaires/2500-440) (16% response rate for TEA/ 21% response rate for Non-TEA). According to Saskatchewan government personnel, very low response rates for mail surveys similar to our study’s response rates, are anticipated for this population. It is possible that our survey did not reach many of the respondents, as indicated by the 440 questionnaires returned as incorrect addresses. We had no way of knowing how many other questionnaires had incorrect addresses and/or respondents who were no longer single mothers and were simply not returned. Health Department officials indicated that single motherhood status can change hourly. A low response rate may also have been due to the content of our questionnaire: only those interested in health and social exclusion were more likely to respond. According to Statistics Canada, extrapolating population demographics such as having a disability and Aboriginal identity from the 2006 Census can be linked to family structures such as Saskatchewan single mothers; because of small numbers the extrapolation of these data does create reliability issues. Due to our concern of reliability issues, as well as the exorbitant cost factor for the extrapolation of these data, we only had access to limited data to determine the representativeness of our study sample to the Saskatchewan TEA/Non-TEA single mother populations. The median monthly income for the Non-TEA respondents was approximately $2500.00/month (author calculated 1=$600 / 2= $900 / 3= $1100 / 4= $1350 / 5= $1750 / 6= $2500), compared to $2867.00/month for the Non-TEA single mother population (2006 Census); the average number of children was 2.0 for Non-TEA respondents compared to 2.7 for the Non-TEA single mother population (2006 Census). The median monthly income for TEA respondents was
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$1100.00/month (author calculated from 2005/2006 TEA rates) compared to $1000.00/month for the TEA single mother population; 76% of the TEA respondents had 12 years of education or higher compared to 83% of the TEA single mother population (may also include recipients with less than 3 months TEA recipiency) (Government of Saskatchewan Statistics). From these available data, we suggest that our TEA/Non-TEA respondents appear to be fairly representative of the TEA/Non-TEA single mother populations respectively. Although our very low response rate may create statistical power problems because of small numbers (i.e. could effect sub-group analyses, including some of the categories of self-rated health, income and education), we felt that the final sample of 375 respondents was adequate for our projected sub-group analyses (Field, 2005).1 The outcome variable of self-rated health (see Table I) is appropriate for use in general surveys (Bowling, 2005; Manor, Matthews & Power, 2001) has predictive validity for physical disease, changes in functional status, sociodemographic characteristics of respondents, and over time and amoung persons with or without a limiting long-standing illness (Burstrom & Fredlund, 2001; Volkers, Westert, & Schellevis, 2007). Individual sociodemographic characteristics (control variables) were age in years, Aboriginal identity (Non-Aboriginal or Aboriginal), care giving load as number of children 5 years and under (no children versus one or more children), income (before-tax monthly income), and limiting long-standing illness or disability (yes or no). Social exclusion factors were educational attainment (Basic education-10 years or under or 11 years; secondary-12 years; post-secondary-13 or more years), sense of control (Spheres of Control, third version: SOC-3 measure), and social supports (Instrumental Support Evaluation List, short form: ISEL-SF) and networks (Social Network Index: SNI). All variables (see Table I) were chosen on the basis of their empirical relationship to health status, as well as their theoretical relevancy to the construct of social exclusion, (see section, Linking a Population Health Approach & Social Exclusion, p 46).
1 We anticipated an effect size of r2 to be approximately .10 (Rubin & Babbie, 2008). In order to have a .20 probability of committing a Type 2 Error, our study would need a statistical power of .80 which would necessitate a (sub) sample size of approximately 90 cases. A Type 2 Error refers to the acceptance of a null hypothesis (i.e. no difference between groups) when in fact the alternative is true (i.e. there is a difference between groups).
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Table I: Sociodemographic Characteristics of TEA/Non-TEA Single Mothers Reported as Means, Standard Deviations & Percentages
NON-TEA (n=202)
TEA (n=63) p-value
Outcome Variable Self-rated health
Poor/fair Good Very Good Excellent
Percentages 14.9 38.8 30.3 15.9 100.0
Percentages 22.4 43.5 24.2 9.9 100.0
p<0.05
Control Variables Before-tax Monthly Income
Under $800 $800-$1000 Over $1000-$1200 Over $1200-$1500 Over $1500-$2000 Over $2000
9.6 4.0 6.1 9.6 20.2 50.5 100.0
9.4 25.3 19.6 18.3 15.8 11.6 100.0
p<0.001
Aboriginal Identity No Yes
67.3 32.7 100.0
46.6 53.4 100.0
p<0.001
Child 5 & Under No Yes
63.1 36.9 100.0
42.1 57.9 100.0
p<0.001
Disability No Yes
71.0 29.0 100.0
60.5 39.5 100.0
p<0.05
Age-Mean Age in Years (SD) 38.08 (9.3) 32.08 (8.5) p<0.001 Social Exclusion Variables Educational Attainment
10 years & under 11 years 12 years (secondary) 13+ years
Note 1: Sample sizes vary slightly for SOC-3 & ISEL-SF measures because of the odd missing value Note 2: Chi-square tests were conducted for TEA/Non-TEA differences in socioeconomic factors, education, and self-rated health. The t-test was used to test for TEA/Non-TEA age in years, SNI, SOC-3, and ISEL-SF scores.
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Data Analysis
All variables (see Table II) were chosen on the basis of their empirical relationship to health status, as well as to their theoretical relevancy to the construct of social exclusion. SPSS (version 15.0) was used to analyze the data. All variables were first examined using standard univariate techniques (frequency distributions, measures of central tendency, dispersion). Bivariate correlational analysis was used to test for the relationship between sociodemographic characteristics, social exclusion factors and self-rated health. As our choice of predictors was based on their theoretical importance, hierarchical linear regression (blockwise entry) was used to explore the relationships between socioeconomic characteristics (control variables), social exclusion factors (main independent variables) and the dependent variable of perceived health (Field, 2005). Our use of hierarchical linear regression which assumes interval level data, with ordinal Likert scale items, is supported in the literature (Garson, 2008). A p value of < .05 was considered statistically significant in all analyses. Inferentially, results did not change when missing values were replaced with the mean (analysis not shown).
Table II. Description of Study Variables
Variable name Measure Outcome Variable Self-rated Health All in all, how would you say your health is: (1) Poor/ Fair,
(2) Good, (3) Very Good, or (4) Excellent? Social Exclusion Variables Educational Attainment What is the highest level of education that you have completed
:(1) basic education (up to10 years), (2) secondary education including high school or vocational education (11-12 years), and (3) higher or university level education (13 years or more)?
Social Supports (ISEL-SF) (Cohen & Hoberman, 1983)
The ISEL-SF which is a multi-dimensional inventory is a 12-item version of perceived social support derived from the original 40-item general population version of ISEL. The ISEL-SF measure utilizes 4 items from each of the tangible (instrumental), appraisal (emotional) and belonging (companionship) support factors from the original 40-item ISEL measure. Respondents use a 4 point response scale (definitely false, probably false, probably true and definitely true) to indicate the extent that people are available to provide specific support resources, each of which comprises a subscale on the ISEL-SF: (1) instrumental support---perceived availability of financial and physical assistance, (2) emotional informational support---perceived availability of someone who will provide information and advice, and (3) companionship support---perception that one is a member of a community or group with whom one can socialize and identify. Total scores in this study ranged from 16 to 48, with higher scores indicating more perceived availability of specific support resources. In this study, the ISEL-SF reported adequate internal consistency (Cronbach’s [Alpha] = 0.89).
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Social Network Diversity (SNI) (Cohen, 1991)
The SNI is a role-based integration measure that assesses participation in different types of social relations. Number (total 12) of types of social relationships
Social Network Density (SNI) (Cohen, 1991)
Number of people in social relationship types. In this study, the SNI reported adequate internal consistency, (Cronbach’s [Alpha] = 0.77).
Sense of Control (SOC-3) (Paulhus & Van Selst, 1990)
The SOC-3 with a 7-point Likert Scale involves three dimensions of perceived control: control over personal events (i.e. “Once I make plans, I am almost certain to make them work”), interpersonal events (i.e. “I have no trouble making and keeping friends”), and socio-political events (i.e. “It is difficult for us to have much control over the things politicians do in office”). The SOC-3 scale items are presented on a 7-point Likert scale ranging from Totally Inaccurate (1) to Totally Accurate (7). Norms of the SOC-3 with a 7-point Likert Scale range from M=135 to M=140 for female adult respondents (aggregate score). In this study, the SOC-3 reported adequate internal consistency (Cronbach’s [Alpha] = 0.82). The SOC-3, the ISEL-SF, & the SNI have been used in diverse populations, and have indicated good internal consistency, Cronbach’s [Alpha] ranging from 0.80 to 0.92.
Sociodemographic Variables
Age in years Reported birth year Disability Do you have any long-standing disability, illness or infirmity? By
long-standing I mean anything that has troubled you over a period of time, or is likely to affect you over a period of time No= 0, Yes= 1
Less than $800=1, $800-$1000=2, over $1000-$1200=3, over $1200-$1500=4, over $1500-$2000=5, over $2000=6
Received TEA No=0, Yes= 1 In Saskatchewan, there are two social assistance programs: TEA and Social Assistance Plan (SAP). TEA recipients are deemed as employable (healthier?), while SAP recipients are not deemed as employable (less healthy?). Because the majority of single mothers are TEA recipients not SAP recipients, this study only includes TEA recipients. A future study could include both TEA/ SAP single mothers.
RESULTS
For hypothesis 1, chi-square tests were conducted for TEA/Non-TEA differences in socioeconomic factors and self-rated health; the t-test (differences in means) was used to test for TEA/Non-TEA age in years, and the SOC-3, SNI, and ISEL-SF scores. Results in Table I indicate that TEA mothers had significantly poorer perceived health, lower educational levels and fewer perceived social networks (density) than Non-TEA mothers. Hypothesis 1 was partially supported. Differences for social supports, network diversity and sense of control in TEA/ Non-
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TEA mothers were in the expected direction and significant at the 10% level. There was a significant association between (1) whether or not a single mother was a social assistant recipient and self-rated health (χ 2 (3) = 6.8, p< .05),Cramers V= .137; TEA mothers (22.4%) had poorer self-rated health compared to Non-TEA mothers (14.9%), and (2) whether or not a mother was a social assistant recipient and educational attainment (χ 2 (3) = 19.7, p< .001), Cramers V= .233; TEA mothers (24.0%) did not have a secondary education compared to Non-TEA mothers (9.0%). On average, TEA mothers (M= 17.2, SE= .9) had less network density than Non-TEA mothers (M= 21.9, SE= 1.1). This difference was significant t (363) = 3.1, p< .001, which represented a small sized effect, r = .16. There were also significant sociodemographic differences between TEA and Non-TEA mothers (see Table I). On average, TEA mothers (M= 32.0, SE= .7) were younger than Non-TEA mothers (M= 38.0, SE= .66). This difference was significant t (361) = 6.3, p< .001, which represented a medium sized effect, r = .31. There was a significant association between whether or not a mother was a social assistant recipient and (before-tax) monthly income (χ 2 (5) = 87.6, p< .001), Cramers V= .496, Aboriginal identity (χ 2 (1) = 15.4, p< .001), Cramers V= .209, disability (χ 2 (1) = 4.4, p< .05), Cramers V= .111, and having children 5 years and under (χ 2 (1) = 15.6, p< .001), Cramers V= .209. TEA mothers had a higher percentage with Aboriginal identity (53.1%) compared to Non-TEA mothers (32.7%), had a higher percentage with (before-tax) monthly income of under $2000.00 per month (88.4%) compared to Non-TEA mothers (49.5%), had more children 5 years and under (57.9%) compared to Non-TEA mothers (36.9%), and reported more disability (39.5%) compared to Non-TEA mothers (29.0%). In summation, social assistance (TEA) was significantly associated with all of the socioeconomic characteristics: monthly income (before taxes), Aboriginal identity, disability, having children 5 years and under, and age. Some readers may ask (based on hypothesis 1) why a regression model of the whole sample, with TEA/Non-TEA as an independent variable was not included in this paper. A regression model of the whole sample from an earlier paper indicated that TEA was not significant. For hypothesis 2, hierarchical linear regression was used to examine associations between the social exclusion factors and the outcome of self-rated health in TEA and Non-TEA mothers (after controlling for sociodemographic characteristics) (Table III). In Model 1 (Table III), for both TEA and Non-TEA mothers, disability was significantly and negatively associated with self-rated health. For Non-TEA mothers only, Aboriginal identity was significantly and negatively associated with self-rated health, while (before-tax) monthly income was
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significantly and positively associated with self-rated health. Model 1 explained approximately 17% of the variation in self-rated health for TEA mothers (R2 = .17) and approximately 25 % of the variation in self-rated health for Non-TEA mothers (R2 =.25). Table III. Multiple Linear Regression Models Showing the Relationship
of Social Exclusion to the Outcome of Self-rated Health Among Saskatchewan Non-TEA/TEA Single Mothers
B Std.
Error Beta P value
Non-TEA Model 1 Monthly Income (before taxes) Age in Years Aboriginal Identity Child 5 & Under Disability
.142 -.003 -.310 .283 -.835
.047 .009 .148 .166 .146
.240 ** -.025
-.151* .142
-.397***
.003 .775 .037 .091 .000
Model 2 Age in Years Monthly Income (before taxes) Aboriginal Identity Child 5 & Under Disability Educational Attainment Sense of Control Network Diversity Network Density Social Support
Model 1 Monthly Income (before taxes) Age in Years Aboriginal Identity Child 5 & Under Disability
.025 .001 .220 .208 -.654
.049 .011 .146 .177 .150
.043 .013 .125 .117
-.366***
.610 .900 .134 .242 .000
Model 2 Age in Years Monthly Income (before taxes) Aboriginal Identity Child 5 & Under Disability Educational Attainment Sense of Control Network Diversity Network Density Social Support
TEA Model 1 R2 = .169, p<0.001 Non-TEA Model 1 R2 = .247, p<0.001 TEA Model 2 R2 = .292, p<0.001 Non-TEA Model 2 R2 = .402, p<0.001 * p< 0.05 (one-tailed) ** p< 0.01 (one-tailed) *** p< 0.001(one-tailed)
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Hypothesis 2 was partially supported for both TEA/Non-TEA
mothers (see results in Model 2, Table III). In Model 2 (Table III) for Non-TEA mothers, social supports and sense of control were significantly associated with positive self-rated health. For TEA mothers, sense of control was significantly associated with positive self-rated health. Education, social supports and networks were not significantly related. The socioeconomic characteristics and social exclusion factors were entered in the second model. In Model 2 for both TEA and Non-TEA mothers with an increase in disability, there was a decrease in health rating. For both TEA and Non-TEA mothers, with an increase in sense of control, there was an increase in health rating. For Non-TEA mothers’ only, with an increase in (before-tax) monthly income, children 5 years and under and social supports, there was an increase in self-rated health. Model 2 explained approximately 29 % of the variation in self-rated health for TEA mothers (R2 =. 29), and approximately 40% of the variation in self-rated health for Non-TEA mothers (R2 =. 40). Based on Variance Inflation Factor (VIF) diagnostics, and given that the average VIF was close to 1 (Bowerman & O’Connell, 1990, as quoted in Field, 2005), we suggest that collinearity was not a problem for these models. In addition, when we tabulated various measures of association (i.e. Phi, Cramer’s V, Kendall’s tau-b and tau-c, Spearman Correlation, Pearson’s r, bi-serial correlation), we found that for the associations between our dichotomous variables, and between our dichotomous variables and ordinal or interval level variables, the significance levels across the different measures were identical or fairly similar to one another, even though the actual values differed slightly.2
DISCUSSION Our study suggests that social exclusion may be negatively linked to perceived health status in TEA/Non-TEA Saskatchewan single mothers. This result parallels Reid’s (2004) study which linked social exclusion to poor perceived health status in low-income women (n=20) living in the province of British Columbia. Our study does have limitations which include the correlational cross-sectional nature of the study (cannot determine causation), the very small response rate, and the high possibility of sample selection bias (i.e. high educational attainment of most respondents). The complexity of the survey instrument may be responsible for a response bias because some of the questions may have been difficult to understand for less educated respondents. Selection bias
2 For example, the associations between TEA & perceived health were as follows: Cramer’s V .137, p<.05; Spearman .140, p<0.004; Bi-serial correlation .184, p<0.003.
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should be somewhat minimized by the randomization process and may not have a large effect on the internal validity of our findings. However, the randomization process may not help avoid a selective response rate that is non-random. Our low response rates do limit the external validity of our findings. In addition, this study did not measure addiction or violence issues or loss of culture or lands and the residential school experience which are negatively linked to Canadian women’s experience of social exclusion and health outcomes (National Aboriginal Health Organization, 2007; Women in Canada: A Gender-Based Statistical Report, 2006). Our study strengths include the randomization process for sample selection, use of a comparison group, and high numbers of respondents with Aboriginal identity. Other Canadian studies that have examined social exclusion in single mother populations had very limited or no respondents of Aboriginal ethnicity (Reid, 2004; Toronto & Community Neighbourhood Services, 2003). We suggest that our findings should be treated with caution. Our study findings indicated that social and economic dimensions of exclusion were important to single mother’s perceived health. Saskatchewan single mothers felt isolated and did not feel in control of their lives. In addition, Non-TEA Saskatchewan single mothers felt that a lack of sufficient income and not having adequate social supports in times of need was detrimental to their perceived health. The correlational findings from this study lend support to policy recommendations at the macro, meso and micro levels. At the macro level, a human capital approach (i.e. a focus on educational and skill development) to improve single mother’s perceived health status and capacity to fully participate in society (i.e. inclusion) should be emphasized rather than a work-first approach. Social assistance/cash transfers could cover the cost of tuition, books, childcare and transportation. If access to satellite educational opportunities and/or a lack of educational facilities is a barrier for some single mothers, cash transfers, in addition to infrastructure and methods to facilitate access to educational opportunities need to go hand in hand. Using data from the 1996 Census, Vanstone (2004) as cited in Marshall (2007), found that even after adjusting for location (urban versus rural), job type (full time versus part-time), and ethnicity, for Saskatchewan adults, ages 19-54, “the returns to education were higher for women than for men” (i.e. impact on annual incomes per each additional year of schooling). “In every case, the impact of schooling on education was strongly positive and statistically significant” (p.13). Not only does an increase in educational levels support economic inclusion, but as this study’s findings suggest, will have a positive impact on their perceived health status.
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In this study’s findings, social supports and feeling confident or in control over life’s events were important to single mother’s perceived health and inclusion. Meso level interventions could include the facilitation of peer support groups (i.e. single mothers sharing their experiences with other single mothers) in addition to on-going advocacy and mentoring from social workers. Micro level interventions could offer confidence-building programs such as life skills, self-esteem courses and/or academic tutoring if needed. In the study ‘Single Parent Support Employment Program’ (Gallant, D. & Associates, 2002) that examined the exclusion of single mothers who received social assistance found that these mothers rated emotional assistance first, income, and then increased confidence as their top three benefits from the intervention (skill development, peer support, childcare, transportation). Although this study did not include a comparison group nor examine health outcomes, their findings with regard to the importance of social supports and feelings of confidence for single mothers are consistent with this study’s findings. As a final note, findings from this study indicated that over 30% of the single mothers reported having a disability. This finding, which is troubling, requires further investigation, and may indicate other supportive measures (i.e. cost of medication, treatment, equipment) are needed. In conclusion, we suggest that for a just society to exist, the structural causes of Canadian women’s exclusion must be recognized as intrinsically connected to the differential relations that women and men have to the family, to the labour market and to social benefits. Single mothers must be treated equally; in other words, to be given the necessary care giving supports to enjoy good health and fully participate in society. Lastly, we suggest that this study represented a small cross-sectional step towards increasing the theoretical understanding of the construct of social exclusion and its potential link to health outcomes. We agree with Reid (2004) that a population health approach provides a salient perspective for understanding and addressing issues in women’s health outcomes and their inclusion in Canadian society. As Reid states, “The experiences of being stereotyped, excluded and made invisible are closely connected with social, cultural and economic circumstances” (p.17). This study raised important questions for further studies such as: What social links, familial and/or state have the most potential health implications for single mothers, for single mothers who are social assistant recipients, for mothers of Aboriginal identity? Are social links similar or different across Canada? What factors contribute to increases or decreases in single mother’s perceived sense of control? Are these factors similar or different across Canada? As there is limited available data, we suggest that more studies are needed to examine the link
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between social exclusion and health in the vulnerable population of Canadian single mothers. Citizens and policy-makers alike must continue to be informed about social exclusion and its link to health because as Canadian author Raphael (2008) suggests, social determinants of health, such as social exclusion, “shape the health of a society” (p.19).
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