NC1100: A Systems Perspective to Community Resilience: Rural healthcare at the intersection of households and businesses
(Multistate Research Project)
NC1100: A Systems Perspective to Community Resilience: Rural healthcare at the intersection of households and businesses
Duration: 10/01/2021 to 09/30/2026
Statement of Issues and Justification
Typically, rural businesses generate lower revenues and employ fewer employees than their urban counterparts, in part because lower populations and lower income populations generate less demand for what businesses offer yet are dependent upon these offerings. Current assessments indicate that improvements in educational attainment and health status are lagging in rural areas, which threatens rural businesses as well as the vitality and resilience of rural communities. Small businesses are an important key to rural revitalization and prosperity because of their potential to provide employment and goods and services (Gladwin et al., 1989). Small businesses are the subject of research on many fronts, but there is insufficient research with respect to their place in rural community resilience and their ability to enhance health equity. Moreover, there is scant research on the health disparities of women and minority owned small businesses in rural communities.
Over the last four decades, globalization and technological change have altered the nature of work in rural communities. In many cases, global outsourcing has replaced traditional trades in mining, manufacturing, and agriculture. While these trends have affected the entire economy similarly, the slowness or inability of rural areas to recover has created an increasing economic divide between the labor and economic opportunities in urban versus rural communities. This confluence of events has led to the out-migration of the younger, more educated population while leaving in place an older population with skills that may not perfectly match the skills demanded by the types of jobs in the new economy (Dabson, 2018). This leaves in place a workforce that may be discouraged, displaced from previous jobs, and with no previous experience relative to the jobs available in these rural communities. As well, in some rural areas, out-migration has led to a labor shortage of working-age adults.
Rural areas rely on a higher proportion of self-employed and employment in small businesses and microenterprises (Phillipson et al., 2019). Small businesses and microenterprises, in turn, rely on a rural labor force limited by persistent labor obstacles – from labor shortages, lower wages, to slow technological advancement – resulting in lower revenues and lower productivity (Lund et al., 2019; Cromartie, 2017; Partridge et al., 2010). The rural labor force has been deeply affected by issues such as physical and mental impairment (von Reichert et al., 2014), lack of training and education infrastructure (Fletcher et al. 2002; Johnstone et al., 2003), and the prescription opioid-use epidemic (Havens et al., 2007; Wunsch et al., 2009). Current research highlights that health services and workplace training are lagging in rural businesses and have important implications on the overall wellbeing and economic opportunities of rural residents (Watkins et al., 2018; Vogler, 2019).
In particular, rural small businesses are constrained by their limited ability to sustain and promote workers’ mental wellness and productivity. Rural areas have higher behavioral health disparities (Gale et al., 2019), substance abuse (Wunsch et al., 2009), and suicide rates (Ivey-Stephenson, 2017) as compared to urban areas. Because workers’ state of mental wellness implicates physical health and productivity, rural small businesses are facing immense challenges in maintaining labor supply, productivity, and quality. To overcome these challenges, community trainings are instrumental. And yet, these resources are not currently accessible to rural small businesses. Moreover, the existing training programs are typically designed for large urban workers so the resource content may not be directly relevant or useful to rural small businesses. These training programs are also expensive, so are probably cost prohibitive to implement. Hence, the current state of the rural workforce still lacks proper educational support and is rife with worsening health and productivity issues at work leading to a decline in rural labor force participation and slower employment growth (Pender et al., 2019).
Organizations invest a significant number of resources in workforce training and development to improve employees’ technical, management, and supervisory skills (Cromwell and Kolb, 2004). Wellness programs have become increasingly popular among large firms who are looking to improve employee wellbeing. Most workplace wellness programs tend to focus on modifiable risks such as nutrition, physical activity, and smoking cessation (Volpp et al., 2008; Halpern et al., 2015) over a short period. However, workplace wellness programs that have focused on overall employee wellbeing over a longer period (e.g., multi-year) have also examined whether these programs accrued any cost savings (health, absenteeism, etc.) for the employer (Jones et al., 2019; Song and Baciker, 2019).
Behavioral health issues such as depression, anxiety, suicidal thoughts, and mental distress are highly prevalent in rural areas (Gale et al., 2019), as is the dependency on prescription opioid-use (Havens et al., 2007; Wunsch et al., 2009). Research shows that the prescription opioid-use epidemic and the prevalence of behavioral health issues reduce the labor force participation rate and increase unemployment rates (Harris et al., 2020). Hence, it is vital understand the tools available and used by small rural businesses that will help them overcome the challenge of maintaining and developing a skilled and healthy labor force. Current research shows that one way to attract and retain talent is for rural firms to provide non-pecuniary benefits such as skills development, career advancement, tuition assistance, and flexible scheduling (Bozarth and Strifler, 2019). To narrow the skill gap, employers need to actively engage in improving the capability and skills of their workers by engaging in training programs (Marri and Schramm, 2018).
Building and maintaining a skilled workforce is a challenge for rural employers. Thin labor markets mean that demand for labor is low, and relatively little competition for workers suggests that employers have little incentive to invest in workforce development training, be it through training or employee wellness programs. There is also a strong call for communities to recognize and to focus on the pervasive mental health crisis in rural America. A crisis which is credited for affecting employee mental health and leading to decreased worker productivity, quality of work, and worker retention in rural America. Previous research has neglected to study the tools that might help rural small businesses cope with these workforce issues, especially those tools related to workforce wellbeing and retention. Designing innovative solutions to tackle these problems is important not only for enhancing employee wellbeing but also to increase the productivity and functionality of rural small businesses.
Once such approach is the recovery-oriented system of care (ROSC). The Substance Abuse and Mental Health Services Administration (SAMHSA) defines a recovery-oriented system of care as being “a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems.” Over the past decade, ROSCs have been created to address both mental health and substance use. The North Central Cooperative Extension Association (NCCEA) is currently funding an Extension effort focused on ROSC development using a complex adaptive system approach to describe the community relative to the pathways that an individual may take to substance use, their interactions as an active user, and the multiple pathways that may exist for entry into long-term recovery. This current work involves a partnership between Extension at Purdue, Illinois and Ohio State universities.
This novel ROSC model advocates for a broad range of organizations, agencies and employers (businesses), as well as community members, to be included in the system of care. Like the SAMHSA model their conceptual framework is depicted as concentric circles, like a bullseye. In this model, the individual is at the center with support services representing personal contacts in the next layer, coordinated systems representing community assets and organizations in the third circle, and finally, outcomes in the last circle. The innovation is related to how the ROSC is formed and functions. A common hub and spoke approach is replaced with a complex adaptive system that can be catalyzed by Extension, but is not led by any single organization. Instead, the ROSC is an ever-evolving network of connections. Outcomes include both individual and community level measures of success and resilience, recovery, as well as health and wellness goals for the individual.
The personal and community organizations and assets listed in the ROSC framework make up recovery capital. Recovery Capital includes four domains: personal, cultural, family/social, and community. Personal capital are physical and human capitals that a person possesses. Cultural capitals are part of community capitals and represent the availability of culturally based treatment and recovery modalities. Family and social capital is found in supportive relationships which may be in or out of the home, at work, in places of worship, or other social spaces. Lastly, community capitals encompass attitudes among government agencies, policies affecting treatment and recovery services, beliefs of the community at large, and availability of treatment and recovery supports. What remains to be done, from a research perspective, is to determine the optimal role of small business in rural ROSCs and the potential benefits realized by the businesses (increased access to and effective recruitment from a healthy workforce, a decrease in employee retention issues, increased connectivity with community members and organizations and other local businesses, etc.) and individuals in recovery (increased access to employment opportunities, decreased incidence of ‘organizational consequences related to employee performance, etc.).
A systematic theoretical and empirical approach warrants considering simultaneous stressors on the business, family, and employees to understand what leads to small business survival and functioning, enhances human capital, and produces sustainable economic opportunities. This project examines innovative and evidence-based approaches for enhancing workforce development and organizational wellbeing for small rural business owners, with an aim of promoting community prosperity and wellbeing.
Related, Current and Previous Work
Marshall has published extensively for both academic and lay audiences related to family business management. For example, an outcome from the USDA-NIFA-AFRI grant (2015-2020) titled Integrating Family and Business Objectives for Stronger Family Farm Sustainability was the creation of the Purdue Institute for Family Business. The Institute provides multi-generational family businesses with research-based business management resources aimed at improving personal leadership performance and driving operational growth. Data from Dr. Marshall’s 2019 national survey of small businesses (N=510) found that small rural business owners perceived themselves to be less successful than urban business owners, despite the fact that they were not statistically different in terms of cash flow problems and business functionality. The level of functionality across the entire sample was based on the SB-BRAG (Small Business-Balance, Resolve, Adaptability, and Growth) scale developed by Wiatt and Marshall (2017).
Marshall has conducted research on the effect of government policy on rural small business owners (Peake et al., 2007; Marshall and Pushkarskaya, 2008; Pushkarskaya and Marshall, 2010) and non-rural small business owners (Peake and Marshall, 2012; Josephson and Marshall, 2016; Hiramatsu and Marshall, 2018). Marshall has also published extensively related to small business and organizational wellbeing (Alexander and Marshall, 2006; Marshall and Alexander, 2006; Remble et al., 2014; McDonald et al., 2017; Peake and Marshall, 2017; McDonald and Marshall, 2018; Li and Marshall, 2019; Wiatt and Marshall, 2020). She has also published conduct and published research related to small business resilience (Shrank et al., 2013; Marshall et al., 2015; Sydnor et al., 2017; Torres et al., 2019; Wiatt et al., 2021; Marshall and Schrank, 2020).
Marshall is currently working on various research projects related to data she collected in 2019 (survey titled Small Business Values Survey). The projects focus on socioemotional wealth (Marshall and Wiatt, 2020), business functionality (Waitt and Marshall, 2017), work-family balance (Wiatt and Marshall, 2020), culture of collaboration, and owner exit strategies. She has two current funded USDA-AFRI research projects related to small rural business organizational wellbeing and rural small business resilience to natural disasters.
Wilcox’s Extension and research work integrates the economic, environmental and social dimensions of sustainability into addressing community and regional economic issues, with a focus on entrepreneurship, placemaking, and community capacity building. He has been involved in the creation of many different Extension programs at Purdue covering a wide range of topics, from local foods (Rebuilding Your Local Food System), economic development (Hometown Collaboration Initiative, Transforming Your Local and Regional Economy, Stronger Economies Together, Business Retention and Expansion, and Rural Economic Development Innovation (REDI) Initiative), and disaster preparedness and recovery (as Co-PI of the national Extension Disaster Education Network grant). Two standout examples are the innovative Purdue University Extension program, Enhancing the Value of Public Spaces (EVPS) and the sister program, EVPS: Creating Healthy Communities. The program provides a framework for collecting data on community assets and using that data to design a high-quality plan that can guide impactful improvements on public spaces. The program includes intensive, community-driven planning activities including a workshop to bring together key stakeholders and decision makers for collaborative activities that explore best practices for improving public spaces (through healthy eating and active living). The program emphasizes forming partnerships to achieve community goals and to strategically guide policy, systems and environmental changes relevant to promoting healthy communities through high value public spaces.
Examples of Wilcox’s recent applied research agenda has included an in-depth cacao supply chain analysis in Colombia (resulting in a national baseline for Extension-related services to the sector and recently serving as the basis for a $20 million+ investment in Colombia to aid farmers through research and Extension); a multi-methods community input analysis for West Lafayette Parks and Recreation (informing their five year Master Plan); collaboration with Indiana AARP to examine quality of life issues affecting senior residents in the Indianapolis and Fort Wayne regions (resulting in an action plan for community engagement); and collaborating on a study focused on the socio-economic effects of wind energy in Indiana (providing decision-makers an unbiased, data driven analysis of the sector).
Potential Collaboration with other Multistate Projects
The following three NCR multistate projects were found to be potential partners for collaboration based on their stated objectives.
- NC1030: Sustainable and Resilient Systems: Transformative Response to Disruptions by Families, Businesses, and Communities. Objectives:
- Identify and measure the sources of major change and disruption and the structural barriers that impact the family/household, the business or the community.
- Identify and measure transformative responses to the positive and negative impacts of change and disruption on the family/household, the business, or the community.
- Determine and inform policy or practice related to the wellbeing of the family, the business, or the community.
- NC1171 Individual, family, and community factors associated with resilience in diverse, rural, low-income families. Objectives:
- Community Capacity: To assess community capacity to support resilience in diverse rural low-income families.
- Individual and family resilience processes: To examine individual and family resilience processes from the perspective of rural, low-income mothers.
- NC2172 Behavioral economics and the intersection of healthcare and financial decision making across the lifespan. Objectives:
- Understanding family resource management under uncertainties over life span.
- Identifying personal characteristics and contextual factors contributing to household financial and health decisions.
- Understanding how financial capability affects household health decisions and outcomes.
- Understanding how health conditions affect household financial decisions.
Identify the strategies used by small rural businesses to maintain and develop a skilled and healthy labor force.
Assess the effect of workforce wellness programs on firm outcomes such as employee retention and profitability.
Assess the impact of health disparities on the wellbeing of households and business owning households in rural communities.
Exploring the role of rural small businesses in community-based efforts to address substance use disorder.
Our systems approach will seek to engage research and Extension at all of the land-grant institutions across the North Central Region (NCR). This will require direct, intentional engagement by the NCRCRD with these institutions through research and Extension networks.
NCR Rural Small Business Data
A North Central regional dataset will be developed as a venue and incentive for interdisciplinary collaboration across states and across research and Extension. The Center would collect and maintain the data. The Center along with the Advisory Committee would develop a policy for its use and distribution.
Data will be collected from small business owners. In this study, we strategically define small businesses as enterprises with less than or equal to 100 employees. The Small Business Administration broadly defines small businesses as those with less than 500 employees. However, according to the US Census Bureau data, in 2015, 98% of small firms had less than 100 employees. A list of businesses in a county with contact information such as address, phone number, and email, is accessible through the Reference USA U.S. Business Database. We estimate that 60,000 rural small businesses across the NCR will be needed to achieve a sample of 6,000 small businesses (500 per state). Most of the data collection will be conducted via Qualtrics® online survey tool. The online surveys through Qualtrics® are designed to be suitable for cross-platform data collection. They ensure that surveys are optimized for respondents on all devices, screen sizes, and orientations, which enhances data quality. However, we recognize the other contact methods such as mail and telephone may be needed to collect the necessary data from rural small business owners.
Prior studies focusing on the importance of health, demographic, socioeconomic, and family factors have also used secondary data such as the Medical Expenditure Panel Surveys (MEPS) and Current Population Surveys (CPS). We will also use a large-sample dataset, the Integrated Public Use Microdata Series (IPUMS) American Community Surveys (ACS) data to collect information.
Wellness Program Evaluation
We will disseminate and evaluate a workplace wellness program titled Small Business Health and Organizational Well-being (SHOW), which has been proposed by colleagues at Purdue and Virginia Tech and empirically determine the effectiveness of the program in improving workplace culture and enhancing employee well-being in small rural businesses. The wellness workshop SHOW is intended to reduce workplace stressors and improve organizational climate by embedding competencies in learning, change, and teamwork. This project examines two key sets of skills related to wellbeing. First, emotional skills refer to the use of healthy strategies to recognize, express, and process emotions (Davies et al., 2010). Second, conflict management skills address the need for positive personal and interpersonal wellness. Both emotional skills and conflict management skills contribute to better mental wellbeing and relationship quality. Taken together, we expect, the SHOW training program, to increase workers’ levels of emotional skills, conflict management skills, motivation, and markers of wellness.
Enhancing the Integration of the Small Business Sector in Community-led Solutions
We will leverage the dissemination of the program titled Community Action to Address Substance Use and deepen the connection to economic development and community resiliency by evaluating the current role of small businesses in community-based efforts to combat substance use disorder and identifying best practices that can be adopted the local level. The program is a community‐based approach that relies on input and collaboration from a broad range of stakeholders that will foster the development of a robust system of care that is culturally aware, trauma‐informed, resilient and sustainable. This approach incorporates prevention efforts but goes well beyond to also address the needs of those currently actively using or at risk for relapse.
This collaborative process includes those providing treatment, support services, law enforcement, the justice system, first responders, healthcare, harm reduction programs, academic institutions, and any other relevant organizations/institutions that may exist within a community. Essential to this proposed work will be a focused attention on small business and workforce development. Through the NCCEA grant, the Extension team has already begun this work through an initial asset mapping exercise process that will result in a unique ROSC map for each pilot community.
Because each community has different resources, assets, and needs, each collaboration and system map will be unique. Although gaps and barriers are highlighted, a community asset-based approach can help create new and reinforce existing relationships that bridge gaps in services as well as changing community beliefs and practices. Through this proposal, NCRCRD will work with the NCCEA-funded team to conduct research on the role of small business and workforce development. This will strengthen the technical assistance offered by the Extension team, deepen the detail of the map and help coalition members successfully address gaps and remove barriers that small businesses are facing – in terms of serving the ROSC, benefiting from a healthy workforce and connecting with their community.
Measurement of Progress and Results
- NCR Panel dataset Comments: a. Policy guide on collection and use of data b. Survey instrument for panel dataset c. Dataset
- Scholarly work such as academic publications and Extension publications
- Newsletter artilces
- Webinar series on rural workforce development and rural health
- Grant proposals to federal agencies and foundations
- Train-the-trainer program related to Small Business Health and Organizational Well-being (SHOW)
- Applied research project examining the role of small business in the Community Action to Address Substance Use pilot efforts in Illinois, Indiana and Ohio. Addition of small business and workforce development-related module in Community Action to Address Substance Use curriculum.
Outcomes or Projected Impacts
- Increased busines owner awareness of wellness programs
- Increased employee retention
- Improved organizational wellness
- Increased business productivity
- Increased resilience of rural communities and economies
- Increased small business growth
- Improved community health and wellness
- Increased partnerships across the region in both research and Extension programs.
- Increased funding for research and Extension faculty and staff across the region.
- Increased capacity for Extension faculty and staff to enhance rural development through education.
- Increased research capacity that leads to transformational change for rural communities.
- Increased dissemination of the collective impact of each regional community development programmatic efforts, to NIFA and other stakeholders.
Milestones(2021):Secondary data collection
(2022):Survey development and data collection
(2022):Development and implementation of Small Business Health and Organizational Well-being (SHOW) program (2022-2023)
Projected ParticipationView Appendix E: Participation
The findings and activities of the project will be disseminated via the NCRCRD website. We will also provide academic publications, Extension publications, and published curricula focused on the three thematic areas and a quarterly newsletter. A quarterly webinar series that reflects the thematic areas and work of the region focused on rural development will also be offered. The NCRCRD will facilitate workshops and train-the-trainer opportunities across the region to Extension professionals.
The North Central Regional Center for Rural Development will provide coordination services for the multistate project. Administrative guidance will be provided by an assigned Administrative Advisor and a NIFA Representative. Dialog and consensus modes will be used to form work teams and execute joint projects.
Alexander, C. and M.I. Marshall. 2006. The Risk Matrix: Motivating the Importance of Risk Management Strategies. Journal of Extension, 22(2).
Bozarth, A. and W.M. Strifler. 2019. Strengthening Workforce Development in Rural Areas. Federal Reserve Bank of Atlanta. Special Topic Brief. https://www.investinwork.org/reports
Cromartie, J. 2017. Rural America at a Glance (No. 1476-2017-5675).
Cromwell, S.E. and J.A. Kolb. 2004. An Examination of Work‐Environment Support Factors Affecting Transfer of Supervisory Skills Training to the Workplace. Human Resource Development Quarterly, 15(4):449-471.
Dabson, B. 2018. The Rural Dimensions of Workforce Development. In Andreason, S., T. Greene, H. Prince, & C.E. Van Horn (eds.) Investing in America’s Workforce: Improving Outcomes for Workers and Employers, Volume 2: Investing in Work. pp 183-194. Kalamazoo MI: W.E. Upjohn Institute for Employment Research.
Davies, K.A., A.M. Lane, T.J. Devonport, and J.A. Scott. 2010. Validity and Reliability of a Brief Emotional Intelligence Scale (BEIS-10). Journal of Individual Differences, 31(4): 198-208.
Fletcher, C.N., J.L. Flora, B.J. Gaddis, M. Winter, and J.S. Litt. 2002. Small Towns and Welfare Reform: Iowa Case Studies of Families and Communities. In Rural Dimensions of Welfare Reform, edited by Bruce A. Weber, Greg J. Duncan, and Leslie A. Whitener. Kalamazoo, MI: W.E. Upjohn Institute for Employment Research.
Gale J, Janis J, Coburn A, Rochford H. 2019. Behavioral Health in Rural America: Challenges and Opportunities. Iowa City, IA: Rural Policy Research Institute; December. Executive Summary.
Gladwin, C.H., B.F. Long, E.M. Bab, L.J. Beaulieu, A. Moseley, D. Mulkey, and D.J. Zimet. 1989. Rural Entrepreneurship: One Key to Rural Revitalization. American Journal of Agricultural Economics, 71(5): 1305-1314.
Halpern, S.D., French, B., Small, D.S., Saulsgiver, K., Harhay, M.O., Audrain-McGovern, J., Loewenstein, G., Brennan, T.A., Asch, D.A. and Volpp, K.G. 2015. Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation. New England Journal of Medicine, 372: 2108-2117.
Harris, M.C., Kessler, L.M., Murray, M.N. and Glenn, B. 2020. Prescription Opioids and Labor Market Pains: The Effect of Schedule II Opioids on Labor Force Participation and Unemployment. Journal of Human Resources, 55(4): 1319-1364.
Havens, J.R., Oser, C.B., Leukefeld, C.G., Webster, J.M., Martin, S.S., O'Connell, D.J., Surratt, H.L. and Inciardi, J.A. 2007. Differences in Prevalence of Prescription Opiate Misuse Among Rural and Urban Probationers. The American Journal of Drug and Alcohol Abuse, 33(2):309-317.
Hiramatsu, T. and M.I. Marshall. 2018. The Long-Term Impact of Disaster Loans: The Case of Small Businesses after Hurricane Katrina. Sustainability, 10(7): 2364.
Ivey-Stephenson, A.Z., Crosby, A.E., Jack, S.P., Haileyesus, T. and Kresnow-Sedacca, M.J., 2017. Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death—United States, 2001–2015. MMWR Surveillance Summaries, 66(18).
Johnstone, B., T. Price, T. Bounds, L.H. Schopp, M. Schootman, and D. Schumate. 2003. Rural/Urban Differences in Vocational Outcomes for State Vocational Rehabilitation Clients With TBI. NeuroRehabilitation, 18(3):197-203.
Jones, D., Molitor, D. and Reif, J., 2019. What Do Workplace Wellness Programs Do? Evidence From the Illinois Workplace Wellness Study. The Quarterly Journal of Economics, 134(4): 1747-1791.
Josephson, A., and M.I. Marshall. 2016. The Demand for Post-Katrina Disaster Aid: SBA Disaster Loans and Small Businesses in Mississippi. Journal of Contingencies and Crisis Management, 24(4): 264-274
Li, W. and M.I. Marshall. 2019. Gender and Business Owner Satisfaction: The Case of Farm and Non-Farm Family Businesses in the Midwest. Journal of Family Business Management, 9(4): 416-428.
Lund, S., J. Manyika, L.H. Segel, A. Dua, B. Hancock, S. Rutherford, and B. Macon. 2019. The Future of Work in America: People and Places, Today and Tomorrow. McKinsey Global Institute.
McDonald, T.M., M.I. Marshall, and M.S., Delgado. 2017. Is Working with Your Spouse Good for Business? The Effect of Working with Your Spouse on Profit for Rural Businesses. Journal of Family and Economic Issues, 38: 477-493.
McDonald, T.M. and M.I. Marshall. 2018. Family Business Responses to Household and Business Cash-Flow Problems. Journal of Family and Economic Issues, 39(1): 163-176.
Marri, A and J. Schramm. 2018. Leveraging Evidence-Based and Practical Strategies to Reduce Skills Gaps, S., T. Greene, H. Prince, & C.E. Van Horn (eds.) Investing in America’s Workforce: Improving Outcomes for Workers and Employers, Volume 1: Investing in Work. pp 11-15. Kalamazoo MI: W.E. Upjohn Institute for Employment Research.
Marshall, M.I. and C. Alexander. 2006. Using A Contingency Plan to Combat Human Resource Risk. Journal of Extension, 22(2).
Marshall, M.I. and H. Pushkarskaya. 2008. What Did They Do With the Money? An Analysis of Tobacco Buyout Recipients’ Expenditure Choices. Journal of Agribusiness, 26(2): 175-198.
Marshall, M.I, L.S. Niehm, S.B. Sydnor, and H.L. Schrank. 2015. Predicting Small Business Demise after a Natural Disaster: An Analysis of Pre-Existing Conditions. Natural Hazards, 79: 331-354.
Marshall, M.I. and H. Schrank. 2020. Sink or Swim? Impacts of Management Strategies on Small Business Survival and Recovery. Sustainability, 12(15): 6229.
Marshall, M.I. and Wiatt, R. Only in the Family? Socioemotional Wealth Among Small Family and Non-Family Businesses. IFERA Conference 2020.
Partridge, M.D., D.S. Rickman, K. Ali, and M.R. Olfert. 2010. The spatial dynamics of factor price differentials: productivity or consumer amenity driven? Regional Science and Urban Economics, 40(6):440-452.
Peake, W.O., M.I. Marshall, and P.V. Preckel. 2007. “A Ranking of State Governments’ Efficient Use of Expenditures to Encourage Small Firm Births. Journal of Small Business Strategy, 18(2): 43-55.
Peake, W.O. and M.I. Marshall. 2012. Exploring Why the Self-Employed Are Less Likely to Have Healthcare Coverage: An Empirical Analysis. Small Business Institute Journal, 8(1): 16-29.
Peake, W.O. and M.I. Marshall. 2017. Women’s Management Practices and Performance in Rural Female-Owned Family Businesses. Journal of Family Business Management, 7(2): 134-150.
Pender, J., T. Hertz, J. Cromartie, and T. Farrigan. 2019. Rural America at a Glance, 2019 Edition, Economic Information Bulletin 301077, United States Department of Agriculture, Economic Research Service.
Phillipson, J., P. Tiwasing, M. Gorton, S. Maioli, R. Newbery, and R. Turner. 2019. Shining a spotlight on small rural businesses: How does their performance compare with urban? Journal of Rural Studies, 68:230-239.
Pushkarskaya, H. and M.I. Marshall. 2010. Family Structure, Policy Shocks, and Family Business Adjustment Choices. Journal of Family and Economic Issues, 31(4): 414-426.
Remble, A.A., M.I. Marshall, and R. M. Keeney. 2014. Household Saving Behavior and the Influence of Family-Owned Businesses. Journal of Family and Economic Issues, 35(3): 411-422.
Schrank, H.L., M.I. Marshall, A. Hall-Phillips, R. Wiatt, and N.E. Jones. 2013. Small Business Demise and Recovery after Katrina: Rate of Survival and Demise. Natural Hazards, 65(3): 2353-2374.
Song, Z. and Baicker, K., 2019. Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial. JAMA, 321(15): 1491-1501.
Sydnor, S, L. Niehm, Y.G. Lee, M.I. Marshall, and H. Schrank. 2017. An Analysis of Post-Disaster and Disruptive Impacts on the Operating Status of Small Businesses after Hurricane Katrina. Natural Hazards, 85:1637-1663.
Wiatt, R. and M.I. Marshall. 2017. FB-BRAG: A Family Business Functioning Assessment. Journal of Extension. https://joe.org/joe/2017october/tt10.php.
Torres, A.P., M.I. Marshall, and S. Sydnor. 2019. Does Social Capital Pay Off? The Case of Small Business Resilience after Hurricane Katrina. Journal of Contingencies and Crisis Management, 27(2): 168-181.
Vogler, J., 2019. Rural Hospital Closures and Local Economic Decline. Working Paper. https://drive.google.com/file/d/13JKT0ePlRhBiMQZ6IKc2dFDdUCTC2o0-/view
Volpp K.G., L.K. John LK, A.B. Troxel, L. Norton, J. Fassbender, G. Loewenstein. 2008. Financial Incentive-Based Approaches for Weight Loss: A Randomized Trial. JAMA. 300(22): 2631-2637.
von Reichert, C., L. Greiman, A. Myers and Rural Institute, University of Montana. 2014. The Geography of Disability in America: On Rural-Urban Differences in Impairment Rates. Independent Living and Community Participation. 7. https://scholarworks.umt.edu/ruralinst_independent_living_community_participation/7
Watkins, C., G. Macy, V. Golla, G. Lartey, and J. Basham. 2018. The “Total Worker Health” Concept: A Case Study in a Rural Workplace. Journal of Occupational and Environmental Medicine, 60(5):387-391.
Wiatt, R.D., Y. Lee, M.I. Marshall, and V. Zuiker. 2021. The Effect of Cash Flow Problems and Resource Intermingling on Business Recovery and Resilience after a Natural Disaster. Journal of Family and Economic Issues, 42: 203-214.
Wiatt, R.D. and M.I. Marshall. 2020. Love of Work or Love and Work? Workaholism among Small Business Owners. 2020 Small Business Institute Conference Proceedings, 44(1): 105-120.
Wunsch, MJ, K. Nakamoto, G. Behonick, W. Massello. 2009. Opioid deaths in rural Virginia: a description of the high prevalence of accidental fatalities involving prescribed medications. American Journal of Addiction, 18(1):5–14.