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Raub A, Heymann J. Supporting children's health needs: an analysis of paid leave policies in 193 countries. Glob Public Health 2023; 18:2062028. [PMID: 35405079 DOI: 10.1080/17441692.2022.2062028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/18/2022] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic has highlighted the extent to which national laws and policies shape public health and economic security. Paid leave policies enable parents to meet children's health needs while maintaining job and income security. These policies matter immensely to children's health every year. Yet, little is known about the extent to which policies exist to support the full range of childhood health needs. Using a novel dataset constructed from legislative text in 193 countries, this study assesses whether laws in place in 2019 are adequate to support meeting children's everyday, serious, and disability-related health needs. Globally, only half of the countries guaranteed working parents access to any paid leave that could be used to meet children's health needs. Only a third addressed everyday health needs, including leave that matters to reducing infectious disease spread. For serious health needs, even when paid leave was available, it was often too short for complex health conditions. Moreover, although all children require parental presence at medical appointments and for serious illness, fewer countries guaranteed paid leave to care for older children than younger. Addressing these gaps is crucial to supporting child health and working families during times of public health crisis and every year.
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Affiliation(s)
- Amy Raub
- WORLD Policy Analysis Centre, University of California Los Angeles, Los Angeles, CA, USA
- School of Social and Political Sciences, University of Melbourne, Melbourne, Australia
| | - Jody Heymann
- WORLD Policy Analysis Centre, University of California Los Angeles, Los Angeles, CA, USA
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Foster CC, Chorniy A, Kwon S, Kan K, Heard-Garris N, Davis MM. Children With Special Health Care Needs and Forgone Family Employment. Pediatrics 2021; 148:e2020035378. [PMID: 34433691 PMCID: PMC9219960 DOI: 10.1542/peds.2020-035378] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Family income is known to affect child health, but this relationship can be bidirectional. We sought to characterize this relationship by quantifying forgone family employment (FFE) due to a child's health condition in families of children with special health care needs (CSHCN) with updated figures. METHODS We conducted a secondary data analysis from the 2016-2017 National Survey of Children's Health. CSHCN with previously employed caregivers were included (N = 14 050). FFE was defined as any family member having stopped work and/or reduced hours because of their child's health or health condition. Child, caregiver, and household characteristics were compared by FFE status. Logistic regression analysis was conducted to evaluate the association between hours of medical care provide by a family member and FFE. US Bureau of Labor Statistics reports were used to estimate lost earnings from FFE. RESULTS FFE occurred in 14.5% (95% confidence interval [CI] 12.9%-16.1%) of previously employed families with CSHCN and was 40.9% (95% CI 27.1%-54.7%) for children with an intellectual disability. We observed disproportionately high FFE among CSHCN who were 0 to 5 years old and of Hispanic ethnicity. We found a strong association between FFE and increasing hours of family-provided medical care, with an adjusted odds ratio (aOR) of 1.72 (95% CI 1.25-2.36) for <1 hour per week (compared with 0 hours), an aOR of 5.96 (95% CI 4.30-8.27) for 1 to 4 hours per week, an aOR of 11.89 (95% CI 6.19-22.81) for 5 to 10 hours per week, and an aOR of 8.89 (95% CI 5.26-15.01) for >10 hours per week. Lost earnings for each household with FFE were estimated at ∼$18 000 per year. CONCLUSIONS With our findings, we highlight the need to implement programs and policies that address forgone income experienced by families of CSHCN.
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Affiliation(s)
- Carolyn C Foster
- Division of Advanced General Pediatrics and Primary Care, Departments of Pediatrics
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anna Chorniy
- Medical Social Sciences
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine
- Institute for Policy Research, Northwestern University, Chicago, Illinois
| | - Soyang Kwon
- Division of Advanced General Pediatrics and Primary Care, Departments of Pediatrics
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care, Departments of Pediatrics
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Departments of Pediatrics
- Institute for Policy Research, Northwestern University, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Departments of Pediatrics
- Medical Social Sciences
- Medicine and Preventive Medicine
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Khan MS. Paid family leave and children health outcomes in OECD countries. CHILDREN AND YOUTH SERVICES REVIEW 2020; 116:105259. [PMID: 32834274 PMCID: PMC7367791 DOI: 10.1016/j.childyouth.2020.105259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 06/04/2023]
Abstract
During the past four decades, most OECD (Organisation for Economic Co-operation and Development) countries have adopted or expanded paid family leave, which offers leave to workers following the birth or adoption of a child as well as care for ill family members. While the effects of paid maternity leave on child health have been the subject of a large body of research, little is known about fathers' leave-taking and the effects of paid paternity leave. This is a limitation, since most of the recent expansion in paid family leave in OECD countries has been to expand leave benefits to fathers. Mothers' and fathers' leave-taking may improve child health by decreasing postpartum depression among mothers, improving maternal mental health, increasing the time spent with a child, and increasing the likelihood of child medical checkup. The purpose of this paper is to examine the effects of paid family leave on the wellbeing of children, extending what we know about the effects of maternity leave and establishing new evidence on paternity leave. The paper examines the effects of paid family leave expansions on country-level neonatal mortality rates, infant mortality rates, under-five mortality rates, and the measles immunization rates in 35 OECD countries, during the time period of 1990 to 2016. Using an event study design, an approximately 1.9-5.2 percent decrease in the infant, neonatal, and under-five mortality rates has been found following the adoption of paid maternity leave. However, the beneficial impact is not as visible for extension of paid leave to fathers. The implications and potential reasons behind the larger protective effects of maternity leave over paternity leave on child health outcomes are discussed.
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Affiliation(s)
- Mariam S Khan
- Department of Public Administration & Policy, American University, 4400 Massachusetts Avenue, Washington, D.C. 20016, United States
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Seixas BV, Macinko J. Unavailability of paid sick leave among parents is a barrier for children's utilization of nonemergency health services: Evidence from the National Health Interview Survey. Int J Health Plann Manage 2020; 35:1083-1097. [PMID: 32567169 DOI: 10.1002/hpm.2988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/03/2020] [Accepted: 05/01/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To assess the association between availability of paid sick leave among parents and children's use of several distinct types of nonurgent health services and emergency care. METHODS Using pooled 2013 to 2017 data from the National Health Interview Survey (NHIS), we created dyadic units of observation linking adults with their children (n = 21 235). Descriptive statistics, logistic regressions for binary outcomes, and regular and zero-inflated negative binomial regressions for count outcomes assessed the relationship between parental coverage by paid sick leave benefits and 12 dependent variables related to health care utilization. Regression analyses controlled for a set of child, parent, and family covariates. RESULTS Overall, 58.3% of individuals in our sample reported having paid sick leave in their current or latest job. There are substantial disparities in availability of paid sick leave in terms of parent sex, race, education, and income. Controlling for covariates, the odds of children with at least one parent with access to paid sick leave having any visit to a medical office in the past 12 months are 27% higher than for children whose parents do not have this benefit. Similar positive associations were observed for general doctor visit (OR = 1.18, 95%CI: 1.05-1.32), mental health professional visit (OR = 1.19, 95%CI: 1.01-1.42), and receipt of flu vaccination (OR = 1.21, 95%CI: 1.11-1.33). There was no statistically significant association with emergency room use, once covariates were controlled. CONCLUSIONS Availability of paid sick leave among parents is associated with increased children's utilization of nonemergency health services and primary care.
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Affiliation(s)
- Brayan V Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - James Macinko
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The Impact of Parental and Medical Leave Policies on Socioeconomic and Health Outcomes in OECD Countries: A Systematic Review of the Empirical Literature. Milbank Q 2018; 96:434-471. [PMID: 30277601 DOI: 10.1111/1468-0009.12340] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Policy Points: Historically, reforms that have increased the duration of job-protected paid parental leave have improved women's economic outcomes. By targeting the period around childbirth, access to paid parental leave also appears to reduce rates of infant mortality, with breastfeeding representing one potential mechanism. The provision of more generous paid leave entitlements in countries that offer unpaid or short durations of paid leave could help families strike a balance between the competing demands of earning income and attending to personal and family well-being. CONTEXT Policies legislating paid leave from work for new parents, and to attend to individual and family illness, are common across Organisation for Economic Co-operation and Development (OECD) countries. However, there exists no comprehensive review of their potential impacts on economic, social, and health outcomes. METHODS We conducted a systematic review of the peer-reviewed literature on paid leave and socioeconomic and health outcomes. We reviewed 5,538 abstracts and selected 85 published papers on the impact of parental leave policies, 22 papers on the impact of medical leave policies, and 2 papers that evaluated both types of policies. We synthesized the main findings through a narrative description; a meta-analysis was precluded by heterogeneity in policy attributes, policy changes, outcomes, and study designs. FINDINGS We were able to draw several conclusions about the impact of parental leave policies. First, extensions in the duration of paid parental leave to between 6 and 12 months were accompanied by attendant increases in leave-taking and longer durations of leave. Second, there was little evidence that extending the duration of paid leave had negative employment or economic consequences. Third, unpaid leave does not appear to confer the same benefits as paid leave. Fourth, from a population health perspective, increases in paid parental leave were consistently associated with better infant and child health, particularly in terms of lower mortality rates. Fifth, paid paternal leave policies of adequate length and generosity have induced fathers to take additional time off from work following the birth of a child. How medical leave policies for personal or family illness influence health has not been widely studied. CONCLUSIONS There is substantial quasi-experimental evidence to support expansions in the duration of job-protected paid parental leave as an instrument for supporting women's labor force participation, safeguarding women's incomes and earnings, and improving child survival. This has implications, in particular, for countries that offer shorter durations of job-protected paid leave or lack a national paid leave entitlement altogether.
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Affiliation(s)
- Arijit Nandi
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Deepa Jahagirdar
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Michelle C Dimitris
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Jeremy A Labrecque
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Erin C Strumpf
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University.,Department of Economics, McGill University
| | - Jay S Kaufman
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Ilona Vincent
- Institute for Health and Social Policy, McGill University
| | - Efe Atabay
- Institute for Health and Social Policy, McGill University
| | - Sam Harper
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Alison Earle
- Fielding School of Public Health, University of California
| | - S Jody Heymann
- Fielding School of Public Health, University of California
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Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home. J Perinat Neonatal Nurs 2014; 28:305-12. [PMID: 24927295 DOI: 10.1097/jpn.0000000000000021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines qualitatively the concerns and coping mechanisms of fathers and mothers of very low-birth-weight (VLBW; <1500 g) neonatal intensive care unit (NICU) infants as they transition to home from the NICU. In-depth, semistructured phone interviews were conducted with a sample of fathers and mothers of VLBW NICU infants in the Chicago area who had transitioned home, and parental concerns were examined during the transition to home. Phone interviews lasting 30 to 60 minutes were transcribed verbatim, and all interviews were coded using content and narrative analysis. Twenty-five parents (10 fathers, 15 mothers) of 16 VLBW infants who had an average gestational age of 29.5 weeks and an average NICU stay of 58.38 days completed the interview. Overriding concerns included pervasive uncertainty, lingering medical concerns, and partner-related adjustment concerns that differed by gender. A variety of resilient coping methods during this stressful transition are also described. Fathers and mothers of VLBW NICU graduates have evolving but often differing concerns as they transition from the NICU to home. Many of these concerns can be addressed with improved discharge information exchanges and anticipatory guidance. Supporting parents during this stressful and often difficult transition may lead to decreased family stress, improved care, and better infant outcomes.
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Nakamura MM, Toomey SL, Zaslavsky AM, Berry JG, Lorch SA, Jha AK, Bryant MC, Geanacopoulos AT, Loren SS, Pain D, Schuster MA. Measuring pediatric hospital readmission rates to drive quality improvement. Acad Pediatr 2014; 14:S39-46. [PMID: 25169456 DOI: 10.1016/j.acap.2014.06.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 06/13/2014] [Accepted: 06/18/2014] [Indexed: 01/19/2023]
Abstract
The Pediatric Quality Measures Program is developing readmission measures for pediatric use. We sought to describe the importance of readmissions in children and the challenges of developing readmission quality measures. We consider findings and perspectives from research studies and commentaries in the pediatric and adult literature, characterizing arguments for and against using readmission rates as measures of pediatric quality and discussing available evidence and current knowledge gaps. The major topic of debate regarding readmission rates as pediatric quality measures is the relative influence of hospital quality versus other factors within and outside of health systems on readmission risk. The complex causation of readmissions leads to disagreement, particularly when rates are publicly reported or tied to payment, about whether readmissions can be prevented and how to achieve fair comparisons of readmission performance. Despite these controversies, the policy focus on readmissions has motivated widespread efforts by hospitals and outpatient providers to evaluate and reengineer care processes. Many adult studies demonstrate a link between successful initiatives to improve quality and reductions in readmissions. More research is needed on methods to enhance adjustment of readmission rates and on how to prevent pediatric readmissions.
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Affiliation(s)
- Mari M Nakamura
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
| | - Sara L Toomey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Mass
| | - Jay G Berry
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Scott A Lorch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Ashish K Jha
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass; Division of General Medicine, Brigham and Women's Hospital, Boston, Mass; Veterans Affairs Boston Healthcare System, Boston, Mass
| | - Maria C Bryant
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | | | - Samuel S Loren
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Debanjan Pain
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Mark A Schuster
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
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Affiliation(s)
- Mark A Schuster
- From the Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, and Harvard Medical School - both in Boston (M.A.S.); RAND, Santa Monica, CA (M.A.S., P.J.C.); and the Department of Pediatrics, David Geffen School of Medicine at UCLA, and the Department of Health Policy and Management, UCLA Fielding School of Public Health - both in Los Angeles (P.J.C.)
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Berry JG, Toomey SL, Zaslavsky AM, Jha AK, Nakamura MM, Klein DJ, Feng JY, Shulman S, Chiang VW, Kaplan W, Hall M, Schuster MA. Pediatric readmission prevalence and variability across hospitals. JAMA 2013; 309:372-80. [PMID: 23340639 PMCID: PMC3640861 DOI: 10.1001/jama.2012.188351] [Citation(s) in RCA: 319] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge. OBJECTIVE To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals. DESIGN, SETTING, AND PATIENTS We analyzed 568,845 admissions at 72 children's hospitals between July 1, 2009, and June 30, 2010, in the National Association of Children's Hospitals and Related Institutions Case Mix Comparative data set. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and Chronic Condition Indicators. Hospitals with adjusted readmission rates that were 1 SD above and below the mean were defined as having "high" and "low" rates, respectively. MAIN OUTCOME MEASURES Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULTS The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n = 36,734). Adjusted rates were 28.6% greater in hospitals with high vs low readmission rates (7.2% [95% CI, 7.1%-7.2%] vs 5.6% [95% CI, 5.6%-5.6%]). For the 10 admission diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs low readmission rates. For example, sickle cell rates were 20.1% (95% CI, 20.0%-20.3%) vs 12.7% (95% CI, 12.6%-12.8%) in high vs low hospitals, respectively. CONCLUSIONS AND RELEVANCE Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was significant variability in readmission rates across conditions and hospitals. These data may be useful for hospitals' quality improvement efforts.
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Affiliation(s)
- Jay G Berry
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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Access to leave benefits for primary caregivers of children with special health care needs: a double bind. Acad Pediatr 2013; 13:222-8. [PMID: 23477748 PMCID: PMC3659309 DOI: 10.1016/j.acap.2013.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 12/29/2012] [Accepted: 01/03/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Family leave benefits are a key tool that allow parents to miss work to care for their ill children. We examined whether access to benefits varies by level of childcare responsibilities among employed parents of children with special health care needs (CSHCN). METHODS We conducted telephone interviews with 3 successive cohorts of employed parents of CSHCN, randomly sampled from a California children's hospital. At Wave 1 (November 2003 to January 2004), we conducted 372 parent interviews. At Wave 2 (November 2005 to January 2006), we conducted 396 parent interviews. At Wave 3 (November 2007 to January 2008), we conducted 393 parent interviews. We pooled these samples for bivariate and multivariate regression analyses by using wave indicators and sample weights. RESULTS Parents with more childcare responsibilities (primary caregivers) reported less access to sick leave/vacation (65% vs 82%, P < .001), access to paid leave outside of sick leave/vacation (41% vs 51%, P < .05), and eligibility for Family and Medical Leave Act benefits (28% vs 44%, P < .001) than secondary caregivers. Part-time employment and female gender largely explained 2 of the 3 associations between more childcare responsibilities and less access to leave benefits. Even in the context of part-time employment, however, primary caregivers were just as likely as secondary caregivers both to miss work due to their child's illness and to report being unable to miss work when they needed to. CONCLUSIONS Due in part to employment and gender differences, leave benefits among parents of CSHCN are skewed away from primary caregivers and toward secondary caregivers. Thus, primary caregivers may face particularly difficult choices between employment and childcare responsibilities. Reducing this disparity in access to benefits may improve the circumstances of CSHCN and their families.
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Locher JL, Rucks AC, Spencer SA, Pettaway GJ, Kilgore ML. Influenza immunization in older adults with and without cancer. J Am Geriatr Soc 2012; 60:2099-103. [PMID: 23126598 DOI: 10.1111/j.1532-5415.2012.04196.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the likelihood of receiving an influenza immunization in older adults before and immediately after a cancer diagnosis occurring in 2001 and for the same time periods with older adults not diagnosed with cancer. DESIGN Retrospective analysis comparing influenza immunization rates of Medicare beneficiaries with and without a diagnosis of cancer. SETTING Surveillance, Epidemiology, and End Results-Medicare Data. PARTICIPANTS Propensity score matching matched a group of 35,229 persons without cancer with 35,257 individuals diagnosed with cancer in 2001. MEASUREMENTS Receipt of influenza vaccination based upon Medicare Claims Data. RESULTS A difference-of-difference analysis revealed that influenza immunization rates increased over time for persons diagnosed with cancer (46.8% before to 50.8% after cancer diagnosis), but the increase was greater in beneficiaries without a cancer diagnosis (42.6% to 79.7%) (P < .001; 95% confidence interval = 0.320-0.324). Logistic regression analysis revealed that individuals without a cancer diagnosis were 7.25 times as likely to receive an influenza immunization. CONCLUSION Older adults who have been recently diagnosed with cancer receive influenza immunizations at much lower rates than older adults who have not been diagnosed with cancer despite interaction with healthcare providers. Opportunities exist to improve influenza immunization in this population, who are susceptible to influenza because of compromised immune systems.
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Affiliation(s)
- Julie L Locher
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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12
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Chung PJ, Lui CK, Cowgill BO, Hoffman G, Elijah J, Schuster MA. Employment, family leave, and parents of newborns or seriously ill children. Acad Pediatr 2012; 12:181-8. [PMID: 22459063 PMCID: PMC3352967 DOI: 10.1016/j.acap.2012.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 02/14/2012] [Accepted: 02/18/2012] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Parents of newborns and children with special health care needs (CSHCN) often experience conflict between employment and family responsibilities. Family leave benefits such as the federal Family and Medical Leave Act and California's Paid Family Leave Insurance program help employed parents miss work to bond with a newborn or care for an ill child. The use of these benefits, however, is rare among mothers of CSHCN and fathers in general and limited even among mothers of newborns. We explored barriers to and experiences with leave-taking among parents of newborns and CSHCN. METHODS We conducted semistructured qualitative interviews in 2008 with 10 mothers and 10 fathers of newborns and 10 mothers and 10 fathers of CSHCN in Los Angeles to explore their need for and experiences with family leave. Qualitative analytical techniques were used to identify themes in the transcripts. RESULTS All parents reported difficulties in accessing and using benefits, including lack of knowledge by employers, complexity of rules and processes, and inadequacy of the benefits themselves. Parents of CSHCN also described being too overwhelmed to rapidly seek and process information in the setting of urgent and often unexpected health crises. Most parents expressed a clear desire for expert guidance and saw hospitals and clinics as potentially important providers. CONCLUSIONS Even when parents are aware of family leave options, substantial barriers prevent many, especially parents of CSHCN, from learning about or applying for benefits. Clinics and hospitals might be opportune settings to reach vulnerable parents at times of need.
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Affiliation(s)
- Paul J. Chung
- Department of Pediatrics, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, CA,Department of Health Services, UCLA School of Public Health, Los Angeles, CA,RAND Health, RAND Corporation, Santa Monica, CA
| | - Camillia K. Lui
- Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA
| | - Burton O. Cowgill
- Division of Cancer Prevention and Control Research, UCLA School of Public Health, Los Angeles, CA
| | - Geoffrey Hoffman
- Department of Health Services, UCLA School of Public Health, Los Angeles, CA
| | - Jacinta Elijah
- Division of Cancer Prevention and Control Research, UCLA School of Public Health, Los Angeles, CA
| | - Mark A. Schuster
- RAND Health, RAND Corporation, Santa Monica, CA,Division of General Pediatrics, Department of Medicine, Children’s Hospital Boston,Department of Pediatrics, Harvard Medical School
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Sorensen G, Landsbergis P, Hammer L, Amick BC, Linnan L, Yancey A, Welch LS, Goetzel RZ, Flannery KM, Pratt C. Preventing chronic disease in the workplace: a workshop report and recommendations. Am J Public Health 2011; 101 Suppl 1:S196-207. [PMID: 21778485 DOI: 10.2105/ajph.2010.300075] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Chronic disease is the leading cause of death in the United States. Risk factors and work conditions can be addressed through health promotion aimed at improving individual health behaviors; health protection, including occupational safety and health interventions; and efforts to support the work-family interface. Responding to the need to address chronic disease at worksites, the National Institutes of Health and the Centers for Disease Control and Prevention convened a workshop to identify research priorities to advance knowledge and implementation of effective strategies to reduce chronic disease risk. Workshop participants outlined a conceptual framework and corresponding research agenda to address chronic disease prevention by integrating health promotion and health protection in the workplace.
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Affiliation(s)
- Glorian Sorensen
- Harvard School of Public Health and the Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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Earle A, Heymann J. Protecting the health of employees caring for family members with special health care needs. Soc Sci Med 2011; 73:68-78. [PMID: 21669484 DOI: 10.1016/j.socscimed.2011.05.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 04/09/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
Abstract
Over half of American workers are holding a paid job while also providing unpaid assistance and support to a family member. Research shows that family members who provide care to children or adults with special health care needs are themselves at risk of physical and mental health problems. Yet, little research has explored how the work environment mediates the effects of caregiving on caregivers' mental and physical health. With a sample of 2455 currently employed U.S. adults from the Work, Family, Community Nexus (WFCN) survey, a random-digit dial, nationally representative survey of Americans aged 18-69, we examine whether paid leave and flexibility policies mediate the relationship between caregiving and health. In Ordinary Least Squares regression models, we find that paid leave to address family members' health was associated with better mental health status as measured by the 5-item Mental Health Inventory and paid sick leave with better physical health status as measured by self-rated overall health status. A supportive supervisor was also associated with improvements in mental and physical health. For both men and women, paid leave and a supervisor's support offset some or all of the negative effects of caregiving, but for women, the buffering effects of working conditions are slightly larger. Enhancing the unpaid leave guaranteed in the U.S. Family and Medical Leave Act so that it is paid and passing national paid sick days legislation will help ensure that employed caregivers can retain their jobs, receive needed income, and meet their own mental and physical health needs.
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Affiliation(s)
- Alison Earle
- Institute on Urban Health Research, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA.
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