State paid family leave policies and infant maltreatment.

BACKGROUND: Growing research points to economic policies as protective mechanisms for vulnerable families. Research on pediatric abusive head trauma suggests that paid family leave (PFL) may protect infants in the general population from physical abuse. OBJECTIVE: To examine the association of state-level paid family leave policies with infant (ages 0-1) maltreatment rates. PARTICIPANTS AND SETTING: A state-level panel dataset was constructed from the National Child Abuse and Neglect Data System (2002-2019) data on infant maltreatment investigations among four states with PFL (California, New Jersey, New York, and Rhode Island) and 36 states without PFL. METHODS: A piecewise longitudinal model and a nested model comparison were conducted to estimate the treatment effect of PFL on the population rate of infant maltreatment investigations. Supplementary analyses examined the moderating effect of three covariates. RESULT: PFL reduced the linear rate of change in infant maltreatment rates in the states where it was enacted by a factor of 0.979 for each year post-policy implementation compared to states without such policies, B = -0.021, SE = 0.008, 95 % CI = [-0.036,-0.005]. Examining treatment states only, the slope of infant maltreatment became significantly shallower post-policy implementation, χ2(1) = 3.178, p = .075. Interactions testing the moderating effects of family poverty and adults with less than high school education were significant, B = -0.304, 95 % CI = [-0.564,-0.052]; B = -0.511, 95 % CI = [-0.799,-0.249], respectively. CONCLUSION: Results suggest that PFL has a beneficial effect on infant maltreatment rates and add to growing evidence that policies aimed to support household economic stability could be a vital child maltreatment prevention policy tool.

The Impacts of New York State's Paid Family Leave Policy on Parents' Sleep and Exercise.

OBJECTIVES: To assess changes in young parents' health behaviors following implementation of New York State's Paid Family Leave Program (NYSPFL). METHODS: We used synthetic control (N = 117,552) and difference-in-differences (N = 18,973) models with data from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2019 to provide individual-level estimates of the effects of NYSPFL on self-reported exercise in the past month and average daily sleep of adults aged 21-30 years living with one or more children under 18 years of age in New York and comparison states. RESULTS: Synthetic control model results indicate that the NYSPFL increased the likelihood of exercise in the past month among mothers, single parents, and low-income parents by 6.3-10.3% points (pp), whereas fathers showed a decrease in exercise (7.8 pp). Fathers, single parents, and those with two or more children showed increases in daily sleep between 14 and 21 min per day. CONCLUSIONS FOR PRACTICE: State paid family and medical leave laws may provide benefits for health behaviors among young parents with children under 18, particularly those in low-income and single-parent households.

Respiratory Syncytial Virus Bronchiolitis Hospitalizations in Young Infants After the Introduction of Paid Family Leave in New York State, 2015‒2019.

Objectives. To determine if the introduction of New York State's 8-week paid family leave policy on January 1, 2018, reduced rates of hospitalizations with respiratory syncytial virus (RSV) bronchiolitis or any acute lower respiratory tract infection among young infants. Methods. We conducted an interrupted time series analysis using New York State population-based, all-payer hospital discharge records, October 2015 to December 2019. We estimated the change in monthly hospitalization rates for RSV bronchiolitis and for any acute lower respiratory tract infection among infants aged 8 weeks or younger after the introduction of paid family leave while controlling for temporal trends and RSV seasonality. We modeled RSV hospitalization rates in infants aged 1 year as a control. Results. Hospitalization rates for RSV bronchiolitis and any acute lower respiratory tract infection decreased by 30% after the introduction of paid family leave (rate ratio [RR] = 0.71; 95% confidence interval [CI] = 0.54, 0.94; and RR = 0.72; 95% CI = 0.59, 0.88, respectively). There were no such reductions in infants aged 1 year (RR = 0.98; 95% CI = 0.72, 1.33; and RR = 1.17; 95% CI = 1.03, 1.32, respectively). Conclusions. State paid family leave was associated with fewer RSV-associated hospitalizations in young infants. (Am J Public Health. 2022;112(2):316-324. https://doi.org/10.2105/AJPH.2021.306559).

COVID-19-related absence among surgeons: development of an international surgical workforce prediction model.

BACKGROUND: During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. METHODS: An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). RESULTS: Based on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7-12, this decreased to 9.2-13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19. CONCLUSION: This framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.

Type and Lengths of Family Leave Among New York City Women: Exploring the Composition of Paid and Unpaid Leave.

INTRODUCTION: Paid family leave (PFL) is an important protective policy mechanism to support the health of mothers and children and the economic security of families This paper explores the links of employment and demographic characteristics on leave type and lengths of overall, paid, and unpaid leave in a large city in the United States. METHODS: Using a sample of 601 women who worked during pregnancy from the 2016 New York City Work and Family Leave Survey, multinomial and linear regression models were used to assess disparities in the type and length of leave taking. RESULTS: Women eligible for the Family and Medical Leave Act (FMLA) have higher relative likelihood to take only paid leave (RRR = 6.588, p < 0.01). While Black women utilized 3.739 weeks of leave more than white women overall, holding all else constant (p < 0.1), this additional leave is composed of 4.739 more weeks of unpaid leave (p < 0.05). Shortened leave taking by women with less than a college degree is driven by fewer weeks of paid leave (p < 0.01). DISCUSSION: Using unique data from a survey of recent mothers in New York City, this study provides deeper understanding of disparities in the composition of leave. This study adds to the literature by identifying disparities in leave composition that are masked in consideration of total lengths of leave for Black women and those not eligible for FMLA protections. Given the consequences of short leave taking and reliance on unpaid leave, examination of leave composition is required to identify and address disparities.

Direct and indirect costs of families with a child with acute lymphoblastic leukaemia in an academic hospital in China: a cross-sectional survey.

OBJECTIVES: To estimate the direct and indirect costs in families with a child with acute lymphoblastic leukaemia (ALL) in China. DESIGN: A single-site, cross-sectional survey of primary caregiver of a child with ALL was performed. SETTING AND PARTICIPANTS: We analysed the total costs incurred on the completion of the first three-phase treatment (induction, consolidation and intensification), which requires intensive hospitalisation. Eligible patients were (1) diagnosed with ALL between 2010 and 2012 at Shanghai Children's Medical Center (SCMC), (2) aged 0-14 years at diagnosis and (3) completed the first three-phase treatment at SCMC. The data were collected between October 2014 and December 2014. OUTCOME MEASURES: We decomposed the total costs into three categories: (1) direct medical costs, which were further divided into outpatient and inpatient costs; (2) direct non-medical costs, which referred to expenses incurred in relation to the illness; and (3) indirect costs due to productivity loss. RESULTS: A total of 161 patients were included in the study. Direct medical costs accounted for about 51.7% of the overall costs, and the rest of 48.3% of the total costs were attributed to direct non-medical costs and indirect costs. Regarding families with different household registration type (rural vs urban), the total costs were significantly different between the two groups (US$36 125 vs US$25 593; p=0.021). Specifically, urban families incurred significantly larger indirect costs than rural families (US$12 343 vs US$4157; p=0.018). Although the direct non-medical costs were not significantly different, urban families spent more money on hygiene cleaning products and auxiliary treatment equipment (p=0.041) and gifts and treats (p=0.034) than rural families. CONCLUSIONS: The financial burden faced by the Chinese families with a child with ALL was tremendous, and the distributions of costs among the three categories were different between urban and rural families.

Classification tree model of the personal economic burden of dementia care by related factors of both people with dementia and caregivers in Japan: a cross-sectional online survey.

OBJECTIVE: The purpose of this study was to clarify the microlevel determinants of the economic burden of dementia care at home in Japanese community settings by classifying them into subgroups of factors related to people with dementia and their caregivers. DESIGN: A cross-sectional online survey. PARTICIPANTS: 4313 panels of Japanese research company who fulfilled the following criteria: (1) aged 30 years or older, (2) non-professional caregiver of someone with dementia, (3) caring for only one person with dementia and (4) having no conflicts of interest with advertising or marketing research entities. PRIMARY OUTCOME MEASURES: Informal care costs and out-of-pocket payments for long-term care (LTC) services. RESULTS: From 4313 respondents, only 1383 caregivers in community-settings were included in this analysis. We conducted a χ² automatic interaction detection analysis to identify the factors related to each cost (informal care costs and out-of-pocket payments for LTC services) divided into subcategories. In the resultant classifications, informal care cost was mainly related to caregivers' employment status. When caregivers acquired family care leave, informal care costs were the highest. On the other hand, out-of-pocket payments for LTC were related to care-need levels and family economic status. Activities of Daily Living and Instrumental Activities of Daily Living functions such as bathing, toileting and cleaning were related to all costs. CONCLUSION: This study clarified the difference in dementia care costs between classified subgroups by considering the combination of the situations of both people with dementia and their caregivers. Informal care costs were related to caregivers' employment and cohabitation status rather to the situations of people with dementia. On the other hand, out-of-pocket payments for LTC services were related to care-need levels and family economic status. These classifications will be useful in understanding which situation represents a greater economic burden and helpful in improving the sustainability of the dementia care system in Japan.

The Effect of California's Paid Family Leave Program on Employment Among Middle-Aged Female Caregivers.

BACKGROUND AND OBJECTIVES: This study examined the effect of a Paid Family Leave program in California (CA-PFL) on employment among middle-aged female caregivers. We also examined differences in the relationship between the availability of paid family leave (PFL) and employment in socioeconomic subgroups of midlife women. RESEARCH DESIGN AND METHODS: Data came from multiple years (2000‒2014) of the Current Population Survey (CPS) (N = 68,773 individuals). Applying a Difference in Differences (DiD) approach to removing potential selection biases related to program participation, we used a logistic regression to estimate the effects of PFL. RESULTS: There was a significant increase in the likelihood of working based on CA-PFL. This positive effect, however, was found only among the early middle-aged, the near-poor, and those had the highest level of education. DISCUSSION AND IMPLICATIONS: Among the late middle-aged, caregiving burden may not affect decisions on whether to exit the labor market, and PFL may not significantly mitigate the well-known negative effects of intense and multiple caregiving roles (parents, spouse, and/or children with disabilities). Future studies should examine PFL effects and their correlates such as age-cohorts, caregiving intensity, and retirement patterns. The unexpected null findings of CA-PFL's effect on employment outcomes for the poor and those with low education levels suggests these vulnerable groups might not be able to fully benefit from the originally intended goal of the policy, instead being left more vulnerable compared to the near poor. Such a possibility increases the importance of focused research and policymaking attention for this group.

Child Influenza Vaccination and Adult Work Loss: Reduced Sick Leave Use Only in Adults With Paid Sick Leave.

INTRODUCTION: Children are a population of interest for influenza. They are at increased risk for severe influenza, comprise a substantial portion of influenza morbidity, and significantly contribute to its transmission in the household and subsequent parental work loss. The association between influenza vaccination and work loss prevention, however, has rarely been studied, and the sparse existing literature has very limited generalizability to U.S. adults, thus requiring better characterization. METHODS: Using pooled National Health Interview Survey data (2013-2015, analyses conducted in 2018) nationally representative of working U.S. adults with household children (n=23,014), zero-inflated negative binomial regression examined the association of child influenza vaccination (exposure) with sick days (outcome) stratified by paid sick leave (no: n=10,741, yes: n=12,273). RESULTS: Child influenza vaccination was associated with significantly lower sick day usage, but only among adults with paid sick leave (prevalence rate ratio=0.79, 95% CI=0.67, 0.93), equating to average annual sick days of 4.07 vs 3.29 in adults with unvaccinated versus vaccinated household children (difference=0.78 fewer days annually). CONCLUSIONS: Influenza vaccination of children is associated with reduced sick leave in household adults, helping to keep the workforce healthy and reduce influenza's costly annual economic burden. This only occurred among adults with paid sick leave, however, which is distributed inequitably by income, education, gender, occupation, and race/ethnicity. Health in All Policies considers downstream health effects of social and economic policy; the failure of federal policy to ensure paid sick leave likely contributes to propagating influenza and health inequities.

Did California Paid Family Leave Impact Infant Health?

The effects of paid parental leave policies on infant health have yet to be established. In this paper we investigate these effects by exploiting the introduction of California Paid Family Leave (PFL), the first program in the U.S. that specifically provides working parents with paid time off for bonding with a newborn. We measure health using the full census of infant hospitalizations in California and a set of control states, and implement a differences-in-differences approach. Our results suggest a decline in infant admissions, which is concentrated among those causes that are potentially affected by closer childcare (and to a lesser extent breastfeeding). Other admissions that are unlikely to be affected by parental leave do not exhibit the same pattern.

Paid Family Leave, Fathers' Leave-Taking, and Leave-Sharing in Dual-Earner Households.

Using difference-in-difference and difference-in-difference-in-difference designs, we study California's Paid Family Leave (CA-PFL) program, the first source of government-provided paid parental leave available to fathers in the Unites States. Relative to the pre-treatment mean, fathers of infants in California are 46 percent more likely to be on leave when CA-PFL is available. In households where both parents work, we find suggestive evidence that CA-PFL increases both father-only leave-taking (i.e., father on leave while mother is at work) and joint leave-taking (i.e., both parents on leave at the same time). Effects are larger for fathers of first-born children than for fathers of later-born children.

Does Paid Family Leave Reduce Nursing Home Use? The California Experience.

The intent of Paid Family Leave (PFL) is to make it financially easier for individuals to take time off from paid work to care for children and seriously ill family members. Given the linkages between care provided by family members and the usage of paid services, we examine whether California's PFL program influenced nursing home utilization in California during the 1999 to 2008 period. This is the first empirical study to examine the effects of PFL on long-term care patterns. Multivariate difference-indifference estimates across alternative comparison groups provide consistent evidence that the implementation of PFL reduced the proportion of the elderly population in nursing homes by 0.5 to 0.7 percentage points. Our preferred estimate, employing an empirically-matched group of control states, finds that PFL reduced nursing home usage by about 0.65 percentage points. For California, this represents an 11 percent relative decline in elderly nursing home utilization.

Utilization of the Family and Medical Leave Act in Radiology Practices According to the 2016 ACR Commission on Human Resources Workforce Survey.

PURPOSE: To assess gender utilization of the Family and Medical Leave Act (FMLA) in radiology practices across the United States. METHODS: The Practice of Radiology Environment Database was utilized to identify U.S. practice leaders, who were asked to complete an electronic survey developed by the ACR Human Resources (HR) Commission. In 2016, new survey questions asked about number of radiologists in each practice who took FMLA, the reasons why, the average number of weeks taken, and how such absences were covered. RESULTS: Thirty-two percent (579/1815) of practice group leaders responded to the survey and of these, 73% (432/579) answered FMLA questions, with 15% of those (64/432) answering affirmatively that a radiologist in their practice had taken FMLA leave. Reasons for this in 2015 included to care for a newborn/adopted child (49%), because of a personal serious health condition (42%), to care for an immediate family member (8%), or for active military duty (1%). Women took a greater number of weeks of FMLA leave than men for all reasons (care of newborn/adopted child: 10.7 versus 4.7; personal serious health condition: 10.3 versus 8.0; care of immediate family member: 9.7 versus 8.7) except for military duty (24 weeks taken, all by men). At least 69% of leave time was paid, irrespective of reason for leave or gender of person taking it. Most practices (82%) made no workforce changes to cover FMLA leave. CONCLUSIONS: Both genders of radiologists needed absences from work for FMLA-sanctioned reasons.

Caregiver Leave-Taking in Spain: Rate, Motivations, and Barriers.

This paper aims to (1) determine the rate of (full- and part-time) caregiver leave-taking in Spain, (2) identify the reasons conducive to a more intense use of this resource, and (3) ascertain the main obstacles to its use, as perceived by caregivers. All 896 people covered by the sample were engaging in paid work and had cared for dependent adults in the last 12 years. This resource, in particular the full-time alternative, was found to be a minority option. The data showed that legal, work-related, and family and gender norm issues are the four types of factors that determine the decision to take such leaves. The most significant obstacles to their use are the forfeiture of income and the risk of losing one's job. Our results suggest that income replacement during a leave would increase the take-up of these resources. Moreover, enlargement of public care services would promote the use of leave as a free choice of caregivers.

The effects of California's paid family leave program on mothers' leave-taking and subsequent labor market outcomes.

This analysis uses March Current Population Survey data from 1999 to 2010 and a differences-in-differences approach to examine how California's first in the nation paid family leave (PFL) program affected leave-taking by mothers following childbirth, as well as subsequent labor market outcomes. We obtain robust evidence that the California program doubled the overall use of maternity leave, increasing it from an average of three to six weeks for new mothers--with some evidence of particularly large growth for less advantaged groups. We also provide evidence that PFL increased the usual weekly work hours of employed mothers of 1- to 3-year-old children by 10 to 17 percent and that their wage incomes may have risen by a similar amount.

Modifiable health risks and illness absence from work: evidence from the panel study of income dynamics.

OBJECTIVE: Modifiable health risks such as smoking, exercise, and body weight have been linked to illness absence from work. This suggests that employers could improve their productivity if their workers adopted healthier lifestyles, but methodological concerns regarding selection bias and omitted variables remain. METHODS: We use a first-difference model of changes in health behaviors and illness- and family-related absence from work among a nationally representative, longitudinal panel of employed individuals. RESULTS: Workers who lost weight or increased their frequency of light exercise also saw their illness absences decrease over a 2-year period. Some, but not all, of the relationship is mediated by the change in health status. No such decrease was observed for family-related absences. CONCLUSION: The findings are consistent with the proposition that both employers and employees could benefit from efforts to support better health habits.

How important are work-family support policies? A meta-analytic investigation of their effects on employee outcomes.

This meta-analysis examines relationships between work-family support policies, which are policies that provide support for dependent care responsibilities, and employee outcomes by developing a conceptual model detailing the psychological mechanisms through which policy availability and use relate to work attitudes. Bivariate results indicated that availability and use of work-family support policies had modest positive relationships with job satisfaction, affective commitment, and intentions to stay. Further, tests of differences in effect sizes showed that policy availability was more strongly related to job satisfaction, affective commitment, and intentions to stay than was policy use. Subsequent meta-analytic structural equation modeling results indicated that policy availability and use had modest effects on work attitudes, which were partially mediated by family-supportive organization perceptions and work-to-family conflict, respectively. Additionally, number of policies and sample characteristics (percent women, percent married-cohabiting, percent with dependents) moderated the effects of policy availability and use on outcomes. Implications of these findings and directions for future research on work-family support policies are discussed.