Paid family leave and parental investments in infant health: Evidence from California.

This paper evaluates the effect of Paid Family Leave (PFL) on breastfeeding and immunizations- two critical parental investments in infant health - which we identify using California's 2004 PFL policy that ensured mothers up to six weeks of leave at a 55% wage replacement rate. We employ difference-in-difference and difference-in-difference-in-differences models for a large, representative sample of children (N = 314,532) born between 2000 and 2013 drawn from the restricted-use versions of the 2003-2014 National Immunization Surveys. Our most conservative estimates indicate that access to PFL is associated with at least a 15% increase in breastfeeding exclusively for at least six months. We find substantially large effects for disadvantaged mothers, adding to the existing evidence that access to state-sanctioned paid family leave might benefit children overall and disadvantaged children in particular.

The Impacts of Paid Family and Medical Leave on Worker Health, Family Well-Being, and Employer Outcomes.

This article reviews the evidence on the impacts of paid family and medical leave (PFML) policies on workers' health, family well-being, and employer outcomes. While an extensive body of research demonstrates the mostly beneficial effects of PFML taken by new parents on infant, child, and parental health, less is known about its impact on employees who need leave to care for older children, adult family members, or elderly relatives. The evidence on employers is similarly limited but indicates that PFML does not impose major burdens on them. Taken together, the evidence suggests that PFML policies are likely to have important short- and long-term benefits for population health, without generating large costs for employers. At thesame time, further research is needed to understand the effects of different policy parameters (e.g., wage replacement rate and leave duration) and of other types of leave beyond parental leave.

The effect of data aggregation on estimations of nurse staffing and patient outcomes.

OBJECTIVE: To examine how estimates of the association between nurse staffing and patient length of stay (LOS) change with data aggregation over varying time periods and settings, and statistical controls for unobserved heterogeneity. DATA SOURCES/STUDY SETTING: Longitudinal secondary data from October 2002 to September 2006 for 215 intensive care units and 438 general acute care units at 143 facilities in the Veterans Affairs (VA) health care system. RESEARCH DESIGN: This retrospective observational study used unit-level panel data to analyze the association between nurse staffing and LOS. This association was measured over both a month-long and a year-long period, with and without fixed effects. DATA COLLECTION: We used VA administrative data to obtain patient data on the severity of illness and LOS, as well as labor hours and wages for each unit by month. PRINCIPAL FINDINGS: Overall, shorter LOS was associated with higher nurse staffing hours and lower proportions of hours provided by licensed professional nurses (LPNs), unlicensed personnel, and contract staff. Estimates of the association between nurse staffing and LOS changed in magnitude when aggregating data over years instead of months, in different settings, and when controlling for unobserved heterogeneity. CONCLUSIONS: Estimating the association between nurse staffing and LOS is contingent on the time period of analysis and specific methodology. In future studies, researchers should be aware of these differences when exploring nurse staffing and patient outcomes.

California's paid family leave law improves maternal psychological health.

OBJECTIVE: To study the effect of California's first in the nation paid family leave policy on maternal postpartum psychological distress for women overall and for disadvantaged groups. METHODS: We use restricted data from 11 waves of the National Health Interview Survey, from 2000 to 2010, to examine mothers with children under the age of 12 months (n = 7379). Outcomes included three measures obtained from the six-item Kessler Psychological Distress Scale: an aggregated score and thresholds for mild and moderate psychological distress. For inference, we used synthetic control models, comparing mothers with infants in California to mothers with infants in the control group, pre-law and post-law. RESULTS: Access to paid family leave was associated with a 0.636-point decrease (95% CI = -1.202, -0.070) in postpartum psychological distress symptoms among mothers with infants, representing a 27.6% decrease from the pre-treatment mean. It was also associated with a 9.1 percentage point reduction (95% CI = -17.8, -0.4) in mild postpartum distress, a 38.4% reduction from the pre-treatment mean. Populations that typically lack access to paid family leave, particularly single and younger mothers, may have seen even larger effects. CONCLUSIONS: Paid family leave was associated with improved mental health for California mothers, suggesting that expansions of state or federal paid family leave policies have the potential to improve maternal postpartum health.

Twenty-four/seven: a mixed-method systematic review of the off-shift literature.

AIM: This article is a report of a review that aimed to synthesize qualitative and quantitative evidence of 'off-shifts' (nights, weekends and/or holidays) on quality and employee outcomes in hospitals. BACKGROUND: Healthcare workers provide 24-hour-a-day, 7-day-a-week service. Quality and employee outcomes may differ on off-shifts as compared to regular hours. DATA SOURCES: Searches for studies occurred between the years 1985-2011 using computerized databases including Business Source Complete, EconLit, ProQuest, PubMed and MEDLINE. REVIEW DESIGN AND METHODS: Design was a mixed-method systematic review with quantitative and qualitative studies. To be included, studies met the following criteria: (1) the independent variable was an off-shift; (2) the article was a research study and peer-reviewed; (3) the article could be obtained in English; and (4) the article pertained to health care. Studies were not excluded on design. RESULTS: Sixty studies were included. There were 37 quality outcome, 19 employee outcome and four qualitative studies. In the quality outcome studies, researchers often used quantitative, longitudinal study designs with large sample sizes. Researchers found important differences between patients admitted on weekends and mortality. Important differences were also found between nighttime birth and mortality and rotating night work and fatigue, stress and low mental well-being. Most studies (9 of 12) did not find an important association between patients admitted at night and mortality. CONCLUSION: Patient outcomes on weekends and employee outcomes at night are worse than during the day. It is important to further investigate why care on off-shifts differs from weekly day shifts.