Access to and use of paid sick leave among low-income families with children.

OBJECTIVE: The ability of employed parents to meet the health needs of their children may depend on their access to sick leave, especially for low-income workers, who may be afforded less flexibility in their work schedules to accommodate these needs yet also more likely to have children in poor health. Our goal was to provide rates of access to paid sick leave and paid vacation leave among low-income families with children and to assess whether access to these benefits is associated with parents' leave taking to care for themselves or others. METHODS: We used a sample of low-income families (<200% of the federal poverty level) with children aged 0 to 17 years in the 2003 and 2004 Medical Expenditure Panel Survey to examine bivariate relationships between access to and use of paid leave and characteristics of children, families, and parents' employer. RESULTS: Access to paid leave was lower among children in low-income families than among those in families with higher income. Within low-income families, children without >or=1 full-time worker in the household were especially likely to lack access to this benefit, as were children whose parents work for small employers. Among children whose parents had access to paid sick leave, parents were more likely to take time away from work to care for themselves or others. This relationship is even more pronounced among families with the highest need, such as children in fair or poor health and children with all parents in full-time employment. CONCLUSIONS: Legislation mandating paid sick leave could dramatically increase access to this benefit among low-income families. It would likely diminish gaps in parents' leave taking to care for others between families with and without the benefit. However, until the health-related consequences are better understood, the full impact of such legislation remains unknown.

Survival and changes in comorbidities after bariatric surgery.

OBJECTIVE: To evaluate survival rates and changes in weight-related comorbid conditions after bariatric surgery in a high-risk patient population as compared with a similar cohort of morbidly obese patients who did not undergo surgery. SUMMARY BACKGROUND DATA: Morbid obesity is increasingly becoming a major public health issue. Existing studies are limited in their ability to assess the risks and benefits of bariatric surgery because few studies compare surgical patients to a similar, morbidly obese, nonsurgical cohort, especially in high-risk populations like the elderly and disabled. METHODS: A retrospective cohort analysis using Medicare fee-for-service patients from 2001 to 2004. Survival rates and diagnosed presence of 5 conditions commonly comorbid with morbid obesity were examined for morbidly obese patients who did and did not undergo bariatric surgery, with up to 2 years follow-up. RESULTS: Morbidly obese Medicare patients who underwent bariatric surgery had increased survival rates over the 2 years of this study when compared with a similar morbidly obese nonsurgical group (P < 0.001). For patients under the age of 65, this survival advantage started at 6 months postoperatively and for patients over age 65, at 11 months. The surgical group also experienced significant improvements in the diagnosed prevalence of 5 weight-related comorbid conditions (diabetes, sleep apnea, hypertension, hyperlipidemia, and coronary artery disease) relative to the nonsurgical cohort after 1 year postsurgery (P < 0.001). CONCLUSIONS: Bariatric surgery appears to increase survival even in the high-risk, Medicare population, both for individuals aged 65 and older and those disabled and under 65. In addition, the diagnosed prevalence of weight-related comorbid conditions declined after bariatric surgery relative to a control cohort of morbidly obese patients who did not undergo surgery.

Does treating maternal depression improve child health management? The case of pediatric asthma.

Past studies have demonstrated an association between maternal depression and poor management of pediatric asthma. Using an instrumental variables strategy to address the endogeneity of depression treatment, I build on this literature to answer the question of whether treating maternal depression leads to an improvement in pediatric asthma management. I show that treatment of mother's depression improves management of child's asthma, resulting in a reduction in asthma costs in the 6-month period following diagnosis of $798 per asthmatic child whose mother is treated for depression.

Preventive care for children in low-income families: how well do Medicaid and state children's health insurance programs do?

OBJECTIVE: Child health problems that are caused or exacerbated by health behaviors remain a leading cause of medical spending for children. We examined receipt of clinician advice by low-income children, comparing children who had public insurance with those who had private insurance, as well as with children who were uninsured for part or all of the year. METHODS: We used children who were aged 3 to 17 and living in families with incomes of <250% of the federal poverty level in the Medical Expenditure Panel Survey data from 2001 to 2003 to estimate linear probability models on receipt of preventive advice. The main outcome measures were receipt of clinician's advice about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a bicycle helmet. We also examined 2 related barriers to receiving clinician advice: whether the child had any preventive care visits in the past year and whether the child had a usual source of care other than a hospital emergency department. RESULTS: Publicly insured children were more likely than privately insured, full-year-uninsured children, and part-year-uninsured children to have had a preventive care visit in the past year, but regardless of health insurance group, many children went without preventive care. Even conditional on having had a preventive care visit, 48% did not receive clinician advice in any of the areas measured, and 41% of the overweight children were advised about neither healthy eating nor exercise in the past year. CONCLUSIONS: Enrolling more uninsured children in Medicaid and State Children's Health Insurance Programs could improve the chances that families receive advice about health behaviors and injury prevention; however, nearly half of the children who were insured for the entire year did not receive important advice from their clinicians.

Differences in pediatric preventive care counseling by provider type.

OBJECTIVE: Many children in the United States do not receive advice about health behaviors and injury prevention during routine preventive care visits. We investigated the role of provider type in the probability of receiving advice. METHODS: We analyzed children aged 3 to 17 in the Medical Expenditure Panel Data 2002 to 2003 surveys who had only 1 preventive clinic or office visit in the past year. We examined whether provider type affects whether the child is advised about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a helmet when riding a bicycle. RESULTS: Pediatricians were more likely to advise about healthy eating (63.6% vs 46.8% for other physicians and 41.1% for nonphysicians; P < .01). They were also more likely than nonphysicians to advise about exercise (40.1% vs 22.2%), the harmful effects of parental smoking (42.4% vs 21.4%), proper safety restraints in a car (39.9% vs 20.5%), and use of a bicycle helmet (45.7% vs 20.9%). Regardless of provider type, rates of advice were low. CONCLUSION: Many pediatric providers, particularly those not trained as pediatricians, are missing opportunities to advise about health behaviors and injury prevention.