Working parents: what factors are involved in their ability to take time off from work when their children are sick?

Short-term outcomes in children following emergency department visits for minor injuries sustained at home

Background

Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes.

Methods

Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression.

Results

The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97).

Conclusions

Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Association between parental access to paid sick leave and children's access to and use of healthcare services

BACKGROUND

We examined the association between parental access to paid sick leave (PPSL) and children's use of preventive care and reduced likelihood of delayed medical care and emergency room (ER) visits.

METHODS

We used the child sample of the National Health Interview Survey data (linked to the adult and family samples) from 2011 through 2015 and logistic and negative binomial regression models.

RESULTS

Controlling for covariates, the odds of children with PPSL receiving flu vaccination were 12.5% [95%CI: 1.06-1.19] higher and receiving annual medical checkups were 13.2% [95%CI: 1.04-1.23] higher than those of children without PPSL. With PPSL, the odds of children receiving delayed medical care because of time mismatch were 13.3% [95%CI: 0.76-0.98] lower, and being taken to ER were 53.6% [95%CI: 0.27-0.81] lower than those of children without PPSL. PPSL was associated with 11% [95%CI: 0.82-0.97] fewer ER visits per year.

CONCLUSION

PPSL may improve children's access and use of healthcare services and reduce the number of ER visits. Am. J. Ind. Med. 60:276-284, 2017. © 2017 Wiley Periodicals, Inc.

Paid sick days and stay-at-home behavior for influenza

Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees' decisions to stay home from work for their own or a child's illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS) consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee's own or a child's illness/injury, influenza-like-illness (ILI), and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee's own illness/injury, ILI, or influenza, and for a child's illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee's own or a child's illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child's illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and families.

Local mandate improves equity of paid sick leave coverage: Seattle's experience

Background

Paid sick leave allows workers to take time off work for personal or family health needs, improving health and potentially limiting infectious diseases. The U.S. has no national sick leave mandate, and many American workers - particularly those at lower income levels - have no right to paid time off for their own or family members’ health needs. This article reports on outcomes of a local mandate, the City of Seattle Paid Sick and Safe Time Ordinance, which requires certain employers to provide paid sick leave to eligible workers.

Methods

Survey collectors contacted a stratified random sample of Seattle employers before the Ordinance went into effect and one year later. Pre- and post- analysis draws on responses to survey items by 345 employers who were subject to the paid sick leave mandate.

Results

Awareness of the policy and provision of paid leave grew significantly over the year after the Ordinance was enacted. More employers offered leave to full-time workers (80.8 to 93.9%, p < .001) and part-time workers (47.1 to 66.7%, p < .001) with particularly large increases in the hospitality sector, which includes food workers (coverage of any hospitality employee: 27.5 to 85.0%, p < .001).

Conclusions

Absent a federal policy, local paid sick time mandates can increase paid sick leave coverage, an important social determinant of health.

Unintentional injuries in child care centers in the United States: a systematic review

The study systematically reviewed all types of unintentional injury and injury prevention research studies occurring within child care centers in the United States. A total of 2 reviewers searched 11 electronic databases to identify 53 articles meeting inclusion criteria. No studies used trauma registries or randomized control trials. Data were not pooled for further analysis because studies lacked standardized definitions for injury, rates, severity, exposure, and demographics. The following child care center injury rates were reported: (0.25-5.31 injuries per 100,000 child-hours); (11.3-18 injuries per 100 children per year); (6-49 injuries per 1000 child-years); (2.5-8.29 injuries per child-year); (2.6-3.3 injuries per child); (3.3-6.3 injuries per 100 observations); (635-835 medically attended injuries per year per 100,000 children and 271-364 child care center playground injuries per year per 100,000 children); and (3.8 injuries per child per 2000 exposure hours). Child care center injury rates were comparable to injury rates published for schools, playground, and summer camp. Most injuries were minor, while most severe injuries (fractures and concussions) were falls from playground structures. Future studies need to use standardized injury definitions and injury severity scales, focus efforts on preventing severe playground injuries in child care centers, and report child care parameters for inclusion in national injury databases.

Early effects of the San Francisco paid sick leave policy

OBJECTIVES

We examined employers' responses to San Francisco, California's 2007 Paid Sick Leave Ordinance.

METHODS

We used the 2009 Bay Area Employer Health Benefits Survey to describe sick leave policy changes and the policy's effects on firm (n = 699) operations.

RESULTS

The proportion of firms offering paid sick leave in San Francisco grew from 73% in 2006 to 91% in 2009, with large firms (99%) more likely to offer sick leave than are small firms (86%) in 2009. Most firms (57%) did not make any changes to their sick leave policy, although 17% made a major change to sick leave policy to comply with the law. Firms beginning to offer sick leave reported reductions in other benefits (39%), worse profitability (32%), and increases in prices (18%) but better employee morale (17%) and high support for the policy (71%). Many employers (58%) reported some difficulty understanding legal requirements, complying administratively, or reassigning work responsibilities.

CONCLUSIONS

There was a substantial increase in paid sick leave coverage after the mandate. Employers reported some difficulties in complying with the law but supported the policy overall.

Emergency department and urgent care for children excluded from child care

BACKGROUND

Children in child care are frequently unnecessarily excluded for illness. We investigated parental use of urgent medical evaluation for sick children unable to attend child care.

METHODS

In May 2012, authors conducted a nationally representative survey of parents, who completed online questions regarding child illness causing absence from child care and their medical care-seeking behavior. Main outcome was parents' use of emergency department or urgent care (ED/UC).

RESULTS

Overall survey participation rate was 62%. Of participating parent cohort with children 0 to 5 years old, 57% (n = 357) required child care, of which 84% (n = 303) required out-of-home child care. Over 88% of parents sought acute medical care for their sick children unable to attend child care. Approximately one-third of parents needed a doctor's note for employers and/or child care. Parents sought medical evaluation (>1 option possible) from primary care (81%), UC (26%), or ED (25%). ED/UC use was most common for rash (21%) and fever (15%). Logistic regression indicated ED/UC use was significantly higher among single/divorced parents (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 2.5-13.5); African American parents (OR = 4.2; 95% CI: 1.2-14.6); parents needing a doctor's note (OR = 4.2; 95% CI: 1.5-11.7); and those with job concerns (OR = 3.4; 95% CI: 1.2-9.7).

CONCLUSIONS

A substantial proportion of parents whose sick children cannot attend child care seek care in ED/UC. Training child care professionals regarding appropriate illness exclusions may decrease ED/UC visits by lowering child care exclusions.

Working conditions and parents' ability to care for children's preventive health needs

OBJECTIVE

To determine whether workplace flexibility policies influence parents' ability to meet their children's preventive primary health care needs.

PATIENTS AND METHODS

Study sample included 917 employed adults with at least 1 child younger than 18 years in their household from a nationally representative survey of US adults. Multivariate logistic regression analyses of factors influencing parental ability to meet their children's preventive primary health care needs were conducted. Analyses assessed the effect of having access to schedule flexibility, a supervisor who is accommodating about work adjustments when family issues arise, and the ability to make personal calls without consequences on the odds of a parents' being unable to meet their child's preventive health care needs.

RESULTS

Being able to make a personal phone call at work was associated with a 56% (P < .05) reduction in the odds of being unable to meet children's preventive health needs. Working at a job that allowed for schedule adjustments was associated with more than 40% (P < .05) lower odds of being unable to meet preventive care needs.

CONCLUSION

Feasible steps to increase flexibility at work could make a substantial difference in parents' ability to obtain preventive care for their children.

Fathers' Involvement in Child Health Care: Associations with Prenatal Involvement, Parents' Beliefs, and Maternal Gatekeeping

Using data from 182 dual-earner couples experiencing the transition to parenthood, this study examined associations between prenatal involvement, gender role beliefs, and maternal gatekeeping and new fathers' involvement in child health care. Results indicated that prenatal father involvement was associated with both fathers' direct engagement in child health care and fathers' perceived influence in child health-related decision-making. Fathers also demonstrated greater direct engagement in child health care when mothers held more nontraditional beliefs about gender roles. Moreover, when mothers were more encouraging of fathers' involvement in childrearing, fathers felt more influential in child health-related decision-making, whereas when mothers engaged in greater gate closing behavior, fathers with more traditional gender role beliefs felt less influential in child health-related decision-making. This study suggests that fathers' prenatal involvement, mothers' beliefs, and maternal gatekeeping may play a role in the development of new fathers' involvement in child health care at the transition to parenthood.

Early child care and illness among preschoolers

The majority of young American children regularly spend time in nonparental care settings. Such arrangements are associated with their experiences of common childhood illnesses. Why this linkage exists, how it varies across the socioeconomic spectrum, and whether it has implications for how parents arrange care are all important theoretical and policy issues. In this study, therefore, we applied a fixed-effects design within structural equation modeling to data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (n = 1,364). Results revealed that children were sick more often when cared for in a center and had more peer exposure in their primary care settings, although this latter association was observed only among children of the least educated mothers. Net of such factors, children in multiple arrangements did not experience more illness, but illnesses tended to decrease subsequent peer exposure as parents changed children's care arrangements.

Barriers to specialty care and specialty referral completion in the community health center setting

OBJECTIVE

To assess the frequency of barriers to specialty care and to assess which barriers are associated with an incomplete specialty referral (not attending a specialty visit when referred by a primary care provider) among children seen in community health centers.

STUDY DESIGN

Two months after their child's specialty referral, 341 parents completed telephone surveys assessing whether a specialty visit was completed and whether they experienced any of 10 barriers to care. Family/community barriers included difficulty leaving work, obtaining childcare, obtaining transportation, and inadequate insurance. Health care system barriers included getting appointments quickly, understanding doctors and nurses, communicating with doctors' offices, locating offices, accessing interpreters, and inconvenient office hours. We calculated barrier frequency and total barriers experienced. Using logistic regression, we assessed which barriers were associated with incomplete referral, and whether experiencing ≥ 4 barriers was associated with incomplete referral.

RESULTS

A total of 22.9% of families experienced incomplete referral. 42.0% of families encountered 1 or more barriers. The most frequent barriers were difficulty leaving work, obtaining childcare, and obtaining transportation. On multivariate analysis, difficulty getting appointments quickly, difficulty finding doctors' offices, and inconvenient office hours were associated with incomplete referral. Families experiencing ≥ 4 barriers were more likely than those experiencing ≤ 3 barriers to have incomplete referral.

CONCLUSION

Barriers to specialty care were common and associated with incomplete referral. Families experiencing many barriers had greater risk of incomplete referral. Improving family/community factors may increase satisfaction with specialty care; however, improving health system factors may be the best way to reduce incomplete referrals.

Leave entitlements, time off work and the household financial impacts of quarantine compliance during an H1N1 outbreak

Background

The Australian state of Victoria, with 5.2 million residents, enforced home quarantine during a H1N1 pandemic in 2009. The strategy was targeted at school children. The objective of this study was to investigate the extent to which parents’ access to paid sick leave or paid carer’s leave was associated with (a) time taken off work to care for quarantined children, (b) household finances, and (c) compliance with quarantine recommendations.

Methods

We conducted an online and telephone survey of households recruited through 33 schools (85% of eligible schools), received 314 responses (27%), and analysed the subsample of 133 households in which all resident parents were employed.

Results

In 52% of households, parents took time off work to care for quarantined children. Households in which no resident parent had access to leave appeared to be less likely to take time off work (42% vs 58%, p=0.08) although this difference had only borderline significance. Among parents who did take time off work, those in households without access to leave were more likely to lose pay (73% vs 21%, p<0.001). Of the 26 households in which a parent lost pay due to taking time off work, 42% experienced further financial consequences such as being unable to pay a bill. Access to leave did not predict compliance with quarantine recommendations.

Conclusions

Future pandemic plans should consider the economic costs borne by households and options for compensating quarantined families for income losses.

The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey

BACKGROUND

Preventive health care services, such as cancer screening can be particularly vulnerable to a lack of paid leave from work since care is not being sought for illness or symptoms. We first describe the prevalence of paid sick leave by broad occupational categories and then examine the association between access to paid sick leave and cancer testing and medical care-seeking in the U.S. workforce.

METHODS

Data from the 2008 National Health Interview survey were analyzed by using paid sick leave status and other health-related factors to describe the proportion of U.S. workers undergoing mammography, Pap testing, endoscopy, fecal occult blood test (FOBT), and medical-care seeking.

RESULTS

More than 48 million individuals (38%) in an estimated U.S. working population of 127 million did not have paid sick leave in 2008. The percentage of workers who underwent mammography, Pap test, endoscopy at recommended intervals, had seen a doctor during the previous 12 months or had at least one visit to a health care provider during the previous 12 months was significantly higher among those with paid sick leave compared with those without sick leave after controlling for sociodemographic and health-care-related factors.

CONCLUSIONS

Lack of paid sick leave appears to be a potential barrier to obtaining preventive medical care and is a societal benefit that is potentially amenable to change.

Protecting the health of employees caring for family members with special health care needs

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.

Presenteeism revisited. A complete review

Presenteeism is defined as employees being present at work but unable to be fully engaged in the work environment. Although presenteeism is pervasive in the workplace, the effects of the condition on employee health and productivity are less well understood. The purpose of this article is to provide a comprehensive review of the concept of presenteeism, including research and management practices.

Paid health and family leave: the Canadian experience in the global context

OBJECTIVES

Two thirds of Canadian adults participate in the workforce. Their health and that of their families can be markedly affected by the availability of paid sick leave, paid leave to care for family members' health and paid parental leave.

METHODS

We gathered data from all Canadian provinces and territories on these essential leave policies and compared Canadian policies with data collected on 186 United Nations (UN) countries.

RESULTS

While Canada pays sickness benefits for 15 weeks for serious illnesses, globally at least 90 countries provide benefits for at least 26 weeks or until recovery. Moreover, within Canada only Saskatchewan and Quebec guarantee job protection if sick leave lasts over 12 days. The federal government guarantees Canadian workers six weeks of paid leave to provide care or support to gravely ill family members. Only 39 countries guarantee such leave with pay. Most, but not all, provinces guarantee workers' job protection during compassionate care leave. Eligibility for job protection during parental leave varies across the country from having no restrictions to requiring at least one year of service.

CONCLUSION

Compared with Canada, many countries offer a longer duration of paid sick leave for employees and replace a higher percentage of wages lost. Internationally, Canada performs well in having policies that guarantee paid leave to care for dependants with serious illnesses, but it lags behind in the provision of paid leave to address the health needs of children or family members' with non-life-threatening conditions. Finally, while paid parental leave is of adequate duration, the wage replacement rate lowers its accessibility to families with limited means.

Unnecessary child care exclusions in a state that endorses national exclusion guidelines

OBJECTIVE

No study has evaluated the association between state endorsement of American Academy of Pediatrics (AAP) and American Public Health Association (APHA) national guidelines and unnecessary exclusion decisions. We sought to determine the rate of unnecessary exclusion decisions by child care directors in a state that endorses AAP/APHA guidelines and to identify factors that are associated with higher unnecessary exclusion decisions.

METHODS

A telephone survey was administered to directors in metropolitan Milwaukee, Wisconsin. Directors were randomly sampled from a list of 971 registered centers. Director, center, and neighborhood characteristics were obtained. Directors reported whether immediate exclusion was indicated for 5 vignettes that featured children with mild illness that do not require exclusion by AAP/APHA guidelines. Weighted data were summarized by using descriptive statistics. Regression analysis was used to identify factors that were associated with directors' exclusion decisions.

RESULTS

A total of 305 directors completed the survey. Overall, directors would unnecessarily exclude 57% of children. More than 62% had never heard of the AAP/APHA guidelines. Regression analysis showed fewer exclusions among more experienced compared with less experienced directors, among larger centers compared with smaller centers, and among centers that were located in areas with a higher percentage of female heads of household. Centers with < or =10% children on state-assisted tuition excluded more.

CONCLUSIONS

High rates of inappropriate exclusion persist despite state endorsement of AAP/APHA guidelines. Focused initial and ongoing training of directors regarding AAP/APHA guidelines may help to reduce high rates of unnecessary exclusions.

Ensuring a healthy and productive workforce: comparing the generosity of paid sick day and sick leave policies in 22 countries

National paid sick day and paid sick leave policies are compared in 22 countries ranked highly in terms of economic and human development. The authors calculate the financial support available to workers facing two different kinds of health problems: a case of the flu that requires missing 5 days of work, and a cancer treatment that requires 50 days of absence. Only 3 countries--the United States, Canada, and Japan--have no national policy requiring employers to provide paid sick days for workers who need to miss 5 days of work to recover from the flu. Eleven countries guarantee workers earning the national median wage full pay for all 5 days. In Ireland and the United Kingdom, the full-time equivalent benefits are more generous for low-wage workers than for workers earning the national median. The United States is the only country that does not provide paid sick leave for a worker undergoing a 50-day cancer treatment. Luxembourg and Norway provide 50 full-time equivalent working days of leave, while New Zealand provides the least, at 5 days. In 6 countries, paid sick leave benefits are more generous for low-wage workers than for median-wage workers.

Issues in measuring child health

Assessing child health is critical to a variety of child health, educational, and social programs, as well as to clinical research and practice. However, despite the apparent wealth of measures available in health, education, and legal and social welfare systems, little agreement exists as to what are the most important measures and for what domains of health. Development of improved measures may capitalize on advances in conceptualization of child health, including the dynamic nature of the interplay of child health and development over time. The need for enhanced measures can be illustrated by consideration of various aspects of pediatric care: well-child care, acute illness care, and the management of children with special health care needs. In particular, the strong theoretical perspectives on aspects of development such as cognition and behavioral development need to be informed by the experience of various states of health and their developmental implications. If generalist academicians are to further their research and educational mission, they must engage, and urgently, in the development and measurement of child health.

Welfare, Work, and Health Care Access Predictors of Low-Income Children's Physical Health Outcomes

This analysis examines whether young children's (N= 494) general physical health is associated with parental employment, welfare receipt, and health care access within a low-income population transitioning from welfare to work. A latent physical health measure derived from survey and medical chart data is used to capture children's poor health, and parental ratings of child health are used to identify excellent health. Controlling for a host of factors associated with children's health outcomes, results show that children of caregivers who are unemployed and off welfare have better health than children of caregivers who are working and off welfare. Children whose caregivers are unemployed and on welfare, or combining work and welfare, have health outcomes similar to children of caregivers who are working and off welfare. Health care access characteristics, such as gaps in health insurance coverage, source of primary care setting, and type of health insurance are associated with children's general physical health. Implications of these results for state TANF programs are discussed.

Need for and use of family leave among parents of children with special health care needs

OBJECTIVE

Parents of children with special health care needs are especially vulnerable to work-family conflicts that family leave benefits might help resolve. We examined leave-taking among full-time-employed parents of children with special health care needs.

METHODS

We identified all children with special health care needs in 2 large inpatient/outpatient systems in Chicago, Illinois, and Los Angeles, California, and randomly selected 800 per site. From November 2003 to January 2004, we conducted telephone interviews with 1105 (87% of eligible and successfully contacted) parents. Among the sample's 574 full-time-employed parents, we examined whether leave benefits predicted missing any work for child illness, missing >4 weeks for child illness, and ability to miss work whenever their child needed them.

RESULTS

Forty-eight percent of full-time-employed parents qualified for federal Family and Medical Leave Act benefits; 30% reported employer-provided leave benefits (not including sick leave/vacation). In the previous year, their children averaged 20 missed school/child care days, 12 doctor/emergency department visits, and 1.7 hospitalizations. Although 81% of parents missed work for child illness, 41% reported not always missing work when their child needed them, and 40% of leave-takers reported returning to work too soon. In multivariate regressions, parents who were eligible for Family and Medical Leave Act benefits and aware of their eligibility had 3.0 times greater odds of missing work for child illness than ineligible parents. Parents with >4 weeks of employer-provided leave benefits had 4.7 times greater odds of missing >4 weeks than parents without benefits. Parents with paid leave benefits had 2.8 times greater odds than other parents of missing work whenever their child needed them.

CONCLUSIONS

Full-time-employed parents of children with special health care needs experience severe work-family conflicts. Although most have leave benefits, many report unmet need for leave. Access to Family and Medical Leave Act benefits and employer-provided leave may greatly affect leave-taking.

Does choosing a treatment depend on making a diagnosis? US and French physicians' decision making about acute otitis media

BACKGROUND

The classic sequential processing model of clinical decision making-in which the treatment choice follows and depends on the diagnostic judgment-may in some cases be replaced by a processing model in which the treatment choice depends on an independent assessment of the diagnostic and other cues. The aim of this study was to determine which processing model would better describe physicians' treatment choices in a simulated clinical task.

METHODS

Seventy-five US and French primary care physicians were presented twice, in a different order, with the same set of 46 scenarios of 15-month-old children suspected of having acute otitis media (AOM). They rated in one set the probability of AOM and in the other set whether they would treat the child with antibiotics (and how confident they felt in their decision). Linear regression analyses revealed the individuals' 2 judgment policies. Hierarchical discriminant analysis was used to analyze the variance explained in the treatment choice by, 1st, the diagnostic judgment, 2nd, the cues specific to treatment, and 3rd, the cues specific to diagnosis.

RESULTS

Even when choosing treatment, the participants placed greatest weight on diagnostic cues, especially the ear findings. Only 28% used the cues that reflected parental issues. For 36%, the diagnostic cues had an effect on the treatment choice independent of the effect (if any) of the diagnostic judgment.

CONCLUSION

In deciding how to treat AOM, the majority of the participating US and French primary care physicians followed the classic sequential processing model, but a substantial minority used instead an independent processing model.

Clinical implications of household food security: definitions, monitoring, and policy

Poverty-related food insecurity is a reality that many clinicians in nutrition and health care encounter either directly or indirectly. It is associated with both overnutrition and undernutrition, but it is not congruent with malnutrition. Food insecurity affects human development and health throughout the lifecycle, but can be particularly harmful during critical or vulnerable stages early and late in life. Understanding the causes and consequences of food insecurity and knowing how to identify them can improve the quality and effectiveness of clinical care, and facilitate prevention and treatment of many kinds of health problems. Numerous public policies and programs exist to ameliorate and prevent poverty-related food insecurity. However, the resources to support them ebb and flow with the politics of annual state and federal budgetary cycles. Support and need for these social-safety-net programs also vary with business cycles. Unfortunately, need often expands as support shrinks along with employment and government revenues during recessions, and shrinks as support expands along with employment and government revenues during expansions.

Welfare to work: the effect of a health-care program in child-care centers

OBJECTIVE

Welfare reform has increased pressure on welfare recipients to enter the labor force. When they become employed, former recipients often do not have paid leave that can be used to care for their young children when they are sick. We wished to determine whether an on-site health-care program in child-care centers serving low-income families affected the amount of time parents took off of work to care for mildly ill children.

METHODS

We surveyed parents in 6 child-care centers with an on-site health-care program and in 2 comparison centers without such a program. To analyze survey results, a regression model including demographic and other variables was used to determine which, if any, variables were associated with time taken by parents from work to care for sick children.

RESULTS

Analyzing the variables of employer leave policy, poverty level, age of child, and enrollment in the health-care program, only the variable of health-care program enrollment was associated with taking less time from work to care for sick children.

CONCLUSION

Health-care programs in child-care settings can help parents meet the health needs of their children while reducing absenteeism from work, thereby contributing to job stability.