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Yabroff KR, Doran JF, Zhao J, Chino F, Shih YCT, Han X, Zheng Z, Bradley CJ, Bryant MF. Cancer diagnosis and treatment in working-age adults: Implications for employment, health insurance coverage, and financial hardship in the United States. CA Cancer J Clin 2024. [PMID: 38652221 DOI: 10.3322/caac.21837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working-age adults not yet age-eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working-age adults with a history of cancer and compare them with estimates among working-age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019-2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | | | - Jingxuan Zhao
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ya-Chen Tina Shih
- Department of Radiation Oncology, University of California-Los Angeles Jonsson Comprehensive Cancer Center, School of Medicine, Los Angeles, California, USA
| | - Xuesong Han
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, Colorado, USA
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Bhattarai B, Thapa HB, Bashyal S, Thapa SK, Chaudhuri S, Agiwal V, Pant H, Singh S, Mahajan H. Structured Counselling and Regular Telephonic follow up to improve Referral flow and compliance in Nepal for Diabetic Retinopathy(SCREEN-D Study): a randomised controlled trial. BMC Health Serv Res 2024; 24:188. [PMID: 38336691 PMCID: PMC10858536 DOI: 10.1186/s12913-024-10647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Diabetic Retinopathy (DR) is an emerging public health issue, leading to severe visual impairment or blindness. Early identification and prompt treatment play a key role in achieving good visual outcomes. The objective of the study was to estimate the effectiveness of SCREEN package on improving referral compliance from peripheral centres to a tertiary eye centre in Nepal. METHODS In this facility-based cluster-randomized trial, ten out of 19 referring centres of the tertiary eye care centre in Lumbini zone, Nepal were randomized into intervention and control groups. A SCREEN packagewereprovided as intervention for DR patients who require advanced treatment in the tertiary centres and was compared with the current practice of the control arm, where structured counselling and follow-up mechanism are absent. Compliance was estimated by a weekly follow-up between the referring centre and the referred hospital. RESULTS We recruited 302 participantsof whom 153 were in the intervention arm. The mean age of the participants was 57.8 years (Standard deviation [SD]±11.7 years). With implementation of SCREEN package71.2% (n=109) in the intervention group and 42.9% (n=64) in the control group were compliant till three months of follow-up (Difference 28.3%, 95% CI: 17.6- 39.0, p<0.05). Compliance was 43% (n=66) with counselling alone, and 66% (n=103) with first telephonic follow-up in the intervention arm. The mean duration to reach the referral centre was 14.7 days (SD± 9.4 days) and 18.2 days (SD± 9.1 days) in the intervention and the control arm, respectively (Difference 3.5 days, 95% CI: 0.7 to 6.4 days). CONCLUSIONS Counselling& follow-up to patients is the key factor to improve the utilization of the health services by patients with DR. Health systems must be strengthened by optimizing the existing referral structure in Nepal. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration and Results System, ClinicalTrials.gov Identifier: NCT04834648 , 08/04/2021.
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Affiliation(s)
- Binita Bhattarai
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal.
- Lumbini Eye Institute and Research Centre, Bhairahawa, Nepal.
| | - Hari Bahadur Thapa
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal
| | - Sandip Bashyal
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal
| | | | | | - Varun Agiwal
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Hira Pant
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Samiksha Singh
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Hemant Mahajan
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
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Brock BA, Mir H, Flenaugh EL, Oprea-Ilies G, Singh R, Singh S. Social and Biological Determinants in Lung Cancer Disparity. Cancers (Basel) 2024; 16:612. [PMID: 38339362 PMCID: PMC10854636 DOI: 10.3390/cancers16030612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Lung cancer remains a leading cause of death in the United States and globally, despite progress in treatment and screening efforts. While mortality rates have decreased in recent years, long-term survival of patients with lung cancer continues to be a challenge. Notably, African American (AA) men experience significant disparities in lung cancer compared to European Americans (EA) in terms of incidence, treatment, and survival. Previous studies have explored factors such as smoking patterns and complex social determinants, including socioeconomic status, personal beliefs, and systemic racism, indicating their role in these disparities. In addition to social factors, emerging evidence points to variations in tumor biology, immunity, and comorbid conditions contributing to racial disparities in this disease. This review emphasizes differences in smoking patterns, screening, and early detection and the intricate interplay of social, biological, and environmental conditions that make African Americans more susceptible to developing lung cancer and experiencing poorer outcomes.
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Affiliation(s)
- Briana A. Brock
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Hina Mir
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Eric L. Flenaugh
- Division of Pulmonary Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Gabriela Oprea-Ilies
- Department of Pathology & Laboratory Medicine, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Rajesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Shailesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
- Cell and Molecular Biology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
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Zbyrak V, Radwan RM, Salgado TM, Dixon DL, Sisson EM, Pamulapati LG. Job satisfaction among board-certified pharmacists in Virginia. J Am Pharm Assoc (2003) 2024; 64:126-132. [PMID: 37774836 DOI: 10.1016/j.japh.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Board certification has been associated with job satisfaction. Identifying factors influencing board-certified pharmacists' job satisfaction can assist employers in recruitment and retention. OBJECTIVES To identify factors associated with job satisfaction among board-certified pharmacists in Virginia. METHODS This cross-sectional study utilized data from the 2018 Virginia Pharmacy Workforce Survey and included pharmacists who held an active license in Virginia, were employed within the last year, and held any Board of Pharmacy Specialties certification. Descriptive statistics were used to summarize the data, and bivariate analyses compared job satisfaction across demographics and practice characteristics. Multivariable logistic regression identified factors associated with job satisfaction. RESULTS Of 15,424 licensed pharmacists, 13,962 completed the survey (90.5%), while 1,284 (9.2%) met the inclusion criteria. Respondents were primarily female (69.4%) with a mean (SD) of 10.5 (9.6) years of work experience. Pharmacists predominantly held one full-time position (81.5%), earned an annual income between $100,000-$149,999 (77.0%), and worked in inpatient health systems (43.9%). Most board-certified pharmacists (93.7%) reported being very/somewhat satisfied with their current job. Job satisfaction was associated with work setting, primary hours worked per week, and paid sick leave benefits in bivariate analyses. In the multivariable logistic regression model, pharmacists working 30-49 versus ≥50 h/wk in their primary job (aOR= 2.91, 95% CI 1.63, 5.20), earning ≥$150,000 versus $100,000-$149,999 (aOR=4.60, 95% CI 1.21, 17.46), and with paid sick leave benefits (aOR= 1.92, 95% CI 1.19, 3.10) were more likely to report higher job satisfaction. Additionally, working in academia (aOR= 5.36, 95% CI 1.45, 19.85), inpatient health system (aOR= 3.13, 95% CI 1.41, 6.94), and outpatient health system (aOR= 4.07, 95% CI 1.33, 12.51) were associated with job satisfaction. CONCLUSION Board-certified pharmacists in Virginia reported high job satisfaction. Primary hours worked per week, income, paid sick leave, and work setting were positively associated with job satisfaction.
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de Perio MA, Srivastav A, Razzaghi H, Laney AS, Black CL. Paid Sick Leave Among U.S. Healthcare Personnel, April 2022. Am J Prev Med 2023; 65:521-527. [PMID: 36878415 PMCID: PMC10440219 DOI: 10.1016/j.amepre.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Healthcare personnel are at risk for acquiring and transmitting respiratory infections in the workplace. Paid sick leave benefits allow workers to stay home and visit a healthcare provider when ill. The objectives of this study were to quantify the percentage of healthcare personnel reporting paid sick leave, identify differences across occupations and settings, and determine the factors associated with having paid sick leave. METHODS In a national nonprobability Internet panel survey of healthcare personnel in April 2022, respondents were asked, Does your employer offer paid sick leave? Responses were weighted to the U.S. healthcare personnel population by age, sex, race/ethnicity, work setting, and census region. The weighted percentage of healthcare personnel who reported paid sick leave was calculated by occupation, work setting, and type of employment. Using multivariable logistic regression, the factors associated with having paid sick leave were identified. RESULTS In April 2022, 73.2% of 2,555 responding healthcare personnel reported having paid sick leave, similar to 2020 and 2021 estimates. The percentage of healthcare personnel reporting paid sick leave varied by occupation, ranging from 63.9% (assistants/aides) to 81.2% (nonclinical personnel). Female healthcare personnel and those working as licensed independent practitioners, in the Midwest, and in the South were less likely to report paid sick leave. CONCLUSIONS Most healthcare personnel from all occupational groups and healthcare settings reported having paid sick leave. However, differences by sex, occupation, type of work arrangement, and Census region exist and highlight disparities. Increasing healthcare personnel's access to paid sick leave may decrease presenteeism and subsequent transmission of infectious diseases in healthcare settings.
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Affiliation(s)
- Marie A de Perio
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio.
| | | | - Hilda Razzaghi
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A Scott Laney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bradley CJ, Kitchen S, Owsley KM. Working, Low Income, and Cancer Caregiving: Financial and Mental Health Impacts. J Clin Oncol 2023; 41:2939-2948. [PMID: 37043714 PMCID: PMC10414725 DOI: 10.1200/jco.22.02537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE Approximately 6 million people provide caregiving to people diagnosed with cancer. Many must remain employed to support their household and to have access to health insurance. It is unknown if caregiving for a spouse diagnosed with cancer is associated with greater financial and mental stress relative to providing care for a spouse with different conditions. METHODS Health and Retirement Study (2002-2020) data were used to compare employed caregivers, younger than age 65 years, caring for a spouse diagnosed with cancer (n = 103) and a matched control group caring for a spouse with other conditions (n = 515). We used logistic regression to examine a decrease in household income, increase in household debt, stopping work, and a new report of a mental health condition over a 4-year period, adjusting for socioeconomic and demographic characteristics, and health insurance status. Subanalyses stratified estimations by median household income. RESULTS Around a third of cancer caregivers reported they stopped working (35%) and had an increase in household debt (30%). Cancer caregivers in households below the median household income were more likely to report decreased income (13.4 percentage points [pp]; P < .10), increased household debt (14.5 pp; P < .10), and stopping work (18.8 pp; P < .05) than similar noncancer caregivers. Mixed results were found for a change in mental health domains. The results were robust to multiple sensitivity analyses. CONCLUSION Cancer caregivers from low-income households were more likely to increase debt and incur work loss compared with noncancer caregivers in similar households. Policies such as paid sick leave and family leave are needed for this strained and important population who have financial and employment responsibilities in addition to caregiving.
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Affiliation(s)
- Cathy J. Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Sara Kitchen
- University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Kelsey M. Owsley
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR
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Oliver-Fornies P, Sánchez-Viñas A, Gomez Gomez R, Ortega Lahuerta JP, Loscos-Lopez D, Aragon-Benedi C, Yamak Altinpulluk E, Fajardo Perez M, Aznar-Lou I. Cost Analysis of Low-Volume Versus Standard-Volume Ultrasound-Guided Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery. Cureus 2023; 15:e38534. [PMID: 37273354 PMCID: PMC10239207 DOI: 10.7759/cureus.38534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/06/2023] Open
Abstract
Background Economic evaluation has become an essential decision-making tool for health systems worldwide. This study was aimed at estimating the difference in the use of healthcare resources, days on sick leave, and costs between patients undergoing a standard-volume versus a low-volume ultrasound-guided interscalene brachial plexus block. Methods This is a post-hoc cost analysis of a double-blind, randomized, and controlled clinical trial. Forty-eight patients undergoing ultrasound-guided interscalene block received either 10 ml or 20 ml of levobupivacaine 0.25%. Analyses involved the public healthcare payer perspective (including visits to general practitioners, nursing staff, physiotherapy facilities, hospital admissions, outpatient diagnostic tests, etc.) and the limited societal perspective, including productivity losses (days on sick leave). Measurements were made at one-month and one-year follow-ups post-intervention. Differences in costs were estimated using two-part models adjusted by the costs incurred in the previous year. Results Subjects in the 10 ml group made greater use of general practitioner visits (mean difference [95% CI]: 3.35 [0.219 to 6.49]; p=0.036) and diagnostic tests (2.43 [0.601 to 4.26]; p=0.009), but less use of physical therapy (-12.9 [-21.7 to -4.06]; p=0.004). Mean (SD) cost differences from the public healthcare payer's perspective were 1,461.34 $ (1,541.62) and 1,024.08$ (943.83) for the 10 ml and 20 ml groups, respectively (p=0.293). From the limited societal perspective, the differences were as follows: 7,036.53$ (8,077.58) and 8,666.56$ (9,841.10), respectively (p=0.937). While there were no differences in the above parameters at the one-month follow-up. Conclusion The volume reduction proposed following interscalene block resulted in meaningful, albeit not statistically significant, clinical benefits and lower costs from a limited societal perspective for shoulder surgery. Thus, healthcare use and days on sick leave are variables to be taken into consideration when calculating the economic impact of surgical procedures.
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Affiliation(s)
- Pablo Oliver-Fornies
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Universitario de Mostoles, Madrid, ESP
| | - Alba Sánchez-Viñas
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, ESP
| | - Roberto Gomez Gomez
- Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, ESP
| | - Juan Pablo Ortega Lahuerta
- Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, ESP
| | - Diego Loscos-Lopez
- Department of Anesthesiology, Critical Care and Pain Medicine, Lozano Blesa University Clinical Hospital, Zaragoza, ESP
| | - Cristian Aragon-Benedi
- Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, ESP
| | - Ece Yamak Altinpulluk
- Medicine, UltraDissection, Madrid, ESP
- Pain Medicine, Morphological Madrid Research Center (MoMaRC), Madrid, ESP
- Anesthesiology Research Office, Ataturk University Medical School, Erzurum, TUR
- Outcomes Research Consortium, Cleveland Clinic Foundation, Cleveland, USA
| | | | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, ESP
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Callison K, Pesko MF, Phillips S, Sosa JA. Cancer Screening after the Adoption of Paid-Sick-Leave Mandates. N Engl J Med 2023; 388:824-832. [PMID: 36856618 PMCID: PMC10084522 DOI: 10.1056/nejmsa2209197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. METHODS We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. RESULTS Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. CONCLUSIONS In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).
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Affiliation(s)
- Kevin Callison
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Michael F Pesko
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Serena Phillips
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Julie A Sosa
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
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The impact of paid sick leave mandates on Women's health. Soc Sci Med 2023; 323:115839. [PMID: 36989657 DOI: 10.1016/j.socscimed.2023.115839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023]
Abstract
The United States does not have a national program to provide job-protected paid leave to workers when they or a family member are ill or need to seek medical care. Many workers receive paid sick leave through their employers, but women, particularly parents, those without a college degree, and Latinas, are less likely than their counterparts to receive employer-provided paid sick leave (PSL). To address the shortfall in PSL coverage, several states and localities have passed laws mandating employers to provide PSL. I examine the impacts of three recent state-level paid sick leave policies on women's self-reported health using data from the Behavior Risk Factor Surveillance System. Using static and event-study difference-in-differences models, I find that PSL mandates decreased the proportion of women reporting fair or poor health by an average of 2.4 percentage points and reduced the number of days women reported their physical and mental health was not good by 0.68 days and 0.43 days in the past 30 days respectively. Effects were concentrated among parents, women without college degrees, and women of color. This study demonstrates that despite being a low-intensity policy, PSL improves women's health and well-being and that mandating workplace benefits may play a role in achieving health equity.
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Vander Weerdt C, Stoddard-Dare P, DeRigne L. Is paid sick leave bad for business? A systematic review. Am J Ind Med 2023; 66:429-440. [PMID: 36815578 DOI: 10.1002/ajim.23469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
Vigorous legislative activity both for and against paid sick leave has occurred over the last decade. Although a compelling body of evidence suggests that paid sick leave supports personal and public health goals, a notable barrier in opposition to paid sick leave is apprehension about the potential short-term and long-term harms to business. This review critically assesses the relationship between paid sick leave and favorable or unfavorable business conditions. Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically review six research databases between 2000 and November 2022. Of 2664 studies identified, 123 were considered potentially relevant and 43 were included in the review. In addition to absence from work, paid sick leave was associated with favorable business conditions such as increased job satisfaction; improved retention; and reductions in occupational injury, contagion, presenteeism, and death; as well as some measures of firm performance and labor market conditions. Overall, our review discovered more evidence supporting the relationship between paid sick leave and favorable business conditions as compared with evidence that supported unfavorable business conditions. Although more research is needed, these findings can be used to inform firm-level and public policy decisions about paid sick leave.
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Affiliation(s)
- Candice Vander Weerdt
- Department of Management, Monte Ahuja College of Business, Cleveland State University, Cleveland, Ohio, USA
| | - Patricia Stoddard-Dare
- School of Social Work, Women's & Gender Studies, Cleveland State University, Cleveland, Ohio, USA
| | - LeaAnne DeRigne
- Sandler School of Social Work, Florida Atlantic University, Boca Raton, Florida, USA
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Pollack CC, Deverakonda A, Hassan F, Haque S, Desai AN, Majumder MS. The impact of state paid sick leave policies on weekday workplace mobility during the COVID-19 pandemic. Public Health 2023; 215:118-123. [PMID: 36689910 PMCID: PMC9464594 DOI: 10.1016/j.puhe.2022.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to evaluate whether the Families First Coronavirus Response Act (FFCRA) modified the association between pre-existing state paid sick leave (PSL) and weekday workplace mobility between February 15 and July 7, 2020. STUDY DESIGN This was a longitudinal, observational study. METHODS The 50 US states and Washington, D.C., were divided into exposure groups based on the presence or absence of pre-existing state PSL policies. Derived from Google COVID-19 Community Mobility Reports, the outcome was measured as the daily percent change in weekday workplace mobility. Mixed-effects, interrupted time series regression was performed to evaluate weekday workplace mobility after the implementation of the FFCRA on April 1, 2020. RESULTS States with pre-existing PSL policies exhibited a greater drop in mobility following the passage of the FFCRA (β = -8.86, 95% confidence interval: -11.6, -6.10, P < 001). This remained significant after adjusting for state-level health, economic, and sociodemographic indicators (β = -3.13, 95% confidence interval: -5.92, -0.34; P = .039). CONCLUSIONS Pre-existing PSL policies were associated with a significant decline in weekday workplace mobility after the FFCRA, which may have influenced local health outcomes. The presence of pre-existing state policies may differentially influence the impact of federal legislation enacted during emergencies.
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Affiliation(s)
- C C Pollack
- COVID-19 Dispersed Volunteer Research Network; Boston, Massachusetts, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College; Lebanon, New Hampshire, USA; Department of Epidemiology, Geisel School of Medicine at Dartmouth College; Lebanon, New Hampshire, USA.
| | - A Deverakonda
- COVID-19 Dispersed Volunteer Research Network; Boston, Massachusetts, USA
| | - F Hassan
- COVID-19 Dispersed Volunteer Research Network; Boston, Massachusetts, USA; School of Public Health, University of Alberta; Edmonton, Alberta, Canada
| | - S Haque
- COVID-19 Dispersed Volunteer Research Network; Boston, Massachusetts, USA; Network Science Institute, Northeastern University; Boston, Massachusetts, USA
| | - A N Desai
- COVID-19 Dispersed Volunteer Research Network; Boston, Massachusetts, USA; Department of Internal Medicine, Division of Infectious Diseases, University of California - Davis; Sacramento, California, USA
| | - M S Majumder
- COVID-19 Dispersed Volunteer Research Network; Boston, Massachusetts, USA; Computational Health Informatics Program, Boston Children's Hospital; Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School; Boston, Massachusetts, USA
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12
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Zheng Z, Fedewa SA, Islami F, Nogueira L, Han X, Zhao J, Song W, Jemal A, Yabroff KR. Paid Sick Leave Among Working Cancer Survivors and Its Associations With Use of Preventive Services in the United States. J Natl Compr Canc Netw 2022; 20:1244-1254.e3. [PMID: 36351332 DOI: 10.6004/jnccn.2022.7058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND We sought to examine the lack of paid sick leave among working cancer survivors by sociodemographic/socioeconomic and employment characteristics and its association with preventive services use in the United States. METHODS Working cancer survivors (ages 18-64 years; n=7,995; weighted n=3.43 million) were identified using 2001-2018 National Health Interview Survey data. Adjusted prevalence of lack of paid sick leave by sociodemographic and socioeconomic characteristics, as well as job sector, working hours, and employer size, were generated using multivariable logistic regression models. Separate analyses examined the associations of lack of paid sick leave with use of various preventive services. RESULTS Of all working cancer survivors, 36.4% lacked paid sick leave (n=2,925; weighted n=1.25 million), especially those working in food/agriculture/construction/personal services occupations or industries (ranging from 54.9% to 88.5%). In adjusted analyses, working cancer survivors with lower household income (<200% of the federal poverty level, 48.7%), without a high school degree (43.3%), without health insurance coverage (70.6%), and who were self-employed (89.5%), were part-time workers (68.2%), or worked in small businesses (<50 employees, 48.8%) were most likely to lack paid sick leave. Lack of paid sick leave was associated with lower use of influenza vaccine (ages 18-39 years, 21.3% vs 33.3%; ages 40-49 years, 25.8% vs 38.3%; ages 50-64 years, 46.3% vs 52.4%; P<.001 for all), cholesterol screening (ages 18-39 years, 43.1% vs 62.5%; P<.05), and blood pressure check (ages 18-39 years, 43.1% vs 62.5%; P<.05) compared with survivors having paid sick leave. CONCLUSIONS In the United States, more than one-third of all working cancer survivors and more than half of survivors working for small employers and in certain occupations/industries lack paid sick leave. Survivors with lower household income or educational attainment are particularly vulnerable. Moreover, lack of paid sick leave is associated with lower use of some recommended preventive services, suggesting that ensuring working cancer survivors have access to paid sick leave may be an important mechanism for reducing health disparities.
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Affiliation(s)
- Zhiyuan Zheng
- 1Surveillance and Health Equity Science, American Cancer Society; and
| | - Stacey A Fedewa
- 1Surveillance and Health Equity Science, American Cancer Society; and
| | - Farhad Islami
- 1Surveillance and Health Equity Science, American Cancer Society; and
| | - Leticia Nogueira
- 1Surveillance and Health Equity Science, American Cancer Society; and
| | - Xuesong Han
- 1Surveillance and Health Equity Science, American Cancer Society; and
| | - Jingxuan Zhao
- 1Surveillance and Health Equity Science, American Cancer Society; and
| | - Weishan Song
- 2Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ahmedin Jemal
- 1Surveillance and Health Equity Science, American Cancer Society; and
| | - K Robin Yabroff
- 1Surveillance and Health Equity Science, American Cancer Society; and
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13
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The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review. Acta Neurochir (Wien) 2022; 164:2789-2809. [PMID: 35945356 DOI: 10.1007/s00701-022-05339-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/02/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE For a long time, return to work (RTW) has been neglected in patients harboring a diffuse low-grade glioma (LGG). However, a majority of LGG patients worked at time of diagnosis. Moreover, these patients now live longer given current treatment paradigms, especially thanks to early maximal surgery. METHODS We systematically searched available medical databases for studies that reported data on RTW in patients who underwent resection for LGG. RESULTS A total of 30 studies were selected: 19 considered RTW (especially rate and timing) as an outcome and 11 used scales of health-related quality of life (HRQoL) which included work-related aspects. Series that considered RTW as a main endpoint were composed of 1014 patients, with postoperative RTW rates ranging from 31 to 97.1% (mean 73.1%). Timing to RTW ranged from 15 days to 22 months (mean 6.3 months). Factors related to an increased proportion of RTW were: younger age, better neurologic status, having a white-collar occupation, working pre-operatively, being the sole breadwinner, the use of awake surgery, and greater extent of resection. Female sex, older age, poor neurologic status, pre-operative history of work absences, slow lexical access speed, and postoperative seizures were negatively related to RTW. No studies that used HRQoL scales directly investigated RTW rate or timing. CONCLUSIONS RTW was scarcely analyzed in LGG patients who underwent resection. However, because they are usually young, with no or only mild functional deficits and have a longer life expectancy, postoperative RTW should be assessed more systematically and accurately as a main outcome. As majority (61.5-100%) of LGG patients were working at time of surgery, the responsibility of neurosurgeons is to bring these patients back to their previous activities according to his/her wishes. RTW might also be included as a critical endpoint for future prospective studies and randomized control trials on LGGs.
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14
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Pomeranz JL, Silver D, Lieff SA, Pagán JA. State Paid Sick Leave and Paid Sick-Leave Preemption Laws Across 50 U.S. States, 2009-2020. Am J Prev Med 2022; 62:688-695. [PMID: 35459452 DOI: 10.1016/j.amepre.2021.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Paid sick leave is associated with lower mortality risks and increased use of health services. Yet, the U.S. lacks a national law, and not all employers offer paid leave, especially to low-wage workers. States have enacted paid sick-leave laws or preemption laws that prohibit local governments from enacting paid sick-leave requirements. METHODS In 2019 and 2021, state paid sick-leave laws and preemption laws in effect in 2009-2020 were retrieved from Lexis+, coded, and analyzed for coverage and other features. Data from the U.S. Bureau of Economic Analysis were used to estimate the jobs covered by state paid sick-leave laws in 2009-2019. RESULTS In 2009, no state had a paid sick-leave law, and 1 state had preemption. By 2020, a total of 12 states had paid sick-leave laws, with a form of preemption (n=9) or no preemption (n=3), and 18 additional states solely preempted local laws without requiring coverage, creating a regulatory vacuum in those states. Although all state paid sick-leave laws covered private employers and required care for children and spouses, some laws exempted small or public employers or did not cover additional family members. The percentage of U.S. jobs covered by state-required paid sick leave grew from 0% in 2009 to 27.6% in 2019. CONCLUSIONS Variation in state paid sick-leave laws, preemption, and lack of employer provision of paid sick leave to low-wage workers creates substantial inequities nationally. The federal government should enact a national paid sick-leave law.
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Affiliation(s)
- Jennifer L Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York.
| | - Diana Silver
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Sarah A Lieff
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
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15
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Islami F, Guerra CE, Minihan A, Yabroff KR, Fedewa SA, Sloan K, Wiedt TL, Thomson B, Siegel RL, Nargis N, Winn RA, Lacasse L, Makaroff L, Daniels EC, Patel AV, Cance WG, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin 2022; 72:112-143. [PMID: 34878180 DOI: 10.3322/caac.21703] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.
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Affiliation(s)
- Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adair Minihan
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Health Services Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kirsten Sloan
- Public Policy, American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Tracy L Wiedt
- Health Equity, Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Tobacco Control Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Lacasse
- American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Laura Makaroff
- Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Discovery Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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