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Access to and Use of Paid Sick Leave Among Low-Income Families With Children

The Urban Institute, Washington, DC

	ABSTRACT

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSIONS REFERENCES

 
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 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.

Key Words: sick leave • fringe benefits

Abbreviations: FPL—federal poverty level • MEPS—Medical Expenditure Panel Survey

One of the many responsibilities of being a parent is caring for the health of one's children, including staying home with a sick child and taking that child to see a medical provider when needed. The ability of employed parents to meet these needs without putting their job and/or income in jeopardy may depend on their access to paid sick leave. Currently, there are few laws requiring or regulating the provision of sick leave. As of 2007, only 7 states (California, Connecticut, Hawaii, Maine, Minnesota, Washington, and Wisconsin) required that private-sector employers offering sick leave must permit employees to use their sick leave to care for certain sick family members, which is referred to as "flexible" sick leave.^1,2 In 2007, policy-makers in San Francisco became the first in the nation to pass legislation requiring all employers to provide flexible paid sick leave to employees as part of a strategy to help employed families better meet their responsibilities.³ Access to paid sick leave is receiving increased attention at the federal level as well. In 2007, Senator Edward Kennedy and Representative Rosa DeLauro introduced the Healthy Families Act (S. 910/H.R. 1542), federal legislation that would require employers with 15 employees to provide a minimum level of paid sick leave for employees working 20 hours per week to use for themselves or for certain family members.

If parents do not have access to paid sick leave, they may choose not to stay home with a sick child so as not to lose pay or, in some cases, risk losing their job. The issue could be especially important 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. Indeed, past research has demonstrated that children in low-income families are more likely to have health problems than children living in higher income families. For example, in 2005, 8.2% of children aged 5 to 17 years with family income below the federal poverty level (FPL) missed 11 days of school because of illness compared with only 4.2% for children in families with income >200% of the FPL.⁴ Currie and Lin⁵ found that children living in poor families had higher incidences of nearly every measured condition (eg, 11.6% of poor children reported activity limitations, whereas only 7.3% of nonpoor children did) and that, even after accounting for these differences in conditions, disparities in overall health remained.

In addition to the difficulties associated with addressing their children's health problems, employed parents who are not afforded paid time to care for their own health may neglect their own health needs, which can have a negative impact on child health. In particular, when untreated, mental illness, such as depression, among parents can reduce the likelihood that children get appropriate medical care. For example, Minkovitz et al⁶ and Fairbrother et al⁷ show that children with depressed mothers are less likely to receive preventive care, and Perry ⁸ shows that treating maternal depression improves pediatric asthma management.

Despite these needs, calculations based on the 2002 National Survey of America's Families indicated that, among employed parents with family income <100% of the FPL, 54.2% had no paid leave compared with just 16.4% for employed parents with family income >200% of the FPL.⁹ Another study found that more than one third of employed parents living at <125% of the FPL had no sick leave relative to one fifth of employed parents with higher incomes.¹⁰ In a small survey of parents of children with special health care needs in 2 cities, Chung et al¹¹ found that those with paid leave benefits had 2.8 times greater odds than parents without paid leave of missing work when their child required care.

Some employed parents who do not have access to paid sick leave do have access to paid vacation. Our study examines access to "combined leave," that is, access to either paid sick leave or paid vacation time, with the understanding that paid vacation benefits may not always be a good substitute for paid sick leave because of defined vacation periods or other restrictions that can make vacation benefits less flexible than paid sick leave for time to be taken on short notice, as in the case of an unexpected illness.

In this article, we used 2003–2004 data from the Medical Expenditure Panel Survey (MEPS) to first provide rates of access to paid sick leave and combined leave among children with family incomes <200% of the FPL relative to families with higher incomes. We then extended the previous literature by analyzing whether access to these benefits is associated with measures of need for these benefits, as well as whether parents take leave to care for themselves or others. In both sections of the article, we examined variation by employer size, because proposed legislation requiring that employers offer sick leave generally exempts smaller firms.

	METHODS

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSIONS REFERENCES

 
Our primary sample consisted of low-income children ages 0 to 17 years who had 1 parent who was employed at an establishment, either part or full-time for at least part of the year (henceforth referred to as "employed families"). To define parental employment characteristics, we used variables that identified employment status and hours worked per week in each of 3 rounds of data collection during the calendar year. We defined "full-time" as working >34 hours per week in an establishment and "full-year" as being employed in an establishment throughout the year.

We identified 18479 children under age 18 years in 2003 and 2004 of the MEPS, 14231 of whom lived in employed families. Our primary sample consisted of the 7423 children in employed families who were low income (earning <200% of FPL), and the 6808 children in higher-income employed families served as a comparison group for some analyses. Children who did not have a parent who worked for an employer, for example children whose parents were unemployed (6.9% of all children) or self-employed (6.6% of all children) for the full-year, were excluded from analysis. We addressed missing data on key variables, such as parental employment status, employer size, benefits data, and child health status, for 10% of the original sample of children by reweighting the remaining sample. We used this weighting adjustment to reduce any biases that might have resulted from nonrandomness in the patterns of missing data and to bring weighted population totals for our analysis sample close to the MEPS 2004 national estimates. The weighting adjustment was based on key characteristics of the child and family.

Our classification of parental variables depended on the number of employed parents in the family. For children who had only 1 employed parent, that parent was used to classify all of the parental data (parental health status, parental educational attainment, establishment size, industry, union status, parental work status, access to paid time off in family, and whether 1 parent took time off from work to care for themselves or others). For children who had 2 employed parents, we created family level tabulations of the number of full-time, full-year employees, access to paid time off, whether 1 parent was in a union, and whether 1 parent took time off from work to care for him or herself or others. We used the health status from the least healthy parent and educational attainment from the parent with the highest degree.

To characterize parent's employer size, we created a hierarchy using the number of employees at the parent's establishment and whether the establishment had >1 location, grouped into the following ordered categories: 1 to 9 employees and 1 location; 10 to 25 employees and 1 location; 26 to 100 employees and 1 location; and >100 employees or >1 location. The parent with the highest category of establishment size according to this hierarchy was used to classify the "largest establishment size among parents’ employers." For these and all of the other job-related variables, we used the parent's current main job as the reference, which was defined by the respondent as the main source of employment.

Key variables for this analysis included whether 1 parent had access to paid sick leave ("Does this person have paid time off if they are sick?") and whether the parent took time off from work to care for their own health ("Did this person miss at least a half day of work due to illness or injury?") or someone else ("Did this person miss more than a half day of work because of someone else's illness, injury, or health care needs, for example, to take care of a sick child or a relative?"). In this survey, it was not possible to determine whether a person with access to paid time off actually used it when he or she took time off from work. Our hypothesis that people are more likely to take time off from work to care for themselves or others if they have access to paid time off assumes that, in most cases, people use this benefit if it is available to them. Because paid vacation can be used to attend to some nonurgent health care needs, we also examined access to paid vacation ("Did this person get paid vacation?"), as well as a variable called "combined leave," when 1 parent had access to either paid sick leave or paid vacation.

Access to paid sick leave and paid vacation leave were defined based on parents’ reports of having these benefits in each of 3 rounds during the year in their current main job. If a parent was unemployed or self-employed in a round, they were recorded as not having the benefit in that round. A parent was recorded as having a benefit for part of the year if he or she had that benefit in 1 round and for the entire year if he or she had that benefit in all 3 of the rounds. Nine parents who reported having a benefit in 2 rounds but were missing data in the third round were recorded as having the benefit for the entire year.

Income and other family level characteristics were defined based on the child's health insurance unit. Health insurance units contained the members of a nuclear family who could be considered eligible for a family health insurance policy and constitute the unit used to determine eligibility for public and private sources of coverage.

We used descriptive and multivariate analyses to examine how access to paid leave varied among low-income families. We considered the characteristics of the child (age, race/ethnicity, and health status); parents’ employment status (presence of 2 full-time/full-year establishment employees, 1 full-time/full-year establishment employee, or only part-time or part-year establishment employees); parent's employer type (establishment/firm size and industry category of parent employed at largest establishment); parents’ other characteristics (educational attainment, union status, and health status); and income as a percentage of the FPL (50% of the FPL, 51%–100% of the FPL, 101%–150% of the FPL, and 151 to <200% of the FPL), defined using the Health and Human Services guidelines for 2003–2004, depending on the year in which the MEPS recorded data from the respondent. We also considered family structure (number of parents in the family, number of children in the family, and presence of other adults) and whether all of the parents in the home were employed full-time/full-year (2-parent families with 2 full-time/full-year employees and single-parent families with 1 full-time/full-year employee), because the presence of a nonemployed or part-time/part-year employed parent may have decreased the employed parent's need for paid sick leave. In our low-income sample, 81.4% of children with all of the parents employed full-time/full-year were children of single parents. Because health variables were asked 3 times in the calendar year, we recorded a child or parent as having fair/poor health if he or she was reported to have either fair or poor health in 1 round. In addition, if a parent reported needing any help with activities or instrumental activities of daily living or having any activity, functional, or sensory limitations, he or she was recorded as being in fair/poor health for our analysis. We discussed estimates from multivariate analysis based on probit and logit models that take into account the complex nature of the sample design of the MEPS when calculating SEs. Results not shown are available by request from the authors.

	RESULTS

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSIONS REFERENCES

 
Access
Table 1 shows access to paid time off by family income. Although 4 of 5 children (80.9%) in higher-income employed families had 1 parent with access to paid sick leave for the entire year, just 36.3% of low-income children in employed families did. Extending the definition of paid leave to include paid vacation time increased the percentage of children with access, but a large gap persisted between children in low- and higher-income families: 87.8% of children in higher-income employed families had access to combined leave for the entire year, whereas just 50.3% of children in low-income employed families did.

Table 2 examines the demographic characteristics that are associated with access to paid sick leave among low-income families. Hispanic ethnicity was correlated with lower access to paid leave compared with white non-Hispanic ethnicity. Among low-income employed families, 41.3% of white non-Hispanic children had a parent with paid sick leave, and 53.7% had combined leave. In contrast, only 27.2% and 45.8% of Hispanic children had a parent with access to these benefits, respectively.

View this table: [in this window] [in a new window]   TABLE 2 Percentage of Low-Income Children With 1 Parent With Access to Benefits, According to Demographic Characteristics

Within low-income employed families, children in families with the lowest income had the least access to paid sick leave. Children in the lowest income group (<50% of the FPL) had a parent with paid sick leave and combined leave at rates of just 11.8% and 16.8%, respectively; families with income between 150% and 200% of the FPL had access rates for these benefits >4 times as high.

Children whose parents worked in smaller establishments were less likely to have access to paid sick leave. Among children in families employed in the largest establishment size (>100 employees or >1 location), 41.6% had a parent with paid sick leave, and 56.4% had a parent with combined leave. These shares fell as establishment size decreased, with 16.2% and 23.8% of children having a parent with paid sick leave and combined leave, respectively, in the smallest establishment size (1 to 9 employees and 1 location). Children in employed families with less educated workers or workers without union representation were also less likely to have access to paid sick leave.

Children with single parents employed full-time/full-year or 2 parents both employed full-time/full-year were twice as likely to have access to paid sick leave and combined leave as children with 1 parent not employed full-time. Although 57.6% of children with full-time/full-year employed parents had access to paid sick leave, only 28.8% of children with 1 parent not employed full-time/full-year had access to the benefit.

Using Paid Sick Leave
Table 3 shows that parents of children in low-income employed families who have access to paid sick leave were more likely to take time off from work to care for themselves or others compared with parents who did not have access to paid sick leave. Approximately two fifths (43.6%) of children in low-income employed families with access to paid sick leave had a parent who took time off from work for others, but just 27.5% had a parent who took time off from work for this reason if they did not have paid sick leave. Among children who were especially likely to have time-consuming health care needs (children in fair or poor health), 67.5% had a parent who took time off from work for others if they had access to paid sick leave, but just 36.6% of these children had a parent take time off to care for others if the parents lacked access to this benefit.

Those parents who were perhaps most in need of paid sick leave were single parents who were employed full-time and 2-parent families in which both parents were employed full-time. As shown in the bottom panel of Table 3, the general patterns discussed above hold up for each of these family types: parents were more likely to take time off from work to care for others or for themselves when they had access to paid sick leave. The share of children with a parent who took time off from work to care for someone other than himself or herself was higher among those with access to paid sick leave than among those without access (48.7% vs 30.2%). As noted above, children with full-time/full-year employed parents were twice as likely to have access to paid sick leave; moreover, these types of families (predominantly single parents) were more likely to take time off from work to care for others when they had access to paid sick leave compared with other families (48.7% vs 40.1%).

Paid vacation leave seemed to be an imperfect substitute for paid sick leave (data not shown). Although there are more families with access to combined leave (36.3% vs 50.3%), the percentage of employees who took time off from work to care for others was lower among the subset of families who only had access to paid vacation leave (30.3%) than among families with access to paid sick leave (43.6%).

	DISCUSSION

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSIONS REFERENCES

 
Low-income employees are not the only ones who benefit from access to paid sick leave; the children of low-income employees rely on their parents to care for them when they are ill and to take them to routine preventive care visits. Among low-income employed families with a child in fair or poor health, less than half have access to any paid time off, and <3 of 10 have access to paid sick leave. Moreover, lack of sufficient paid sick leave may cause some parents to opt for part-time jobs so that they can meet their children's health care needs, which may reduce family income.

We find that having full-time/full-year employed parents and the number of parents employed full-time/full-year are important determinants of access to paid sick leave. Over time, however, jobs that offer these benefits to even full-time employees without high levels of education, especially jobs with union representation and jobs with larger employers, have become less available.^12,13 In addition, the availability of adequate, affordable child care can affect whether it is possible for all parents in a family to be employed full-time even if positions are available.¹⁴ Similarly, if a parent has his or her own health problems to attend to, full-time employment may not be a viable option.

Our findings suggest that legislation mandating paid sick leave could dramatically increase access to this benefit among low-income families. Such a policy would likely diminish the gaps that are observed in parents taking time off from work to care for others or themselves between families with and without access to paid sick leave. In addition, it would likely diminish the gaps in the use of sick leave that we observed across employer size among those who currently have no paid leave in the family. The reach of legislation would be less extensive if the smallest employers are exempted from a mandate, because >12% of low-income children live in families where the largest employer has <10 employees and are least likely to have access to the benefit. Thus, a policy excluding the smallest firms would fall short of addressing the needs of many children in low-income employed families.

Mandating access to paid sick leave does not necessarily mean that parents will take time off to attend to their own or their children's health care needs. On the one hand, some low-income families with paid sick leave do not take time off from work to attend to illness or preventive care; it may be the case that parents feel pressured not to take the leave for fear of jeopardizing their employment situation. On the other hand, relative to those without this benefit, low-income parents in families with paid sick leave are more likely to take time off to take care for themselves and their children.

Although employers may recognize the needs of their employees to have paid time off to attend to health maintenance for themselves and their children, there has not been a trend toward offering these benefits in greater numbers; a survey of employers found that, whereas nearly one third of employers recognized that low-wage employees had a particular need for such supports, less than one quarter of employers were actively targeting the needs of those workers.¹⁵

	CONCLUSIONS

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSIONS REFERENCES

 
The health-related impacts of implementing mandatory access to paid sick leave are not well understood. In the course of our work for this article, we examined whether access to paid sick leave increased the likelihood that children received preventive care and found no impact. Preventive care is one of the easiest types of health care use to schedule in advance, however, making it a weak test of the impact of paid sick leave. Paid sick leave could have much larger effects on families when workers or children face unexpected illness; the MEPS data unfortunately did not lend itself to this type of analysis. More research is needed to assess the impact of access to paid sick leave on health care use, health status, and functioning among both parents and children. Although our research suggests that access to paid sick leave improves the ability of employed parents to meet the health needs of their children, until the health-related consequences are better understood, the full impact of legislation mandating paid sick leave remains unknown.

	ACKNOWLEDGMENTS

 
This paper was prepared as part of the Urban Institute's Low Income Working Families project, with funding provided by the Annie E. Casey Foundation. We thank Linda Blumberg, Pamela Holcomb, and Karin Martinson for comments and suggestions on earlier drafts.

	FOOTNOTES

 
Accepted Mar 20, 2008.

Address correspondence to Lisa Clemans-Cope, PhD, The Urban Institute, 2100 M St NW, Washington, DC 20037. E-mail: lclemans{at}ui.urban.org

The authors have indicated they have no financial relationships relevant to this article to disclose.

Findings from this article were presented for the Urban Institute Roundtable "Public and Private Roles in the Workplace: What Are the Next Steps in Supporting Working Families?" May 23, 2007; Washington, DC.

The views expressed in the manuscript are those of the authors and do not necessarily represent those of the Urban Institute, its board of trustees, or its sponsors.

What's Known on This Subject Previous literature has shown rates of access to parental paid leave among children according to income. A small 2-city survey of parents of children with special health care needs compared rates of access and use of paid versus unpaid leave.

 

What This Study Adds We analyzed whether access to paid sick and/or vacation leave among low-income children is associated with parents’ taking leave to care for themselves or others. We examined variation across policy-relevant characteristics, including employer size, family employment, and child health status.

 

	REFERENCES

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSIONS REFERENCES

 

1. Wisensale S. California's paid leave law: a model for other states? In: Haas L, Wisensale S, eds. Families and Social Policy: National and International Perspectives. Binghamton, NY: Haworth Press, Inc; 2006:177 –196
2. Center for Policy Alternatives. Sick leave protection. Available at: www.stateaction.org/issues/issue.cfm/issue/SickLeaveProtection.xml. Accessed October 22, 2007
3. San Francisco Office of Labor Standards Enforcement. Paid sick leave ordinance. Available at: www.sfgov.org/site/olse_index.asp?id=49389. Accessed October 3, 2007
4. Bloom B, Cohen RA. Summary Health Statistics for U.S. Children: National Health Interview Survey, 2006. Vital Health Stat 10. 2007(234) :1 –79.
5. Currie J, Lin W. Chipping away at health: more on the relationship between income and child health. Health Aff (Millwood). 2007;26 (2):331 –344[Abstract/Free Full Text]
6. Minkovitz CS, Strobino D, Scharfstein D, et al. Maternal depressive symptoms and children's receipt of health care in the first 3 years of life. Pediatrics. 2005;115 (2):306 –314[Abstract/Free Full Text]
7. Fairbrother G, Kenney G, Hanson K, Dubay L. How do stressful family environments relate to reported access and use of health care by low-income children? Med Care Res Rev. 2005;62 (2):205 –230[Abstract]
8. Perry CD. Does treating maternal depression improve child health management? The case of pediatric asthma. J Health Econ. 2007;27 (1):157 –173[CrossRef][ISI][Medline]
9. Phillips KR. Getting Time Off: Access to Leave Among Working Parents. Washington, DC: Urban Institute; 2004. Series B; No. B-57
10. Heymann SJ, Earle A, Egleston B. Parental availability for the care of sick children. Pediatrics. 1996;98 (2 pt 1):226 –230[Abstract/Free Full Text]
11. Chung PJ, Garfield CF, Elliott MN, Carey C, Eriksson C, Schuster MA. Need for and use of family leave among parents of children with special health care needs. Pediatrics. 2007;119 (5). Available at: www.pediatrics.org/cgi/content/full/119/5/e1047
12. Farber HS. The decline of unionization in the United States: what can be learned from recent experience? J Labor Econ. 1990;8 (1 pt 2):S75 –S105[CrossRef][ISI]
13. Glied S, Lambrew J, Little S. The Growing Share of Uninsured Workers Employed by Large Firms. Commonwealth Fund. October 2003. Available at: www.cmwf.org/publications/publications_show.htm?doc_id=221335. Accessed October 29, 2007
14. Winston P. Meeting Responsibilities at Work and Home: Public and Private Supports. Washington, DC: Urban Institute; 2007
15. Friedman D. Employer supports for parents with young children. Future Child. 2001;11 (1):62 –77[CrossRef][Medline]

This Article Abstract Full Text (PDF) P3Rs: Submit a response Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Clemans-Cope, L. Articles by Pantell, M. S. PubMed PubMed Citation Articles by Clemans-Cope, L. Articles by Pantell, M. S. Related Collections Office Practice

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