The causal effects of maternal employment attributes on family health outcomes and health disparities: implications for policy and practice
Shepherd-Banigan, Megan Elizabeth
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Socioeconomic disparities in maternal and child health are well-known, widespread problems in the US. A high proportion of women with young children participate in the labor force making maternal employment attributes, such as income, leave benefits, workplace flexibility, and stress potential determinants of maternal and child health inequalities. This dissertation research examined the contribution of maternal employment attributes to family health outcomes and disparities, including adolescent health, maternal depressive symptoms, and pediatric preventive service utilization. To examine the effect of maternal paid leave (sick and vacation) and work intensity on pediatric preventive care among children aged 0-17, we used data from the Medical Expenditures Panel Survey and the National Health Interview Survey (years 2007-2010) and applied instrumental variable techniques. Our results demonstrate that paid sick leave may influence compliance with several preventive care services for children, including well-child visits, dental care and receipt of the influenza vaccine. Paid sick leave predicted an increase in the marginal probability of complying with recommended well-child visits (0.13; 95% CI: 0.032, 0.23), dental exams (0.31; 95% CI: 0.15, 0.47), preventive dental care (0.30; 95% CI: 0.11, 0.50), and influenza vaccines (0.17; 95% CI: 0.07, 0.27). To study the relationship between maternal employment attributes and maternal depressive symptoms among women with very young children, we examined data from the NICHD (National Institute of Child Health and Development) Early Child Care and Youth Development Study (SECCYD) (years 1991-2005). Results from individual fixed effects analyses suggest that some employment attributes may predict depressive symptoms. Women who worked from home reported a statistically significant decrease in depression scores over time (â=-1.60, SE=0.53, p=0.002). Women who reported a one-unit increase in job concerns experienced, on average, a 2-point increase in depression scores over time (â=1.91, SE=0.43, p<0.01). Finally, we used data from the NICHD SECCYD and endogenous treatment effect models to assess the influence of cumulative maternal income (between birth and 3rd grade) on adolescent health and development. We found no evidence that cumulative maternal income predicted adolescent outcomes. However, other components of the early family environment were related to specific outcomes. A one-unit increase in family socioeconomic status was associated with a 0.05 point decrease in the probability of being overweight or obese at age 15. High work intensity (more periods of employment over time and more hours worked per week) and high birth weight (>4,000 grams) were also associated with a 0.09 and 0.10 point increase in the probability of being overweight or obese at age 15, respectively. Higher levels of health endowment were predictive of improved adolescent outcomes at age 15, including better health status, fewer behavioral problems, and no tobacco use. Parental marital status (being married) and White race/ethnicity were also protective against risk-taking. Results from this dissertation research suggest that maternal employment attributes exert real and important influences on family health. Our research highlights the effects of specific attributes, including paid sick leave, schedule control and flexibility, supportive work environments, and work intensity on various maternal and child health outcomes. These findings suggest that policies to assure adequate access to leave and flexible working hours and locations might ease the challenges faced by working families.
- Health services