We propose to estimate the causal effect of paid sick leave mandates on the use of cancer prevention services including screenings for breast and colorectal cancers, smoking cessation counseling, and smoking cessation medications. Though the benefits of breast cancer screening, colorectal cancer screening, and smoking cessation services are significant and well-known, current use of these services remains below recommended levels. Work commitments and the prospect of lost wages are known factors contributing to delays in seeking medical care. Paid sick leave, which allows workers paid time away from their job, mitigates these concerns and has the potential increase access to health care professionals. Recently, 8 states and 25 cities and counties have enacted legislation requiring employers to provide paid sick leave benefits to their workers. However, a causal relationship between paid sick leave mandates and use of cancer prevention services has yet to be established. In a preliminary study, we show that these mandates led to increased access to paid sick leave benefits among previously uncovered workers. We now seek to determine whether the expansion of paid sick leave increases the use of cancer prevention services and adherence to recommended cancer screenings. Our objective for this project is to estimate the effect of paid sick leave mandates on rates of breast cancer screenings (Aim #1: screening and diagnostic mammography and adherence to ACS and USPSTF recommendations), colorectal cancer screenings (Aim #2: colonoscopy, CT colonography, flexible sigmoidoscopy, and stool-based screenings), and smoking cessation services (Aim #3: smoking cessation counseling and prescription fills for smoking cessation medication). We will accomplish our objective by combining information on paid sick leave mandates with medical and prescription drug claims covering 50 million life-years over a ten-year period from the Truven Health Analytics MarketScan Commercial Claims Research Database. We will employ validated, statistically rigorous econometric modeling to compare changes in the use of cancer prevention services for those affected by a paid sick leave mandate to those who were unaffected. Our proposed research seeks to investigate a particularly salient barrier to cancer detection and provide the first causal evidence of the effect of paid sick leave on cancer prevention. Addressing this knowledge gap is of critical importance as improved adherence to preventive care services, including screenings for breast cancer, colorectal cancer, and tobacco cessation, is estimated to save more than 2 million life-years annually and reduce health care expenditures by nearly $4 billion per year. Our results will inform an active policy debate over the merits of paid sick leave coverage, identify opportunities to address the sub-optimal use of preventive care, and quantify the potential for paid sick leave benefits to improve population health and quality of life.
By the end of 2018, nearly 15 million workers will have gained paid sick leave benefits as a result of recent mandates enacted by several states, counties, and municipalities. Work commitments and the prospect of lost wages are known factors contributing to delays in seeking medical care. This project will provide the first causal estimates of the effect of paid sick leave mandates on the use of cancer prevention services including screenings for breast and colorectal cancers, smoking cessation counseling, and smoking cessation medications.
