Paid Sick Leave Mandates and Cancer Prevention

项目摘要/摘要 我们建议评估有薪病假规定对癌症预防服务使用的因果影响。 包括乳腺癌和结直肠癌的筛查、戒烟咨询和戒烟 药物。尽管乳腺癌筛查、结直肠癌筛查和吸烟的好处 戒烟服务意义重大且广为人知，目前这些服务的使用率仍低于推荐水平 级别。工作承诺和工资损失的前景是造成求职延迟的已知因素 医疗护理。允许员工带薪休假的带薪病假缓解了这些担忧，并 有可能增加获得医疗保健专业人员的机会。最近，8个州和25个市县 已经制定了法律，要求雇主向其工人提供带薪病假福利。然而，a 带薪病假要求和癌症预防服务使用之间的因果关系尚未得到证实 已经成立了。在一项初步研究中，我们表明，这些命令增加了获得带薪病假的机会。 以前未覆盖的工人的福利。我们现在寻求确定是否扩大带薪病假 Leave增加了癌症预防服务的使用和对推荐的癌症筛查的坚持。 我们这个项目的目标是评估带薪病假对乳腺癌发病率的影响。 筛查(目标1：筛查和诊断性乳房X光检查以及遵守ACS和USPSTF 建议)、结直肠癌筛查(目标2：结肠镜检查、CT结肠造影术、灵活 乙状结肠镜检查和粪便筛查)和戒烟服务(目标3：戒烟 咨询和处方填写戒烟药物)。我们将通过以下方式实现我们的目标 将有关带薪病假要求的信息与覆盖5000万的医疗和处方药索赔相结合 来自Truven Health Analytics MarketScan®商业索赔研究的十年寿命年数 数据库。我们将使用经过验证的、统计上严格的计量经济学模型来比较使用中的变化 为那些受带薪病假任务影响的人提供癌症预防服务，并向那些未受影响的人提供服务。 我们提出的研究试图调查癌症检测的一个特别显著的障碍，并提供第一个 带薪病假对癌症预防效果的因果证据。解决这一知识鸿沟至关重要 重要的是更好地遵守预防性护理服务，包括乳腺癌筛查， 据估计，结直肠癌和戒烟每年可以挽救200多万人的生命，并减少 医疗保健支出每年增加近40亿美元。我们的结果将为一场关于 有薪病假保险的优点，找出机会解决预防性护理的次优使用问题，以及 量化带薪病假福利的潜力，以改善人口健康和生活质量。

PROJECT SUMMARY/ABSTRACT 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.