Paid Sick Leave Mandates and Cancer Prevention

项目总结/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 包括乳腺癌和结肠直肠癌筛查、戒烟咨询和戒烟 药物治疗虽然乳腺癌筛查、结肠直肠癌筛查和吸烟的好处 戒烟服务是重要的和众所周知的，目前使用这些服务仍然低于建议 程度.工作承诺和工资损失的前景是造成求职拖延的已知因素。 医疗等带薪病假允许工人带薪休假，减轻了这些担忧， 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 已制定法例，规定雇主须为雇员提供有薪病假福利。但 带薪病假规定与癌症预防服务使用之间的因果关系尚未确定。 确立了习在一项初步研究中，我们表明这些强制规定导致带薪病假的获得增加 以前未被覆盖的工人的福利。我们现在寻求确定是否扩大带薪病假 休假增加了癌症预防服务的使用，并增加了对推荐的癌症筛查的坚持。 我们该项目的目标是估计带薪病假强制令对乳腺癌发病率的影响 筛查（目标1：筛查和诊断性乳腺X线摄影以及ACS和USPSTF的依从性 建议），结直肠癌筛查（目标#2：结肠镜检查，CT结肠造影，灵活 乙状结肠镜检查和粪便筛查）和戒烟服务（目标3：戒烟 戒烟药物的咨询和处方填写）。我们将通过以下方式实现我们的目标 将带薪病假规定与医疗和处方药索赔的信息结合起来，覆盖5000万人 Truven Health Analytics MarketScan®商业索赔研究的10年生命年 数据库我们将采用经过验证的，统计上严格的计量经济学模型来比较使用的变化 为那些受带薪病假授权影响的人提供癌症预防服务。 我们提出的研究旨在调查癌症检测的一个特别突出的障碍，并提供第一个 带薪病假对癌症预防效果的因果证据。解决这一知识差距至关重要， 重要的是，要加强对预防保健服务的坚持，包括乳腺癌筛查， 据估计，结肠直肠癌和戒烟每年可挽救200多万生命年， 每年医疗保健支出近40亿美元。我们的研究结果将为有关全球气候变化的积极政策辩论提供信息。 带薪病假覆盖面的优点，确定解决预防性护理的次优使用的机会，以及 量化带薪病假福利改善人口健康和生活质量的潜力。

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.