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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Childhood Vaccination with MMR, Flu, and HPV.

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Strategy. Paid Sick Leave Laws

Approach. Support paid sick leave laws for parents which can increase vaccination rates among children.

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Overview. Paid sick leave laws require employers in the affected jurisdictions to provide paid time off to employees for use when ill or injured. Sick employees may use the time to care for themselves by seeing a healthcare provider or stay home until they are healthy enough to work again, without concern for lost wages. In some cases, sick leave can be used to provide care to a sick child, or for instances related to domestic violence. As of 2022, the U.S. Bureau of Labor Statistics estimates that 21% of civilian workers in the U.S. do not have paid sick leave.[1] Women, Hispanics, low-wage workers, and employees with lower levels of education are less likely to have paid sick leave than their counterparts.[2, 3, 4] Individuals with paid sick leave also tend to have higher incomes [5, 6, 7] while those without it are more likely to have income below the poverty line[8] and receive safety net services.[9] Some local governments cannot enact paid sick leave measures due to state preemption legislation.[10]

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Care coordination and case management records
  • Parent/family feedback surveys
  • Information dissemination tracking Policy reviews or tracking

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of counties with local health jurisdictions partnered with state level Title V that enact paid sick leave resource centers. (Measures the policy adoption and implementation of the intervention)
  • Number of parents who gain access to paid sick leave through their employers as a result of resource centers led by Title V. (Assesses the increased availability and usability of the benefit to the focus population of parents)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of counties with local health jurisdictions partnered with state level Title V that enact paid sick leave resource centers. (Measures the policy adoption and implementation of the intervention)
  • Percent of parents who gain access to paid sick leave through their employers as a result of resource centers led by Title V. (Assesses the increased availability and usability of the benefit to the focus population of parents)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of partnerships led by Title V established between public health agencies, healthcare providers, and community organizations to educate and assist parents in utilizing paid sick leave for child vaccinations that results in an increase in knowledge. (Shows the multi-sectoral collaboration to support the approach's effectiveness)
  • Number of employers that receive technical assistance and resources to help them understand and comply with paid sick leave laws, including their application to child vaccination that leads to an increase in knowledge. (Indicates the level of support provided to facilitate the approach's successful implementation)
  • Number reduction in differences in childhood vaccination rates between children from families with lower incomes and those from families with higher incomes in jurisdictions with paid sick leave law resource centers (Shows the approach's impact on advancing health outcomes and reducing the socioeconomic gradient in vaccination)
  • Number of policymakers, business leaders, and public health supporters collaborating with Title V who recognize and champion paid sick leave as a critical strategy for supporting both economic security and public health, including childhood vaccinations. (Indicates the approach's influence on shifting narratives and building broad-based support for systemic change)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Number of partnerships led by Title V established between public health agencies, healthcare providers, and community organizations to educate and assist parents in utilizing paid sick leave for child vaccinations that results in an increase in knowledge. (Shows the multi-sectoral collaboration to support the approach's effectiveness)
  • Number of employers that receive technical assistance and resources to help them understand and comply with paid sick leave laws, including their application to child vaccination that leads to an increase in knowledge. (Indicates the level of support provided to facilitate the approach's successful implementation)
  • Percent reduction in differences in childhood vaccination rates between children from families with lower incomes and those from families with higher incomes in jurisdictions with paid sick leave law resource centers (Shows the approach's impact on advancing health outcomes and reducing the socioeconomic gradient in vaccination)
  • Percent of policymakers, business leaders, and public health supporters collaborating with Title V who recognize and champion paid sick leave as a critical strategy for supporting both economic security and public health, including childhood vaccinations. (Indicates the approach's influence on shifting narratives and building broad-based support for systemic change)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] US DOL-PSL - US Department of Labor (US DOL), Bureau of Labor Statistics (BLS). Employee benefits in the United States - March 2017.

2 BLS-Bartel 2019 - Bartel AP, Kim S, Nam J. Racial and ethnic differences in access to and use of paid family and medical leave: Evidence from four nationally representative datasets. Monthly Labor Review. US Bureau of Labor and Statistics (BLS); 2019.

3 Zhai 2018 - Zhai Y, Santibanez TA, Kahn KE, Black CL, de Perio MA. Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among US workers. Vaccine. 2018;36(48):7316-7323.

4 Chen 2016 - Chen ML. The growing costs and burden of family caregiving of older adults: A review of paid sick leave and family leave policies. The Gerontologist. 2016;56(3):391-396.

5 Cook 201[1] - Cook WK. Paid sick days and health care use: An analysis of the 2007 National Health Interview Survey data. American Journal of Industrial Medicine. 2011;54(10):771-779.

6 Clemans-Cope 2008 - Clemans-Cope L, Perry CD, Kenney GM, Pelletier JE, Pantell MS. Access to and use of paid sick leave among low-income families with children. Pediatrics. 2008;122(2):e480-6.

7 CWF-Collins 2004 - Collins SR, Davis K, Doty MM, Ho A. Wages, health benefits, and workers’ health. New York: The Commonwealth Fund (CWF); 2004: Issue Brief #788.

8 Stoddard-Dare 2018b - Stoddard-Dare P, DeRigne LA, Mallett C, Quinn L. How does paid sick leave relate to health care affordability and poverty among US workers? Social Work in Health Care. 2018;57(5):376-392.

9 Stoddard-Dare 2018a - Stoddard-Dare P, Quinn L, Mallett C. Paid sick leave status in relation to government sponsored welfare utilization. American Journal of Orthopsychiatry. 2018;88(5):608-615.

10 Grassroots Change - Grassroots Change: Connecting for better health. Preemption Watch.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.