Maternal employment, breastfeeding, and health: evidence from maternity leave mandates

Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. We also look for impacts of the reform on self-reported indicators of maternal and child health captured in our data. For most indicators we find no effect.     

Facilitating the acceptance of employment of older registered nurses among Japanese female registered nurses younger than 65 years old

Objective: In Japan, policies to ensure employment for persons aged 65 and older are being implemented. To facilitate the employment of older registered nurses working in hospitals, the understanding of registered nurses younger than 65 is necessary. We investigated the factors associated with the acceptance of employment of older registered nurses among registered nurses younger than 65.Materials and Methods: The subjects were female registered nurses younger than 65 working in 34 hospitals in Mie Prefecture. We distributed anonymous self-administered questionnaires. We conducted factor analyses of both respondents’ opinions on the employment of “Registered nurses aged 65–69” and “Registered nurses aged 70–74”. Multiple regression analysis was conducted to examine the associations between the “Acceptance of employing registered nurses aged 65–69” and “Opinions on the employment of registered nurses aged 65–69” (Statistical model 1). Moreover, multiple regression analysis was also conducted to examine the associations between the “Acceptance of employing registered nurses aged 70–74” and the “Opinions on the employment of registered nurses aged 70–74” (Statistical model 2).Results: Using factor analyses, the same factors were extracted for both, “Registered nurses aged 65–69” and “Registered nurses aged 70–74”. These factors were: “Health and job performance”, “Utilization of the knowledge and experience of older registered nurses”, “Reducing the workload burden of registered nurses”, and “Manners of older registered nurses”. Using multiple regression analyses, “Health and job performance”, “Utilization of the knowledge and experience of older registered nurses”, and “Reducing the workload burden of registered nurses” were significantly associated with “Acceptance of employing registered nurses aged 65–69” (Statistical model 1). The same 3 factors were also significantly associated with “Acceptance of employing registered nurses aged 70–74” (Statistical model 2).Conclusion: Hospital managers must pay careful attention to these 3 factors.     

The Effect of Total Hip Arthroplasty on Employment

This study was undertaken to investigate the impact of total hip arthroplasty on a patient's work ability. Fifty-four patients who were in the workforce completed a questionnaire 1 year after total hip arthroplasty. Thirty-eight (86%) of 44 patients working preoperatively were working 1 year after surgery, whereas only 2 (20%) of 10 patients who were not working preoperatively resumed work. Those who resumed work were younger and reported better Oxford-12 and physical function scores. Patients who resumed working had improvements in their ability to meet workplace physical demands and in productivity. Total hip arthroplasty has positive effects on work capacity in patients who return to work. To help patients remain in the workforce, surgery should be undertaken before a patient's hip dysfunction forces them off work.     

Health insurance coverage and self‐employment

BackgroundSelf‐employed workers are 10% of the US labor force, with growth projected over the next decade. Whether existing policy mechanisms are sufficient to ensure health insurance coverage for self‐employed workers, who do not have access to employer‐sponsored coverage, is unclear.ObjectiveTo determine whether self‐employment is associated with lack of health insurance coverage.Data SourcesSecondary analysis of Medical Expenditure Panel Survey (MEPS) data collected 2014‐2017.Study DesignParticipants were working age (18‐64 years), employed, civilian noninstitutionalized US adults with two years of Medical Expenditure Panel Survey (MEPS) participation in 2014‐2017. We compared those who were employees vs those who were self‐employed. Key outcomes were self‐report of health insurance coverage, and of delaying needed medical care.Data Extraction MethodsLongitudinal design among individuals who were employees during study year 1, comparing health insurance coverage among those who did vs did not transition to self‐employment in year 2.Principal Findings16 335 individuals, representing 121 473 345 working‐age adults, met inclusion criteria; of these, 147, representing 1 097 582 individuals, transitioned to self‐employment. In unadjusted analyses, 25.7% of those who became self‐employed were uninsured in year 2, vs 8.1% of those who remained employees (P < .0001). In adjusted models, self‐employment was associated with greater risk of being uninsured (26.1% vs 8.0%, risk difference 18.0%, 95% confidence interval [CI] 9.2% to 26.9%, P = .0001). A time‐by‐employment type product term suggests that 10.0 percentage points (95%CI 0.3 to 19.7 percentage points, P = .04) of the risk difference may be attributable to the change to self‐employment. Self‐employment was also associated with delaying needed medical care (12.0% vs 3.1%, risk difference: 8.9%, 95% CI 3.1% to 14.6%, P = .003).ConclusionsOne in four self‐employed workers lack health insurance coverage. Given the rise in self‐employment, it is imperative to identify ways to improve health care insurance access for self‐employed working‐age US adults.     

Non-standard employment and mortality in Belgian workers: A census-based investigation

Objectives:Evidence is growing that non-standard employment is associated with adverse health. However, little is known about the relationship between different non-standard employment arrangements and subsequent all-cause and cause-specific mortality. Using population-wide data, the present study investigated this link.Methods:Data was derived from the 2001 Belgian census and a 13-year-long follow-up. The analyses comprised 1 454 033 healthy and disability-free employees aged 30–59 years at baseline. Cox regressions were fitted to analyze the mortality risks of those in non-standard employment forms (temporary agency, seasonal, fixed-term, causal work and employment program) compared to permanent employees.Results:Several groups of workers in non-standard employment arrangements in 2001 exhibited a higher mortality risk relative to permanent employees during the follow-up after adjusting for socio-economic and work-related factors. This was especially the case among men. The relative mortality disadvantage was particularly elevated for male temporary agency workers. External causes of death played an important role in this association.Conclusions:A mortality gradient between the core and outer periphery of the Belgian labor market has been observed. This study also shows that the excess risk of death, previously attributed to non-permanent employment as a whole, hides inequalities between specific forms of non-standard work (eg, temporary agency, seasonal, fixed-term employment).     

The effects of public health insurance in labor markets with informal jobs: Evidence from Mexico

This paper studies the labor market effects of the most significant public health insurance expansion in the Americas: Mexico's Seguro Popular (SP). To identify its impact, I exploit the staggered rollout of SP across municipalities. I find that SP increases labor supply by reducing the likelihood of informal workers exiting the labor market. This reduction is driven by women, who experience a 15% decrease in the probability of transitioning from informal employment to inactivity. I also find that this reduction is concentrated among female secondary earners residing in households with dependents. These findings suggest that SP may operate through a novel channel, namely that health insurance enables caregivers to continue working by reducing health shocks among dependents.     

Flexible employment,flexible eating and health risks

Over the last 30 years, the risks to public health from working conditions have subtly shifted in line with new economic regimes, notably the shift towards contractualist, individualised market driven and ‘flexible’ regulation of employment associated with the neo-liberal project. Yet, the resulting transformation in temporal schedules has occurred without due consideration of potential health impacts. We contend that contemporary employment policies pose a threat to public health because of their impact on how time is valued, used and experienced. In particular, time matters for earning an income and for basic health behaviours, like healthy eating. The sociological theory of timescapes is used to interpret a qualitative study of food consumption and labour market engagement practices among three generations of Australians. We find that wide variability in individual employment schedules is accompanied by desynchronised social lives and less healthy eating practices. The research leads us to theorise that employment regimes that are flexible for employers require workers to live flexible or fluid cultural lives, disembedded from the temporal structure of previous social rituals, whether culinary, familial or friendship. The health consequences of this requirement remain unrecognised by policy-makers.     

THE IMPACT OF MENTAL AND SUBSTANCE‐USE DISORDERS ON EMPLOYMENT TRANSITIONS

The cyclic nature of serious mental illness (SMI) and substance‐use disorders (SUD) suggests that persons with these conditions may experience high rates of transitions among employment states (full‐time, part‐time, and no employment). This study uses longitudinal data from two waves of the National Epidemiologic Survey of Alcoholism and Related Conditions to examine employment transitions for persons with SMI/SUD relative to a no‐disorder control group. Conditional on employment status in Wave I, we estimate conditional odds ratios and marginal effects of each diagnosis on the probabilities of part‐time or full‐time employment in Wave II, holding constant other characteristics that influence employment decisions. The results show transitions across employment states are common for all groups but more frequent for persons with SMI/SUD than the controls. Persons with SMI are less likely, and persons with SUDs more likely, to transition out of no employment than the controls. Part‐time employment is a relatively transitory state, particularly for persons with SMI/SUD, but full‐time employment brings a measure of job stability to all groups. After controlling for differences in observable characteristics, the marginal effects of SMI and alcohol disorders on employment transitions are largely significant, but the effects of drug disorders are not. Copyright © 2013 John Wiley & Sons, Ltd.