Nancy A. Melville

February 24, 2010

February 24, 2010 (Crystal City, Virginia) — The provision of paid leave to allow workers to receive health screenings significantly increased the number of women receiving breast exams, Pap tests, and cholesterol screenings, according to a study presented here at Preventive Medicine 2010: the Annual Meeting of the American College of Preventive Medicine. Paid leave particularly improved screening rates among Hispanic women.

With no federal requirement that employers provide workers with paid leave, the United States stands out as the only country in the Organization for Economic Cooperation and Development without such benefits, said Fernando A. Wilson, PhD, assistant professor in the Department of Health Management and Policy at the University of North Texas Health Science Center in Denton.

"In Europe, the minimum paid leave is about 20 days a year; in Japan and Canada, it's about 10 days," Dr. Wilson told Medscape Public Health & Prevention. "In 1993, we passed the Family Medical Leave Act, which provides 12 weeks of unpaid leave, but efforts in Congress to require paid leave benefits have not succeeded."

In an effort to evaluate paid leave as a possible economic incentive to increase screening rates, Dr. Wilson and his colleagues examined observations in the nationally representative 2002 to 2006 Medical Expenditure Panel Survey of 18,263 adult females, 19 to 64 years, who were continuously employed for 12 months.

The study included multivariate analyses that adjusted for factors such as age, race/ethnicity, socioeconomic status, occupation, insurance status, self-reported health status, usual healthcare provider, hours of work, and wages.

Outcome measures included having a breast examination, Pap test, and cholesterol screening test in the previous 12 months.

The results showed that the likelihood of women with paid leave receiving a breast exam was 74.7%, compared with 70.8% for those with no paid leave (P = .007). The percentage of those receiving a Pap test was 73.7%, compared with 67.9% for those with no paid leave (P < .001). The percentage of women with paid leave receiving cholesterol screening was 57.4%, compared with 48.6% for those with no paid leave (P < .001).

For Hispanic women, the provision of paid leave increased the rate of breast exams to 65.0%, compared with 52.6% for those with no paid leave. Pap testing was 67.1% for those with paid leave, compared with 54.1% for those with no paid leave. The cholesterol screening rate was 54.6% for those with paid leave, compared with 41.9% for those with no paid leave.

The study also showed higher breast cancer screening rates when paid leave was provided for mothers with a family of 3 or more (75.8% vs 69.5%; P = .004) and full-time (as opposed to part-time) employees (75.8% vs 69.5%; P = .004).

"Mothers with heavy family responsibilities and full-time employees clearly have tighter time constraints, and paid leave can help ease the burden of taking time off," Dr. Wilson said.

On the basis of the results, the researchers estimated that the expansion of paid leave benefits to all female employees could increase the number of breast exams by 2.2 million, the number of Pap tests by 2.9 million, and the number of cholesterol screenings by 1.4 million.

Dr. Wilson noted that the rates of paid leave for women in the United States are, in fact, going in the opposite direction. The percentage of female employees with paid leave declined from 83.1% in 2002 to 79.8% in 2008, and for employees with less college education, the rate dropped from 79.6% to 73.2%, he said.

Increased screening rates could translate to fewer deaths from cancer and cardiovascular disease, Dr. Wilson said.

"According to [Surveillance, Epidemiology and End Results] data, if you diagnose cervical cancer in stage I, the 5-year survival probability is about 90%, but if it's not detected until stage III or IV, that figure drops to about 20%. The rates are similar for breast cancer," he explained. And "after age 40, if you don't catch elevated cholesterol levels, you double your risk of mortality from cardiovascular disease."

The issue of paid leave for health screenings falls under a broader effort underway at the Centers for Disease Control and Prevention (CDC)'s Task Force on Community Preventive Services to identify effective interventions to promote health and prevent disease.

According to Mary C. White, MPH, PhD, chief of the Epidemiology and Applied Research Branch at the CDC's Division of Cancer Prevention and Control in Atlanta, Georgia, the task force has found some evidence of a benefit from cheaper breast cancer screening; more studies are needed.

"To date, the task force has concluded that there was sufficient evidence of effectiveness to recommend reducing out-of-pocket costs to increase breast cancer screening, although there was insufficient evidence of effectiveness for cervical or colorectal cancer screening," she told Medscape Publich Health & Prevention.

"A finding of insufficient evidence underscores the need for additional research in this area," Dr. White added.

The study did not receive funding. Dr. Wilson and Dr. White have disclosed no relevant financial relationships.

Preventive Medicine 2010: the Annual Meeting of the American College of Preventive Medicine (ACPM): Abstract 212745. Presented February 20, 2010.

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