TOP 47 - Examining the Impact of State Paid Family Leave on Parental Engagement, Continuous Insurance Status, Housing Stability, and Food Security in the First Year of Life

Publication Number: 3776.TOP 47

Rachel Levy, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Kathryn Paul, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background: Paid family leave (PFL) has been identified as a key, effective investment in fostering a nurturing environment for infants and reducing socioeconomic disparities in access and outcomes for infants. In the last five years, ten states have adopted state-sponsored PFL, up from four prior to 2020. Existing research has shown PFL’s impact on infant mortality, timely vaccination rates, parent mental health, and breastfeeding. Few of these studies have examined outcomes PFL could plausibly impact through enhanced family and financial stability such as parental engagement, continuous insurance status, housing stability, and food security. Additionally, most U.S. PFL studies focus on early-adopted states (California, New Jersey, Rhode Island), limiting generalizability of prior studies to newer PFL adopting states.

Objective: We aim to examine the impacts of PFL on three states that have more recently adapted PFL and have therefore been less studied. We additionally aim to examine other pertinent outcomes that have not been as well documented in the literature in hopes of providing evidence surrounding PFL from a different lens. More specifically, we aim to ask: did the implementation of state mandated PFL in New York, Washington, and the District of Columbia impact parental engagement, continuous insurance status, housing stability, and food security for infants in the first year of life?

Design/Methods: We will conduct a quasi-experimental, Calloway Sant’Anna difference-in-difference study using the 2016-2024 National Survey of Children’s Health (NSCH). The NSCH employs a multistage sampling and weighting process to produce a population-representative sample of U.S. children ages 0-17. The analytic cohort will include survey respondents with infants aged ≤1 year residing in the three exposure states. We will first perform state-specific analyses to estimate within state effects of PFL on each outcome of parental engagement, continuous insurance status, hosing stability, and food security. We will then combine New York, Washington, and DC into a pooled experimental group to assess aggregate impact of PFL. We will assess outcomes during two to four years pre- and four to six years post-implementation of PFL (depending on state policy start date). We will measure these outcomes from validated NSCH composite measures. Each state will be compared to a demographically and/or regionally similar control without PFL: Virginia (for DC), Pennsylvania (for New York), and North Carolina (for Washington).