Heymann S J, Earle A, Egleston B
Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115, USA.
Pediatrics. 1996 Aug;98(2 Pt 1):226-30.
Parents have always played a critical role in the care of sick children. Although parents' roles remain crucial to children's health, parental availability has declined during the past half century. The percentage of women with preschool children who work has risen almost fivefold in 45 years from 12% in 1947 to 58% in 1992. The percentage of women in the paid work force with school-aged children has almost tripled in the same period, from 27.3% to 75.9%. Research has examined the effects of a variety of parental work conditions on children. However, past research has not examined how working conditions affect the ability of parents to care for their sick children. In this article, we examine how often the children of working parents get sick and whether parents receive enough paid leave to care for their sick children.
This analysis makes use of two national surveys, which provide complementary information regarding the care of sick children. The National Longitudinal Survey of Youth is a longitudinal survey of a nationally representative probability sample of 12,686 men and women; the National Medical Expenditure Survey is a panel survey of 34,459 people. First, we estimated the family illness burden. Second, we looked in detail at the number of days of sick leave mothers had. Third, we examined whether mothers who had sick leave had it consistently during a 5-year period. Finally, we conducted a logistic regression to determine what factors were significant predictors of both lacking sick leave.
More than one in three families faced a family illness burden of 2 weeks or more each year. Yet, 28% of mothers had sick leave none of the time they were employed between 1985 and 1990. Employed mothers of children with chronic conditions had less sick leave than other employed mothers. Thirty-six percent of mothers whose children had chronic conditions had sick leave none of the time they were employed. Although 20% of working parents who did not live in poverty lacked sick leave, 38% of parents who did live in poverty lacked sick leave. The problem is also more marked for nonwhite parents. Although 23% of working white parents lacked paid sick leave, 31% of nonwhite parents lacked sick leave. One in six families that lacked sick leave had to cover for more than 4 weeks of family illness during the year.
In 1993, the US Congress passed the Family and Medical Leave Act (FMLA). However, by limiting the medical leave to the care of major illnesses, primarily those requiring hospitalization, the FMLA does not address the majority of children's sick care needs. For the common childhood illnesses that are not covered by the FMLA, employed parents often must rely on their sick leave if they are to care for their sick children themselves. Yet, we found that many employed parents lack sick leave. This is particularly true of parents of children with chronic conditions and poor and minority families.
父母在患病儿童的照料中一直发挥着关键作用。尽管父母的角色对儿童健康依然至关重要，但在过去半个世纪里，父母可提供照料的时间减少了。有学龄前儿童的职业女性比例在45年间几乎增长了五倍，从1947年的12%增至1992年的58%。有学龄儿童的职业女性比例在同一时期几乎增长了两倍，从27.3%增至75.9%。已有研究探讨了各种父母工作状况对孩子的影响。然而，以往研究并未考察工作状况如何影响父母照料患病子女的能力。在本文中，我们研究了职业父母的孩子生病的频率，以及父母是否有足够的带薪假期来照料患病子女。
本分析利用了两项全国性调查，它们提供了有关照料患病儿童的补充信息。全国青年纵向调查是对12686名男女进行的具有全国代表性概率抽样的纵向调查；国家医疗支出调查是对34459人进行的小组调查。首先，我们估计了家庭疾病负担。其次，我们详细查看了母亲的病假天数。第三，我们考察了有病假的母亲在5年期间是否持续有假。最后，我们进行了逻辑回归分析，以确定哪些因素是缺乏病假的重要预测因素。
超过三分之一的家庭每年面临2周或更长时间的家庭疾病负担。然而，在1985年至1990年就业期间，28%的母亲从未有过病假。患有慢性病孩子的职业母亲比其他职业母亲的病假更少。孩子患有慢性病的母亲中，36%在就业期间从未有过病假。虽然20%不贫困的职业父母缺乏病假，但38%生活贫困的父母缺乏病假。这个问题在非白人父母中也更为突出。虽然23%的在职白人父母没有带薪病假，但31%的非白人父母没有病假。六分之一缺乏病假的家庭在一年中不得不应对超过4周的家庭疾病。
1993年，美国国会通过了《家庭和医疗休假法》（FMLA）。然而，通过将病假限制在照料主要疾病（主要是那些需要住院治疗的疾病）上，《家庭和医疗休假法》并未满足大多数儿童的病假照料需求。对于《家庭和医疗休假法》未涵盖的常见儿童疾病，如果职业父母要亲自照料患病子女，他们通常必须依靠自己的病假。然而，我们发现许多职业父母缺乏病假。患有慢性病孩子的父母以及贫困和少数族裔家庭尤其如此。
