The United States is one of the only countries in the world that doesn’t guarantee paid parental leave. We point out this fact a lot, but it’s useful to think about what that means. What does it mean for a family when parents don’t have paid leave and don’t have the ability to take time off when a baby is born?
It means a lot of things. It means moms going back to work while still recovering from childbirth, it means parents struggling to figure out child care for their baby, and it often means babies going to group child care settings, which may be wonderful but do expose them to germs — germs that are more dangerous when babies are small than when they’re bigger. There are a lot of reasons that we talk about the importance of paid leave. We can talk about these reasons and we can see why they might matter for kids’ outcomes, for families’ outcomes, but to figure out how much they matter and in what ways, that’s what research is for.
And this past summer, Dr. Katherine Ahrens and Dr. Jennifer Hutcheon, who are both epidemiologists and professors, wrote a paper titled “Paid Family Leave and Prevention of Acute Respiratory Infections in Young Infants.” The paper is an analysis of paid leave in New York State, and the authors are looking at the impacts of that paid leave on hospitalizations for infants, mostly for RSV.
Bottom line from the paper: paid family leave keeps babies healthier and keeps them out of the hospital, and now we have the data to prove it and to show that the effects are large in terms of numbers.
Putting together a research paper like this is surprisingly tricky. You need to know what questions you’re asking, and you need to think about how you’re going to determine causality rather than just correlation. So we’re going to take their research from idea to final peer-reviewed paper, and we’re going to talk about everything you always wanted to know about how research is conducted.
Here are three highlights from the conversation:
Why is it important for research to have funding?
Definitely NICHD, the National Institute of Child Health and Human Development, shares a lot of interest with what Jenn and I do because it’s focused on families and maternal health and infant health and child health. That’s a good institute for us to apply for funding from.
What is the difference between a natural experiment and a regular experiment?
What is the path between writing a paper and having it published?
And so we kind of felt like these comments from these reviewers, though the paper was rejected, they were actually pretty addressable. We had thought a lot about our model and a lot about why not to use this typical method that’s used often by health economists. So we actually asked JAMA if we could respond to the reviewer comments and at the same time submit the paper to JAMA Pediatrics, which is another JAMA-family journal but it specializes in pediatrics. And they said okay. So we did that. We responded to the comments of the original reviewers at the same time we submitted to JAMA Pediatrics. That process went very smoothly. It wasn’t actually sent out for review again. They used the original reviewers. It was a very efficient process.
Full transcript
This transcript was automatically generated and may contain small errors.
That grant did not get funded. And as we were kind of rethinking what to do with it for resubmitting and things like that, one of the considerations that we had is that when you’re evaluating these policies, because not everybody in the population is affected by a policy. So some people will have already had leave or will already be taking leave, some people still won’t take leave, even if it’s available. You need to have a fairly strong signal in the group of people who are affected by the paid family leave policy to be able to detect it overall.
I think we were a little bit worried that because there’s a couple steps involved in prevention of rapid repeat pregnancy, it has to be that you are more likely to go to your postpartum visit and get contraception to be able to actually prevent a rapid repeat pregnancy that maybe we couldn’t detect signal overall. And then I happened to be working on another project that was looking at prevention of lower respiratory tract infection in infants and going through all the literature on the risk factors of which the main one that stands out is day care and older siblings. And so that kind of was the connection between saying, “Hey, if we want a strong direct effect, why aren’t we looking at the effective paid family leave on newborn respiratory tract infections? That’s kind of how we got to where we were.
Definitely NICHD, National Institute of Child Health and Human Development shares a lot of interest with what Jenn and I do because it’s focused on families and maternal health and infant health and child health. That’s a good institute for us to apply for funding from.
Okay. You sort of get into this space, but it is not initially the thing you’re most interested in. Can you just say a little bit about this idea of rapid repeat pregnancies and actually what that is and where you started, what were you trying to understand there?
There are only 13 states enacted paid family leave with Maine being the 13th state. So it’s not the majority of states in the U.S. that have paid family leave, which is an outlier among many high income countries. I think we’re the only-
And then there’s this challenge which is, and you talked about confounding, but just to be clear on the challenge, you couldn’t really just write a paper where you compare people who have leave to people who don’t, because those groups are really, really different. Maybe they’re in different countries, but even if you looked within the U.S., paid leave is more likely from an employer for people who are white collar who have more resources and other ways. So you wouldn’t really be able to do that. So your challenge there is to say, “Okay, I’m interested in this question of how paid leave might impact infant illness, but I can’t just compare people.” So what is your next step in trying to figure out how you can do a better job figuring out a causal relationship?
So we had to actually go to each state and apply to use the data directly from each state’s Department of Health. We had to go write an application and go before their data governance board and ask for the data and say our hypotheses and methods and everything. So we did that for New York, Maine, Vermont, New Hampshire, and Massachusetts, New York. And then the control states did not have any paid family leave at the time of January 2018.
So the control states that we picked was sort of this balancing act of do they have data, do they have the data we want, and are they a reasonable control state and can we afford them? Because there were some states I think that were very, very expensive to get the data that we couldn’t.
It’s so frustrating because it’s so… Maybe not frustrating, but it’s such a huge part of the work of a project like this. And then it gets three lines in the method section. We use these control states, you’re like, “But let me explain to you about that meeting I had with the people in Massachusetts and I can’t believe what they asked me to do.” It’s like, no, nobody gets to hear about that problem.
More ParentData, including what it feels like to actually be reviewed by your peers, what do you do as a researcher when your research doesn’t match your hypothesis and when it does, and where this research might take public policy, after the break.
I found that a very stressful part about working on this project. A lot of the other work I’m working on right now is things related to drug safety, where if you find a signal of concern, that’s worth knowing and reporting on. But if you find something safe, that’s also important and worth reporting on, whereas something like paid family leave is a bit harder because of the feelings invested in it. So I think when we got our answer, I exhaled. And when we did every single sensitivity analysis, I exhaled a little bit more. And then when the last of our sensitivity analysis that we did was the one where we looked to see if we saw a similar effect in one-year-olds who were infants that we hypothesized would not be affected by paid family leave because their parents weren’t eligible. And we saw that there was basically no change at the same time in those infants. And so I think that’s when I finally truly exhaled.
And then also with this, to point out, this is something that you have maybe some opinion about how the data should go. So we had an elaborate analytic plan that we ran by our co-authors and we had a meeting before because they were all on the same page because I find that’s the best way to do things where you don’t get down into a, “Well, what if we look at this way? What if we look at it that way?” We had a good pre-analysis plan.
Okay, so then you write the paper, you have your results, you have your beautiful sensitivity analysis. What is the path between writing a paper like this and having it published? I’m not sure if people have any sense of what happens. What do you do with your paper?
And so we kind of felt like these comments from these reviewers, though the paper was rejected, they were actually pretty addressable. We had thought a lot about our model and a lot about why not to use this typical method that’s used often by health economists. So we actually asked JAMA if we could respond to the reviewer comments and at the same time submit the paper to JAMA Pediatrics, which is another JAMA Family Journal, but it specializes in pediatrics. And they said, “Okay.” So we did that. We responded to the comments of the original reviewers at the same time we submitted to JAMA Pediatrics. That process went very smoothly. It wasn’t actually sent out for review again. They used the original reviewers. It was a very efficient process.
There’s definitely a lot of room for improvement in peer review. It’s hard to think of a time where I’ve gotten comments from reviewers where my thought was, “Oh, I had never thought of that before. That’s such a great point.” Most of the time, it’s comments that are worth discussing a little bit more. But because you have a limit on the number of words you can put in your manuscript, you couldn’t put it in the first time. And so maybe you get to discuss something in a little bit more detail later. But it’s hard to think of times where I’ve really felt like they made a major improvement to my work.
It’s suggesting me, the process can’t be perfect because every field is doing it differently. So if we had a really great process, we’d probably all have the same process. And it must be that it’s kind of in some way problematic. But your paper got published and then when it gets published, then what happens? What do you do? If paper comes out, does anything happen?
For example, earlier this fall, I wrote an article that went deeply into Jen and Kate’s paper’s findings, and explain where this paper fits in the world of public policy, which I think we can all agree is in desperate need of data like this. Read it at parentdata.org.
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