State Paid Sick Leave Mandates and Receipt of Pediatric Preventive Dental Care

Abstract

BACKGROUND AND OBJECTIVES:

Biannual preventive dental visits are recommended to promote good oral health and identify problems, yet children in many families do not receive this care due to time-related barriers. Paid sick leave mandates have the potential to relieve parental time constraints and facilitate scheduling and attending pediatric dental visits; thus, we sought to evaluate the effects of state paid sick leave mandates on children’s receipt of preventive dental care.

METHODS:

Using 2016 to 2023 National Survey of Children’s Health data and a difference-in-differences approach, we compared trends in children’s receipt of preventive dental care in states that did and did not implement paid sick leave mandates.

RESULTS:

Pre-implementation of paid sick leave mandates, children residing in states that later implemented these policies were more likely to have received preventive dental care, to be non-Hispanic white, to have private health insurance, and to have parents with more than a high school education, relative to children residing in states that never implemented paid sick leave mandates. State paid sick leave mandates were associated with a 3.2% relative increase (95% CI: 0.2%, 6.2%) in rates of children receiving preventive dental care, controlling for time-varying demographic and policy characteristics, with state and year fixed effects.

CONCLUSIONS:

State-paid sick leave mandates may alleviate competing parental work and caregiving responsibilities and provide parents with additional time and flexibility to obtain dental care for their children.

INTRODUCTION

Preventive dental visits are important for maintaining good oral health during childhood—they offer opportunities for the delivery of preventive care, detection and early treatment of problems, and education about good hygiene practices—and they can have lasting benefits for both oral health specifically and overall health across the life course.^1–3 For example, poor oral health is associated with elevated risk for diabetes and cardiovascular disease.^4,5 Clinical interventions, including fluoride treatments and sealants, are effective in preventing and controlling dental caries (commonly called tooth decay), the most common chronic condition among children in the United States (US),⁶ with half of all children aged 6 to 9 years having dental caries.⁷ However, caries and other oral health conditions often go untreated,⁷ as many children do not receive regular dental care.⁸ A potential barrier for families seeking preventive dental care for their children is the time required to receive this care, which includes travel time to and from the dental office, time for the appointment, as well as time for potential appointment delays. Working parents may face particular challenges, as they often must schedule and attend their children’s dental appointments around work hours. As a result of competing parental work and caregiving responsibilities, some families forgo children’s dental services,^9,10 with 41% of people not receiving dental care reporting time-related barriers.¹¹

Unlike the vast majority of industrialized countries, the US lacks a national policy that allows employees to use paid time to attend to health care needs of themselves and their families.¹² Without a federally mandated paid sick leave (PSL) policy, many states have implemented PSL mandates that confer approximately 7 days of financially protected time off per year.¹³ Employees can carry unused benefits over to the next calendar year and can use mandated PSL for any health services, including preventive dental care, received by themselves or their children. These state PSL mandates may provide working parents with additional time and flexibility¹⁴ to obtain dental care for their children without foregoing wages or risking job loss. Prior research has found that state PSL mandates are associated with increased use of several types of health services among adults,¹⁵ including receipt of screening, vaccinations, prescriptions, and contraceptives.^16–18 Some studies have begun to explore the impacts of PSL on children’s receipt of health care, finding increases in child mental health specialty service use among certain age groups postimplementation of state PSL mandates (under review) and higher rates of doctor and mental health professional visits among children with a parent who has access to PSL.¹⁹ However, less is known about the effects of state PSL mandates on children’s receipt of preventive dental care.

To address this gap in the literature, we used nationally representative survey data to examine the effects of state PSL mandates on receipt of pediatric preventive dental care using nationally representative survey data. Given existing evidence of increased use of various medical services following the implementation of PSL mandates,^15–18 we hypothesized that state PSL mandates would contribute to more children receiving preventive dental care.

METHODS

Data and Variables

We used data from the 2016 to 2023 National Survey of Children’s Health (NSCH), an annual repeated cross-sectional survey on health and well-being among US children aged 0 to 17 years.²⁰ The NSCH includes information on a randomly selected child in each sampled household provided by an adult in that household familiar with the child’s health and health care use (eg, a parent). We excluded children less than one year, as teeth typically emerge at 6 months of age, and the American Academy of Pediatric Dentistry recommends that children have their first dental visit by their first birthday,²¹ and children residing in the District of Columbia and Connecticut, where PSL mandates were implemented more than a year before the start of our study period. Of the remaining survey participants, we excluded 2.1% (n = 6471) who had missing outcome or covariate information, resulting in a final analytic sample of 304 197 children.

We obtained state policy data on PSL mandates from the National Partnership for Women and Families.¹³ As of the most recent data release in November 2024, 19 states (including the District of Columbia) had PSL mandates currently in effect or planned to go into effect by the end of 2025. NSCH data collection began each year between June and August, and so we coded PSL mandates as in place in a given calendar year if the policy was in effect by the end of May of that year. All state PSL mandates require employees to work specified amounts of time to “earn” PSL; thus, we lagged the state PSL mandate by one year to allow time for employees to accrue (and perhaps learn about) these benefits. During the study period, 11 states had PSL mandates that had been in effect for at least one year (Supplemental Figure 1).

Our primary outcome was receipt of preventive dental care in the past 12 months, operationalized dichotomously based on parents’ responses to the survey question: “During the past 12 months, did this child see a dentist or other oral health care provider for preventive dental care, such as check-ups, dental cleanings, dental sealants, or fluoride treatments?” Individual-level NSCH demographic covariates included the child’s sex, age, race and ethnicity, health insurance type, and the highest level of education among reported adults in the household. We also accounted for state-level time-varying covariates such as whether a state provided Medicaid dental benefits for adults (no coverage or emergency only; limited coverage; enhanced coverage), paid time off mandates and paid family and medical leave state insurance programs from the National Partnership for Women and Families,²² monthly Temporary Assistance for Needy Families (TANF) benefits in US dollars for a family of 4 (inflated to 2023 dollars using the Consumer Price Index) from the University of Kentucky Center for Poverty Research,²³ and state demographic characteristics (sex, age, race, ethnicity, and educational attainment) from the Current Population Survey.²⁴ Covariates were reasonably balanced across children in states that did and did not implement PSL mandates (Supplemental Figure 2).

Analysis

We weighted the data using NSCH-provided survey weights to ensure that our sample was representative of the US population of noninstitutionalized children across the eight-year study period, and were clustered by state and sampling stratum.²⁵ First, we generated descriptive statistics of the individual- and state-level characteristics of our weighted analytic sample and plotted trends in receipt of preventive dental care, both overall and stratified by state PSL mandate status. We also described the baseline rates of pediatric preventive dental care among demographic subgroups. To estimate the effects of state PSL mandates on receipt of pediatric preventive dental care, we then implemented difference-in-differences methods using a two-stage imputation procedure developed by Gardner (2022).²⁶

We used “not-yet-treated” and “never treated” observations (ie, children residing in PSL mandate states prior to PSL mandate implementation and children residing in states that never implemented PSL mandates) in the first stage of the Gardner procedure to estimate the relationships between covariates and receipt of preventive dental care, with state and year fixed effects. These estimated parameters allowed us to impute the “missing” counterfactual outcome for children in PSL mandate states postimplementation of PSL mandates. In the second stage, we then regressed the residualized outcome on state PSL mandates. SE estimation accounted for counterfactual imputation. We then multiplied the coefficient estimate (ie, the increase in probability of receiving a preventive dental visit due to PSL mandate implementation) by the total population of children ages 1–17 in states that had not implemented a PSL mandate by the end of our study period to calculate the number of additional children who would have received dental care in 2023 had all states implemented PSL mandates by that time.

We also estimated an event study to probe the assumption that children in states that implemented vs did not implement PSL mandates would have followed parallel trends in receipt of preventive dental care in the absence of policy implementation, as difference-in-differences methods rely on the validity of this “parallel trends” assumption. In doing so, we decomposed the main treatment variable (state PSL mandate lagged by one year) into a series of interaction terms between being treated and time-to-event, where the event is the year of treatment. We assessed the period ranging from up to 4 years pretreatment to up to 4 years post-treatment, and included pretreatment data from children in states that implemented PSL following the study period. Although the parallel trends assumption is fundamentally untestable, the event study coefficient estimates in pretreatment years demonstrated that there were no significantly different trends in pediatric preventive dental care in states that (later) would and would not adopt a PSL mandate before the mandate implementation (Supplemental Figure 3).

Subgroup analyses evaluated heterogeneity in the effects of state PSL mandates on receipt of pediatric preventive dental care. The share of workers with PSL (in the absence of a PSL policy) is typically lower for those who live in households with incomes less than $100 000, attained some college education or less, and are Black or Hispanic.^27,28 Therefore, we hypothesized that state PSL mandates would be more beneficial to children in households with lower socioeconomic status (SES) and thus examined variation in the effects of PSL mandates by proxies for SES: health insurance type (any private insurance coverage vs public insurance only) and parental education level (more than high school vs high school or less). Because of longstanding racial inequities in the receipt of health services, we also conducted subgroup analyses by race and ethnicity. We hypothesized that state PSL mandates would be more beneficial for children who are Black or Hispanic because of the low rates of workers of color with access to PSL. Finally, we evaluated the effect heterogeneity by age group, hypothesizing that state PSL mandates would be more beneficial to young children who are more reliant on their families to facilitate care.

We implemented several stability analyses to confirm the robustness of our main findings to alternative specifications and samples. For example, we excluded time-varying covariates from the primary difference-in-differences regression. To test whether our findings were driven by any specific survey years, particularly during the COVID-19 pandemic, we sequentially dropped each year of data and re-estimated our primary difference-in-differences regression. In the iteration of this “leave-one-out” analysis that dropped data from 2016, we also dropped children in states that could no longer be observed for at least a year pretreatment (ie, California, Massachusetts, Oregon). Similarly, to test whether findings were driven by the experiences of children in any specific state(s) enacting PSL mandates, we sequentially dropped children residing in each treated state and re-estimated our primary difference-in-differences regression. Because the “leave-one-out” analyses by state for California and for New York produced point estimates that differed most from the effect among all states, we also conducted this analysis excluding children residing in either of these 2 states.

All analyses were performed using Stata 19.0 (StataCorp, College Station, TX). The George Mason University Institutional Review Board determined that this study does not meet the definition of human subjects research.

RESULTS

The weighted analytic sample was predominantly male patients (51.1%), aged 5 to 12 years (47.1%), non-Hispanic white (50.1%), and covered by only private insurance (58.3%) (Table 1). Parents reported that 78.5% of children had received preventive dental care in the past 12 months, and 20.9% of children resided in a state that had implemented a PSL mandate at the time of survey completion. Child demographic characteristics were similar by state PSL mandate status, with slightly greater proportions of children who had received preventive dental care, were non-Hispanic white, had private health insurance only, and had parents with more than a high school education in states that implemented PSL mandates vs those that did not. Only states that implemented PSL mandates had paid family and medical leave state insurance programs as well, and Medicaid dental benefits and TANF benefits for a 4-person family were more generous in these states (Table 1). From 2016 to 2023, the percentage of children who had received preventive dental care in the past 12 months was relatively constant, with a slight decrease following the declaration of the public health emergency in 2020 (Supplemental Figure 4). Children aged 5 to 12 were most likely to receive preventive dental care, as were non-Hispanic white children, children with private insurance, and children with parents who had more than a high school education (Table 2).

TABLE 1.

Percentages of Study Population With Preventive Dental Care, Demographic, and State Characteristics

Characteristic	All States (Unweighted N = 304 197)	States That Implement a PSL Mandate, Prepolicy (Unweighted n = 60 427)	States That Do Not Implement a PSL Mandate (Unweighted n = 188 077)
Primary outcome, %
Received preventive dental care in past 12 mo	78.5	78.8	77.7
Treatment variable, %
PSL mandate (lagged 1 y)	20.9	0.0	0.0
Individual characteristics, %
Female, %	48.9	49.1	48.8
Age, %
1–4 y	22.7	23.1	22.6
5–12 y	47.1	47.3	47.1
13–17 y	30.2	29.6	30.2
Child’s race and ethnicity, %
Non-Hispanic Black	13.0	11.0	15.8
Non-Hispanic white	50.1	54.2	53.3
Non-Hispanic other races	10.9	11.8	9.0
Hispanic	25.9	23.0	22.0
Child’s health insurance type, %
Public only	30.2	29.0	30.7
Private only	58.3	61.2	56.6
Private and public	4.7	4.8	4.8
Not insured	6.7	5.1	7.9
Parental education level, %
Less than high school	9.1	8.4	8.5
High school	19.1	17.7	20.4
More than high school	71.7	73.9	71.1
State characteristics, %
Paid time off mandate, %	2.5	9.6	1.0
Paid family and medical leave policy, %	21.3	29.7	0.0
TANF 4-person family ($/mo)	$1468.96	$1592.67	$1313.95
Medicaid dental benefits, %
None or emergency-only coverage, %	33.0	11.4	47.7
Limited coverage, %	19.3	22.0	25.1
Enhanced coverage, %	47.7	66.6	27.2
Female, %	51.0	50.9	51.1
Race and ethnicity, %
Black, %	13.2	11.4	15.4
White, %	76.3	77.5	76.8
Other races, %	10.5	11.1	7.9
Hispanic, %	18.9	16.4	16.3
College degree or higher, %	31.8	33.4	29.7

Abbreviations: PSL, paid sick leave; TANF, Temporary Assistance for Needy Families.

Percentages are weighted such that the sample is representative of the US population of noninstitutionalized children aged 1 to 17.

TABLE 2.

Percentages of Study Subpopulations That Received Preventive Dental Care in Past 12 Months

Characteristic	All States, %	States That Implement a PSL Mandate, Prepolicy, %	States That Do Not Implement a PSL Mandate, %
Overall sample	78.5	78.8	77.7
Race and ethnicity
Non-Hispanic white	80.5	80.9	79.4
Non-Hispanic Black	74.7	72.2	75.0
Non-Hispanic other races	76.8	77.0	75.2
Hispanic	77.1	77.9	76.3
Age group
1–4 y	52.7	51.0	51.8
5–12 y	86.8	87.6	86.0
13–17 y	84.9	86.4	84.0
Insurance type
Public only	75.6	74.4	75.7
Private only	82.4	82.4	81.8
Public and private	79.4	78.6	79.0
Uninsured	56.8	60.0	54.7
Parental education
Less than high school	68.6	68.5	66.0
High school	73.4	74.8	72.3
More than high school	81.1	80.9	80.6

Abbreviations: PSL, paid sick leave; US, United States.

Percentages are weighted such that the sample is representative of the US population of noninstitutionalized children aged 1 to 17.

Following implementation of a state PSL mandate, rates of receiving pediatric preventive dental care increased by 2.5 percentage points (effect estimate = 0.025; SE = 0.012), from a pretreatment prevalence of 78.9% to 81.4%, which corresponds with a 3.2% relative increase (95% CI: 0.19%, 6.17%) (Table 3). These results were robust to covariate adjustment (Supplemental Table 1). If all states had implemented PSL mandates during our study period, an estimated additional 2 331 653 children aged 1 to 17 would have received preventive dental care in 2023. Although there were no significant differences in the effects of PSL mandates on receipt of pediatric preventive dental care by child demographics or parental education, the estimated effect sizes were largest among non-Hispanic white children (effect estimate = 0.029; SE = 0.009), Hispanic children (effect estimate = 0.040; SE = 0.019), and children ages 1–12 (effect estimate = 0.037; SE = 0.015) (Figure 1). Findings from our leave-one-out analyses by treated state (Supplemental Figure 5) and survey year (Supplemental Figure 6) were comparable to our main findings, with the exception of those that excluded participants from California or from New York. The effects of statewide PSL mandate implementation in California contributed to the observed effect in the overall sample, because our analysis that dropped children from this state produced null findings. Conversely, the effect size increased when we dropped children from New York from the analysis. However, excluding children who reside in either California or New York resulted in a comparable estimate to our main findings.

TABLE 3.

Effects of State PSL Mandates on Receipt of Pediatric Preventive Dental Care, Controlling for Time-Varying Characteristics

Outcome	Coefficient Estimate (SE)	Percent Change (95 CI)	Pretreatment Mean in PSL Mandate-Implementing States
Received preventive dental care in the past 12 mo	0.025a (0.012)	3.18 (0.19, 6.17)	0.79

Abbreviations: PSL, paid sick leave; US, United States.

This table reports coefficient estimates from a regression of pediatric preventive dental care receipt on state PSL mandates lagged by one year, controlling for individual and state characteristics, state fixed effects, and year fixed effects. Data are weighted such that the sample is representative of the US population of noninstitutionalized children aged 1 to 17. SEs that account for clustering within state and sampling stratum are reported in parentheses.

^aStatistically different from zero at the 5 level.

FIGURE 1.

Effects of state-PSL mandates on receipt of pediatric preventive dental care by demographic characteristics, controlling for time-varying characteristics. This figure reports coefficient estimates from regressions of pediatric preventive dental care receipt on state PSL mandates (lagged 1 year) for different subpopulations, controlling for individual and state characteristics, state fixed effects, and year fixed effects. Data are weighted such that the sample is representative of the US population of noninstitutionalized children aged 1 to 17. Coefficient estimates are reported with markers and 95 CIs that account for clustering by state and sampling stratum are reported with vertical lines.

Abbreviations: PSL, paid sick leave; US, United States.

DISCUSSION

Children are recommended to visit the dentist twice a year, allowing them to receive care to prevent dental caries and to identify concerns that may need additional treatment. The benefits of good oral health are lasting and associated with school attendance and academic performance,²⁹ job interviews, and overall well-being.³⁰ Despite these health, social, and economic benefits, some parents face barriers in obtaining dental care for their children due to work-related time constraints. Our national study finds a significant 3.2% relative increase in the rates of children receiving preventive dental care after statewide implementation of a PSL mandate, suggesting that PSL mandates may facilitate parents’ abilities to take time off work so their children can receive recommended dental care. This effect size is similar to the effect of increased Medicaid payments for dental care. Specifically, a previous study found that increasing the amount paid for dental prophylaxis from $20 to $30 led to a 3.9 percentage point increase in the likelihood that a Medicaid-insured child received a dental visit in the past 6 months.³¹ Because state Medicaid programs are facing immense budget cuts, our findings offer important evidence that other policies may similarly increase children’s receipt of care. Over 2 million additional children could have received preventive dental care in 2023 had all states implemented PSL mandates by that time.

Preventive dental care during childhood is associated with fewer dental caries, fewer missing teeth, and improved self-reported oral health.³² Thus, increases in pediatric preventive dental care as a result of state PSL mandate implementation may have benefits across the life course. Moreover, receipt of regular preventive care allows children to establish a “dental home,” which is a concept adopted from the medical home model and is intended to provide care that is “safe, culturally-sensitive, individualized, comprehensive, continuous, accessible, coordinated, compassionate, and patient- and family-centered.”³³ Children without a dental home may be more likely to seek care in emergency departments, which is costly and typically can provide only palliative care rather than needed treatment. There may be additional benefits beyond improved oral health for children who, because of PSL mandate implementation, receive preventive dental care. For example, adults with better oral health have higher earnings.³⁴

Overall, rates of children receiving annual preventive dental care in our study were generally high (~79%), but lower than ideal. Rates of receiving preventive dental care were substantially below average among children aged 1 to 4, non-Hispanic Black and Hispanic children, uninsured children, and those with public health insurance, and children whose parents had a high school education or less. Prior research has similarly highlighted lower rates of dental visits for young children who are Black or Hispanic, or are from families with low incomes or low educational attainment,³⁵ emphasizing the need to identify interventions that help these subgroups obtain dental care. PSL mandates offer a possible policy intervention to promote the use of preventive dental care among Black and Hispanic children, as research shows that these families are less likely than white families to have access to PSL through their employer in the absence of a state or local mandate.²⁸ We observed a significant increase in the rates of receipt of preventive dental care among Hispanic children, although the small sample of non-Hispanic Black children in our study limited our ability to conclude the effects of PSL mandates among this population. Effect sizes were generally comparable across subgroups in our sample by race and ethnicity, insurance status, and parental education level, and so these uniform increases in rates of receiving preventive dental care were not sufficient to overcome baseline inequities in children’s receipt of dental care. The nonsignificant association between state PSL mandate implementation and receipt of preventive dental care among children with public insurance, for instance, could be due to other barriers to care, including the low rate of dentists that accept Medicaid and the Children’s Health Insurance Program (CHIP). Fewer than 20% of dentists accept Medicaid and CHIP in 14 states.³⁶

Our findings were driven by the effects of PSL mandates among children younger than 13 years of age, as PSL mandates were not associated with changes in the rates of receiving preventive dental care among teens. By providing parents with additional time to seek health services for their children, PSL mandates may be most beneficial for parents with younger children who are more reliant on parental involvement to receive care. For example, older children may be able to visit the dentist independently of their parents, perhaps with older siblings or other family members. Parents with older children have also had more time to acclimate to their children’s health needs and more time to secure stable employment with more flexible employers, as younger parents and those with younger children are more susceptible to parental workplace discrimination.³⁷ PSL mandates may help overcome some of the hostility that parents may face from employers when requesting leave to care for their children, although additional research is warranted to ensure that, in practice, these policies truly facilitate access to PSL for all employees without repercussions.

The effects of state PSL mandates in California and New York, specifically, may also be contributing to our overall results. For instance, the effects of a state PSL mandate in California on children’s receipt of pediatric preventive dental care may inflate the overall effect size because of its large population (California was the largest US state by population size in 2024) and generous PSL policy. Estimates suggest that 6.9 million people gained access to PSL for the first time following California’s PSL mandate—more than double the size of the second largest state in terms of the number of workers gaining access to PSL.¹³ California’s PSL mandate is unique in that it has no exemptions in terms of firm size, and exempt workers include, for example, government workers with a collective bargaining agreement that includes PSL. Need for dental care may also influence how successful a PSL mandate is at increasing pediatric preventive dental visits. For example, if a few children in a state receive annual dental visits, there is more room for growth. In 2016, only 46% of children with Medicaid or CHIP in California had a dental visit, which is slightly lower than the national average (50%).³⁸ Additionally, California’s policy is implemented early in our study period and, as the event study suggests, if PSL mandate effects increase over time, then we may be picking up dynamics in policy effects over time when we include/exclude children residing in California. In contrast, the weaker effects of a statewide PSL mandate in New York may be diminishing the overall effect size, which could potentially be explained by a city-level PSL mandate that was implemented in New York City (covering roughly half of the state’s population) in 2020, before the state PSL mandate. Further, the New York state PSL mandate was implemented later during the COVID-19 pandemic, during a period when rates of dental care were depressed, which may also attenuate the effects of the policy.

Limitations

Our definition of receipt of preventive dental care includes care provided by nondentists. This may include fluoride varnish applications provided during medical visits, which we posit would also be increased by PSL mandates, as well as school-based preventive dental care, which may not be impacted by PSL mandates. Less than 2% of our sample received preventive care from a nondentist. Prior research suggests that survey items asking for parental reports of children receiving annual preventive dental care vary based on who is sampled and how the question is worded, suggesting the NSCH is an imperfect estimate of receipt of dental care.³⁹ Additionally, parental reports of children’s receipt of preventive dental care may be inflated if social desirability bias leads respondents to be more likely to report receipt of recommended care. These data are also prone to recall bias and parents’ perceptions of their child’s experiences, which are not verified by dental records or insurance claims. However, these sources of bias would not impact our findings if all subgroups were equally impacted, regardless of their state’s PSL mandate status.

The focus of our analysis is on state-level PSL mandates, and it does not account for variation in what these policies entail or how they are implemented,²⁷ nor does it consider substate PSL mandates that require employers to provide PSL in certain local jurisdictions. As such, we systematically underestimate the number of households that were exposed to PSL mandates, and thus our estimated effects of PSL mandates may be biased toward the null. Additionally, NSCH data do not allow us to identify which families were eligible for and/or received PSL. By including families who were not directly impacted by these policies, the estimated effects of PSL mandates are again likely attenuated. Methodologically, our approach relies on the assumptions that the covariates included in the first-stage regression were sufficient for estimating a valid counterfactual and that pediatric preventive dental care trends in treated and untreated states would have remained parallel in the absence of policy intervention. Each of these assumptions is inherently unverifiable, although our event study findings lend support to the validity of the parallel trends assumption.

Policy Implications

State PSL mandates offer a potential intervention to alleviate time-related barriers that families often face in seeking preventive health services for their children. These policies provide parents with additional time to schedule and attend preventive dental visits and greater work-life flexibility to better prioritize pediatric preventive dental care. Although the American Academy of Pediatric Dentistry recommends biannual preventive dental visits for children, many families do not receive this care, and rates of dental care receipt are especially low for Black and Hispanic children, uninsured children, and those with public health insurance, and children whose parents had a high school education or less. PSL mandates, at the federal, state, or local levels, may allow families that otherwise would forgo preventive services to more consistently receive recommended dental care for their children.

CONCLUSION

Increased receipt of pediatric preventive dental care following the implementation of PSL mandates highlight the importance of PSL mandates for granting parents time to care for their children’s health needs. Our findings contribute to the body of literature that demonstrates a link between state PSL mandates and increased health service use, not only for employees but for their dependent children as well. PSL mandates offer a tool for policymakers to consider at a federal level and in the 32 states without these policies to promote the use of preventive health services for families and their children. However, lower-than-ideal rates of dental visits and persistent inequities by race and ethnicity, insurance status, and parental education level demonstrate the need for additional policies to address structural barriers to access to both PSL and dental care more broadly.

ABBREVIATIONS

NSCH

National Survey of Children’s Health

PSL

paid sick leave

TANF

Temporary Assistance for Needy Families

US

United States