UCSF

For the 30 million parents of young children in the US, the financial stress and time pressure of raising a child can negatively impact health and increase cardiovascular risk factors. Limited family support policies, such as paid family leave, can exacerbate the challenges of parenthood, especially for families with fewer resources. In particular, the US has the world’s highest childcare costs relative to parent wages and is the only high-income country without a national paid family leave policy. This dissertation examined how parenthood, sociodemographic factors, and family support policies shape parent health. We evaluated relationships between parenthood and cardiovascular risk factors using multivariable regression models. We examined relationships between family support policies and parent health using quasi-experimental methods leveraging variation in state-level paid family leave policies and state-funded free preschool programs. We also examined whether associations differed across sociodemographic factors, to identify groups of parents at greater risk of poor cardiovascular health and to assess the potential for polices to influence health inequities. Chapter one examined the relationships between parenthood and cardiovascular risk factors using multivariable regression models among roughly 250,000 participants in the US National Health Interview Survey (NHIS) 1997-2018 waves. We found that parenthood is linked to fewer hours of sleep and lower odds of meeting physical activity guidelines, but also lower psychological distress, lower odds of smoking, and fewer days of heavy drinking per year. Differences were especially pronounced for mothers, particularly those with an infant or multiple young children, and associations were more adverse for lower-income and single mothers. Chapter two evaluated how state-level paid family leave policies impact perinatal and postpartum health using the Pregnancy Risk Assessment Monitoring System 2004-2021 waves with roughly 715,000 participants. We used difference-in- differences methods designed to account for staggered policy implementation and treatment effect heterogeneity. We found that paid family leave was associated with increased breastfeeding duration, decreased maternal depressive symptoms, and may be associated with increased postpartum checkup attendance among lower-income people. We also found paid family leave was associated with worsening of some birth outcomes, potentially resulting from selection in utero, data limitations, or true negative effects. Chapter three examined the relationship between generosity of state-funded free preschool in each parent’s state of residence and parents’ sleep, physical activity, and psychological distress. We linked NHIS to preschool policy data for roughly 14,000 parents of preschool-aged children in NHIS waves 2001-2018. We used two-way fixed effects models and accounted for potentially co-occurring policies. We found that state-level preschool generosity was associated with a higher probability of parents meeting physical activity guidelines, and with lower psychological distress among structurally marginalized groups including lower-income mothers and Black mothers. This research informs evidence-based policy designed to support the health of parents and families in the US.