LETTERS IMPACT OF PAID SICK LEAVE POLICY: A SOCIAL PLANNER’S PERSPECTIVE In their article, Kumar et al.1 examine the impact of paid sick days on influenza attack rates in workplaces using an agent-based model. Their findings show that paid sick leave reduces influenza transmission and hence the burden of illness in workplaces. The authors would like to point out the work by Liao et al.,2,3 which studies the impact of paid sick leave on the spread of influenza from a social planner’s perspective. As opposed to focusing on workplaces, this study measures the impact of the paid sick leave on an entire society. The study measures attack rates, medical costs, workers’ productivity and social welfare under a variety of scenarios. A detailed individual-based model is used for simulating these scenarios that consider the following variables: (1) Honesty of the workers receiving paid sick leave, (2) Compliance of the workplaces in granting paid sick leave, (3) Maximum number of sick days allowed, (4) Infectivity of the disease, and

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(5) Productivity of the workers who work while sick. The results show that if workers are honest, a liberal paid sick leave policy is highly beneficial to society. However, even if the workers are not honest, paid sick leave still increases social welfare in the majority of scenarios considered. That is because the benefits of paid sick leave outweigh the losses. The results of Kumar et al.1 once again show that paid sick leave can be a very effective policy instrument for controlling influenza outbreaks. Our research shows that the conclusions are robust to variations in assumptions and model parameters. j Achla Marathe, Jiangzhuo Chen, Stephen Eubank, Shaojuan Liao, Yifei Ma,

PhD PhD PhD PhD PhD

About the Authors Achla Marathe, Jiangzhuo Chen, and Stephen Eubank are with the Virginia Bioinformatics Institute, Virginia Tech, Blacksburg. Achla Marathe is also with the Department of Agricultural and Applied Economics and Stephen Eubank is also with the Department of Population Health Sciences, Virginia Tech. Shaojuan Liao is with Freddie Mac, Washington, DC. Yifei Ma is with Teradata. Correspondence should be sent to A. Marathe, PhD, 1880 Pratt Drive, Corporate Research Center, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, VA. 24061 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted August 27, 2013. doi:10.2105/AJPH.2013.301639

Contributors All authors contributed equally to this letter.

Acknowledgments This research was funded by the Department of Defense (grant HDTRA1-11-1-0016; contract HDTRA1-11-D0016-0001) and the National Science Foundation (grant CCF-1216000; grant CNS-1011769). Research reported in this publication was also supported by the National Institute of General Medical Sciences of the National Institutes of Health under MIDAS (award 2U01GM070694-09). Note. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the National Science Foundation, or the Department of Defense.

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References 1. Kumar S, Grefenstette JJ, Galloway D, Albert SM, Burke DS. Policies to reduce influenza in the workplace: impact assessments using an agent-based model. Am J Public Health. 2013;103(8):1406---1411. 2. Liao S, Ma Y, Chen J, Marathe A. Paid Sick Leave: Is It a Good Way to Control Epidemics? Paper presented at: International Conference on Complex Sciences: Theory and Applications; December 5---7, 2012; Santa Fe, New Mexico. Available at: http://staff.vbi.vt.edu/chenj/pub/ 2012_COMPLEX.pdf. Accessed October 11, 2013. 3. Ehrenberg R. When paid sick leave pays. ScienceNews. January 12, 2013. Available at: https://www.sciencenews. org/article/international-conference-complex-sciences. Accessed October 11, 2013.

KUMAR ET AL. RESPOND We thank Marathe et al. for alerting us to their study of the impact of paid sick leave on the burden of influenza,1 published in the International Conference on Complex Sciences: Theory and Applications. We regret that we did not have the opportunity to discuss our results in light of their study, which was published while our recent article was in press. Liao et al. show that at the overall population level, paid sick days reduce the burden of influenza illness. In addition, under multiple assumptions about rational and honest behavior and workplace compliance with a paid sick days policy, they show that the policy can be cost-effective from the societal standpoint. Their detailed study adds to the evidence base for decision-makers grappling with the economics of providing paid sick days. We would like to call attention to a specific dimension on which our studies differ. Public health research and practice are concerned both with the reduction of overall disease in the population and with eliminating disparities between population subgroups.2 In our recent study, we focused on quantifying the differential impact of paid sick days policies on workplaces of different sizes. We hypothesized that paid sick days policies would have a different impact on small workplaces than on large ones because access to paid sick days currently increases with workplace size.3 Our study showed that this was indeed the case. The 2 studies under discussion highlight that

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agent-based models—because of their characteristic features of heterogeneity of agents and spatially explicit agent interactions4—are well suited to studying not only the impact of heterogeneous behavior on overall population health but also differential impacts of policies and interventions on population subgroups.5 Both issues have an important place in evidence-based decision-making in public health, and we are grateful for this opportunity to discuss them in light of the study by Liao et al. j Supriya Kumar, PhD, MPH John J. Grefenstette, PhD David Galloway, MS Steven M. Albert, PhD Donald S. Burke, MD

About the Authors Supriya Kumar and Donald S. Burke are with the Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. John J. Grefenstette and David Galloway are with the Public Health Dynamics Laboratory, Graduate School of Public Health, University of Pittsburgh. Steven M. Albert is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Correspondence should be sent to Supriya Kumar, 704A Parran Hall, 130 DeSoto Street, Pittsburgh PA 15261, Phone: 412-624-0234 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted September 7, 2013. doi:10.2105/AJPH.2013.301676

References 1. Liao S, Ma Y, Chen J, Marathe A. Paid sick-leave: is it a good way to control epidemics? Presented at: International Conference on Complex Sciences: Theory and Applications; December 5---7, 2012; Santa Fe, NM. 2. Adler NE, Rehkopf DHUS. disparities in health: descriptions, causes, and mechanisms. Annu Rev Public Health. 2008;29:235---252. 3. Bureau of Labor Statistics. Employee Benefits in the United States --- March 2010. Washington, DC: BLS; 2010. 4. Epstein JM. Generative Social Science: Studies in Agent-Based Computational Modeling. Princeton, NJ: Princeton University Press; 2006. 5. El-Sayed AM, Scarborough P, Seemann L, Galea S. Social network analysis and agent-based modeling in social epidemiology. Epidemiologic perspectives & innovations: EP+I. 2012;9(1):1.

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Kumar et al. respond.

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