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Impacts of paid sick leave policy adoption on heat-associated emergency department visit rates in two New Jersey municipalities: a quasi-experimental study

Year: 2026

Type: article

Abstract: Introduction By supporting well-being, paid sick leave (PSL) policies may reduce heat vulnerability. A quasi-experimental difference-in-difference study of associations between early PSL policy adoption and heat-related morbidity outcomes in Jersey City and Newark, NJ, was conducted. Methods Using data from the Healthcare Cost and Utilization Project State Emergency Department Database, a panel dataset of monthly counts of municipality-level all-cause emergency department (ED) visits among adults aged 18–64 from May to September 2011–2016 was constructed. The study linked these with monthly averages of daily minimum and maximum temperatures and was calculated using Oregon State University’s PRISM Group data. Multivariable fixed-effect Poisson models were used with panel Newey-West sandwich covariate estimators and finite-sample corrections to estimate associations between monthly average temperature and ED visit rates before and after PSL adoption. Models included the main temperature parameter; an interaction between temperature and an indicator for PSL adoption (pre-2014 = 0; 2014–2016 = 1); terms for monthly fine particulate matter (μg/m 3 ) and precipitation (mm); and a population offset term. Results Rates of ED visits were 1.2% (95% CI: 0.995, 1.030) higher for every 1 0 Celsius increase in monthly average maximum temperature, pre-policy enactment; associations were modestly attenuated post-policy enactment (rate ratio: 1.005, 95% CI: 0.993, 1.018). However, comparison municipalities, which did not adopt a PSL policy during the study period, experienced similar attenuation post-policy enactment, suggesting that associations might be explained by other factors, aside from the PSL policy. Conclusion Additional research evaluating the impacts of PSL and other labor policies on heat vulnerability, with larger data sets and greater temporal granularity, is needed.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1923152

Authors: Leah H. Schinasi, Augusta A. Williams, Joe Simeone, Claire Moore, Alina Schnake-Mahl

Institutions: Drexel University, SUNY Upstate Medical University

Language: English

Topic: Climate Change and Health Impacts

Subfield: Health, Toxicology and Mutagenesis

Field: Environmental Science

Domain: Physical Sciences

SDGs: Good health and well-being, Decent work and economic growth, Sustainable cities and communities

Open Access status: gold

Estimated APC paid: $3,801