Areas for Future Research

The questions raised in and limitations of this study illustrate many areas for further research. Among them, there is a need for:

• Better national surveys with questions about workers’ access to paid sick time and designated paid family and medical leave, with more detail about what level of wage replacement workers are offered, for how long, and whether they have faced consequences for using that time—and with samples big enough to disaggregate rural residents and workers from others.
• More data collection nationally and in concentrated areas of high Native, Asian, and Pacific Islander populations so that their access to leave and the distances they must travel to receive health care can be better studied and understood.
• The ability to cross-match individual-level data on paid leave access and distances or travel time to various types of healthcare facilities at a granular level.
• Qualitative research, including rural-resident-led ethnographic research, as well as quantitative research, focused on rural workers’ and caregivers’ unique challenges accessing care, and any issues caused by distances to work and to health care—including the extent to which challenges finding or receiving care lead to reduced work, missed work, or quits or discharges from work.
• Research focused in rural areas on whether the prime-age employment gap between rural and non-rural areas is attributable, in part, to caregiving responsibilities.
• Research focused in rural areas on the relationship between paid leave and labor force participation, part-time versus full-time employment or underemployment, and modeling that examines how family-supportive interventions might strengthen employment, the tax base, and individual, sub-population and community health outcomes.
• Paid leave implementation research in states with paid family and medical leave programs, with a particular focus on barriers, opportunities, and nuances that apply to rural communities and rural health systems—including especially for Black, Latine, Native, and Asian communities. Research that projects the needs of rural people in states with substantial rural populations that are considering paid leave (e.g., Maine, New Mexico and Minnesota) would also be beneficial.
• Research on health and economic outcomes in paid leave states among rural residents.

It would also be helpful to understand the ways in which community organizations, businesses, public health authorities and departments, and policymakers might intervene in expanding access to paid leave and in helping to build a case for public policies and public investments from health, job quality, and economic development perspectives. Work could be done to assess these stakeholders’ views on opportunities and challenges. There is also a need for research on employer best-practices in creating supportive work environments across jobs and industries in rural communities.