Media Briefings

The pandemic’s impacts on parents

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COVID-19 has challenged parents to manage their own health, the health of their children, their work, and their finances in a setting of unprecedented risk and economic pressure. At SciLine’s latest media briefing, three experts explained what is known, based on research, about: the effects of pandemic-induced stress and burnout on parents; the economic and workforce implications of school and childcare closures; and how stress, decision fatigue, and other factors may influence the choices parents make about their kids’ health.

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Introduction

[0:00:20]

RICK WEISS: Hello, everyone. Welcome to SciLine’s media briefing on COVID’s impacts on parents. I’m SciLine’s director, Rick Weiss. And for those not familiar with us, SciLine is a philanthropically funded, editorially independent free service for journalists and scientists based at the nonprofit American Association for the Advancement of Science. Our mission is to make it easier for reporters like you to get more scientifically validated evidence into your news stories, and that means not just stories about science but really any story that can be strengthened with some science, which, frankly, in our view, is almost any story you can think of. Among other things, we offer a free matching service that helps connect you to scientists, who are both deeply knowledgeable in their field and are excellent communicators, on deadline. Just go to sciline.org and click on, I need an expert. And while you’re there, check out our other helpful reporting resources.

A couple of quick logistical details before we get started. We have three panelists today who will make short presentations of up to about 7 minutes each before we open things up for Q&A. To enter a question during or after these presentations, simply hover over the bottom of the Zoom window, select Q&A, enter your name and news outlet and your question. If you want to pose your question to a specific panelist, that’s fine. Just be sure to note that. A full video of this briefing should be available on our website by this evening or tomorrow and a timestamped transcript within a couple of days. If you would like a raw copy of the recording more immediately, just submit a request with your name and email in the Q&A box, and we can send you a link to the video before the end of today. You can also use the Q&A box to alert any of us on staff to any technical difficulties.

OK, I’m not going to give full introductions to our speakers. Their bios are on the SciLine website under media briefings on the bios tab. I’ll just say that we’re going to hear first from Dr. Brian Zikmund-Fisher, who’s going to speak about how people generally assess and act on risks, with a particular emphasis on how parents handle the task of balancing risks to themselves and their children during the pandemic. Next, we’re going to hear from Dr. Alicia Modestino, who will address how parents are juggling the economic challenges posed by COVID, including the tough balance between work and child care and the potential impact of recent programs to alleviate child poverty by providing financial support to parents. And third, we’ll hear from Dr. Margaret Kerr, who will focus on what the research says about how parents’ mental health has been holding up through the pandemic, along with some research-backed societal strategies for minimizing parental burnout. OK. With that, I’d like to get right over to you, Dr. Zikmund-Fisher.

Factors affecting parents’ (and others’) reactions and decisions related to COVID-19 risks

[0:03:29]

BRIAN ZIKMUND-FISHER: Hold on one second. So today I’m going to be talking about the factors affecting parents’ reactions and their decision-making related to COVID-19 risks. I’m going to cover…

[0:03:46]

RICK WEISS: And Brian—I think you want to just—I didn’t mean to interrupt. I think you want to get into presentation mode here. Right now I’m seeing notes.

[0:03:54]

BRIAN ZIKMUND-FISHER: OK. That’s not the way it was set up last time, but… let me just switch it. Hold on.

[0:03:58]

RICK WEISS: OK. No problem.

[0:04:03]

BRIAN ZIKMUND-FISHER: Is that better?

[0:04:04]

RICK WEISS: Much.

[0:04:05]

BRIAN ZIKMUND-FISHER: All right. So, I’m going to cover six key ideas about risk perceptions. I’m not going to go into these in detail because I’ll cover them one by one. But all of this is leading us towards a big idea, which is, at this moment in time, parents are facing decision risk fatigue. And the question is, how can we help parents manage the decision-making that they have to be making on a day-by-day basis? First big idea I want to talk about is risk tradeoffs. And put simply, we don’t like risk tradeoffs. Having to think about, well, there’s this chance of A bad thing happening and that chance of B bad thing happening—trying to balance multiple risks at once is very difficult. And this researcher, Elke Weber, calls this the finite pool of worry. We can only worry about so many things at one point in time. What that means is that the key question here is which risks do we focus on at any given moment?

Given COVID-19, there’s lots of risks that we might need to be considering. First, obviously, there’s the risk from the disease—mortality risks, long COVID risks, et cetera. We have to trade those off against our perceptions of the risks of the vaccine, both the adverse events, which are rare but do exist, as well as the fact that it’s a new vaccine, new technology, et cetera. And then, of course, there are the risks of protective measures—the education, socialization, and economic costs of living in a pandemic, making choices about what we can or cannot do. And by the way, that includes health risks from, for example, failing to do preventive care because we’re trying to avoid getting COVID-19.

Second key idea is the question of did we cause a risk? Because we don’t see all risk equivalently. COVID-19, if we get it, happens to us. We didn’t cause anything. However, if we’re talking about vaccine-related harms or the harms of, say, not sending your child to school because you’re trying to avoid getting COVID, we cause those harms, and hence we feel very differently about them.

A third key idea here is the idea that people vary in the degree to—that they pay attention to probability, i.e. chance. Some people vary how much they react to different risks based upon proportion. Very common things, they’ll react to; rare things, they won’t. But for other people, they pretty much just pay attention to whether or not it might happen or not. And as an example of this, think about your kid playing soccer and the risk of concussion. That might be a very rare thing, but if you’re somebody who’s going to focus on the fact it might happen to your kid, then you’re going to feel much more concerned about those risks in making a decision about whether or not to allow that to occur.

Speaking of fear, a key thing in the context of the pandemic is the idea that fear and emotional reactions to risk change over time. And in particular, we’ve known for about 35 years that new and uncertain things scare us more than familiar ones do. So, if you think about the pandemic, early on in the pandemic, everything was new. The disease was new. The vaccine was new. The measures we were taking to respond to it was new. So, we had lots of emotions about all of these different things. Now all of these components of pandemic—managing the pandemic—are more familiar, and we just can’t muster up as much emotion about them.

As an example of this, I was thinking about the difference between the first kid and the second kid. First kid drops their pacifier—oh, my gosh, we have to clean it off, sterilize it, et cetera. When you get to the second kid, you wipe it off, you stick it back in because you’re—you just can’t continue to be as concerned about something after you’ve been dealing with it for a long period of time. And this is related to a phenomenon called psychic numbing. As we’ve been all exposed to these case counts and statistics related to COVID-19, you would think that as the numbers get bigger, we would get more concerned about them, but we don’t. And in fact, Paul Slovic has written about the fact that as the numbers get bigger, we actually get less and less concerned about them. We can’t muster enough emotion to take into account the largeness of the cost that our society is feeling.

And the last thing I’m going to bring up, which is very relevant to parental decision-making, is self/other differences. Risk that I face is different than what I might think about the risk that you face. And when we think about parents, obviously they’re trading off the decisions for themselves and for their kids. So, kids are vulnerable. We want to protect them. The key question, though, goes back to the beginning. Which risks are we going to pay attention to? Are we going to focus in on the risks of the disease? Well, if that’s true, then as parents, we want to protect our kids even more from that. But if we’re focusing on other risks, say, concerns about the vaccine or concerns about loss of socialization, then as parents, we want to protect our kids even more from that.

And that takes us to the current moment, right? Right now COVID-19 risks are starting to feel less critical than they did before because of the time, because of our cumulative exposure. And this is unfolding in different ways for different people. For vaccinated people, you know, the chance of severe disease is much lower once you’re vaccinated. So, the tradeoff—how much are you willing to go—give up? Are you willing to go out to dinner or go see a movie? That choice feels different than it did before. For unvaccinated, well, they’ve survived this far. And that experiential learning also mutes our emotional reactions to COVID-19. But of course, the burden of the protective measures that we’re trying to engage with on a day-by-day basis, the choices about what to do or not do, still remain. And now we know the protective measures aren’t perfect, given all the people who got omicron despite being vaccinated and engaging in protective behaviors like mask-wearing.

So, the key question comes down to what is worth doing and what’s not worth doing? Which takes me to the big idea here of the decision fatigue. Parents are having to make daily risk choices, and choices are hard. Like, every single aspect of daily life involves a risk tradeoff. Is it worth going to the movies with my kids? Is it worth allowing my kid to go to a birthday party and interact with others? Is it worth having them go to school when we know that there are cases circulating at school? The information and the guidance is changing. So, we can’t just make one decision and continue it for months on end; we have to keep making those decisions day after day. Unfortunately, our choices are driven by values, and our values are in conflict. You know, I want safety for my kid, and I want my kid learning at school. I want my child to get my attention, and I want to be able to get work done when I’m at home. I want my child to be able to play with their grandparents, and I want my grandparents to be safe from getting COVID through my kid. That sense of responsibility that parents feel means that every one of these choices is fraught with concern, and there’s no clear right.

Now, the one thing I’ll say as a public health faculty member is the one clear right here is vaccination. We know it makes a difference. We know it reduces your risk of severe disease. But we’re all trying to manage all these other things—the choices about individual behaviors, what’s safe to do and what’s not. And to some degree—I’ll leave this with, you know, we need to give ourselves a little bit of a break ’cause this is hard.

[0:11:23]

RICK WEISS: Fantastic. Great, great overview of the problems that everyone and parents in particular are facing. And I love the pacifier example. That kind of says it all. Thank you. Next, over to Dr. Alicia Modestino.

Economics and the role of childcare during the pandemic

[0:11:38]

ALICIA MODESTINO: Thank you. I just feel like my entire existence as a parent was validated over the last two years by your presentation. I’m going to talk about economics and the role of child care during the pandemic, and I want to start off by reminding everyone that if you get nothing out of this, understand that child care provides an essential service for working parents that is important to expanding the economy’s labor force, particularly for women who have children. And also, please remember that these slides will be on the website because I’m going to shove as much data as I can in these next 7 minutes.

All right. So first, I’d like to start off talking about how big this problem is. This is not a small problem. So, about 50 million workers live in the United States with the children under the age of 14 in their households requiring some amount of care. That represents 1 out of every 2 prime-aged workers in the United States, and about 30% of these workers also live with children who are under school age. And so, that means that they require the most amount of care. This bar chart here is showing you that even prior to the pandemic, the number of children who are in paid care. So, this is at least 10 hours of care that is paid for that’s not under their parents’ supervision, that that had been increasing over time. About 30% of children ages 0 to 14—or, sorry, about 25% of children ages 0 to 14 and 30% of children ages 0 to 4. Child care usage also varies considerably across states. And so, this is showing you the number of children who are in regular nonparental care from age 0 to 5 that ranged before the pandemic from a low of about 33% in Nevada to a high of 70% in Massachusetts.

And even if you fast forward to April 2020, you’ll find that most working parents were reporting—at least two-thirds of them—that they had very large difficulties in finding care during the pandemic when things were shut down. And now, even two years later, about 25% of working parents are reporting that it’s still difficult to find care. Even before the pandemic, there was a lot of inequality in terms of who could access care. And in particular, nonwhite parents had fewer options. They lived in what’s called child care deserts. So, those are places where there’s either no available licensed child care, or the number of children relative to the number of slots is 3 to 1, so essentially making day care not available at all. Here, this bar chart is showing you that about 50% of Americans live in such a child care desert, and people of color are much more likely to live in places where there’s even less care that’s available.

Now, the disruption caused by the pandemic really raised a lot of concerns about the viability of the child care industry and its consequences for child care workers, parents and children. So, for the child care industry, the margins have always been thin for providers. And the imposition of COVID-19 restrictions in terms of cleaning and reducing the number of children who can be in spaces really just caused a lot of providers to go out of business, potentially causing a loss of 450,000 child care slots. Why is that important? Well, fewer child care slots means less available care for workers. And prior to the pandemic, U.S. businesses were losing $13 billion annually because of their employee’s child care problems. For child care workers, before the pandemic, there were about 1.5 million people who were employed by this industry, with earnings of over $24 million. About 350,000 lost their jobs in March and April of 2020. And even as of February of this year, employment was still 12% below the pre-pandemic level, compared to only 2% below that level for the U.S. as a whole. And in part, that’s due to the very low pay in the industry. And that’s something I’m happy to talk about during the Q&A.

For parents, you know, before the pandemic, infant center-based care—all child care is very expensive. But for a single child, it was $11,000 a year. That was about 18% of median household income. Remember, the Biden administration is talking about limiting the amount that people have to pay if it’s above 7% of their household income. So, this is a lot of parents in this situation. And as we’ve seen the supply dwindle and the demand increase, the cost of care has only increased. And I just checked, and it’s up to $15,000 a year now, on average. And let’s not forget about the children. So, one survey in Massachusetts found that the majority of parents were reporting that they were worried that their children were missing out on important developmental experiences. Let’s also not forget that typically, this burden falls disproportionately on women in terms of the labor market outcomes. So, as of February 2022, the labor force for women age 20 and older is down by roughly 1 million from two years ago, whereas men in that same age bracket have fully recovered.

And I’ve circled sort of each of the key points in this chart here where we saw the initial day care shutdowns as well as every time school went back into session but not really because we were either in remote learning or there are lots of disruptions. And so, with every single COVID wave, we’re finding that women are having more disruption to their labor market experiences. And you can even see that with the most recent data as men and women are diverging in February of 2022, when we saw the omicron surge. Black and Hispanic women have suffered some of the steepest drops in employment since the pandemic began, almost twice that of men. Some of this has to do with the kinds of jobs that Black and Hispanic women are in, typically in-person jobs. They’re also more likely to be single parents and have households with fewer resources to be able to provide for child care. So, you put all that together, and that makes it really difficult to be able to hold a job with any kind of stability.

And this is very different from other recessions that we’ve seen. So, typically during a recession, Black women actually have better labor market outcomes than Black men but not during the pandemic. And child care is a big part of that story. Now, during 2020, nearly 20% of working parents reported they had lost a job or reduced their hours because of a lack of child care, and that’s separate from any other economic impacts. How do I know this? Because this comes from a survey of 2,500 working parents that I conducted during 2020. And of course, that’s part in, you know, because the impact of child care has fallen largely on women who significantly decrease their time spent on housework and caring for children. Among the unemployed, almost more than a quarter of women said it was because of child care, compared to only 14% of dads.

However, if they had access to paid family leave, or the ability to work from home, they were less likely to say that they were unemployed because of child care. Moms were also more likely than dads to reduce their work hours, unless they were able to work from home. They typically lost 16 hours a week. That’s two full working days. However, they were less likely to say they had to reduce their hours if they had access to a child care subsidy. And the lack of child care’s had a greater impact, again, on women with younger children, fewer household resources, less-flexible jobs. For those parents, they largely relied on grandparents as an informal source of care during the pandemic.

Now the pandemic only served to increase inequality among working parents who could have access to any of these kinds of child care support, such as flexible hours or child care subsidies. This bar chart here is just showing you the disparity by level of education. But in our survey, we found the same kinds of disparities in terms of race or socioeconomic status. And really, during 2020, public policy efforts to address child care fell really far short of the need. So, the initial CARES Act gave the child care industry about $3.5 billion. That was less than each one of the three airlines got in terms of a bailout. And it really didn’t go very far. In Massachusetts, it covered, like, $2,200 per provider for about two months. And as a result, we’ve lost 13% of our child care programs since then. There are a lot of barriers to applying for the Paycheck Protection Program. Only half of child care providers applied. Only about a quarter ended up actually getting a loan. And then the Families First Coronavirus Act provided actually paid leave for families. But not many people knew about it. And those who did know about it had difficulty accessing those benefits through their employers. And then they expired at the end of December 2020. And so, they didn’t go very far.

Since then, we’ve seen the American Rescue Plan. That provided some relief for parents but didn’t really do too much, particularly for parents of school-age children or child care workers. So, for parents, we saw an expansion of the child tax credit from 2,000 to 3,000. You could deduct more for your caregiving. But that all expired at the end of 2021. And we’ve seen an estimated 3.7 million children fall back into poverty because those payments expired. For child care providers, they expanded some of those child care development block grants and also gave another billion in Head Start to the early education program, as well as an additional 24 billion for a stabilization fund for child care providers. And so, in Massachusetts, we’ve used that to pay for things like cleaning supplies and other kinds of supports that they would need to be able to raise wages for workers. What’s missing? A lot of what’s in the Build Back Better Bill is what’s missing—so, paid leave for new parents or workers who experience ongoing caregiving needs, universal pre-K for 3- and 4-year-olds that would then get us to kindergarten and fill that gap and then subsidies that would make care affordable to households beyond the neediest—so, people not paying more than 7% of their income to be able to pay child care workers a living wage. So, I’m also happy to give examples of what the private sector is doing during the Q&A, as there’s some interesting stories there as well.

[0:21:39]

RICK WEISS: A fantastically comprehensive look of what’s going on in this sector—thank you so much. See what I love about these briefings. I think reporters appreciate—you know, you combine the kind of research-backed data that we’re providing today with whatever your personal stories are from people you interview in your communities, and you’ve got some really important journalism and useful journalism coming together. Let’s move on to Margaret Kerr—Dr. Margaret Kerr. And…

[0:22:14]

MARGARET KERR: And are you seeing the correct version of the slides?

[0:22:18]

RICK WEISS: I don’t see the slides up. I don’t think it’s shared.

[0:22:21]

MARGARET KERR: Oh, OK—one second here. How about now?

[0:22:38]

RICK WEISS: Great.

COVID-19 impacts on the mental health of parents

[0:22:39]

MARGARET KERR: Great. Yeah. I feel like this is the correct order to be going in here because I think much of what I’m going to say is going to piggyback off of what Dr. Modestino said. As in, I think that mental health and child care for parents are intimately intertwined. So…

[0:22:59]

RICK WEISS: Maggie, I’m going to interrupt. I—on my screen, at least, I’m seeing your slide covered.

[0:23:03]

MARGARET KERR: Oh, you’re seeing the Zoom window?

[0:23:04]

RICK WEISS: There you go. That’s better.

[0:23:07]

MARGARET KERR: OK. Wait. OK. How come none of that happens in the practice?

[0:23:13]

(LAUGHTER)

[0:23:13]

MARGARET KERR: That’s the way life is. OK. Thanks, everybody. My name is Margaret Kerr. I’m an assistant professor at UW Madison, and I study parents’ emotions and experiences. So, I’m going to start by briefly reviewing what we know about parents’ experiences during the COVID-19 pandemic. So, because of stay-at-home orders and school closures that started in April 2020, many parents faced increased time demands and new stressors. And so, those things included concerns about the health and safety of their family, job or income losses and balancing work and virtual learning or child care at the same time, which we just heard a little bit about. And as a result, numerous studies have come out showing that parents experienced increased distress and mental health symptoms such as depression and anxiety.

So, for example, a study from my lab that came out in 2021 shows that, in a sample of primarily non-Hispanic white parents, 39% of parents reported moderate to severe anxiety and/or depression symptoms, and 66% of parents reported that COVID-19 had negatively impacted their psychological health. And so, studies examining the enduring impact of COVID on parents beyond this initial spring or summer of 2021 are still pretty limited. There is some emerging evidence suggesting that parents are still struggling. So, the American Psychological Association Stress in America study that just came out says that as of February 2022—so, just last month—70% of parents reported that the pandemic remains a daily stressor. Parents continue to report higher levels of stress than nonparents and are more likely to say their mental health has worsened over the course of the pandemic. Ongoing stressors that they list are disruptions to child care and worries about their children’s development.

And one specific and major impact of the COVID-19 pandemic on parents that I want to focus on today has been parental burnout. In 2019, the World Health Organization recognized burnout syndrome as an official disease. And while it has been primarily associated with the workplace, like job burnout, there’s a new and rapidly growing field of scientific research suggesting that burnout can occur in other roles, such as parenting. Parental burnout is defined as a state of intense exhaustion related to the parental role in which parents become emotionally detached from their children and doubtful of their capacity to be a good parent. It occurs when parents are under chronic parenting stress, and there’s a sustained imbalance between parents’ resources—so, things like social and community support, coping skills, child care—and parents’ challenges or stressors—things like mental health, COVID-19 stress, financial concerns and family responsibilities like doing virtual learning. Burnout has serious consequences, and a few of the things that we do know is that it increases the risk of child abuse and neglect and even some suicidal ideations for parents.

And in some ways, parental burnout can be even worse than job burnout because parents aren’t able to get a break. They can’t take a day off. There’s really no way to sort of get a relief from that, especially during COVID. And the pandemic contributed to this as it caused significant disruptions to parents’ resources and brought on new stresses and challenges. And so, even at the beginning of the pandemic, there was evidence across several studies that parental burnout levels had increased. And some things that we know that are associated with more parental burnout during COVID-19 are length of lockdown or quarantine, home or virtual schooling, having children that need high levels of attention and lack of support from one’s co-parent or partners. And similarly, another study found that parents from families who experienced more hardships—so, things like job loss, income loss, amount of caregiving burden or their own illness—reported worse daily wellbeing during COVID-19. And while all parents face challenges during COVID-19, mothers, low-income parents and parents of color have been disproportionately impacted. And that’s something that we saw in the last presentation as well.

The Kerr, et al., study that I mentioned earlier found that anxiety and parental burnout were higher for women than men, and anxiety and depression were higher among low-income families compared to higher-income families. Another study found that during the early stages of COVID-19, women with young children—and so, that’s roughly birth through high school-aged children—reported more psychological distress than any other group. And those groups include men with children, men without children and women without children. And among dual earner couples early in the pandemic, mothers reduced their work hours four to five times more than fathers and were more likely to exit the workforce.

And across several studies, there’s evidence that families of color experience greater food insecurity, discrimination and losses in resources and health care access compared to non-Hispanic white parents. Further, low-income families and families of color reported more instrumental and financial hardships compared to higher-income white counterparts. And one of the many factors contributing to this, although there are quite a few, is that parents of color were more likely to be in low-wage jobs and jobs that could not be done from home, like essential workers, resulting in making a choice between childcare and work, which is something that Dr. Modestino talked about already.

And finally, I want to talk about—despite all the hardships and strains faced by parents during the pandemic, there have been some silver linings. And so, this graph I’m showing you here is from the Kerr, et al., 2021 study I have already covered. And what you see on the left side is a list of emotions. And in April 2020, we asked parents how much they were feeling those emotions compared to before the pandemic started. The blue section represents the percentage of parents who reported feeling those emotions more than usual. And so, what you can see here is that over half of parents, about 58%, reported feeling more closeness to their children, and 54% reported more gratitude. And that’s specific to their parenting role compared to prior to the pandemic.

And we know from research that positive emotions help people build personal resources and work against the negative impact of stress and negative emotions. So, these positive emotions are really beneficial for parents. And one strategy for coping with pandemic stress may be engaging in activities that increase positive emotions—things like savoring or gratitude journals. And for parents who are struggling from burnout or other mental health challenges, it’s important for them to—for parents to seek support. And this might be professionally through therapy and things like that and among—also among other parents or close friends, so, social support. Social support is a valuable resource that’s been shown to reduce stress and help parents cope. Another important strategy might be for parents to lower their expectations of themselves as parents. We know that things like parenting perfectionism contributes to worse distress—and also celebrating even the smallest successes that parents have during this incredibly challenging time. And the last point I’d like to make, which I think has been covered a little bit already, is that while I spent most of my time talking about how individuals are doing and what individuals can do—sorry—what—and what individuals can do to cope, the pandemic has drawn attention to the ways that society as a whole can better support parents.

So, in addition to the child care issues we heard about today, other things parents would benefit from are better access to paid leave and more family-friendly workplaces. For example, research has shown that paid parental leave for both mothers and fathers has positive benefits for maternal and child health, parent-child bonding and women’s participation in the workforce. And that’s something we can talk more about during the Q&A, if you’d like. So, thank you so much.

Q&A


What are some science-backed tips and pitfalls-to-avoid for reporters covering the pandemic’s impact on parents?


[0:31:02]

RICK WEISS: Thank you. Dr. Kerr, another fascinating collection of important data. I think—and you want to stop sharing your screen there…

[0:31:10]

MARGARET KERR: Got it.

[0:31:10]

RICK WEISS: …I think. Yep. And really interesting data, I think, on that silver-lining material as well, that maybe crisis, in some ways, brings people a little closer together in some important ways. So great. We’re going to get into the Q&A here. I’ll remind reporters that if you would like to ask a question, just hover over the Q&A icon at the bottom of your screen. Let us know who you are and what you’d like to ask. But just to get things started, what we typically do in these briefings is start with a question that’s really aimed at helping reporters directly as they do their jobs covering this beat. And I’d like to ask each of you to think of one thing that you think either the media has been doing well as they cover the issue of the pandemic and parenting or one thing that you, you know, wish the media, frankly, was doing a little better, and let reporters know from your professional stance, you know, what you’re seeing that you like or don’t like or that you think is helpful or not helpful. And I’ll go back and start with you, Brian.

[0:32:12]

BRIAN ZIKMUND-FISHER: So, I think the thing that strikes me is—that reporters have struggled with but, frankly, everybody is struggling with is the way we should be thinking about the guidance and the guidelines and the constantly changing, you should be wearing a mask, you shouldn’t be wearing a mask, you should be 6 feet apart—all of those types of things. The problem, of course, is that they come across like they’re absolutes. Like, if you’re 5 1/2 feet away from somebody, you’re in danger. If you’re 7 feet away, you’re great. But of course, the world doesn’t work that way. Same thing with all the debates over, you know, this type of mask versus that type of mask. We have to manage risk. We can’t completely avoid it. We can do things to minimize it. And so, I wish the conversation around these constantly updating guidelines just acknowledge that sort of holistic truth more and enabled people to recognize that they should pay attention, but they don’t. We’re not trying to have you say, you know, this is perfectly OK, and this is not but instead to use the information to make the best choices we can.

[0:33:17]

RICK WEISS: Great. Great advice. Thank you. Dr. Modestino.

[0:33:23]

ALICIA MODESTINO: Sure. I’m going to give you one of each. So, I think the media is great at telling anecdotes and stories of parents who are struggling. But to be honest, every parent is struggling. I don’t know a single one that’s not. And we’ve kind of seen all these stories. I really wish that we could elevate the magnitude of the problem. And so, as much as it probably was a little bit of a drinking from a firehose to some extent, I threw a lot of data at you guys because it’s 50 million workers. It’s 1 out of every 2 working-age individual who’s dealing with this work-and-family kind of balance. And it’s a million women missing from the labor market still, two years later. And I think if we could put a finer point on the magnitude of this problem, then maybe we could get some action at the federal level.

[0:34:13]

RICK WEISS: Interesting. Great. Dr. Kerr.

[0:34:17]

MARGARET KERR: Great. I have a similar, I think, point, actually. So, the first thing I’ll say that is being done well is just the focus on parents’ experiences and mental health in general. Prior to this pandemic, that was not a—like, a hot topic in the media or in science, and I’ve always been sort of fighting a battle against, like, we need to care about how parents are doing ’cause it’s very closely related to how our whole society is doing and how our children are doing. And so, I love to see this focus on parents. I think it’s critically important. And I think the related thing is that, like, I want—I would love to see us continue to focus on that. So, as maybe things around the pandemic start to wrap up, like, we need to continue thinking about how can we support parents? What are the things that we can do to make it easier to be a parent in this country? And I think the things that Dr. Modestino brought up are very important and critical points to do that.


Is there research on ways to encourage people to make evidenced-based decisions when it comes to health risks?


[0:35:17]

RICK WEISS: Great. Thank you. And we’ll move into some questions now, I have one directed to you, Brian. It seems that people often make risk decisions based on what feels right to them. Is there research on how to address these tendencies to encourage people to make more informed, evidenced-based decisions when it comes to health risks?

[0:35:39]

BRIAN ZIKMUND-FISHER: Well, so first, I want to make the argument that feelings are not inherently bad. Like, we make decisions about risk by paying attention to our feelings. And this isn’t a feelings-versus-rational problem. It’s about how do we take into account the evidence that’s available to us and weigh it in an appropriate way, including the fact that there may be some risks that are going to feel different to you than they might feel to somebody else. And that’s just a reflection of our different values. I think the thing to pay attention to here is our tendency to zoom in. And I talked a little bit about this in my presentation. We zoom in on—focus on one risk by itself, and we say, oh, I don’t want that, and so we just ignore the rest. The honest truth is there’s going to be some risks that we face no matter what we do. And the rational piece here is just to acknowledge that truth that there is a trade-off and to try as best we can to weigh things against each other. I don’t think that there’s a single right answer for how best to make risk decisions, but one of the key pieces of it is this is a process. You have to consider multiple things at once and not just sort of overreact to one risk, whatever that one thing is.

[0:36:57]

RICK WEISS: Sounds like part of what you’re saying is also that people need to be willing to change their minds, maybe, either because the situation has changed or they’ve just thought about it more with the risk.

[0:37:06]

BRIAN ZIKMUND-FISHER: And part of the reason you can change your mind is because when you really look at the sets of risks, there are good reasons that you can pay attention to. Like, OK, I had a reason for doing this, but now there’s another reason. Now let me pay attention to that and weigh these against each other.


What would happen if childcare centers raised their prices and paid workers more?


[0:37:21]

RICK WEISS: Great. OK. A question here for you, Alicia. The child care industry seems to be characterized on one hand by tight margins and low pay for workers and, on the other, an excess of demand for a shortage of spots. What would happen if child care centers just raised their prices and paid their workers more?

[0:37:44]

ALICIA MODESTINO: This is a great question. So, the child care industry is a really interesting one, and I get this question all the time about how is it that child care is so expensive, and yet child care workers earn so little? So, part of the problem is that this is a very labor-intensive industry. You can’t automate it. You can’t outsource it. You know, it’s not something that you can change the nature of how the business is run. And part of it—it’s actually regulated, right? So, there’s a number of children relative to the number of staff. Those ratios are actually legislated and regulated and enforced pretty closely, and we think that there’s a good reason why they’re like that. And anyone will tell you that you would never want to watch more than three or four toddlers by yourself at a time, that it would be a very bad idea.

And so, it’s just such an inherently labor-intensive industry. The other piece of it is that child care in particular is not compulsory, right? So, public school is compulsory. Everybody must buy. Everybody must go, right? And so, the state subsidizes that very heavily. And you know exactly how many children are going to show up every day, give or take, you know, some absences. But people will dip in and out of child care because it’s so expensive. So, if my work schedule gets cut one day a week, I’m sure as heck going to pull my kid out of day care because those are dollars that I can’t afford to spend. And so, that creates this instability for the provider, and so, they can’t necessarily raise wages with a lot of confidence that they’re going to be able to cover that cost going forward very easily, unless they get a lot more kids under their supervision, which they can’t do, and they can’t expand. And during COVID, we’ve actually made them contract the number of spots that they can have based on the space that’s allowed to them.

So, there’s these really real constraints, which really kind of points to the importance of creating a public subsidy for this sector, right? So, if we were able to subsidize parents to be able to purchase care so that they’re not spending more than 7% of their income on child care, then you could perhaps leave your children in care more continuously as you experience these dips in your labor market schedules and things like that. And that’s actually even better for the children to have these maintained, more sustained relationships with caregivers as well. And so, there’s a real sort of, you know, need to be able to create this stability inside the industry that then would also allow the industry to raise wages to some extent so that they could attract more workers back into the industry ’cause a lot of workers have left. They can make a lot more money doing any kind of retail job now, if that’s paying $17 an hour at Target or even more than that, with a lot less stress, to be honest. You know, day care is not an easy job. So, I think that it’s this combination of factors and—you know, to be able to sort of lift up this industry.

I think one last point I’ll make is that some people worry that this is inflationary—right?—to be able to subsidize an industry, and then you’d increase demand and raise prices. But this is an industry that’s providing infrastructure to workers, right? So, if you voted for the infrastructure bill for roads and bridges to get people to work, then you should be voting for the child care bill—right?—that’s going to provide the infrastructure to let working parents get back to work ’cause we just showed with Zoom, you actually don’t need roads and bridges, but you do need child care.

[0:40:54]

RICK WEISS: Great analogy. Appreciate that.

[0:40:56]

MARGARET KERR: Can I just add something to that, which is that, like, you know, what we’ve seen both with child care and with, like, parents’ mental health is this disadvantage for women. And if what happened was everybody just raised the wages, then most cases—in many cases, one of the parents would be forced to stay home with the children, and that would most likely be the women. And so, that would just continue to enforce this inequality that we’re already seeing in wages and workforce participation.

[0:41:23]

ALICIA MODESTINO: I’ll even give you a worse benchmark there. In our survey, we actually asked people, like, how do you make these child care decisions? Who stays home with the kids, you know, when you lose the child care? And we gave them a bunch of reasons, like who’s working more? Who’s earning more? We also gave them, who’s better at taking care of the kids? Who’s better at taking care of the kids actually had a higher percentage of parents than who earns more, which was just kind of shocking. We just put it in there for completeness, and it was kind of shocking that that popped up. So, there’s a lot of inequality on the home front, on the labor market front, that we still need to address.

[0:41:59]

RICK WEISS: Interesting. I’d love to hear those debates within the family about who’s better at taking care of the kids, but we won’t go there for now.

[0:42:06]

ALICIA MODESTINO: Not now (Laughter).

[0:42:07]

RICK WEISS: I know the kind of trouble I got into when I claimed at one point that I was better at putting diapers on. That was my job for the next two years.

[0:42:14]

ALICIA MODESTINO: (Laughter).


How do time and ongoing exposure to challenges such as COVID-19 or climate change affect people’s attitudes toward addressing them?


[0:42:14]

RICK WEISS: So, Brian, question for you. You talked about emotions getting muted over time with exposure to stressors. Does that principle apply beyond COVID to other issues like, say, climate change, where people may not feel inspired to act because their emotions have been dampened?

[0:42:33]

BRIAN ZIKMUND-FISHER: So, that’s a small lead-in to an enormous conversation. And let me just bookmark a couple points here. One, the key idea from a risk perception standpoint is this newness. So, when you first start thinking about risk, when you don’t think that much is known about it, that’s when it’s easiest for us to pay attention. On the climate change question, you know, I think part of this is how often—how long have we been talking about this stuff? And when did different groups? And it’s not the same for each—people, each individual. When did we really start to engage with the question of climate change? After you’ve been engaged with it for a while, you just can’t marshal as much emotional energy about something. That doesn’t mean you can’t think about it. That doesn’t mean you can’t act. But it’s not going to be that sort of strong emotional response. And so, that is a generalizable idea. I think it happens particularly saliently when we’re talking about things like pandemics, whether it’s before, during and then hopefully somewhere down the future might be an after. But that distinction of we didn’t have to think about this now and now, all of a sudden, we are, is the thing that really triggers us just to focus in on it to the detriment of paying attention to other things that we do need to pay attention to.


How has the pandemic affected nonparent caregivers, such as grandparents?


[0:43:52]

RICK WEISS: OK. Question here directed to either Dr. Modestino or Dr. Kerr. Freelance reporter Elaine Cha from Saint Louis, is there anything you’ve observed that affects nonparent caregivers like grandparents in ways that we should be thinking more or better about, particularly as social service or community-based agencies that support youth by supporting those youths’ grown-ups?

[0:44:26]

ALICIA MODESTINO: I’ll just say one thing that I’ve noticed, at least from a labor market stance, is if you look at the big wave of retirements that we’ve seen, you know, some of that is older workers wanting to exit the labor market, avoid COVID, or, you know, they’ve just had enough. But there’s a large exit of older women who did become primary caregivers for their grandchildren during COVID. And so, you know, there’s that carryover of it’s a million women. It doesn’t necessarily have to be women age 20 to 54 for them to be tagged with child care as the reason why they exited the labor market. And really that was a decision that was very fraught in terms of who was being exposed to COVID. And so, the disparity that we saw in our survey was that about a third of parents had some form of backup child care during the early months of the pandemic. Wealthier parents bought a nanny. They bought a former day care worker. But lower income households pretty much relied on the grandparents. And that was a really hard decision to make early in 2020 when there were no vaccines.

[0:45:26]

RICK WEISS: Right. Maggie, anything to add there?

[0:45:29]

MARGARET KERR: Yeah. Just the—you know, there is a fair amount of research coming out on other caregiving, so family caregiving and people who are caring for other people in their family, not necessarily a parent-child role. And we’re seeing really similar things to what we’re seeing with parents, which is that caregiving during COVID is just—was just really hard on people and for a variety of different reasons. If people are caring for non—like, caring for someone who’s ill, that had huge implications during COVID and what it means to be exposed to that person or your own exposure, you know, putting that person at risk. And also there’s a fair amount of people doing caregiving for multiple different family members. So, there’s what we call sandwich caregivers, so parents who care for their children and also elderly parents, which is slightly off of the question. But there’s just a lot of—my point is that there is a lot of different caregiving roles, and all of them have been strained during COVID.


Has the U.S. birthrate changed during the pandemic?


[0:46:31]

RICK WEISS: Question for any panelist here. Has the stress of the pandemic changed the U.S. birthrate? Are adults reporting reasons for having fewer or more babies during the pandemic? Anyone looking at that?

[0:46:45]

ALICIA MODESTINO: I know there’s definitely been a decline in the birthrate, or at least there had been in the early, you know, year or so after the pandemic. And, you know, for understandable reasons, it slowed everything down, including relationship formation or, you know, put on hold a lot of people’s decisions. But there’s also been a long-term decline in U.S. birthrates. And so, this really just—it—just like everything else, the pandemic just exacerbated sort of an ongoing trend that we have seen.


Have divorce or separation rates changed during the pandemic?


[0:47:15]

RICK WEISS: It makes me wonder also whether divorce or separation rates have been tracked and changed over the period of the pandemic. I know this is a little bit off maybe your research areas, but, Maggie, do you have some data there?

[0:47:29]

MARGARET KERR: Yeah. I don’t know it extremely well. But I do know that there is—I think just like what Dr. Modestino said, like, it exacerbated everything. So, imagine that you have conflict in your relationship, and then you’re forced to be home with that person for months and not have any space. And that might be different for families with different—I think the amount of space that you had in your house was a big factor. But I think we did see that. And we also saw some increases of domestic violence and child abuse and things like that while parents were under stress and—or people were under stress and forced to be stuck in one space together without their normal supports.


In Washington, D.C., early childhood educators are receiving one-time payments to help supplement their salaries. Is this an effective approach?


[0:48:11]

RICK WEISS: And, Alicia, a question for you. Washington, D.C., is giving early childhood educators $10,000 checks this year to supplement their low salaries. What do you think about this one-time payment approach?

[0:48:25]

ALICIA MODESTINO: You know, it’s better than nothing. Hopefully, it will keep some of those daycare providers in place for longer. I know that we’re doing that for front-line workers. You know, states got a lot of leeway in terms of how they spent some of these federal dollars to be able to provide bonuses to front-line workers. And let’s not forget, all during the pandemic—this was a kind of a line of argument I had for quite a while—what was the difference between a 4-year-old and a 5-year-old? A 4-year-old went to school, early childhood education, in-person every day during the pandemic—right?—but a 5-year-old largely was learning remotely. And so those were very much front-line workers who showed up every single day and, you know, had to go through all sorts of COVID protocols and try to keep everybody as safe as possible. So, it’s better than nothing, but far better would be to build back better—right?—and professionalize the industry the way it should be.

And I think part of the reason why we have been so slow to do this is that really, the legacy of child care, early child care, is in slavery, and it was largely Black women who were taking care of white women’s children. And so, we’ve seen that this kind of work has been discounted. It’s been seen as kind of invisible, right, that anyone could do it, and it’s been very poorly paid for a very long time. And it’s time to really elevate it to the very important work that it is, and to create a living wage for these workers. Half of all daycare workers are in some form of public assistance because their wages are so low, and that’s just unacceptable.


How does the U.S. compare to other countries when it comes to subsidizing childcare costs?


[0:49:58]

RICK WEISS: Well, that leads me to just raise a question of my own here, that you mentioned earlier, the possibility of subsidies to cover at least some of the costs of child care. How does the United States compare—I have a rough idea, but maybe you’ve got the details, too—on an international level? Is it common for other countries to subsidize the costs of child care?

[0:50:18]

ALICIA MODESTINO: Yeah, absolutely. So, most other industrialized countries subsidize child care. It’s high-quality care that starts from birth. And so, you even have some ex-pats, Americans who chose to stay in other countries when they give birth and have their first children because they know that they’re going to be very well-supported by high-quality, subsidized child care that’s completely affordable. Same thing with paid leave. We’re one of the only countries in the world—not even industrialized, the entire world—that doesn’t have paid leave. And even the little, tiny amount of paid leave that we’re talking about in the Build Back Better bill, that three weeks or four weeks or whatever it is, that’s just, you know, again, a good start, but it’s just not going to go very far. There’s not even a daycare provider that will take an infant under six weeks, right? And so, you’re still leaving this doughnut hole, and paid leave is the first rung of child care. So, I—the United States is just so, so far behind that it’s unbelievable that we can’t get this passed.

[0:51:20]

MARGARET KERR: I’d like to add something, and it’s partially a question, but—for Alicia, but I was wondering, like, I have noticed in my own research, which that when Build Back Better came around, there was just so much conversation about paid leave, which is, you know, intimately important, I think. I had my own baby during COVID. I know that it’s important. But I didn’t see as much coverage—and this goes back to the question about, like, what can reporters cover well—about the child care subsidies. And I knew from my own research that they were in this bill, and I was just wondering, like, why isn’t everyone talking about this because that—like, subsidies for parents around the 7% threshold is life-changing, in my opinion.

[0:52:08]

ALICIA MODESTINO: Yeah, that’s a great point because also the constituency is very large, right? So, there’s only a small swath of people who desperately need paid leave right now. I mean, everybody will pass through that arc, which is something people seem to forget, like, when they’ve had their own paid leave, maybe. But that for—there’s many, many Americans, I just showed you, 50 million workers—right?—who are paying for some form of child care, whether it’s after school care or whether it’s actual infant care or early childhood. And so, those subsidies would touch a lot more voters—right?—than the paid leave would, and again, would be a really good step for that. You know, and I think one of the other things that we forget about with paid leave is, again, it’s that first rung on the child care ladder there, but it’s certainly not the only one, and it’s not the only one that, you know, touches as many people as a subsidy would. I think the last thing I want to say, too, is just—only 25% of workers right now in the United States have paid leave through their employer, and only about 4% ever take that leave, male or female. And it’s largely women who do. And we asked that in our survey and found even during the pandemic, only the 25% had access to paid leave during the pandemic, and only 4% took it. And so, I don’t know when you can take paid leave if it’s not during a pandemic. It just shows the stigma that we have in the United States around people taking time to care for their children, even at that very early stage.


Do parents with kids of different ages approach health risks differently? Are there differences between new and more experience parents?


[0:53:38]

RICK WEISS: Brian, a question for you. Can you say more about the way parents treat risk differently depending on whether they’re new or experienced? And do parents treat their children of different ages to different levels of risk?

[0:53:52]

BRIAN ZIKMUND-FISHER: So, I will own that I probably cannot speak directly to the last question in terms of the child’s ages. I could make some hypotheses, but I don’t have any evidence to back that up. I do think that there is a pretty clear—and this is going to surprise nobody—there’s a pretty clear way in which we learn through our experiences as parents about how to manage the responsibility of making choices. And so, when it’s—when you have your first child, and each new thing you have to face. OK, so is it safe for them to walk by themselves across the street? OK, I got to think about that, I got to make a choice. OK, is it safe for them to take a bus by themselves? OK, that’s a different age range, but it’s a new thing to wrestle with, et cetera. Like, we learn. Having gone through that once, having wrestled with—figured out what are the relevant questions, having wrestled with, you know, when were you comfortable? When were you not comfortable? Do you think you did the last one at the right point in time, et cetera? When the next kid comes along, it’s a different process, right? It’s not new. We both can’t marshal up a lot of emotion about it, but we’re also more experienced in it. We know what it is we need to pay attention to and what we don’t. And as a result, the decision making about later children with more experienced parents is just fundamentally different. That doesn’t mean it’s always better. And I want to be clear about that. We make different choices. Sometimes that means we’re paying less attention to some things that we ought to be paying more attention to. But it is a fundamentally different process because of that learning experience.


How often do parents disclose their need for support or seek support for themselves? Are there stigma issues at play?


[0:55:32]

RICK WEISS: Got time for just a couple last questions here. And one of them that came in here is: What difference, if any, have you found in parents willingness to seek support or disclose their need for support that’s specifically for themselves? Is there a stigma there that’s a problem? Alicia or Maggie, one of you?

[0:55:52]

MARGARET KERR: Yeah, I can speak to that a little bit. I don’t know—I don’t have, like, research evidence on how much parents sought support after versus before, but in general, there’s a—there’s stigmas around getting mental health support in general. There’s also access issues during the pandemic and how—which there was before that were exacerbated, as many other things were. But there’s also this idea that parents are supposed to give up—and this is, like, a research-based concept—that parents are supposed to give up everything for their kids. It’s called intensive parenting. And that they should be self-sacrificing and put all their resources, time and energy into raising their children. And something that is worse in mothers than fathers. And so, in that way, I think there’s a lot of stigma around taking—particularly for mothers, but for both parents—of taking time to do things to take care of themselves. And it induces a lot of guilt in parents and is hard for them to do. And so, there’s stigma around, like, oh, I need to take care of myself, so there must be something wrong with me that I need to do these fundamental things that all human beings need to do to take care of themselves.

[0:57:09]

BRIAN ZIKMUND-FISHER: If I can just follow up on that. You know, this is a great example of the kind of risk trade-offs that are really difficult. Like, you know you need be to—need to be taking care of your kid’s needs. Do you give yourself permission to wait the importance of taking care of your own needs and the risks that will come from that because we certainly know that you can’t parent well if you are not taking care of your own needs? So, that’s another example of this trade off that is just having to be thought through on a daily basis and constantly changing.

[0:57:37]

MARGARET KERR: And it was hard for parents before these other risks were introduced.

[0:57:44]

ALICIA MODESTINO: One of the other things that I’ll just say, too, is that in our survey, even if women and men—even if parents were likely to hold onto their jobs or not reduce their hours, that didn’t mean they were OK. They were sleeping a lot less, they had higher levels of parental stress, higher levels of PTSD and depression on all these different scales that we measured them on. So, I think there’s a lot of, you know, parents who are out there doing exactly what we’re talking about here and, you know, trying to take care of their kids as best they can, and not necessarily getting the help they get, even when it means, like, asking to reduce your hours or taking a paid leave that you need to be able to do that because you are only one person.


What is one key take-home message for reporters covering the pandemic’s impact on parents?


[0:58:23]

RICK WEISS: Great point. We are just about at the top of the hour, so I want to make a last loop around and just ask each of you for a take-home message if there’s one thing you want reporters to walk away with today on the topic we’ve been talking about. I’ll just remind reporters here that these slides will be up almost immediately after the briefing. Let us know if you need tape right away, otherwise, the video will be up soon. But, Brian, let’s start with you, just with a take-home for the audience.

[0:58:52]

BRIAN ZIKMUND-FISHER: Just acknowledging the burden of making choice. And—the pandemic has forced so many choices on everyone. We’re all trying to deal with it as best we can, and this is hard, and that’s part of what causes the mental exhaustion that we’re all feeling.

[0:59:07]

RICK WEISS: Alicia?

[0:59:09]

ALICIA MODESTINO: I think we just have to acknowledge that child care is infrastructure. Our data showed that women were much less likely to lose their jobs because of child care when they had access to paid leave and they were able to work from home, and they were much less likely to have to reduce their hours if they had access to child care subsidies. And so these are critical supports that allow people to stay in the labor market, to stay on track in terms of their careers and provide for their families.

[0:59:36]

RICK WEISS: Thank you. And, Maggie.

[0:59:38]

MARGARET KERR: Yeah. I think I’ll add just that, generally, parents are not OK. Parents are really struggling. We need to support them now and in the future. And even when, like, the pandemic is over, whatever that might mean, it’s going to take a long time for families to recover from this.

[0:59:58]

RICK WEISS: Well, I want to just give a huge thanks to our three panelists today who have been so data rich and generous with their conclusions, their research-based conclusions and their advice and their observations about what’s going on in the parental scene right now with the pandemic. This has been just incredibly informative. Thank you to the reporters who have tuned in. Remember to follow SciLine on Twitter @RealSciLine, check out our website, sciline.org, and the other services that we offer you in your work. And thanks to everyone, we’ll see you at the next SciLine media briefing.


Creative Commons LicenseThe text and video on this page are licensed as Creative Commons CC BY-SA 4.0. Journalists are free to use any text or video on this page with or without attribution to SciLine.

Dr. Margaret Kerr

Assistant professor in human development & family studies, University of Wisconsin-Madison

Margaret Kerr, Ph.D., is an assistant professor in human development & family studies at the University of Wisconsin-Madison School of Human Ecology and a state specialist in vulnerable and underserved children with the Division of Extension. She is also an affiliate of the Institute for Research in Poverty. Dr. Kerr’s work focuses on examining parents’ mental health and emotional experiences, with a particular focus on the factors that influence how adults perceive and experience parenting, including COVID-19, gender, attachment, and socioeconomic status. She also works on brief interventions, such as relational savoring, that support parents’ well-being by helping them to identify and relish moments of positive connection with their children. In her outreach work through Extension, she develops and implements parent-focused programming, including a parenting podcast for fathers who are incarcerated.

Declared interests: None.

Dr. Alicia Sasser Modestino

Associate professor of public policy and urban affairs and economics, Northeastern University

Alicia Sasser Modestino is an associate professor with appointments in the School of Public Policy and Urban Affairs and the department of economics at Northeastern University, where she also serves as the research director of the Dukakis Center for Urban and Regional Policy. Dr. Modestino’s current research focuses on labor and health economics, including youth development, changing employer skill requirements, childcare, and the opioid crisis. Much of her research is interdisciplinary and involves large-scale empirical evaluations to determine underlying causal relationships using a variety of data, methods, and techniques.

Declared interests: None.

Dr. Brian Zikmund-Fisher

Professor of health behavior and health education; research professor of internal medicine, University of Michigan-Ann Arbor

Brian J. Zikmund-Fisher, Ph.D. is professor of health behavior and health education, research professor of internal medicine, and associate director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan-Ann Arbor. He is also the editor-in-chief of the journals Medical Decision Making and MDM Policy & Practice. A decision psychologist by training, Dr. Zikmund-Fisher is an expert in health risk perceptions and how best to communicate risk to facilitate health and medical decision making. He examines how to make health data more intuitively meaningful to patients, the public, and policymakers alike, studies the impact of people’s consistent preferences for more versus less health care on over- and underutilization of care, and explores the power of narratives in health communications.

Declared interests: None.

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