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Early childhood development and education programs can also help reduce educational gaps. Furthermore, extended early childhood programs for children up to 3rd grade, also referred to as booster programs, can provide comprehensive educational, health, and social services to complement standard early childhood and kindergarten programs. Quality education in elementary school is necessary to reinforce early childhood interventions and prevent their positive effects from fading over time.

The developmental and educational opportunities that children have access to in their early years have a lasting impact on their health as adults. Furthermore, by their mid—30s the children who participated in the comprehensive early childhood development and education program had a lower risk for heart disease and associated risk factors, including obesity, high blood pressure, elevated blood sugar, and high cholesterol.

Early childhood development and education are key determinants of future health and well—being. Additional research is needed to increase the evidence base for what can successfully impact the effects of childhood development and education on health outcomes and disparities. This additional evidence will facilitate public health efforts to address early childhood development and education as social determinants of health.

Early childhood interventions: Proven results, future promise [Executive summary]

Disclaimer: This summary of the literature on early childhood development and education as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. As a result, there may be variability in the use of terms, for example, black versus African American. Early childhood interventions: proven results, future promise. The effectiveness of early childhood development programs: a systematic review. Am J Prev Med. The foundations of lifelong health are built in early childhood [Internet].

Child Dev Perspect.

Technical Appendix

The early education of socioeconomically disadvantaged children. Ann Rev Psychol. Early childhood care and education: effects on ethnic and racial gaps in school readiness. Future Child. From neurons to neighborhoods: the science of early childhood development. Washington: National Academy Press; Health disparities and gaps in school readiness. The statistical significance of subgroup effects was set at.

Major findings regarding preschool participation are shown in Table 3. Relative to the comparison group and controlling for preprogram characteristics, the preschool group had significantly higher rates of high school completion The preschool group also had more years of education. Rates of overall college attendance were similar, reflecting no differences in 2-year attendance. As shown in Table 4 , for extended program participation, relative to fewer years of participation and controlling for preprogram characteristics, 4- to 6-year participants had higher rates of high school completion Relative to preschool participation and controlling for kindergarten achievement, extended intervention was not associated with attainment extended-2 contrast.

For preschool participation, by age 24 years, the preschool group relative to the comparison group had significantly lower rates of felony arrest They also were less likely than the comparison group to be found guilty of a crime both overall and for a felony No group differences were found for overall and violent arrests. Relative to fewer years of participation, extended intervention was linked to lower rates of arrest for violence No differences were found for the extended-2 contrast.

With regard to preschool participation, the preschool group was somewhat more likely to have a stable employment history or to have attended college by age 24 years. No other indicators showed significant differences, including receipt of Temporary Assistance for Needy Families among females and Medicaid. For school-age participation, the program group had fewer months receiving any public aid Temporary Assistance for Needy Families, Food Stamps, or Medicaid from ages 18 to 24 years.

In addition to lower rates of public aid receipt, extended intervention participants had higher rates of full-time employment than the comparison group The employment difference was similar for the extended-2 contrast. For preschool participation, the preschool group had higher rates of health insurance coverage from any source than the comparison group Rates of both private and public insurance coverage favored the program group.

No differences were found for substance use, smoking, and teenage parenthood. The lone significant finding in school-age participation was that participants had a lower rate of disability assistance. The extended program group was less likely than the comparison group to receive disability assistance as young adults extended-1 contrast; 4.

Although overall rates of health insurance were equivalent, participants had a higher rate of private insurance coverage than the comparison group The program group had a lower rate of out-of home placement. No differences were detected for smoking and substance use. For preschool participation, relative to the comparison group, the intervention group was less likely to have 1 or more depressive symptoms No differences were found for either program contrast in extended program participation. We found limited evidence of differential intervention effects.

Males had a significantly greater preschool effect on high school completion No other subgroup effects were detected. This study makes several contributions to child development. First, as the most comprehensive investigation of an established large-scale program, the CPC intervention had impacts on adult health and well-being not apparent in previous studies. That the impacts of intervention extend beyond educational performance is not surprising given the well-documented links between education outcomes and adult health, mental health, and social behavior.

Most noteworthy, this is the first ECI study to our knowledge linking participation to higher rates of insurance coverage and lower rates of depressive symptoms, a byproduct of better school performance and attainment. Links to adult crime prevention have been documented, 8 , 9 but not for large-scale prospective studies or over a wide range of indicators. At present, the economic returns of ECIs exceed costs by an average ratio of 6 to 1. Second, we find continuing effects of intervention on educational attainment.

Legislative Priority: Early Childhood Education – Home Visiting

In addition to impacts on high school completion and years of completed education, preschool was associated with significantly higher rates of attendance in a 4-year college. This is particularly important given the increasing economic and health benefits experienced by college and postsecondary graduates relative to nongraduates and school dropouts. Additional follow-ups will provide a more complete assessment of socioeconomic status. That preschool intervention was linked to a lower rate of out-of-home placements suggests that school-based ECIs can prevent maltreatment.

Third, we found evidence that program participation continuing into the primary grades was associated with greater adult well-being. Relative to less extensive intervention, participation for 4 to 6 years was associated with higher educational attainment, a higher rate of full-time employment, less need for public aid, and lower levels of out-of-home placement and violent crime. As expected, effect sizes were lower when kindergarten achievement was included as a covariate. Overall, these findings indicate the positive effects of length of intervention and provide long-term empirical support for efforts to integrate services between preschool and third grade.

A final contribution of the study is that differential effects of intervention were investigated for program, child, and family characteristics. Although for most outcomes the impact of intervention was similar for different subgroups, preschool participation was linked to higher school completion for males. This pattern is consistent with the year follow-up study.

Why does the CPC intervention promote enduring effects on health and well-being? Four program elements seem paramount. First, a system of intervention is in place beginning at age 3 years that continues to the early grades. This school-based system promotes stability in children's learning environments, which can provide smooth transitions to formal schooling.

Well-trained and well-compensated staff are common for programs demonstrating long-term effects. Given the growing evidence of long-term positive effects of ECI, the processes through which intervention leads to greater well-being are better understood. We note 3 limitations that may affect the interpretability of findings.

First, because study findings are based on a quasi-experimental design, causal inferences are less certain than findings from many randomized controlled trials. Although it is possible that unmeasured factors contributed to part of the estimated effects, the consistency of findings over a wide range of analyses strengthens interpretations.

Second, some outcome measures were not assessed completely. As 1 indicator of mental health, depressive symptoms were obtained from a brief self-report checklist and not from clinical assessments, suggesting that intervention effects may be underestimated. Employment and income were measured prior to the completion of postsecondary education for many study participants. More stable and predictable economic profiles occur between ages 25 and 30 years. Finally, although the generalizability of findings to existing state- and federal-funded early education programs is greater than most previous studies, the intervention effects are most likely to be reproduced in urban contexts serving relatively high concentrations of low-income children.

This study provides evidence that established early educational interventions can positively influence the adult life course in several domains of functioning. The scope and magnitude of intervention effects reveal not only the benefits to participants in fundamental indicators of health and well-being but also the potential returns to society for investments in early educational programs.

Correspondence: Arthur J. Author Contributions: Study concept and design : Reynolds and Temple. Drafting of the manuscript : Reynolds, Temple, Robertson, and Topitzes. Critical revision of the manuscript for important intellectual content : Reynolds, Temple, Ou, Mersky, and Niles.

Obtained funding : Reynolds. Administrative, technical, and material support : Reynolds, Ou, and Niles. Study supervision : Reynolds, Temple, and Ou. Each funding agency provided financial support for data collection, management, and analysis of project records. Arch Pediatr Adolesc Med. All Rights Reserved. Save Preferences. Privacy Policy Terms of Use. Twitter Facebook Email. This Issue.

Citations View Metrics. Barnett, W. Karoly, L. Early childhood interventions: Proven Results, Future Promise. RAND Corporation. Carr, M. Assessment in early childhood settings: Learning stories. Behrman, R. Caring for infants and toddlers.

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