DOES ENHANCEMENT OF ACADEMIC SKILLS IN CHILDHOOD ALSO ENHANCE ADULT HEALTH STATUS? Frances Campbell, Elizabeth Pungello, Thomas Keyserling, R. Grant Steen.

DOES ENHANCEMENT OF ACADEMIC SKILLS IN CHILDHOOD ALSO ENHANCE ADULT HEALTH

STATUS?

Frances Campbell, Elizabeth Pungello, Thomas Keyserling, R. Grant SteenUniversity of North Carolina at Chapel Hill

PURPOSE

• Does Enhanced School Readiness Affect Adult Health of African Americans?

– Adult health at age 30 assessed as a function of early childhood educational intervention for children born into poverty

RANDOM ASSIGNMENT TO GROUPS

• Abecedarian– Treatment: child care setting– Control

• Project CARE– Treatment: child care setting– Treatment: home visiting– Control

METHOD

– All infants admitted were from high-risk families– Half received educational intervention in a child care setting from

infancy to kindergarten entry– Primary pediatric care on site for treated children– Control of nutrition during first year through provision of iron-fortified

formula to all children up to age 15 months– Cognitive development up to young adulthood and adult educational

and economic accomplishments at age-30 reported as a function of early childhood treatment and control status

FAMILY DEMOGRAPHICS AT BIRTH OF TARGET CHILDA

Family Characteristics % Mean SD Range Mother’s age in years 20.3 4.8 13-44 Maternal Education

% less than high school 67 % high school graduate 34

% more than high school 5 Marital Status

Never married 75Married 19Separated or divorced 6Percent African American 93.4

a. Data primarily from Burchinal et al., Child Development, 1997

SUCCESSES OF THE PROGRAM

• The early childhood program made a significant and long-lasting difference in the average cognitive/academic development of the treated children.

• Growth curve modeling showed that children with child care based treatment outperformed the control group children on– standardized intellectual measures from early childhood to young

adulthood – age-referenced standardized tests of reading and mathematics from

age 8 to age 21 years

COGNITIVE TEST PERFORMANCE (3 TO 21 YEARS)

Data from ABC study only

80

90

100

110

3 4.5 6 7.5 9 10.5 12 13.5 15 16.5 18 19.5 21

Age (Years)

Treatment Control

Co

gni

tive

Sco

re

MATH TEST SCORES (8-21 YEARS)

80

85

90

95

100

8 10 12 14 16 18 20 22

Age (Years)

TREATMENT CONTROL

September 29, 2010

OUTCOMES AT AGE 30

• Abecedarian/CARE follow-up at age 30: child care treated group significantly outperformed control group on:– Years of education– Job prestige– Employed full-time at least 16 of past 24 months

YEARS OF EDUCATION

Mean years8

9

10

11

12

13

14

15

16

13.4

12.4 TreatedConrol

p <.05

HIGH SCHOOL AND COLLEGE COMPLETION

% HS grad % College grad0

102030405060708090

89

20

81

9

Treated Control

JOB PRESTIGE SCORES

Job Prestige323334353637383940

39.5

35

Treated Control

p <.05

PERCENT EMPLOYED FULL-TIME 16 OF PAST 24 MONTHS*

% Full Employment0

1020304050607080

75

54

Treated Control

p<.05

EXAMINING HEALTH STATUS AS A FUNCTION OF EARLY CHILDHOOD INTERVENTION

• Hypothesis: The ABC/CARE early childhood educational intervention improved adult health outcomes

• Assessed health status in mid-30s• Measures

– Brief health history– Physical examination

• Disease• Weight, BMI• BP (clinical measure)

– Laboratory (Non-fasting blood sample)• cholesterol• hematocrit• A1C

CHALLENGES

• Location of early childhood participants more than 30 year later.• 1. Family contacts evolve – die, move• 2. Vocational situations constrain adult participation in study• 3. Medical contacts solicited by researchers rather than sought for

treatment

SAMPLE ATTRITION: PERCENT OF SAMPLE RETAINED

Abecedarian CARE

n % n %

Original sample 111 66

Living and eligible at age 30 103 92.79 63 95.45

Participated at age 30 101 90.99 56 88.89

Medical participants by study and gender

Treated females 18 69.23 5 100

Treated males 20 74.07 6 66.67

Control females 22 78.57 6 66.67

Control males 12 54.55 5 35.71

Total participants in medical study 72 69.90 22 34.92

ADULT HEALTH BEHAVIORS

Early Childhood Status

Treated Control

Variable N = 49 N = 45

% Regular Exercise 64 42

% Smoker 68 62

% Primary Doctor 56 51

ADULT MEDICAL INDICATORS AS A FUNCTION OF EARLY CHILDHOOD TREATMENT

Early Childhood Status

Treated Control

Variable N = 49 N = 45

Mean BMI (SD)

% Diagnosed hypertension 48 52

% Diagnosed diabetes 8 7

% Anemic 16 11

% Depressed (per meds) 6 7

% Past hospitalization (per MD) 23 24

HEALTH INSURANCE COVERAGE AS A FUNCTION OF EARLY CHILDHOOD INTERVENTION*

Early Childhood Intervention

Treated Control

Insurance type n % n %

Covered through own/spouse work 25 51 20 45

Medicaid 4 8 6 13

None 14 29 13 29

Don’t know 6 12 6 13

*Based on data from interview at age 30

SIGNIFICANT DIFFERENCES RELATED TO EARLY CHILDHOOD TREATMENT

• Those with early childhood treatment had significantly higher weight than preschool controls.

• This finding is moderated by gender– Females had significantly higher BMI scores than males

DIFFERENCES RELATED TO GENDER

• Males had – higher hemoglobin scores– lower cholesterol scores

• Males were less– likely to rate their own health as good– likely to be anemic– likely to have a regular doctor

• Males were more– likely to report regular exercise– likely to be smokers– likely to report drinking alcohol

DIFFERENCES RELATED TO AGE

• Study participants ranged in age from 30 to 39• Age significantly affected

– Incidence of diabetes– Anemia– Medication for depression– Use of marijuana or other drugs– Past hospitalization– Obesity– Having a primary health care provider

BOTTOM LINE

• For children born into poverty, early environmental enrichment can positively affect early cognitive development, academic performance, and later adult educational attainment and vocational success

• Biological contingencies (family history) and available resources (poverty) during growth years may overpower modest effects of positive early childhood circumstances on adult health

OTHER FINDINGS

Males and females displayed different patterns of findings: females were more prone to obesity, males were more prone to smoke and drink alcohol, but also more likely to report regular exercise.Trends for older adults to display more health problems were seen.

CONCLUSION

• Hypothesis was not supported: early childhood environmental enrichment did not significantly impact adult health.

• Possible reasons for findings:– Young age of sample

• Health disparities related to educational/vocational advantages may not yet manifest themselves

– Small sample size • Modest effects do not reach statistical significance

– High attrition in medical sample• Males significantly less likely to participate, unknown status of

non-returnees

INNOVATIONS

• The early childhood program was a randomized control trial and as such, had treatment/control differences in adult health been detected, associating them with the early childhood program would have been justified.

• Results suggest caution in over-generalizing modest adult educational and vocational benefits to include significantly better adult health status among those who grow up in poverty.

• There are no simple solutions to the health problems of poor, minority individuals.