Post on 29-Dec-2015
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
HIGH SCHOOL AND COLLEGE COMPLETION
% HS grad % College grad0
102030405060708090
89
20
81
9
Treated Control
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.