Does Enhancement of Academic Skills in Childhood Also Enhance Adult Health Status? - PowerPoint Presentation

Slide1

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 HillSlide2

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 povertySlide3

Random Assignment to Groups

AbecedarianTreatment: child care settingControlProject CARETreatment: child care setting

Treatment: home visiting

ControlSlide4

Method

All infants admitted were from high-risk familiesHalf 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 statusSlide5

Family Demographics at Birth of Target Child

a

Family Characteristics

%

Mean

SD

Range

Mother’s age in years

20.3

4.8

13-44 Maternal Education % less than high school67 % high school graduate34 % more than high school5 Marital StatusNever married75Married19Separated or divorced6Percent African American93.4

a. Data primarily from Burchinal et al., Child Development, 1997Slide6

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 onstandardized intellectual measures from early childhood to young adulthood

age-referenced standardized tests of reading and mathematics from age 8 to age 21 yearsSlide7

C

ognitive Test Performance (3 to 21 years)

Data from ABC study only

Cognitive ScoreSlide8

Math Test Scores

(8-21 years)

September 29, 2010Slide9

Outcomes at Age 30

Abecedarian/CARE follow-up at age 30: child care treated group significantly outperformed control group on:Years of educationJob prestigeEmployed full-time at least 16 of past 24 monthsSlide10

Years of Education

p <.05Slide11

High School and College CompletionSlide12

Job Prestige Scores

p <.05Slide13

Percent Employed Full-time

16 of Past 24 Months*

p<.05Slide14

Examining health status as a function of early childhood intervention

Hypothesis: The ABC/CARE early childhood educational intervention improved adult health outcomesAssessed health status in mid-30sMeasures

Brief health history

Physical examination

Disease

Weight, BMI

BP (clinical measure)

Laboratory (Non-fasting blood sample)

cholesterol

hematocrit

A1CSlide15

Challenges

Location of early childhood participants more than 30 year later.1. Family contacts evolve – die, move2. Vocational situations constrain adult participation in study3. Medical contacts solicited by researchers rather than sought for treatmentSlide16

Sample Attrition: Percent of Sample Retained

Abecedarian

CARE

n

%

n

%

Original sample

111

66

Living and eligible at age 3010392.796395.45Participated at age 3010190.995688.89Medical participants by study and gender Treated females1869.235100 Treated males2074.07666.67 Control females2278.57666.67 Control males1254.55535.71Total participants in medical study7269.902234.92Slide17

Adult Health Behaviors

Early Childhood Status

Treated

Control

Variable

N = 49

N = 45

% Regular

Exercise

6442% Smoker6862% Primary Doctor5651Slide18

Adult Medical Indicators as a Function of Early Childhood Treatment

Early

Childhood Status

Treated

Control

Variable

N = 49

N = 45

Mean BMI (SD)

% Diagnosed hypertension4852% Diagnosed diabetes87% Anemic 1611% Depressed (per meds)67% Past hospitalization (per MD)2324Slide19

Health Insurance Coverage as a Function of Early Childhood Intervention*

Early

Childhood Intervention

Treated

Control

Insurance type

n

%

n

%

Covered through own/spouse work 25512045Medicaid48613None 14291329Don’t know612613*Based on data from interview at age 30Slide20

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 malesSlide21

Differences related to gender

Males had higher hemoglobin scoreslower cholesterol scoresMales were lesslikely 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 alcoholSlide22

Differences related to age

Study participants ranged in age from 30 to 39Age significantly affectedIncidence of diabetesAnemiaMedication for depression

Use of marijuana or other drugs

Past hospitalization

Obesity

Having a primary health care providerSlide23

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 Slide24

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.Slide25

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-returneesSlide26

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.