1. DOES ENHANCEMENT OF ACADEMIC SKILLS IN CHILDHOOD ALSO ENHANCE ADULT HEALTH STATUS? Frances Campbell, Elizabeth Pungello, Thomas Keyserling, R. Grant Steen University of North Carolina at Chapel Hill

2. 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

3. RANDOM ASSIGNMENT TO GROUPS Abecedarian – Treatment: child care setting – Control Project CARE – Treatment: child care setting – Treatment: home visiting – Control

4. 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

5. FAMILY DEMOGRAPHICS AT BIRTH OF TARGET CHILD A Family Characteristics%MeanSDRange Mother’s age in years20.34.813-44 Maternal Education % less than high school67 % high school graduate34 % more than high school5 Marital Status Never married75 Married19 Separated or divorced6 Percent African American93.4 a. Data primarily from Burchinal et al., Child Development, 1997

6. 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

7. COGNITIVE TEST PERFORMANCE (3 TO 21 YEARS) Data from ABC study only Cognitive Score

8. MATH TEST SCORES (8-21 YEARS) September 29, 2010

9. 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

10. YEARS OF EDUCATION p <.05

11. HIGH SCHOOL AND COLLEGE COMPLETION

12. JOB PRESTIGE SCORES p <.05

13. PERCENT EMPLOYED FULL-TIME 16 OF PAST 24 MONTHS* p<.05

14. 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

15. 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

16. SAMPLE ATTRITION: PERCENT OF SAMPLE RETAINED AbecedarianCARE n%n% Original sample11166 Living and eligible at age 3010392.796395.45 Participated at age 3010190.995688.89 Medical participants by study and gender Treated females1869.235100 Treated males2074.07666.67 Control females2278.57666.67 Control males1254.55535.71 Total participants in medical study7269.902234.92

17. ADULT HEALTH BEHAVIORS Early Childhood Status TreatedControl VariableN = 49N = 45 % Regular Exercise6442 % Smoker6862 % Primary Doctor5651

18. ADULT MEDICAL INDICATORS AS A FUNCTION OF EARLY CHILDHOOD TREATMENT Early Childhood Status TreatedControl VariableN = 49N = 45 Mean BMI (SD) % Diagnosed hypertension4852 % Diagnosed diabetes87 % Anemic1611 % Depressed (per meds)67 % Past hospitalization (per MD)2324

19. HEALTH INSURANCE COVERAGE AS A FUNCTION OF EARLY CHILDHOOD INTERVENTION* Early Childhood Intervention TreatedControl Insurance typen%n% Covered through own/spouse work25512045 Medicaid48613 None14291329 Don’t know612613 *Based on data from interview at age 30

20. 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

21. 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

22. 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

23. 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

24. 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.

25. 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

26. 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.