A multicomponent, preschool to third grade preventive intervention and educational attainment at 35 years of age

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IMPORTANCE Educational attainment is the leading social determinant of health, but few studies of prevention programs have examined whether the programs are associated with educational attainment outcomes after the mid-20s, especially for large-scale programs that provide a longer duration of services. OBJECTIVE To examine the association between a preschool to third grade intervention and educational attainment at midlife and differences by program duration, sex, and parental educational level. DESIGN, SETTING, AND PARTICIPANTS This matched-group, alternative intervention study assessed 1539 low-income minority children born in 1979 or 1980 who grew up in high-poverty neighborhoods in Chicago, Illinois. The comparison group included 550 children primarily from randomly selected schools participating in the usual early intervention. A total of 989 children who entered preschool in 1983 or 1984 and completed kindergarten in 1986 were included in the Chicago Longitudinal Study and were followed up for 27 to 30 years after the end of a multicomponent intervention. A total of 1398 participants (90.8%) in the original sample had educational attainment records at 35 years of age. The study was performed from January 1, 2002, through May 31, 2015. INTERVENTIONS The Child-Parent Center Program provides school-based educational enrichment and comprehensive family services from preschool to third grade (ages 3-9 years). MAIN OUTCOMES AND MEASURES Educational outcomes from administrative records and self-report included school dropout, 4-year high school graduation, years of education, postsecondary credential, and earned degrees from associate's to master's or higher. RESULTS A total of 1539 participants (mean [SD] age, 35.1 [0.32] years; 1423 [92.9%] black and 108 [7.1%] Hispanic) were included in the study. After weighting on 2 propensity scores, preschool participants had higher rates of postsecondary degree completion, including associate's degree or higher (15.7%vs 10.7%; difference, 5.0%; 95%CI, 1.0%-9.0%), master's degree (4.2%vs 1.5%; difference, 2.7%; 95%CI, 1.3%-4.1%), and years of education (12.81 vs 12.32; difference, 0.49; 95%CI, 0.20-0.77). Duration of participation showed a consistent linear association with outcomes. Compared with fewer years, preschool to second or third grade participation led to higher rates of associate's degree or higher (18.5%vs 12.5%; difference, 6.0%; 95%CI, 1.0%-11.0%), bachelor's degree (14.3%vs 8.2%; difference, 6.1%; 95%CI, 1.3%-10.9%), and master's degree or higher (5.9%vs 2.3%; difference, 3.6%; 95%CI, 1.4%-5.9%). The pattern of benefits was robust and favored male participants for high school graduation, female participants for college attainment, and those from lower-educated households. CONCLUSIONS AND RELEVANCE This study indicates that an established early and continuing intervention is associated with higher midlife postsecondary attainment. Replication and extension of findings to other locations and populations should further strengthen confidence in the health benefits of large-scale preventive interventions.

Original languageEnglish (US)
Pages (from-to)247-256
Number of pages10
JournalJAMA Pediatrics
Issue number3
StatePublished - Mar 2018

Bibliographical note

Funding Information:
Funding/Support: This study was supported by grant R01HD034294 from the National Institute of Child Health and Human Development, grant U411B110098 from the US Department of Education, and grant OPP1173152 from the Bill & Melinda Gates Foundation.


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