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Early-intervention may improve later health
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CHICAGO—Minority preschoolers from low-income families who participated in a comprehensive school-based intervention appear to fare better educationally, criminally and economically into young adulthood, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

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“Early childhood interventions have demonstrated consistent positive effects on children’s health and well-being,” the authors write as background information in the article. The types of programs that have received the largest growth in public funding are preschool programs for mostly at-risk 3- and 4-year-olds that provide both educational and family services in a center-based environment. One such intervention, the Child-Parent Center program in Chicago, is available from preschool through third grade and features instruction by qualified teachers, low child-to-staff ratios, health and nutrition services and an intensive parent program that includes classroom involvement, field trips and home visits.

Arthur J. Reynolds, Ph.D., of the University of Minnesota, Minneapolis, and colleagues, studied the long-term effects of the Child-Parent Center program. A total of 1,539 low-income minority children who were born in 1979 or 1980 and attended programs at 25 sites between 1985 and 1986 were compared with 550 children who participated in alternative full-day kindergarten programs available to low-income families. The children were tracked through age 24 using various methods, including records from schools, Medicaid and county, state and federal agencies, as well as a survey completed by the participants between ages 22 and 24 years.

By age 24, children who had participated in the Child-Parent Center preschool were:

  • More likely to have finished high school (71.4 percent vs. 63.7 percent) and to be attending four-year colleges (14.7 percent vs. 10 percent)
  • More likely to have health insurance coverage (70.2 percent vs. 61.5 percent)
  • Less likely to be arrested for a felony (16.5 percent vs. 21.1 percent) or incarcerated (20.6 percent vs. 25.6 percent)
  • Less likely to have depressive symptoms (12.8 percent vs. 17.4 percent


Children who participated in the program during school years also were more likely to be working full-time (42.7 percent vs. 36.4 percent), have completed more years of education and have lower rates of arrests for violent offenses (13.9 percent vs. 17.9 percent), and were less likely to receive disability assistance (4.4 percent vs. 7 percent).

The fact that positive results of the program extend beyond educational achievements is not surprising given the links between education, mental and physical health and behavior, the authors note. “Because expenditures for the medical care and justice systems comprise roughly 20 percent of the gross domestic product, the potential cost savings to governments and taxpayers of early childhood prevention programs are considerable,” they write.
(Arch Pediatr Adolesc Med. 2007;161(8):730-739.

Editor's Note: This work was supported by grants from the National Institute of Child Health and Human Development and from the Doris Duke Charitable Foundation, as well as by the Foundation for Child Development, the National Institute for Early Education Research, the McCormick Tribune Foundation and the University of Wisconsin, Madison Graduate School. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


The quasi-experimental design of the study by Dr. Reynolds and colleagues makes it difficult to draw solid conclusions about the best preschool programs for low-income children, writes David Olds, Ph.D., of the University of Colorado at Denver and Health Sciences Center in an accompanying editorial.

“To better estimate the impact of quality preschool programs and components of program quality, we need a well-funded programmatic series of randomized controlled trials,” Dr. Olds writes. “Funding such work will create a strong evidentiary foundation for improving intervention effectiveness and generate even greater policy support for quality preschool.”

“Some will argue that the quasi-experimental evidence on quality components is so strong that we don’t need randomized controlled trials to sort out these details; but with the quality of currently funded preschool programs so far below the standards embodied in the model programs on which the case for expanded preschool is based, we will need extraordinarily strong evidence to ensure that policymakers do not cave into pressures to serve larger numbers of children at a lower cost.”
(Arch Pediatr Adolesc Med. 2007;161(8):807-809.

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.


Despite studies like Dr. Reynolds’ that demonstrate the effectiveness of early childhood interventions, prisons are more likely to get adequate funding than preschools, writes James Forman Jr., J.D., of Georgetown Law School, Washington, D.C., in an additional accompanying editorial.

“In our country, when we run out of prison space, we simply build more,” he writes. “The result is that we have the highest incarceration rate in the world despite being the nation’s wealthiest country. Early-childhood education, on the other hand, is woefully under-funded.”

“The findings from the Child-Parent Centers should not surprise us,” he continues. “They prove that a well-designed and well-executed early-childhood education program can make a significant difference in the life outcomes of children from low-income households. They also show that no single intervention is enough: good early-childhood education needs to be accompanied by (among other things) adequate health care and needs to be followed by quality K-through-12 education.” Such programs could, among other benefits, reduce the number of prisons and prisoners in the United States, Forman concludes.
(Arch Pediatr Adolesc Med. 2007;161(8):809-810.

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at} .

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