High-quality early childhood programs have been shown to have substantial benefits in reducing crime, raising earnings, and promoting education. Much less is known about their benefits for adult health. We report the long-term health impacts of one of the oldest and most heavily cited early childhood interventions with long-term follow-up evaluated by the method of randomization: the Carolina Abecedarian Project (ABC). Using recently collected biomedical data, we find that disadvantaged children randomly assigned to treatment have significantly lower prevalence of risk factors for cardiovascular and metabolic diseases in their mid-30s. The evidence is especially strong for males. The mean systolic blood pressure among the control males is 143, while only 126 among the treated. One in four males in the control group is affected by metabolic syndrome, while none in the treatment group is. To reach these conclusions, we address several statistical challenges. We use exact permutation tests to account for small sample sizes and conduct a parallel bootstrap confidence interval analysis to confirm the permutation analysis. We adjust inference to account for the multiple hypotheses tested and for nonrandom attrition. Our evidence shows the potential of early life interventions for preventing disease and promoting health.

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In the Abecedarian Project, a prospective randomized trial, the effects of early educational intervention on patterns of cognitive and academic development among poor, minority children were examined. Participants in the follow-up were 104 of the original 111 participants in the study (98% African American). Early treatment was full-time, high-quality, educational child care from infancy to age 5. Cognitive test scores collected between the ages of 3 and 21 years and academic test scores from 8 to 21 years were analyzed. Treated children, on average, attained higher scores on both cognitive and academic tests, with moderate to large treatment effect sizes observed through age 21. Preschool cognitive gains accounted for a substantial portion of treatment differences in the development of reading and math skills. Intensive early childhood education can have long-lasting effects on cognitive and academic development.

Adult (age 30) educational, economic, and social-emotional adjustment outcomes were investigated for participants in the Abecedarian Project, a randomized controlled trial of early childhood education for children from low-income families. Of the original 111 infants enrolled (98% African American), 101 took part in the age-30 follow-up. Primary indicators of educational level, economic status, and social-adjustment were examined as a function of early childhood treatment. Treated individuals attained significantly more years of education, but income-to-needs ratios and criminal involvement did not vary significantly as a function of early treatment. A number of other indicators were described for each domain. Overall, the findings provide strong evidence for educational benefits, mixed evidence for economic benefits and little evidence for social-adjustment outcomes. Implications for public policy are discussed.

The authors examined the associations between socioeconomic status (SES), race, maternal sensitivity, and maternal negative-intrusive behaviors and language development in a sample selected to reduce the typical confound between race and SES (n = 146). Mother-child interactions were observed at 12 and 24 months (coded by randomly assigned African American and European American coders); language abilities were assessed at 18, 24, 30, and 36 months. For receptive language, race was associated with ability level, and maternal sensitivity and negative-intrusive parenting were related to rate of growth. For expressive communication, race, SES, and maternal sensitivity were associated with rate of growth; race moderated the association between negative-intrusive parenting and rate of growth such that the relation was weaker for African American than for European American children. The results highlight the importance of sensitive parenting and suggest that the association between negative-intrusive parenting and language development may depend upon family context. Future work is needed concerning the race differences found, including examining associations with other demographic factors and variations in language input experienced by children, using culturally and racially validated indices of language development.