Early Childhood Investments Substantially Boost Adult Health

Abstract

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.

Early skill formation and the efficiency of parental investment: A randomized controlled trial of home visiting

“…Permutation methods do not depend on distributional assumptions and thus facilitate the estimation of treatment effects in small samples. While our analysis replicates a few recent studies of an early childhood intervention using this approach (Heckman et al 2010a;Campbell et al 2014), it is not yet extensively used in the policy evaluation literature.…”

“…In addition, this is the only study of early life outcomes which has approached attrition using an Inverse Probability Weighting technique to ensure that a larger weight is given to participants who are under-represented in the study. This approach has been employed to examine adult health outcomes in Campbell et al (2014), yet this rigorous approach has not yet been applied to studies of early life outcomes. The widespread use of the methods applied here would help harmonise the early intervention literature and improve within study internal validity, the absence of which has limited insight from previous research.…”

“…Adapted from the description in Campbell et al (2014), we make the assumption that the outcome is independent of the missing data pattern, conditional on treatment assignment and observable baselines characteristics. This can be written as 12 While the degree of item non-response was minimal for the majority of the instruments used (less than 2% at each time point), there were more substantial cases of missing data for some of the home environment, appropriate care and parental interaction measures.…”

“…Evidence from the few experimentally designed programs, implemented in childhood but with long term follow-up, suggests positive effects into adulthood including fewer behavioral problems and criminal convictions, lower dependency on welfare, increased employment, and improved health (Olds et al 1998;Heckman et al 2010a;Campbell et al 2014). Cunha and Heckman (2007) present a model of skill formation demonstrating that early skills facilitate the accumulation of more advanced skills, and these higher level skills make further investment throughout the lifecycle more productive through a process of dynamic complementarity.…”

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…For example, 1 publication 332 documented improved Framingham risk scores in individuals ≈30 years after having been randomized to an intensive preschool daycare program for disadvantaged children. The impact of social programs on cardiovascular health has generally not been considered by cardiovascular professionals.…”