Seeing and hearing: The impacts of New York City’s universal pre-kindergarten program on the health of low-income children

Abstract

Prior research suggests that high quality universal pre-kindergarten (UPK) programs can generate lifetime benefits, but the mechanisms generating these effects are not well-understood. In 2014, New York City made all 4-year-old children eligible for high-quality UPK programs that emphasized developmental screening. We examine the effect of this program on the health and healthcare utilization of children enrolled in Medicaid using a difference-in-regression discontinuity design that exploits both the introduction of UPK and the fixed age cutoff for enrollment. The introduction of UPK increased the probability that a child was diagnosed with asthma or with vision problems, received treatment for hearing or vision problems, or received a screening during the prekindergarten year. UPK accelerated the timing of diagnoses of vision problems. We do not find any increases in injuries, infectious diseases, or overall utilization. These effects are not offset by lower screening rates in the kindergarten year, suggesting that one mechanism through which UPK might generate benefits is that it accelerates the rate at which children are identified with conditions that could potentially delay learning and cause behavioral problems. We do not find significant effects of having a child who was eligible for UPK on mothers' health, fertility, or healthcare utilization.

A Quasi-Experimental Study of the Effects of Pre-Kindergarten Education on Pediatric Asthma

“…First, we analyzed hearing problems (i.e., starting from “38” in ICD 9 code) and vision problems (i.e., starting from “36” and “37” in ICD-9 codes) as outcomes using the same analytical model (see Appendix D ). These outcomes may have a positive association with Pre-K attendance as shown in a previous study [ 15 ]. Second, we constructed three study subsamples based on the participants’ continuity of Medicaid enrollment because not all participants remained enrolled in Medicaid throughout the study period (i.e., from the beginning of 2011 to the end of 2017).…”

“…However, few studies to date have empirically addressed the short-term effects of Pre-K programs on childhood health outcomes. A recent national heart study revealed that attending a universal Pre-K program in New York City was associated with increased diagnosis of several health problems (e.g., asthma, vision problems, and hearing problems) Similarly, an increased use of healthcare services (e.g., treatment for hearing or vision problems) was observed [ 15 ]. These findings suggest Pre-K programs may offer valuable settings for the early detection of children’s ill health status in children and promote the use of appropriate health care services.…”

Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review

“… 73–75 Hiring school nurses to help students navigate from screening to full eye exams and comply with treatment was reported to be effective compared with screening alone 76 (although some universal childhood screening programmes were very effective at promoting follow-up). 77 …”

“…[73][74][75] Hiring school nurses to help students navigate from screening to full eye exams and comply with treatment was reported to be effective compared with screening alone 76 (although some universal childhood screening programmes were very effective at promoting follow-up). 77 Initiatives with wider, integrated approaches also demonstrated effectiveness at improving attendance at follow-up eye exams (though not always significantly so). These initiatives tended to include several components, such as prescheduling follow-up appointments, 43 78 running follow-up appointments at convenient locations, 79 incorporating education elements 43 59 80 and providing financial incentives.…”

Age-specific Effects of Early Daycare on Children's Health

“…The few studies that assess the effects of daycare exposure on child health are inconclusive in terms of the direction and magnitude of the effects. Programs targeting families from low socio-economic backgrounds generally benefit children's health (e.g., Conti et al, 2016, Hong et al, 2019 while the effects of universal daycare programs on health depend on the quality of the program, the counterfactual care mode, the considered age groups and the outcomes at measure. For example, a cheap, low-quality daycare expansion in Quebec has adverse health effects (e.g., Baker et al, 2008, Heckman et al, 2010, Kottelenberg and Lehrer, 2013, while daycare expansions providing better quality care have the potential to have null or positive effects on child health (e.g., Bosque-Mercader, 2022, Cornelissen et al, 2018, van den Berg and Siflinger, 2022.…”