A 25-year follow-up study of a comprehensive early health and education intervention program begun in the early 1970s shows that inner-city children who participated not only did better educationally, but had better physical and mental health in adulthood.
The findings, published in the July Pediatrics, add to evidence that programs like Early Head Start, which was modeled on this intervention, provide good value to society.
While several have shown that early intervention programs lead to better academic outcomes during the school years, this study, led by researchers at Children's Hospital Boston and Boston College, is one of the first to look at long-term effects on health and health behaviors.
"This study supports what many in the medical community have long suspected to be true, that quality early intervention programs directly affect health outcomes when those children reach adulthood," said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. "From its inception, the Robert Wood Johnson Foundation has been committed to improving the health and health care of all Americans, particularly the most vulnerable among us. Foundations like ours are uniquely positioned to support long-term studies that help build the evidence base over time and demonstrate that quality preventive programs improve health outcomes, reduce disparities, and have substantial economic and social value."
The Brookline Early Education Program (BEEP), a community-based child health and development program was initiated by the Brookline Public Schools and the Robert Wood Johnson Foundation and ran from 1972-1979. Enrollment was open to all families in suburban Brookline, Mass., and to some urban families in neighboring Boston. The program provided health, educational and social services to parents, aimed at having children enter kindergarten healthy and ready to learn. Interventions included home visits, parent groups, toy and book libraries, pre-kindergarten programs, and health and developmental monitoring. Families enrolled three months before the child's birth and participated until the child reached kindergarten age.
Of 282 children initially enrolled in BEEP, the investigators were able to survey 120 as young adults, and compared them with non-participants from the same school systems. "There were significant impacts in the lower income, high risk groups," says Judith Palfrey, MD, Chief of the Division of General Pediatrics at Children's Hospital, Boston and the study's first author. "We were excited to find a protective factor for health and mental health. While there had been demonstrable program effects at second grade for both urban and suburban participants, we did not detect a significant long term effect for the suburban participants compared to other young people from Brookline. We were thrilled that the program seemed to wipe out the health disparities that are found between urban and suburban youth under most current circumstances."
Overall, residents of suburban Brookline had higher educational levels, higher rates of private insurance, and better health than the urban Boston residents, with little difference between the BEEP and non-BEEP groups; Palfrey speculates that this was because Brookline offers many programs and supports for families. However, within the urban group, there were significant differences: BEEP participants had, on average, completed more than one year of additional schooling; were less likely to report incomes below $20,000 than non-participants (28% vs. 72%); were more likely to report very good or excellent health (64% vs. 42%); and had higher rates of private insurance (68% vs. 42%). They also reported healthier lifestyles, more competence in taking care of their health, and less depression.
Urban BEEP participants who received the most services tended to have higher incomes and better health outcomes than those receiving the fewest services, but due to small sample size, the differences did not reach statistical significance. However, the investigators believe that home visits were an important component of BEEP.
"BEEP started out as an educational program," says Palfrey, who began studying BEEP soon after its inception. "But program visitors would go to a home and see the mother crying, or that the family was isolated, or that it was an immigrant family that didn't have birth certificates for their babies. There was more social service intervention than anticipated. If you really want to meet the needs of high-risk families, you have to go out to them."