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Reynolds AJ, Ou SR, Eales L, et al. Assessment of a Comprehensive Early Childhood Education Program and Cardiovascular Disease Risk in Midlife. JAMA Netw Open. 2021;4(8):e2120752doi: 10.1001/jamanetworkopen.2021.20752.
Reynolds, A. J., Ou, S. R., Eales, L., Mondi, C. F., & Giovanelli, A. (2021). Assessment of a Comprehensive Early Childhood Education Program and Cardiovascular Disease Risk in Midlife. JAMA network open, 4(8), e2120752. https://doi.org/10.1001/jamanetworkopen.2021.20752
Reynolds, Arthur J, et al. "Assessment of a Comprehensive Early Childhood Education Program and Cardiovascular Disease Risk in Midlife." JAMA network open vol. 4,8 (2021): e2120752. doi: https://doi.org/10.1001/jamanetworkopen.2021.20752
Reynolds AJ, Ou SR, Eales L, Mondi CF, Giovanelli A. Assessment of a Comprehensive Early Childhood Education Program and Cardiovascular Disease Risk in Midlife. JAMA Netw Open. 2021 Aug 02;4(8):e2120752. doi: 10.1001/jamanetworkopen.2021.20752. PMID: 34415316; PMCID: PMC8379657.
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JAMA Netw Open. 2021 Aug 02;4(8):e2120752. doi: 10.1001/jamanetworkopen.2021.20752.

Assessment of a Comprehensive Early Childhood Education Program and Cardiovascular Disease Risk in Midlife.

JAMA network open

Arthur J Reynolds, Suh-Ruu Ou, Lauren Eales, Christina F Mondi, Alison Giovanelli

Affiliations

  1. Human Capital Research Collaborative and Institute of Child Development, University of Minnesota, Minneapolis.
  2. Institute of Child Development, University of Minnesota, Minneapolis.
  3. Brazelton Touchpoints Center, Division of Developmental Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
  4. Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco.

PMID: 34415316 PMCID: PMC8379657 DOI: 10.1001/jamanetworkopen.2021.20752

Abstract

IMPORTANCE: Educational attainment is an underrecognized factor associated with racial disparities in cardiovascular disease (CVD) risk. Early childhood programs providing comprehensive family services can promote educational and socioeconomic success, but few, if any, studies of large-scale programs have assessed their associations with midlife CVD risk and mediating factors.

OBJECTIVE: To examine the association between an early childhood program providing multisystemic services from ages 3 to 9 years with midlife CVD risk and whether years of education mediate these associations.

DESIGN, SETTING, AND PARTICIPANTS: Using a matched-group, quasi-experimental design, a cohort of Black and Hispanic children in the Chicago Longitudinal Study enrolled in an established early childhood program from 1983 to 1989 or the usual services were followed up for 30 years after the end of the intervention. A midlife survey on well-being was administered when the participants were aged 37 years. Analyses were conducted from September 1, 2020, to October 15, 2020.

INTERVENTION: The Child-Parent Center (CPC) Education Program provides school-based educational enrichment and comprehensive family services for 6 years, from ages 3 to 9 years (preschool to third grade [P-3]).

MAIN OUTCOMES AND MEASURES: General and hard Framingham Risk Scores (FRSs) were calculated from self-reported physical health and behavior profiles in the midlife Chicago Longitudinal Study survey. Years of education completed at age 34 years were measured primarily from administrative records.

RESULTS: There were 1539 participants in the original sample (1430 Black participants [92.9%]; 108 Hispanic participants [7.0%]; 1 White participant [0.1%]); 1104 of 1401 participants (78.8%) in the tracked sample completed a midlife survey on well-being by age 37 years, and 1060 participants had data available for analysis (mean [SD] age, 34.9 [1.4] years; 565 women [53.3%]), including 523 participants who grew up in high-poverty contexts. After adjusting for 17 baseline attributes and differential attrition via propensity score weighting, CPC preschool was associated with significantly lower general FRS (marginal coefficient, -2.2 percentage points [% hereafter]; 95% CI -0.7% to -3.6%; P = .004) and hard FRS (marginal coefficient, -1.6%; 95% CI -0.5% to -2.6%; P = .004), for a 20% reduction in cardiovascular disease risk. The program group was also less likely to have high-risk FRS status, including being in the top quartile of hard FRS (marginal coefficient, -7.2%; 95% CI, -0.3% to -11.6%; P = .02). Those who participated for 4 to 6 years (CPC P-3) had lower general FRS than those who participated for fewer years, but the difference was not significant (marginal coefficient, -1.2%; 95% CI, -2.5% to 0.2%; P = .09); longer participation was associated with placement in the median or higher risk category for general FRS (marginal coefficient, -7.9%; 95% CI -0.7% to -12.4%; P = .007) and hard FRS (marginal coefficient, -9.0%; 95% CI -0.6% to -11.4%; P = .02). Years of education completed by age 34 years accounted for up to 23% of the observed group differences for FRSs, including CPC preschool (general FRS, from -2.16% to -1.66%; difference = -0.5%) and P-3 (general FRS, from -1.16% to -0.71%; difference = -0.45%).

CONCLUSIONS AND RELEVANCE: In this quasi-experimental design study, a comprehensive early childhood program for a community cohort at high risk of disparities was associated with lower CVD risk later in life. Corroborating previous research, years of education through college matriculation accounted for a sizable percentage of this association. Early childhood enrichment may contribute to CVD prevention.

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