An early childhood intervention improved adult health

Every once in a while, a study just blows me away. “Early Childhood Investments Substantially Boost Adult Health“:

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 on the long-term health effects 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 millimeters of mercury (mm Hg), whereas it is only 126 mm Hg among the treated. One in four males in the control group is affected by metabolic syndrome, whereas none in the treatment group are affected. 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.

Between 1972 and 1977, these researchers randomized 109 families with 111 children to usual life or the Carolina Abecedarian Project (ABC):

The intervention consisted of a two-stage treatment targeted to different segments of child life cycles: an early childhood stage (from birth through age 5) and a subsequent school-age stage (from age 6 through 8). The first stage of the intervention involved periods of cognitive and social stimulation interspersed with caregiving and supervised play throughout a full 8-hour day for the first 5 years. The stimulation component was based on a curriculum that emphasized development of language, emotional regulation, and cognitive skills. The second stage of the intervention focused on improving early math and reading skills through having “home-school resource teachers” customize learning activities based on materials being covered at school and then deliver these materials to the parents to use at home…

The ABC intervention also had a nutritional and health care component during the first stage. Treated children had two meals and a snack at the childcare center. They were offered primary pediatric care (both well- and ill-child care), with periodic check-ups and daily screening.

You can read more details about the program here. Then, decades later, they checked in to see how healthy they were. Males who were randomized to the ABC program had significantly lower blood pressure (systolic 143 vs 126). That’s a massive difference. They had significantly lower levels of hypertension. They had lower levels of metabolic syndrome and lower Framingham risk scores. To get a sense of the magnitude of the difference, one in 4 males in the control group had metabolic syndrome; none in the ABC group did. Women also had improvements, although not as dramatic.

Males in the intervention group were significantly more likely to have health insurance at age 30, and to have bought it. They were more likely to get care when they were sick at age 30, too. They were at lower risk for overweight throughout their childhood. Women in the intervention group were less likely to start drinking alcohol before age 17. They were more likely to be active and to eat more healthily.

The cost of this program was about $16,000 per child in 2010 dollars.

I am sure the attacks against this study will come in the usual flavors. It’s a small study. It was a long time ago. These programs cost money and we don’t know the cost of the benefits. I’m literally rolling my eyes at this (I need a gif for that).

Randomized controlled trials are hard, and a study of 111 kids is not to be ignored. They’re also expensive, and we don’t seem to want to spend money on research these days. You try doing follow-up on people in a study for DECADES. I’m in awe of these researchers.

Moreover, anytime you do a follow-up of 30+ years, by definition the intervention will be old by the time you get results. There’s no other way to do it. It’s such a silly attack.

Finally, hypetension, obesity, diabetes, cardiovascular disease – these are real and expensive problems. $16,000 early in life would be money well spend to prevent them from occurring later in life. I find it hard to believe it wouldn’t be cost-effective in the long run.

We’re willing to spend hundreds of billions of dollars a year on drugs and treatments that manage these issues. I know we love “medical” interventions, but sometimes the best thing we can do is not “medical”. Studies like these show that hardship in early life has long-term implications. Studies like this show us we can do something about it. The question is, will we? Or will we demand “one more study” and wait another three decades before doing this all over again.


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