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Early Childhood Education to Promote Health Equity: A Community Guide Systematic Review

Hahn, Robert A. PhD, MPH; Barnett, W. Steven PhD; Knopf, John A. MPH; Truman, Benedict I. MD, MPH; Johnson, Robert L. MD; Fielding, Jonathan E. MD, MPH, MBA; Muntaner, Carles MD, PhD; Jones, Camara Phyllis MD, MPH, PhD; Fullilove, Mindy T. MD, MS; Hunt, Pete C. MPHthe Community Preventive Services Task Force

Journal of Public Health Management and Practice: September/October 2016 - Volume 22 - Issue 5 - p E1–E8
doi: 10.1097/PHH.0000000000000378
Original Articles

Context: Children in low-income and racial and ethnic minority families often experience delays in development by 3 years of age and may benefit from center-based early childhood education.

Design: A meta-analysis on the effects of early childhood education by Kay and Pennucci best met Community Guide criteria and forms the basis of this review.

Results: There were increases in intervention compared with control children in standardized test scores (median = 0.29 SD) and high school graduation (median = 0.20 SD) and decreases in grade retention (median = 0.23 SD) and special education assignment (median = 0.28 SD). There were decreases in crime (median = 0.23 SD) and teen births (median = 0.46 SD) and increases in emotional self-regulation (median = 0.21 SD) and emotional development (median = 0.04 SD). All effects were favorable, but not all were statistically significant. Effects were also long-lasting.

Conclusions: Because many programs are designed to increase enrollment for high-risk students and communities, they are likely to advance health equity.

This review investigates the potential of center-based early childhood education to foster the larger public health goal of health equity, with a focus on low-income and racial and ethnic minority populations in the United States.

Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services (Drs Hahn and Knopf), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; National Institute for Early Education Research, Rutgers University, New Brunswick, New Jersey (Dr Barnett); Office of the Associate Director for Science (Dr Truman) and Division of Adolescent & School Health (Dr Hunt), National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, CDC, Atlanta, Georgia; UMDNJ–New Jersey Medical School, Newark (Dr Johnson); UCLA Fielding School of Public Health, Los Angeles, California (Dr Fielding); University of Toronto, Toronto, Ontario, Canada (Dr Muntaner); Morehouse School of Medicine, Atlanta, Georgia (Dr Jones); and Departments of Public Health and Psychiatry, Columbia University, New York (Dr Fullilove).

Correspondence: Robert A. Hahn, PhD, MPH, Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, MS-E69, 1600 Clifton Rd NE, Atlanta, GA 30329 (

Names and affiliations of Task Force members can be found at

The work of John Knopf was supported with funds from the Oak Ridge Institute for Science and Education (ORISE). The authors particularly thank Noa Kay and Annie Pennucci (Washington State Institute for Public Policy).

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

No financial disclosures were reported by the authors of this article.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.