摘要：Objectives. We used 37 years of follow-up data from a randomized controlled trial to explore the linkage between an early educational intervention and adult health. Methods. We analyzed data from the High/Scope Perry Preschool Program (PPP), an early school-based intervention in which 123 children were randomized to a prekindergarten education group or a control group. In addition to exploring the effects of the program on health behavioral risk factors and health outcomes, we examined the extent to which educational attainment, income, family environment, and health insurance access mediated the relationship between randomization to PPP and behavioral and health outcomes. Results. The PPP led to improvements in educational attainment, health insurance, income, and family environment Improvements in these domains, in turn, lead to improvements in an array of behavioral risk factors and health ( P = .01). However, despite these reductions in behavioral risk factors, participants did not exhibit any overall improvement in physical health outcomes by the age of 40 years. Conclusions. Early education reduces health behavioral risk factors by enhancing educational attainment, health insurance coverage, income, and family environments. Further follow-up will be needed to determine the long-term health effects of PPP. Prekindergarten programs provide a secure environment in which children are cognitively enriched, typically via a curriculum that enhances math and linguistic skills. The prekindergarten years (approximately 3 to 4 years of age) are thought to be a critical window for children's intellectual and socioemotional development. 1 – 4 Prekindergarten programs may be especially important for children with parents with a limited amount of education, who may not be able to provide as rich a learning environment as that available to children whose parents are better educated. 3 Prekindergarten programs targeting children from low-income households have been shown to produce lifelong improvements in schooling, income, family stability, and job quality. 5 – 16 These intertwined improvements in social circumstances may in turn improve health through reductions in behavioral risk factors, enhanced job safety, better health insurance coverage, safer neighborhoods of residence, better access to healthy foods, and lower levels of psychological stress. 7 , 9 , 16 – 20 Nonetheless, the long-term causal linkage between education and health and the pathways through which education affects health have not previously been established in a randomized controlled trial. We investigated whether the High/Scope Perry Preschool Program (PPP) randomized controlled trial improved adult health outcomes and health behavioral risk factors and explored how these outcomes were mediated.
