Abstract

Ensuring access to pre-kindergarten (Pre-K) education remains a pressing policy issue in the United States. Prior research has shown the positive effects that Pre-K has on children’s cognitive development. However, studies on its effects on children’s health outcomes are scarce. This study aimed to investigate the effects of the Pre-K program on pediatric asthma. Children’s individual data from existing research conducted in North Carolina were linked with state Medicaid claims data from 2011–2017. There were 51,408 observations (person-month unit) of 279 children enrolled in Pre-K and 333 unenrolled children. Asthma was identified using the ICD 9/10 codes. A difference-in-differences model was adopted using a panel analysis with three time periods: before, during, and after Pre-K. The explanatory variables were interaction terms between Pre-K enrollment and (a) before vs. during period and (b) during vs. after period. The results indicated that children enrolled in Pre-K had a greater risk of asthma diagnosis during Pre-K (b = 0.0145, p = 0.058). Conversely, in the post-intervention period, the enrolled children had a lower of receiving an asthma diagnosis (b = −0.0216, p = 0.002). These findings indicate that Pre-K may increase the use of asthma-related health services in the short term and decrease the service use after participants leave the program.

Highlights

  • Child gender, family military affiliation, more children in the household, history of metabolic diseases, asthma-related conditions, higher frequency of child routine health examinations, and lower-population-density counties were associated with Pre-K enrollment

  • The findings of this study support the hypothesis that Pre-K can increase the use of health services related to asthma during the program and decrease the service use after the enrolled children leave the program

  • The magnitude of the decrease after the program period was greater than the increase during it among the Pre-K participants

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Summary

Introduction

Access to high-quality pre-primary education remains a longstanding and pressing policy issue in the United States and other countries [1]. In the United States, federal funding for expanding pre-kindergarten (Pre-K) education for all. 4-years-olds (i.e., universal Pre-K) has strong support in opinion polls [2] and is generally seen as a bipartisan political issue. Despite this broad support, enrollment rates and the quality of Pre-K programs differ across states and regions. The average nationwide enrollment rate of 4-year-olds in public-funded (i.e., state- or city-funded) Pre-K programs has more than doubled over the last two decades, in 2016 this rate was merely

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