Disadvantaged Environments Research Articles

Association of urban environments with Atherosclerotic cardiovascular disease: A prospective cohort study in the UK Biobank

Urban environments and cardiovascular health are closely linked, yet only a few specific exposures have been explored in isolation and mostly adopting cross-sectional design. The influence of socioeconomic status and genetic predisposition also remains unclear. Hence, leveraging the UK Biobank data (n = 206,681), we conducted a prospective analysis of 213 urban environmental variables and their association with atherosclerotic cardiovascular disease (ASCVD). The ExWAS and regularized Cox models analyses highlighted air pollution, industrial sites, and complex street networks as primary environmental risk factors. Instead, land-use density of leisure, public services, infrastructure and residential, and drinking water hardness showed a negative association with ASCVD risk. By integrating sparse canonical correlation and mediation analyses, we found distinct urban environment patterns through diverse pathways influence ASCVD. The environment characterized by pollution and complex streets impact ASCVD through adverse mental health (mediation proportion:30.7 %, 95 % CI:22.4 %-44.0 %), while highly-developed community and high-water hardness environment via cardiometabolic status (22.6 %, 95 % CI:19.7 %-26.0 %). Further, we found low socioeconomic status amplifies disadvantaged urban environment effects on ASCVD, yet there were no similar findings for ASCVD genetic predisposition. This research deepened our understanding of city-cardiovascular health links and the role of socioeconomic status, with implications for urban planning and public health interventions.

Endogeneity of pedestrian survival time and emergency medical service response time: Variations across disadvantaged and non-disadvantaged communities

The Vision Zero-Safe Systems Approach prioritizes fast access to Emergency Medical Services (EMS) to improve the survivability of road users in transportation crashes, especially concerning the recent increase in pedestrian-involved crashes. Pedestrian crashes resulting in immediate or early death are considerably more severe than those taking longer. The time gap between injury and fatality is known as survival time, and it heavily relies on EMS response time. The characteristics of the crash location may be associated with EMS response and survival time. A US Department of Transportation initiative identifies communities often facing challenges. Six disadvantaged community (DAC) indicators, including economy, environment, equity, health, resilience, and transportation access, enable an analysis of how survival and EMS response times vary across DACs and non-DACs. To this end, this study created a unique and comprehensive database by linking DACs data with 2017–2021 pedestrian-involved fatal crashes. This study utilizes two-stage residual inclusion models with segmentation for DACs and non-DACs accounting for the endogenous relationship between EMS response and pedestrian survival time. The results indicate that EMS response time is higher and pedestrian survival time is lower in DACs than in non-DACs. A delayed EMS response time is associated with a greater reduction in survival time in DACs compared to non-DACs. Factors, e.g., nighttime and interstate crashes, contribute to higher EMS response time, while pedestrian drugs, driver speeding, and hit-and-run behaviors are associated with a greater reduction in survival time in DACs than non-DACs. The implications of the findings are discussed in the paper.

Zero Hunger by 2030 - SDG 2 We are off target, AGAIN

According to the just released report, the world is still off target when it comes to meeting SDG 2, zero hunger. Hunger affects 1/5 in Africa, 1/11 globally, is on the rise in Africa, remains the same in Asia, while notable progress is being made in Latin America and the Caribbean. It is noted that fewer and fewer people are able to afford a heathy diet, a diet that is diverse in form and nutrients. Obesity is on the rise globally and in some population groups which did not know of it before, mainly because of poor food choices and also adopting foreign dietary habits, and sedentary lifestyles. Anaemia in women is on the rise, meaning their reproductive health and that of their offsprings are affected. The report does not paint a good picture for Africa as it reveals a slow reduction in stunting and wasting. It shows a continent that has been slow to recover from negative COVID impacts. "Financing to End Hunger, Food Insecurity and Malnutrition in All its Forms" is the theme. It is noted that only 25% of ODA (Overseas Development Assistance) goes towards financing food and nutrition programs. Clearly, this needs to be improved, especially following the many pledges that have been made this far. The realization continues to be that serious political will is needed to be able to achieve this. The question is: who is supposed to demonstrate this political will? As I have written before, we have had many global and regional meetings, all addressing world hunger, malnutrition, and micronutrient deficiency. In this report, there is a call to many to do more: donors, both corporate and individual; Governments need to commit more, why? Sovereign nations need to grow their economies in order to serve their people, in order for their countries to participate equitably in building and promoting the world economy. I have enjoyed watching the 2024 Olympics in Paris. In a short span of three weeks, we have seen the best sports competition ever. We see pure human talent. I was a sports nut in my youth but never heard of the Olympics until I was a lot older. It is one thing to have talent, and it is another to have access to showcase it and use it to God's glory, and to encourage others. The report at hand is on how to find resources to finance food and nutrition and poverty eradication programs. Look, without a fairly decent life, no one can make it to the Olympics. How proud I feel when I see the Kenyan Flag on the podium, and the National anthem played all because a Kenyan has won a bronze, a silver or a gold. This time around there were countries receiving their first medal ever, ever since the Games started in 1776 at Olympia in southern Greece and revived in 1896. Some of the athletes come from fairly disadvantaged environments, practice poorly and do not even have coaches let alone experts on programming or diet. What if they had exactly what is needed to make an excellent athlete? Or even half of it? And diet is huge in this case. An athlete needs to build good muscle and to learn how to release energy depending on the sport. Should we not prioritize and adequately fund food and nutrition programs in order to give everyone an equal chance of achieving a healthy body? This report was emphasizing how far off target we are from meeting SDG 2, Zero hunger. We need political will, at all levels. Let us work on it.

Entrepreneurial Adult Education as a Catalyst for Youth Employability in Disadvantaged Areas

In this article, we establish a correlational reflection between ‘‘entrepreneurial’’ andragogy and youth employability through a description of its characteristics and other specificities, the identification of its strengths and weaknesses and by proposals likely to engender an andragogy more likely to materialize its objectives. In fact, three data collection instruments are involved to achieve such a construct, in particular, a documentary exploitation necessary for a theorization of our theme, a questionnaire against ours ample of 22 young entrepreneurs and finally a guide maintenance for another sample of 6 andragogues. The results of this research reveal a ‘‘trompe l’œil’’ (57%) in terms of the characteristics and/or specificities of entrepreneurial andragogy in a disadvantaged environment point to the ‘‘lack’’ or ‘‘insufficiency’’ of State funding (82, 3%) as a major weakness of the adult training and consecutively propose and improvement and/or facilitation of the said (92, 6%), for more promising processes of habilitation and empowerment. In addition to its theoretical aspect, the scientific implication of such a study lies in the amplification of the field of knowledge relating to the general training of young adults, and more to entrepreneurship training in particular. The professional side of the implication of such a reflection concerns more its propensity to want to increase the knowledge, know- how and above all know-how of andragogues in terms of training, monitoring and support for young people from disadvantaged backgrounds specifically.

Sleep, Health Outcomes and Body Weight (SHOW) study: a measurement burst design study on sleep and risk factors for obesity in black emerging adults in North Carolina, USA

IntroductionBlack emerging adults (18–28 years) have the highest risk of short sleep duration and obesity. This increased risk may be partly explained by greater stress levels, which may result from...

Associations of neighborhood sociodemographic environment with mortality and circulating metabolites among low-income black and white adults living in the southeastern United States

BackgroundResiding in a disadvantaged neighborhood has been linked to increased mortality. However, the impact of residential segregation and social vulnerability on cause-specific mortality is understudied. Additionally, the circulating metabolic correlates of neighborhood sociodemographic environment remain unexplored. Therefore, we examined multiple neighborhood sociodemographic metrics, i.e., neighborhood deprivation index (NDI), residential segregation index (RSI), and social vulnerability index (SVI), with all-cause and cardiovascular disease (CVD) and cancer-specific mortality and circulating metabolites in the Southern Community Cohort Study (SCCS).MethodsThe SCCS is a prospective cohort of primarily low-income adults aged 40–79, enrolled from the southeastern United States during 2002–2009. This analysis included self-reported Black/African American or non-Hispanic White participants and excluded those who died or were lost to follow-up ≤ 1 year. Untargeted metabolite profiling was performed using baseline plasma samples in a subset of SCCS participants.ResultsAmong 79,631 participants, 23,356 deaths (7214 from CVD and 5394 from cancer) were documented over a median 15-year follow-up. Higher NDI, RSI, and SVI were associated with increased all-cause, CVD, and cancer mortality, independent of standard clinical and sociodemographic risk factors and consistent between racial groups (standardized HRs among all participants were 1.07 to 1.20 in age/sex/race-adjusted model and 1.04 to 1.08 after comprehensive adjustment; all P < 0.05/3 except for cancer mortality after comprehensive adjustment). The standard risk factors explained < 40% of the variations in NDI/RSI/SVI and mediated < 70% of their associations with mortality. Among 1110 circulating metabolites measured in 1688 participants, 134 and 27 metabolites were associated with NDI and RSI (all FDR < 0.05) and mediated 61.7% and 21.2% of the NDI/RSI-mortality association, respectively. Adding those metabolites to standard risk factors increased the mediation proportion from 38.4 to 87.9% and 25.8 to 42.6% for the NDI/RSI-mortality association, respectively.ConclusionsAmong low-income Black/African American adults and non-Hispanic White adults living in the southeastern United States, a disadvantaged neighborhood sociodemographic environment was associated with increased all-cause and CVD and cancer-specific mortality beyond standard risk factors. Circulating metabolites may unveil biological pathways underlying the health effect of neighborhood sociodemographic environment. More public health efforts should be devoted to reducing neighborhood environment-related health disparities, especially for low-income individuals.

Socio-economic determinants influencing adherence to secondary prophylaxis in patients with rheumatic heart disease: a systematic review.

Rheumatic heart disease (RHD) poses a substantial global health challenge, especially impacting resource-limited nations, with over 40.5 million cases reported in 2019. The crucial role of Benzathine penicillin G in both primary and secondary prevention, particularly the latter, emphasizes its significance. Following PRISMA guidelines, our systematic review explored Medline, Scopus, Google Scholar, and Embase databases from 1990 to 2022. Registered with PROSPERO ), the review utilized quality appraisal tools, including the PRISMA checklist, Cochrane bias tool and Newcastle-Ottawa scale. The objective was to identify and stratify the impact of socio-economic factors on adherence to secondary prophylaxis in RHD. The impact of education on adherence has been found to be significant. Socially disadvantaged environments significantly influenced adherence, shaped by education, socio-economic status, and geographical location and access to healthcare. Surprisingly, lower education levels were associated with better adherence in certain cases. Factors contributing to decreased adherence included forgetfulness, injection-related fears, and healthcare provider-related issues. Conversely, higher adherence correlated with younger age, latent disease onset, increased healthcare resources, and easy access. Patient education and awareness were crucial for improving adherence. Structured frameworks, community initiatives, and outreach healthcare programs were identified as essential in overcoming barriers to secondary prophylaxis. Taking active steps to address obstacles like long-distance commute, waiting time, injection fears, and financial issues has the potential to greatly improve adherence. This, in turn, can lead to a more effective prevention of complications associated with RHD.

Individual and Interpersonal Factors Associated with Youth Antisocial Behavior among a Low Income, Immigrant, and Ethnic Urban Youth Sample

This study explores the association between youth antisocial behavior outcomes and predictors including individual factors (youth attitudes) and interpersonal factors (friends and parents) in a low income, immigrant, and ethnic community in Pomona, California USA. Social cognitive theory is used in a cross sectional design to perform correlation and multiple regression analysis on survey data from 2,693 high school students. While factors related to youths and their best friends were associated with youth antisocial behavior outcomes, parental factors did not show any association with youth antisocial behavior outcomes in both correlation and regression analysis. These results conflict with dominant trends in the literature and underscore the need for at risk communities such as Pomona to develop their own community data so that intervention programs can respond to their unique circumstances. The following intervention strategies are recommended for youth program designers in Pomona: prioritize individual youth and friends in intervention activities; develop intervention strategies to grow parental influence on youth antisocial behavior such as integrating engagement tools which immigrant, minority, and low income parents could use to counter antisocial risk factors and enhance protective factors. Future research should investigate the factors that drive the influence of best friends on youth antisocial behavior particularly how these trump parental influence in Pomona and other disadvantaged environments. The research findings should shape the intervention strategies recommended above.

Distal-to-proximal etiologically relevant variables associated with the general (p) and specific factors of psychopathology.

The general factor of psychopathology, often denoted as p, captures the common variance among a broad range of psychiatric symptoms. Specific factors are co-modeled based on subsets of closely related symptoms. This paper investigated the extent to which wide-ranging genetic, personal, and environmental etiologically relevant variables are associated with p and specific psychopathology factors. Using data from four waves (ages 11-19) of TRAILS, we modeled a bifactor model of p and four specific factors [internalizing, externalizing, ADHD, Autism Spectrum Disorder (ASD)]. Next, we examined the associations of 19 etiologically relevant variables with these psychology factors using path models that organized the variables according to the distal-to-proximal risk principle. Collectively, the etiologically relevant factors, including temperament traits, accounted for 55% of p's variance, 46% in ADHD, 35% in externalizing, 19% in internalizing, and 7% in ASD. The low 7% is due to insufficient unique variance in ASD indicators that load more strongly on p. Excluding temperament, variables accounted for 29% variance in p, 9% ADHD, 14% EXT, 7% INT, and 4% ASD. Most etiologically relevant factors were generic, predicting p. In addition, we identified effects on specific factors in addition to effects on p (e.g., parental SES, executive functioning); only effects on specific factors (e.g., parental rejection); opposite effects on different factors [e.g., diurnal cortisol (high INT but low EXT, p); developmental delay (high ASD and p but low EXT)]. Frustration, family functioning, parental psychopathology, executive functioning, and fearfulness had strong effects on p. (1) Strong generic effects on p suggest that etiologically relevant factors and psychopathology tend to cluster in persons. (2) While many factors predict p, additional as well as opposite effects on specific factors indicate the relevance of specific psychopathology factors in understanding mental disorder. (3) High frustration, neurodevelopmental problems, and a disadvantaged family environment primarily characterize p.

The impact of out-of-home care on brain development: a brief review of the neuroscientific evidence informing our understanding of children's attachment outcomes.

Researchers interested in the effects of early experiences of caregiving adversity have employed neuroscientific methods to illuminate whether and how such environmental input impacts on brain development, and whether and how such impacts underpin poor socioemotional outcomes in this population. Evidence is compelling in documenting negative effects on the individual's neurodevelopment following exposure to adverse or disadvantaged environments such as institutionalization or maltreatment. Neuroimaging research focused specifically on attachment-relevant processing of socioemotional stimuli and attachment outcomes among children looked-after is scarcer, but largely consistent. This review begins by summarizing the key general brain structural and functional alterations associated with caregiving deprivation. Then, neuroscientific evidence that is more directly relevant for understanding these children's attachment outcomes, both by employing social stimuli and by correlating children's neural markers with their attachment profiles, is reviewed. Brief interpretations of findings are suggested, and key limitations and gaps in the literature identified.

Food environment trajectories: a sequence analysis from the CARTaGENE cohort.

The purpose of this study was to create a typology of longitudinal exposure to food environment based on socio-economic context. Food environment trajectories were modelled using a sequence analysis method, followed by a logistic regression to describe those trajectories. The study took place in Quebec, Canada, using food environment data from 2009, 2011 and 2018 merged with participants' demographic and socio-economic characteristics. At recruitment, 38 627 participants between the ages of 40 and 69 years from six urban areas in Quebec were included in the CARTaGENE cohort study. The cohort was representative of the Quebec urban population within this age range. Our study revealed five trajectories of food access over time: (1) limited access to food stores throughout the study period, (2) limited access improving, (3) good access diminishing, (4) good access throughout the period and (5) low access throughout the period. Logistic regression analysis showed that participants who were unable to work (OR = 1·42, CI = 1·08-1·86), lived in households with five or more persons (OR = 1·69, CI = 1·17-2·42) and those living in low-income households (OR = 1·32, CI = 1·03-1·71) had higher odds of experiencing a disadvantaged food environment trajectory. Additionally, the level of education and age of participants were associated with the odds of experiencing a disadvantaged food environment trajectory. The study demonstrates that people facing socio-economic disadvantage are more likely to experience a disadvantaged food environment trajectory over time.

Cuando un proyecto de cambio fracasa en la escuela: aprendizajes inesperados

This case study examines the implementation of an Action Research cycle in a charter school in Castilla-La Mancha, in a disadvantaged environment. We assess the feasibility of introducing active methodologies, such as cooperative learning, to improve coexistence and reduce school failure. Although the implementation of cooperative learning was limited, we observed significant improvements in coexistence and academic performance. This study demystifies the idea that an incomplete project is a failure, as it shows improvements despite not being carried out in its entirety.

De-Stigmatizing Sex-Working and Re-Asserting the Humanity of the Female Figure in African Literature

The literary sphere is replete with the female figure as sex-workers and objects of sexual exploitation, for gratification and pleasure, and are classified as such. This goes with denigration and stigmatization. Remarkably, culpability about the objectification of the female, especially young girls lies with the men of varied ages, and class. These girls are usually betrayed and abandoned, consequently leaving them stranded and in very hopeless situation. The general conception, even certain studies postulate that females indulging in sexual adventure and trapped in sex trafficking are classified as prostitution, immediately connoting sex in exchange for money. Fictional representations abound which throw up instances of such stereotypes. But traducers have neglected to question the humanity of the so-called sex-workers, the circumstances surrounding their identity and the environment of existence. This study takes a reverse trajectory to inquire and adduce the fact that those class of females are only leaving out their humanity and sexuality, but are merely caught up in the intricacies of a disadvantaged environment. Using the framework of ecofeminism, this paper embarks on a literary analysis of girls who are enamored by curiosity, desire and emotion to explore their femininity, but are caught in the trap. The primary texts are Okey Ndibe’s Arrows of Rain and Kaine Agary’s Yellow Yellow which explore issues of objectification and betrayal of the key female characters, who are used and dumped like the environment that are constantly being abused. The study sues for empathy and recognition of rights and humanity of the females.

Lázár Ervin A kék meg a sárga című meséjének dramatizált feldolgozása óvodai környezetben

In the first part of the paper, some activity models implemented in university courses will be presented, in which the students are introduced, during the dramatization of fairy tales in the framework of joint creative work, to a variety of performance techniques, playing and experimenting with the learned theater effect elements. One of the aims of these courses is to help the students become familiar with fairy tale dramatization forms and fairy tale types that are suitable for integrating educational areas particularly important from the point of view of the development of children growing up in disadvantaged environments (e.g. story content to overcome language disadvantages and incomplete social competences). In the second part of the paper, four types of dramatization models of a particular fairy tale (A kék meg a sárga [The Blue and the Yellow] by Hungarian author Ervin Lázár) will be presented. The practical experiences, reflections, and professional lessons to be learned from the kindergarten implementation of the drafts for the models will be presented, focusing, in addition to the artistic experience, on how the realized adaptations of Ervin Lázár's fairy tale serve the development of emotional and cognitive competences, the overcoming of learning disadvantages arising from disadvantaged situations, and the community integration of the children concerned.

Neighborhood Contexts, Family Characteristics, and Non-Cognitive Skills among Adolescents

ABSTRACT With mounting evidence showing the significance of non-cognitive skills for morbidity and mortality, information on the antecedents of non-cognition skill development is central for research, policy, and interventions on health. As such, this study examines the extent to the which (a) non-cognitive skills—namely, conscientiousness, future orientation, and risk aversion—are associated with neighborhood contexts of disadvantage and disorder; and (b) the association between neighborhood contexts and non-cognitive skills sustains after controlling for family socioeconomic status (SES), structure, conflict, and cohesion among adolescents. Survey-weighted linear regression models based on a sample of 10,874 respondents from Waves I and III of The National Longitudinal Study of Adolescent to Adult Health (Add Health) reveal that, as expected, neighborhood disadvantage and disorder are independently associated with conscientiousness and future orientation, such that more favorable neighborhood environments are associated with greater levels of these two traits. However, contrary to expectation, living in a socioeconomically disadvantaged environment is associated with increased risk aversion (i.e. reduced risk-taking). Moreover, we find that after adjusting for family SES and covariates, neighborhood associations are no longer significant, and family SES remains positively associated with the three non-cognitive traits. Overall, our results suggest that any association between neighborhood environment and non-cognitive skills occurs through more proximal, family contexts.

Considering intersectionality and interacting levels of early intervention on early brain development-a commentary on Nelson etal. (2023).

It has long been recognized that an individual's experiences can metaphorically 'get under the skin' and become biologically embedded, thus affecting behavior and life outcomes (Hertzman, 2012). While this term is most often used to describe how adverse experiences influence biological process, it is rarely discussed how the same can be said of positive experiences, such as intervention to prevent or treat negative outcomes. In their annual review, Nelson etal. (2023) provide a timely and comprehensive review of how early intervention capitalizes on the neuroplasticity of the postnatal years, turning periods of 'vulnerability' to ones of 'opportunity'. Drawing on decades of expertise, they discuss the neurobiological mechanisms of intervention in two contexts: caregiving interventions for children growing up in disadvantaged environments, and therapeutic interventions for children at elevated risk of neurodevelopmental disorders such as Autism. They thought-provokingly describe both how early intervention operates through mechanisms of neural plasticity and how this can and should inform policy decisions to provide the greatest benefit to children. Here, I aim to underscore the importance of this review by addressing the intersection of these topics; specifically, I muse on how the scientific discovery of biological processes and the ethical imperative to support vulnerable children's development are intimately intertwined, and how this highlights both critical lines of future inquiry as well as policy implications.

Emotional Education in Vulnerable Contexts. An Emotion- and Art-Based Intervention in a Primary School

Objective. This study aimed to verify the effectiveness of an intervention based on Emotional Intelligence (EI) and the arts. Method. A didactic program was conducted to develop EI with 55 Primary Education students, ranging from 8 to 12 years old. The program focused on artistic and musical activities. The participants belonged to a school with high rates of marginality and social exclusion. The data were collected through a pretest, a post-test, and a deferred post-test, with the TMMS24-Questionnaire, to assess EI in three dimensions: attention, clarity, and emotional repair. Results. After data collection, the study analyzed the students’ performance in the emotional dimensions; it found significant improvements in most of the dimensions studied. Conclusions. The main results show the usefulness of these programs in improving the EI of students in disadvantaged environments.

Resting brain activity in early childhood predicts IQ at 18 years

Resting brain activity has been widely used as an index of brain development in neuroscience and clinical research. However, it remains unclear whether early differences in resting brain activity have meaningful implications for predicting long-term cognitive outcomes. Using data from the Bucharest Early Intervention Project (Zeanah et al., 2003), we examined the impact of institutional rearing and the consequences of early foster care intervention on 18-year IQ. We found that higher resting theta electroencephalogram (EEG) power, reflecting atypical neurodevelopment, across three assessments from 22 to 42 months predicted lower full-scale IQ at 18 years, providing the first evidence that brain activity in early childhood predicts cognitive outcomes into adulthood. In addition, both institutional rearing and later (vs. earlier) foster care intervention predicted higher resting theta power in early childhood, which in turn predicted lower IQ at 18 years. These findings demonstrate that experientially-induced changes in brain activity early in life have profound impact on long-term cognitive development, highlighting the importance of early intervention for promoting healthy development among children living in disadvantaged environments.

Annual Research Review: Early intervention viewed through the lens of developmental neuroscience.

The overarching goal of this paper is to examine the efficacy of early intervention when viewed through the lens of developmental neuroscience. We begin by briefly summarizing neural development from conception through the first few postnatal years. We emphasize the role of experience during the postnatal period, and consistent with decades of research on critical periods, we argue that experience can represent both a period of opportunity and a period of vulnerability. Because plasticity is at the heart of early intervention, we next turn our attention to the efficacy of early intervention drawing from two distinct literatures: early intervention services for children growing up in disadvantaged environments, and children at elevated likelihood of developing a neurodevelopmental delay or disorder. In the case of the former, we single out interventions that target caregiving and in the case of the latter, we highlight recent work on autism. A consistent theme throughout our review is a discussion of how early intervention is embedded in the developing brain. We conclude our article by discussing the implications our review has for policy, and we then offer recommendations for future research.

Understanding Heterogeneity in the Impact of Public Preschool Programs.

We examine the North Carolina Pre-K (NC Pre-K) program to test the hypothesis that observed variation in effects resulting from exposure to the program can be attributed to interactions with other environmental factors that occur before, during, or after the pre-k year. We examine student outcomes in 5th grade and test interaction effects between NC's level of investment in public pre-k and moderating factors. Our main sample includes the population of children born in North Carolina between 1987 and 2005 who later attended a public school in that state, had valid achievement data in 5th grade, and could be matched by administrative record review (n = 1,207,576; 58% White non-Hispanic, 29% Black non-Hispanic, 7% Hispanic, 6% multiracial and Other race/ethnicity). Analyses were based on a natural experiment leveraging variation in county-level funding for NC Pre-K across NC counties during each of the years the state scaled up the program. Exposure to NC Pre-K funding was defined as the per-4-year-old-child state allocation of funds to a county in a year. Regression models included child-level and county-level covariates and county and year fixed effects. Estimates indicate that a child's exposure to higher NC Pre-K funding was positively associated with that child's academic achievement 6 years later. We found no effect on special education placement or grade retention. NC Pre-K funding effects on achievement were positive for all subgroups tested, and statistically significant for most. However, they were larger for children exposed to more disadvantaged environments either before or after the pre-k experience, consistent with a compensatory model where pre-k provides a buffer against the adverse effects of prior negative environmental experiences and protection against the effects of future adverse experiences. In addition, the effect of NC Pre-K funding on achievement remained positive across most environments, supporting an additive effects model. In contrast, few findings supported a dynamic complementarity model. Instrumental variables analyses incorporating a child's NC Pre-K enrollment status indicate that program attendance increased average 5th grade achievement by approximately 20% of a standard deviation, and impacts were largest for children who were Hispanic or whose mothers had less than a high school education. Implications for the future of pre-k scale-up and developmental theory are discussed.