The effect of an early education program on adult health: the Carolina Abecedarian Project randomized controlled trial

Objectives. We explored whether a successful randomized controlled trial of early education, the Carolina Abecedarian Project (ABC), which enrolled infants from 1972 to 1977 at the Frank Porter Graham Child Development Institute in Chapel Hill, North Carolina, improved health outcomes and behaviors by 21 years of age.Methods. ABC randomized 111 infants to receive an intensive early education program or nutritional supplements and parental counseling alone; participants have been followed to the present day. We examined the effect of ABC on health outcomes and behavioral risk factors when participants were aged 21 years, and then explored the mediators of this relationship.Results. Relative to the control group, the ABC treatment group was previously found to have improved cognition and educational attainment. We found that the intervention also improved heath (P = .05) and health behaviors (P = .03) when participants were aged 21 years. These improvements in behaviors were not mediated by IQ, math and reading scores at 15 years of age, educational attainment, or health insurance.Conclusions. Effective early education programs may improve health and reduce risky health behaviors in adulthood.Enhancements to schooling have the potential to improve a wide range of socioeconomic outcomes, including cognitive development, educational attainment, and occupational status, which may, in turn, increase health and longevity.^1–8 The considerable disadvantages faced by children from low-income families can be mitigated by high-quality early education programs that provide cognitive enrichment.^9–14 Such programs may therefore serve as an effective and efficient way to simultaneously improve population health and reduce health disparities.¹⁵The adult health benefits of early childhood education have only been studied in a randomized controlled trial once before.¹⁶ That study, the Perry Preschool Program (PPP), found that a moderately intensive parental and prekindergarten program reduced risky health behaviors in former participants (relative to the control group) by 40 years of age.The Carolina Abecedarian Project (ABC), a small, intensive program designed to enhance cognition and language development starting in infancy, afforded another opportunity to explore this relationship through young adulthood, with randomized data.¹⁷ ABC produced large improvements among treated children (relative to control participants) in IQ by 3 years of age, higher reading and math achievement by 15 years of age, lower rates of teen pregnancy and depression, and greater likelihood of college enrollment at 21 years of age.^18,19 We investigated whether ABC also improved adult behavioral risk factors and health.