Poster #135 - The impact of state-funded preschool policy on parents’ health

• In Event: Friday Poster Reception

Abstract

Background: The US has the highest childcare costs relative to parents’ wages in the world. The time and financial pressures of childcare can increase stress, prevent parents from participating in healthy behaviors, and negatively impact health, especially for parents with fewer resources. While the federal Head Start program provides free early childhood education for low-income families, availability is limited. Some states have enacted policies to provide state-funded preschool for 4-year-old children, but the level of provision varies widely. This study evaluates the potential for free state-funded preschool to improve parents' health. 

Research Question: For parents with a preschool-aged child, how does the presence and generosity of free state-funded preschool in their state affect their mental health, sleep, and ability to engage with physical activity? 

Methods: We leveraged administrative information on geographic and temporal variation in state-funded preschool, which we linked to the National Health Interview Survey (NHIS). We included NHIS 2001-2018 waves for all states and the District of Columbia and included adult respondents who had a preschool-aged child with at least one outcome and complete cases on predictors (~N=15k). We used annual state-level data on state-funded preschool, including its presence, enrollment level, funding, and quality benchmarks (e.g., maximum class size, teacher degree requirements, etc.) to derive an index of preschool policy generosity (range: 0-1) that each parent of a preschool-aged child (i.e., 4 to 5 years) was exposed to in their state of residence. Our outcomes were usual hours of sleep per night, meeting physical activity guidelines (yes/no), and psychological distress via the Kessler 6 scale (range: 0-24). We accounted for co-occurring policies (e.g., state Child Tax Credit and Earned Income Tax Credit, etc.), individual and state-level covariates, and fixed effects for state and year. We examined effect modification by sex, partnership status, family income, and race and ethnicity. 

Results: Our preschool generosity index ranged from 0.1 to 0.96 across states and years (mean 0.5, SD 0.24); mean generosity increased over time. The District of Columbia had the highest average generosity; the five lowest scoring states had no programs (Wyoming, Idaho, New Hampshire, South Dakota, Utah). Preschool generosity was associated with physical activity, but not with sleep or distress at an overall level. A 10% higher score in the distribution of state-funded preschool generosity was linked with a significant increase in the odds of meeting physical activity guidelines (OR: 1.08, 95%CI: 1.02, 1.16). We found evidence of effect modification by partnership status, income, and race and ethnicity. For example, in stratified results, higher preschool generosity was linked to a significant decrease in psychological distress among low-income women and Black women. 

Conclusion: State-level preschool access policies may help parents achieve physical activity guidelines, an important determinant of cardiovascular health. This aligns with prior research finding parents get less physical activity than non-parents. At a time when many families are struggling to make ends meet, this research can inform preschool access policies.

Author

• Whitney Wells, University of California, San Francisco
  Presenting Author