Structural Equality and Support Index in Early Childhood Education.

Importance: Whether early childhood education is associated with a wide range of adult outcomes above and beyond individual- and family-level outcomes is unknown. As a consequence of improving educational and career success, it is postulated that participation in high quality, comprehensive programs can promote residence in more supportive community contexts in adulthood. Objective: To investigate whether participation in high-quality early childhood programs (ECP) in high-poverty neighborhoods is associated with neighborhood-level social determinants of health (SDH) at midlife. Design, Setting, and Participants: This cohort study analyzed data from the Chicago Longitudinal Study, a prospective cohort investigation following-up 989 children aged 3 to 4 years attending the Child-Parent Center (CPC) preschool program between 1983 and 1985 and a comparison group of 550 children using a nonrandomized trial design. Participants from the original sample who completed a telephone interview on health and well-being between ages 32 and 37 years were included in this analysis. Data analysis was conducted from April to June 2024. Exposure: Participation in a CPC program, which includes preschool (ages 3 to 4 years) and school-age (kindergarten through third grade), vs usual early education programs. Main Outcomes and Measures: The study used a new SDH measure (Index of Structural Equality and Support [I-SES]) based on the Healthy People 2030 framework. This 9-item index score included neighborhood-level assessment, measurement of the quality of education and health services, and assessment of racial discrimination in social and community contexts. Years of education by age 34 years was assessed as the key mediator of influence. Results: A total of 1124 individuals (mean [SD] age at survey completion, 34.9 [1.4] years; 614 women [54.6%]; 1054 non-Hispanic Black [93.8%]; 69 Hispanic [6.2%]; 1 non-Hispanic White [<0.1%]) were included in the study, of whom 740 were in the CPC cohort and 384 were in the comparison cohort. After adjustment for baseline attributes and attrition, compared with no CPC preschool, CPC preschool was associated with significantly higher mean (SD) I-SES scores (5.93 vs 5.53; mean difference, 0.40; 95% CI, 0.16-0.65; standardized mean difference = 0.22). Compared with CPC participation for 0 to 3 years, CPC participation for 4 to 6 years showed a similar pattern of positive associations (adjusted mean I-SES score, 5.97 vs 5.69; mean difference, 0.28; 95% CI, 0.06-0.50; P = .01; SMD = 0.15). CPC participation had a larger-magnitude association with I-SES in married vs single-parent households. Years of education partially mediated the association of CPC with I-SES (up to 41%), especially among those growing up in the highest-poverty neighborhoods. Conclusions and Relevance: This cohort study found that early childhood programming is associated with SDH in adulthood. These findings reinforce the importance of early childhood education in addressing health disparities and contributing to healthier, more equitable communities and suggest that educational attainment is a key mechanism for health promotion.