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Chapter 7: Impact of Head Start on Children’s Health Status and Access to Health Services
Highlights
By the end of the program year, Head Start had positive, albeit modest, average impacts on some indicators of children’s health:
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For children in both the 3- and 4-year-old group, a relatively large and statistically significant impact was found on the receipt of dental care, i.e., Head Start children were more likely to have received dental care than non-Head Start children.
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For children in the 3-year-old group, a statistically significant impact was found on parents’ reported ratings of their children’s health status, i.e., more parents of children in the Head Start group reported that their child’s health was either excellent or very good.
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There were several statistically significant impacts of Head Start for children in both age groups whose native language is not English, including, for children in the 3-year-old group, positive impacts on parental reports of their child’s health status and on the receipt of dental care. For children in the 4-year-old group, there was a significant impact on whether the child had health insurance and on the receipt of dental care.
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Related to the findings on home language, significant impacts are found for Hispanic children in both age groups on receipt of dental care, and for children in the 3-year-old group on parental reports of their child’s health status.
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Among children in both the 3- and 4-year-old groups, positive impacts were found on parental reports of child’s health status for children with special needs and on the receipt of dental care for children with special needs in the 3-year-old group.
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The impact of Head Start on children’s receipt of dental care was found to increase with increasing levels of reported caregiver depression at baseline for children in the 3-year-old group. Among children in the 3-year-old group, the positive impact of Head Start on parent’s report of their child’s health status also increased with higher levels of reported initial caregiver depression.
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Among children whose parents were married, those in the Head Start group were rated higher by their parents on health status than those in the non-Head Start group, for the 3-year-old group.
It is important to note that the analysis of Head Start’s impact on children’s health is based solely on reports from parents. No direct measurement of children’s actual health status, or their receipt of health care services, was undertaken for this study.
Organization and Presentation of Findings
This chapter focuses on the impact of Head Start on a few selected measures of children’s health as reported by parents in spring 2003. As described in Chapter 4, these measures included parent report of whether the child had health insurance or dental care, the child’s health status, and whether the child needed ongoing medical care in general or for an injury.
As in previous chapters, the discussion is based on an examination of statistically significant “intent-to-treat” impact estimates using the complete sample of children who were randomly assigned in 2002, focusing first on overall average impacts for all newly entering children in both the 3- and 4-year-old groups. The discussion then moves to an examination of the extent to which impacts occurred for key subgroups of Head Start children and how different in size impacts may be for various subgroups. Appendix 7.1 presents estimated impacts of Head Start on program participants.
The statistical results discussed in this chapter are presented in a series of tables, some of which are provided in Appendix 7.2. Exhibits 7.1 (for children in the 3-year-old group) and 7.2 (for the 4-year-old group) present the overall average impact estimates for the combined sample. Exhibits 7.3-A and 7.3-B (for the 3- and 4-year-old groups, respectively) summarize all of the statistically significant average impacts (both for the overall group and for a set of 10 subgroups discussed in Chapter 4) and provide both the estimated impact and its associated effect size. Finally, Exhibits 7.4 through 7.13, provided in Appendix 7.2, show the complete set of results of the moderator/subgroup analyses, with a separate table for each individual measure of health outcomes (again, only for the full combined sample).
Estimated Impact of Access to Head Start
This first section discusses the estimated impact of Head Start on health outcomes using the full sample of children randomly assigned to either Head Start or to the non-Head Start group, referred to as “intent-to-treat” impact estimates. These measures show the average effect of access to the program.
As shown in Exhibit 7.1, for children in the 3-year-old group, a small statistically significant impact was found for parent reports of the child’s health status being excellent or very good (as shown in Exhibit 7.3-A, effect size=0.12), and a modest significant impact on the receipt of dental care (a 17 percentage point difference, effect size=0.34). As shown in Exhibit 7.2, a modest statistically significant impact was also found on the receipt of dental care for children in the 4-year-old group (a 16 percentage point difference, effect size=0.32).
The consistent, and relatively large, impact on children’s receipt of dental care is particularly important in light of numerous studies that have documented substantial disparities in the level of dental services received by low-income and minority children, who are most at risk of having untreated cavities compared with other children. For example, a Government Accounting Office (GAO) study published in 2000 reported that among children ages 2 through 5 who had family incomes below $10,000, nearly one in three had at least one decayed tooth that had not been treated.1 In contrast, only 1 in 10 preschool children whose family incomes were $35,000 or higher had untreated cavities.
This disparity is recognized in the Healthy People 2010 objectives, one of which is to “Increase the proportion of low-income children and adolescents who received any preventive dental service during the past year” 2 from 20 percent in 1996 (baseline) to 57 percent in 2010. The proportion of Head Start children who had received dental care exceeded the target in the Healthy People 2010 dental care objective.
Moderator/Subgroup Differences
The analysis of impacts by subgroups of children and families (detailed in Appendix 7.2 and summarized in Exhibits 7.3-A and 7.3-B for those found to be statistically significant) show some variations in impact for particular types of Head Start participants. The most notable findings are discussed below as in previous chapters beginning with possible differences in impact between or among subgroups and then examining impacts on particular subgroups.
Differences in Impact
The impact of Head Start on children’s receipt of dental care was found to increase with increasing levels of reported caregiver depressive symptoms for children in the 3- and 4 -year-old groups. In addition, for children in the 3-year-old group, the positive impact of Head Start on parent’s report of their child’s health status (as good or excellent) also increased with higher levels of reported caregiver depressive symptoms. Moreover, for the 3-year-old group, Head Start had a greater impact on non-English speaking parents’ report of their child’s health status as good or excellent.
Other statistically significant findings in Exhibits 7.3-A and 7.3-B are not discussed because it is possible they are due to chance alone and do not represent true impacts of the intervention (see discussion of subgroup impact analysis in Chapter 4). 3
Impacts on Particular Subgroups
Home language. There were several statistically significant impacts of Head Start for children whose home language was not English. Among children in both the 3- and 4-year-old groups, positive impacts were found on parental reports of their child’s receipt of dental care. For children in the 4-year-old group, there was also a significant impact on whether the child had health insurance, with non-English-speaking children in the Head Start group being more likely to have health insurance than similar children in the non-Head Start group.
Parent’s report of their child’s health status, however, provided mixed results by age group. For children in the 3-year-old group, Head Start had a positive impact on non-English-speaking families’ report on health status (i.e., parents of children in the Head Start group were more likely to report their child’s health as good or excellent, compared to parents in the non-Head Start group), but the opposite was true for parents of children in the 4-year-old group. Non-English-speaking parents of children in the Head Start group were less likely to report their child’s health as being good or excellent. For children in both age groups, Head Start had a positive effect on English-speaking and non-English-speaking parents’ report of their child’s receipt of dental care.
Race/ethnicity. Related to the findings on home language, significant positive impacts were found for Hispanic children on several of the health measures. Significant impacts were found for children in both age groups on receipt of dental care and, for children in the 3-year-old group, on parental reports of their child’s health status. In addition, there was an impact on White children’s receipt of dental care for both age groups.
Special needs. There were also statistically significant impacts of Head Start for children in the 3-year-old group with special needs, i.e., positive impacts were found on parental reports of their child’s health status and on the receipt of dental care.
The subgroup-specific impact findings indicate widespread effects with children from all but one of the examined subgroups found to be benefiting from Head Start.
| Outcome Measure | Intent-To-Treat Impact Estimates | ||||
|---|---|---|---|---|---|
| Head Start Mean (%) | Non-Head Start Mean (%) | Mean Difference 2 (%) | Regression-Adjusted Impact Estimates (Demographic Covariates Only)(%) | Regression-Adjusted Impact Estimates (With Fall Measure)(%) | |
| (Sample N=2,071): | |||||
| Child Has Health Insurance | 92.1 | 91.6 | 0.0 | 0.00 | -0.00 |
| Child Health Status Is Excellent or Very Good | 80.6 | 75.8 | 5.0 | 6.00* | 5.00* (0.12) |
| Child Needs Ongoing Care 1i | 13.2 | 12.9 | 0.3 | -0.00 | 0.20 |
| Child Had Care for Injury in Last Month | 9.0 | 8.2 | 0.7 | 0.00 | 0.00 |
| Child Had Dental Care 1ii | 68.9 | 51.8 | 17.0*** | 17.00***(0.34) | 13.00*** |
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* = p≤0.05, ** = p≤0.01, *** = p≤0.001. 1 Fall measure used in regression failed statistical test. (back: 1i, 1ii) 2 Differences are rounded to the nearest 0.1. (back) Note: Numbers in parentheses in shaded boxes are estimated effect sizes. |
| Outcome Measure | Intent-To-Treat Impact Estimates | ||||
|---|---|---|---|---|---|
| Head Start Mean (%) | Non-Head Start Mean (%) | Mean Difference 2 (%) | Regression-Adjusted Impact Estimates (Demographic Covariates Only)(%) | Regression-Adjusted Impact Estimates (With Fall Measure)(%) | |
| (Sample N= 1,638): | |||||
| Child has Health Insurance | 88.9 | 88.0 | 0.1 | 0.01 | 0.02 |
| Child Health Status Is Excellent or Very Good | 79.1 | 81.1 | -2.0 | -0.03 | -0.03 |
| Child Needs Ongoing Care 1i | 11.2 | 11.2 | 0.0 | 0.00 | 0.02 |
| Child Had Care for Injury in Last Month | 11.6 | 12.0 | -0.4 | -0.01 | -0.01 |
| Child Had Dental Care 1ii | 73.2 | 56.9 | 16.3** | 0.16** (0.32) | 0.13** |
* = p≤0.05, ** = p≤0.01, *** = p≤0.001. 1 Fall measure used in regression failed statistical test. (back: 1i, 1ii) 2 Differences are rounded to the nearest 0.1. (back) Note: Numbers in parentheses in shaded boxes are estimated effect sizes. |
| Outcome Measure | Estimated Impact of Access to Head Start | Effect Size | |
|---|---|---|---|
| Overall Impact | Child Health Status Excellent or Very Good | 0.05* | 0.12 |
| Child Had Dental Care | 0.17*** | 0.34 | |
| Difference in Impact 1 | Child Health Status: Home Language (Non-English Impact Exceeds English) | 0.12* | 0.28 |
| Child Health Status: Depression | 0.05* | 0.12 | |
| Child Had Care for Injury: Race (White Impact Exceeds African American) | 0.08* | 0.30 | |
| Child Had Care for Injury: Race (White Impact Exceeds Hispanic) | 0.13*** | 0.48 | |
| Child Had Dental Care: Depression | 0.16*** | 0.32 | |
| Impact on Subgroup 2 | Child Health Status: Special Needs | 0.19* | 0.44 |
| Child Health Status: Parent Married | 0.08* | 0.19 | |
| Child Health Status: Hispanic | 0.12** | 0.28 | |
| Child Health Status: Home Language Not English | 0.14** | 0.33 | |
| Child Had Care for Injury: White | 0.07*** | 0.26 | |
| Child Had Care for Injury: Hispanic | -0.06* | - 0.22 | |
| Child Had Dental Care: Special Needs | 0.24* | 0.48 | |
| Child Had Dental Care: No Special Needs | 0.16*** | 0.32 | |
| Child Had Dental Care: Parent Married | 0.18*** | 0.36 | |
| Child Had Dental Care: Parent Not Married | 0.16*** | 0.32 | |
| Child Had Dental Care: White | 0.17*** | 0.34 | |
| Child Had Dental Care: Hispanic | 0.22*** | 0.44 | |
| Child Had Dental Care: Home Language Not English | 0.22*** | 0.44 | |
| Child Had Dental Care: Home Language English | 0.15*** | 0.30 | |
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* = p≤0.05, ** = p≤0.01, *** = p≤0.001. 1 A total of 35 differences in impacts between subgroups were examined. The complete set of results, including differences not found to be statistically significant, appears in Appendix 7.2. Findings for depression indicate the change in Head Start’s estimated impact that accompanies a 1-point increase in mother’s baseline depression score. Findings for baseline factors other than depression indicate the amount by which Head Start’s estimated impact for the first subset of participants listed in the row label exceeds that for the second subset listed. (back) 2 A total of 50 subgroup impacts were examined. The complete set of results, including differences not found to be statistically significant, appears in Appendix 7.2. (back) |
| Outcome Measure | Estimated Impact of Access to Head Start | Effect Size | |
|---|---|---|---|
| Overall Impact | Child Had Dental Care | 0.16*** | 0.32 |
| Difference in Impact 1 | Child Had Health Insurance: Race (Hispanic Impact Exceeds African American) | 0.08* | 0.24 |
| Child Health Status: Special Needs (No Special Needs Impact Exceeds Special Needs) | 0.22* | 0.56 | |
| Child Had Dental Care: Depression | 0.16*** | 0.32 | |
| Impact on Subgroup 2 | Child Had Health Insurance: Home Language NotEnglish | 0.06* | 0.18 |
| Child Health Status: Special Needs | -0.23* | -0.59 | |
| Child Health Status: Parent Married | -0.08** | -0.21 | |
| Child Health Status: Home Language Not English | -0.08* | -0.21 | |
| Child Had Dental Care: No Special Needs | 0.16*** | 0.32 | |
| Child Had Dental Care: Parent Married | 0.18*** | 0.36 | |
| Child Had Dental Care: Parent Not Married | 0.14** | 0.28 | |
| Child Had Dental Care: White | 0.24*** | 0.48 | |
| Child Had Dental Care: Hispanic | 0.12* | 0.24 | |
| Child Had Dental Care: Home Language Not English | 0.17** | 0.34 | |
| Child Had Dental Care: Home Language English | 0.16*** | 0.32 | |
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* = p≤0.05, ** = p≤0.01, *** = p≤0.001. 1 A total of 35 differences in impacts between subgroups were examined. The complete set of results, including differences not found to be statistically significant, appears in Appendix 7.2. Findings for depression indicate the change in Head Start’s estimated impact that accompanies a 1-point increase in mother’s baseline depression score. Findings for baseline factors other than depression indicate the amount by which Head Start’s estimated impact for the first subset of participants listed in the row label exceeds that for the second subset listed. (back) 2 A total of 50 subgroup impacts were examined. The complete set of results, including differences not found to be statistically significant, appears in Appendix 7.2. (back) |
1 US GAO. (April 2000). Oral Health: Dental Disease is a Chronic Problem Among Low-Income Populations. Washington, DC: GAO/HEHS-00-72. (back)
2 US Department of Health and Human Services. (2000). Healthy People 2010: 21 – Oral Health. Retrieved from: www.healthypeople.gov/document/HTML/Volume2/21Oral.htm (back)
3 While each of the remaining subgroup findings taken one at a time is structured to limit the probability of a “false positive” to 1 in 20, as a group it is almost inevitable that some of these results will reach that level by chance alone. Only when a substantial share of all the tests of impact conducted for a given subgroup—or of a difference in impact between two subgroups—is statistically significant across all four of the outcome domains considered (not simply the outcomes reported in this chapter) can we be sure that at least some of those findings represent real impacts. (back)
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