Social Determinants of Health: Full Day Kindergarten Programs
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends full-day kindergarten programs to improve the health prospects of low-income and racial and ethnic minority children. Evidence shows that when compared with half-day kindergarten or full-day kindergarten on alternating days, full-day programs substantially improve reading and mathematics achievement—determinants of long-term academic and health-related outcomes (e.g., reduced teen pregnancy and risk behaviors).
The achievement gains apparent at the beginning of first grade do not, themselves, guarantee academic achievement in later years. Ongoing school environments that support learning and development are essential.
Because academic achievement is linked with long-term health, and because full-day kindergarten programs are commonly implemented in racial and ethnic minority or low-income communities, these programs are likely to improve health equity. Equity in health is widespread, achievable, equality in health and in the major social determinants of health in all the principal social divisions of a population.
The full CPSTF Finding and Rationale Statement and supporting documents for Social Determinants of Health: Full Day Kindergarten Programs are available in The Community Guide Collection on CDC Stacks.
Intervention
Full-day kindergarten is a formal program offered for children ages 4 to 6 years in a school or school-like setting, during the school year prior to entering first grade. Activities are organized, developed, and supervised by at least one adult. Full-day kindergarten programs are 5 days a week and last 5 to 6 hours per day.
The goals of kindergarten are to prepare children academically, socially, and emotionally for effective participation in the educational system.
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review published in 2010 (Cooper et al., 55 studies, search period through 2009). The search for more recent evidence (search period through March 2011) did not identify additional studies about full-day kindergarten programs.
Studies of the long-term effects of early childhood education also were reviewed to draw inferences about the possible long-term effects of full-day kindergarten.
Study Characteristics
- Included studies compared full-day kindergarten with either half-day kindergarten or alternating day full-day kindergarten. Several studies compared half-day kindergarten with alternating-day full-day kindergarten and found no clear difference
- No randomized control studies were included in the review
- Among studies reporting program location, 69% were in urban locations and 31% were in non-urban locations
- Programs were more likely to be offered in the southern region of the United States than in other regions
- Information on race and ethnicity was recorded in the meta-analysis if the population was reported to be “homogeneous.” While criteria for this assessment were not given, if stringently applied, they may have excluded information in many studies
- Full-day programs provide more instruction in math and reading as compared with half-day programs. Based on a national survey, students in full-day kindergarten were reported to receive 30-31% more instruction per day in math and reading than students in half-day (Walston & West, 2004)
Summary of Results
Short Term Effects
Full-day kindergarten led to statistically significant effects among children:
- Scores on standardized achievement tests or assigned grades improved by the end of kindergarten or the beginning of first grade (50 studies)
- Compared with half-day kindergarten enrollees, math scores among full-day enrollees improved by 0.24 standard deviations, and verbal scores improved by 0.46 standard deviations
- Students showed an increased ability to work and play with others—an indicator of social-emotional health (1 study)
Early academic achievement is an established determinant of long-term academic and health-related outcomes; thus improvements in academic achievement among low-income and racial and ethnic minority children can be expected to improve their long-term health.
Long-Term Effects
- In the Cooper et al. review, studies that considered whether full-day kindergarten had lasting effects showed inconsistent results by the time children reached the end of third or fourth grade
- A larger body of evidence that included systematic reviews of the long-term effects of early childhood education showed longer-term benefits associated with pre-kindergarten educational programs
- Greater benefits were seen when children went on to attend high-quality primary schools as opposed to low-quality primary schools, emphasizing the importance of on-going school environments that support learning and development
Summary of Economic Evidence
The economic review included six studies. One study addressed the costs and benefits of full-day kindergarten versus half-day kindergarten; five studies provided information about costs; one study provided information about a single economic benefit and not other potential benefits.
- The six identified studies did not give a clear picture about costs beyond the broad finding that full-day kindergarten is relatively more expensive than half-day kindergarten
- Results from one study showed full-day kindergarten could be cost-beneficial if additional programs were undertaken to ensure maintenance of the short term academic gains. Researchers noted, however, that costs of additional programs not included in their estimates would have to be taken into account
- One study indicated substantial economic benefits of full-day kindergarten associated with a reduction of the proportion of children retained in class and required to repeat a grade
Applicability
Based on populations and settings in the included studies, the finding should be applicable to all children in the United States living in urban and non-urban areas. Studies reported greater benefits, however, for minority and low-income populations.
Evidence Gaps
- What are the long-term effects of full-day vs. half-day kindergarten? How do subsequent schooling and family and community environments affect long term outcomes?
- What are the differential effects of full-day kindergarten on low-income and minority children vs. higher income non-minority children?
- What is the cost-benefit ratio of full-day vs. half-day kindergarten?
Implementation Considerations and Resources
- Training and retaining teachers is a critical challenge for programs as they develop and implement full-day kindergarten programs
- Children whose academic performance has improved because of full-day kindergarten programs may receive less attention in elementary school if their teachers give more attention to classmates with achievement problems. To maintain the beneficial effects, full-day kindergarten programs must be followed with high-quality schooling
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.