Early Childhood Education to Promote Health Equity: A Community Guide Economic Review.

CONTEXT: A recent Community Guide systematic review found that early childhood education (ECE) programs improve educational, social, and health-related outcomes and advance health equity because many are designed to increase enrollment for high-risk children. This follow-up economic review examines how the economic benefits of center-based ECE programs compare with their costs. EVIDENCE ACQUISITION: Kay and Pennucci from the Washington State Institute for Public Policy, whose meta-analysis formed the basis of the Community Guide effectiveness review, conducted a benefit-cost analysis of ECE programs for low-income children in Washington State. We performed an electronic database search using both effectiveness and economic key words to identify additional cost-benefit studies published through May 2015. Kay and Pennucci also provided us with national-level benefit-cost estimates for state and district and federal Head Start programs. EVIDENCE SYNTHESIS: The median benefit-to-cost ratio from 11 estimates of earnings gains, the major benefit driver for 3 types of ECE programs (ie, state and district, federal Head Start, and model programs), was 3.39:1 (interquartile interval [IQI] = 2.48-4.39). The overall median benefit-to-cost ratio from 7 estimates of total benefits, based on all benefit components including earnings gains, was 4.19:1 (IQI = 2.62-8.60), indicating that for every dollar invested in the program, there was a return of $4.19 in total benefits. CONCLUSIONS: ECE programs promote both equity and economic efficiency. Evidence indicates there is positive social return on investment in ECE irrespective of the type of ECE program. The adoption of a societal perspective is crucial to understand all costs and benefits of ECE programs regardless of who pays for the costs or receives the benefits.

Disparities in current cigarette smoking prevalence by type of disability, 2009-2011.

OBJECTIVES: Smoking, the leading cause of disease and death in the United States, has been linked to a number of health conditions including cancer and cardiovascular disease. While people with a disability have been shown to be more likely to report smoking, little is known about the prevalence of smoking by type of disability, particularly for adults younger than 50 years of age. METHODS: We used data from the 2009-2011 National Health Interview Survey to estimate the prevalence of smoking by type of disability and to examine the association of functional disability type and smoking among adults aged 18-49 years. RESULTS: Adults with a disability were more likely than adults without a disability to be current smokers (38.8% vs. 20.7%, p<0.001). Among adults with disabilities, the prevalence of smoking ranged from 32.4% (self-care difficulty) to 43.8% (cognitive limitation). When controlling for sociodemographic characteristics, having a disability was associated with statistically significantly higher odds of current smoking (adjusted odds ratio = 1.57, 95% confidence interval 1.40, 1.77). CONCLUSIONS: The prevalence of current smoking for adults was higher for every functional disability type than for adults without a disability. By understanding the association between smoking and disability type among adults younger than 50 years of age, resources for cessation services can be better targeted during the ages when increased time for health improvement can occur.