INVESTING IN HEALTH: THE LONG‐TERM IMPACT OF HEAD START ON SMOKING

I. INTRODUCTION There is a strong evidence that early childhood socioeconomic conditions have long-term economic consequences, reinforcing and sustaining disparities over the lifecourse (1) This observation provides a compelling rationale for public investments targeted toward disadvantaged children to expand opportunities and break the cycle of poverty. Head Start is the principal federally funded program through which the United States invests directly in the human capital of disadvantaged preschool children. Since its inception in 1965 as part of President Lyndon Johnson's "War on Poverty," Head Start has provided services to more than 23 million preschool children; in 2005, there were more than 900,000 children enrolled in the program at a total cost of $6.8 billion (Office of Head Start 2006a). To achieve its overall goal of increasing the school readiness of participants, Head Start provides a comprehensive set of services including education, health, nutritional, and social services to participants and their families. Research has shown that Head Start has positive impacts on participants' human capital, both in childhood and in adulthood. (2) In recent years, questions have arisen about the relative effectiveness of Head Start and whether it should be continued in its present form (U.S. Department of Health and Human Services 2003). Much of the debate has centered on the magnitude and persistence of the cognitive achievements of Head Start participants. However, given the link between education and health, (3) and the comprehensive nature of Head Start (with substantial health components), one could reasonably expect it to have a favorable impact on participants' health as well as education. If significant health effects were found to persist into adulthood, this in itself could alter the evaluation of Head Start and have important implications for the associated policy debate. Smoking is the leading preventable cause of mortality in the United States (Mokdad et al. 2004). It is linked to an extensive list of diseases (Chaloupka and Warner 2000) and imposes large economic costs on society (Centers for Disease Control and Prevention 2002). Tobacco use generally begins before individuals graduate high school and, as an addictive behavior, youth smoking is linked to adult smoking (U.S. Department of Health and Human Services 1994). Adolescents from low socioeconomic status households with low academic achievement are more likely to use tobacco products (U.S. Department of Health and Human Services 1994). Thus, comprehensive development programs targeted toward disadvantaged youths that are designed to improve child outcomes have the potential to influence smoking, improve health over the lifecourse, and reduce the social costs from smoking. Suggestive evidence that Head Start might influence the smoking behavior of participants comes from evaluations of other preschool programs that targeted low-income children. Participants in both the Carolina Abecedarian preschool program and the High/Scope Perry Preschool Program were much less likely to smoke as adults (Barnett and Masse 2007; Belfield et al. 2006). In this article, we assess the impact of Head Start participation on adult smoking behavior using data from the Panel Study of Income Dynamics (PSID) and its supplements on early childhood education and health. We examine the cohort of adults (above age 21 in 1999) whose age is low enough to have potentially participated in a Head Start program. Following Currie and Thomas (1995) and Garces, Thomas, and Currie (2002), we employ a sibling-based model to control for unobservable family characteristics that may affect smoking or the decision to participate in Head Start. Our results show that Head Start participation significantly influences smoking-related behavior. We estimate that if Head Start participants had not enrolled in the program, these individuals would be approximately 20 percentage points more likely to smoke cigarettes beyond age 25. …