NEONATAL OUTCOMES RELATED TO SCHOOL READINESS IN AN URBAN KINDERGARTEN POPULATION

Background: Research shows that students beginning school ready to learn have more productive and healthier adult lives and that students from lower income families are less likely to begin school ready to learn. This study examined whether neonatal outcomes influenced school readiness in an urban population and whether childcare and neighborhood characteristics modified this association. Methods: A retrospective cohort study of 39,463 first time kindergarten students from 2002 to 2012 in a large urban public school district was conducted by linking student’s readiness scores to their birth certificate data and neighborhood characteristics based on the maternal census tract of residence. Multivariate hierarchical linear models examined differences in mean school readiness scores of low birth weight (LBW) and preterm birth (PTB) students adjusting for student and parent characteristics and the clustering of students in cohort years, schools and neighborhoods. Results: Respective prevalence of LBW and PTB was 13.7% and 14.6% in the study sample. Fifty percent of students attended a district PK program while one-quarter of students received informal home care (23%) or family child care (3%) in the twelve months before entering kindergarten. Adjusted results showed LBW and PTB were independently associated with lower readiness scores and that prior care type significantly modified the relation between LBW and school readiness. Readiness scores were highest for students who attended a district funded PK program and lowest for those who received no formal care. Readiness gaps by birth weight were observed in these groups but not in other PK and center based care programs. Neighborhood characteristics were related to school readiness, but did not modify the relation between LBW and school readiness. Conclusions: LBW and PTB were associated with lower school readiness; prior childcare modified this relation. Scores were highest for district PK students. Expansion of publicly funded PK programs in low-income urban public school districts may better prepare students for school than other childcare types, including private nursery PK programs and other center based childcare programs. The birth weight disparity in readiness among district PK students highlights the need for improved early childcare programs in the school district