Evaluating the effects of preschool access policies on parents' cardiovascular health and health inequities: a quasi-experimental population-based investigation

For the approximately 28 million parents of young children in the US, the demands of parenthood can increase well-known risk factors for cardiovascular (CV) disease. The US has the highest childcare costs relative to parents’ wages in the world, one of the lowest preschool attendance rates among high-income countries, and large inequities in access to preschool by sociodemographic factors. The financial and time pressures of childcare may increase stress and prevent parents from participating in physical activity, accessing healthy foods, and getting enough sleep–especially for parents with fewer resources. To support young families, some states have enacted policies for universal pre-kindergarten (pre-K) access for 3- and 4-year-old children. Universal pre-K may help parents maintain CV health, however, the limited research in this area has focused on occupational outcomes for parents and no research has evaluated the impact of universal pre-K on parent health. The proposed research will leverage the National Health Interview Survey (NHIS) to contribute evidence on the relationships between parenthood, universal pre-K, and sociodemographic factors in influencing parents’ CV risk factors. The study will examine five CV risk factors for parents: physical activity, sleep, body mass index (BMI), smoking, and alcohol use. Aim 1 will build on existing evidence on associations between parenthood and CV risk factors by examining whether sociodemographic factors modify these associations and evaluating secular trends over time. Insights will help identify at-risk subgroups for tailoring prevention efforts and addressing existing inequities in CV health. Aim 2 will examine the impact of universal pre-K on parent CV risk factors, leveraging multiple sources of quasi-random policy variation. The candidate will create a novel database of geographic and temporal variation in universal pre-K and co-occurring policies to link the policy environment a parent is exposed to (based on their childrens’ year of birth and state of residence) to NHIS. Aim 3 will determine whether the impact of universal pre-K on parents’ CV risk factors varies by sociodemographic factors. Aims 2 and 3 will contribute robust quasi-experimental evidence to inform policymaking. This study will contribute the first examination of the potential effectiveness of universal pre-K as a population-based strategy to improve CV risk factors for parents and reduce later-life development of CV disease. This research will support NHLBI’s objective to investigate factors that contribute to cardiovascular health inequities and identify strategies to mitigate inequities on a population-level. Supported by a team of expert mentors, the candidate will benefit from coursework, directed mentorship, and a world-class research training environment at the University of California, San Francisco. The candidate will receive training in the etiology of CV risk factors, advanced methods for policy evaluation in the presence of co-occurring policies, and optimizing research for informing policymaking. This fellowship will prepare the candidate for a future career as a social epidemiologist examining the health impacts of complex social policies. Project Number: 1F31HL177887-01 | Fiscal Year: 2025 | NIH Institute/Center: National Heart Lung and Blood Institute (NHLBI) | Principal Investigator: Whitney Wells | Institution: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, SAN FRANCISCO, CA | Award Amount: $50,781 | Activity Code: F31 | Study Section: Special Emphasis Panel[ZRG1 F18-E (20)] View on NIH RePORTER: https://reporter.nih.gov/project-details/1F31HL17788701