Elsevier

Academic Pediatrics

Volume 9, Issue 3, May–June 2009, Pages 142-149.e71
Academic Pediatrics

Review
Early Childhood Health Promotion and Its Life Course Health Consequences

https://doi.org/10.1016/j.acap.2008.12.007Get rights and content

Objective

To explore whether health promotion efforts targeted at preschool-age children can improve health across the life span and improve future economic returns to society.

Methods

We selected 4 health topics to review—tobacco exposure, unintentional injury, obesity, and mental health—because they are clinically and epidemiologically significant, and represent the complex nature of health problems in this early period of life. The peer-reviewed literature was searched to assess the level of evidence for short- and long-term health impacts of health promotion and disease prevention interventions for children from before birth to age 5. This review sought to document the monetary burden of poor child health, the cost implications of preventing and treating child health problems, and the net benefit of the interventions.

Results

The evidence is compelling that these 4 topics—tobacco exposure, unintentional injury, obesity, and mental health—constitute a significant burden on the health of children and are the early antecedents of significant health problems across the life span. The evidence for the cost consequences of these problems is strong, although more uneven than the epidemiological data. The available evidence for the effectiveness of interventions in this age group was strongest in the case of preventing tobacco exposure and injuries, was limited to smaller-scale clinical interventions in the case of mental health, and was least available for efforts to prevent obesity among preschoolers.

Conclusions

Currently available research justifies the implementation of health interventions in the prenatal to preschool period—especially to reduce tobacco exposure and prevent injuries. There is an urgent need for carefully targeted, rigorous research to examine the longitudinal causal relationships and provide stronger economic data to help policy makers make the case that the entire society will benefit from wise investment in improving the health of preschool-age children and their families.

Section snippets

Selection of Topics

This project set out to review the availability of evidence to support policies of societal investments in early child health by selecting health topics that would be meaningful to a policy audience. In order to limit the scope of the study, we selected 4 health problems (tobacco exposure, unintentional injury, obesity and mental health) that reflect the following rationale: The topics comprise priorities set in The Year 2010 Objectives for the Nation by including both physical and mental

Tobacco Exposure

There is a positive net economic benefit from prevention of tobacco exposure, and cessation of smoking at home and in public can improve health in childhood and throughout the life span. Smoking impacts young children through prenatal exposure and environmental tobacco smoke (ETS). Almost a half million US babies are born annually to mothers who smoke during pregnancy, and an estimated 25% of children are exposed to ETS by household members.3 Prenatal exposure to cigarette smoking is associated

Summary

In sum, the evidence of effective preventive interventions is compelling yet uneven across the 4 health topics for this age group. The Table summarizes the identified effective interventions at their level of action: individual, family, community/neighborhood, and society/policy. These levels are defined by the primary target of the interventions rather than by the settings where the interventions take place. For example, if an intervention involved national-level campaigns or law enforcement,

Acknowledgments

This study was funded by both the Partnership for America's Economic Success and the Zanvyl and Isabelle Krieger Fund. We appreciate reviews from Susan Bales and Beth Hare, and support from Sara Watson, Elaine Weiss, and Lauren Zerbe. No potential conflicts of interest and corporate sponsors are reported.

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