The Effect of Small Class Sizes on Mortality Through Age 29 Years: Evidence From a Multicenter Randomized Controlled Trial

Limiting the number of students per classroom in the early years has been shown to improve educational outcomes. Improved education is, in turn, hypothesized to improve health. The authors examined whether smaller class sizes affect mortality through age 29 years and whether cognitive factors play a role. They used data from the Project Student Teacher Achievement Ratio, a 4-year multicenter randomized controlled trial of reduced class sizes in Tennessee involving 11,601 students between 1985 and 1989. Children randomized to small classes (13–17 students) experienced improved measures of cognition and academic performance relative to those assigned to regular classes (22–25 students). As expected, these cognitive measures were significantly inversely associated with mortality rates (P < 0.05). However, through age 29 years, students randomized to small class size nevertheless experienced higher mortality rates than those randomized to regular size classes (hazard ratio (HR) = 1.58, 95% confidence interval (CI): 1.07, 2.32). The groups at risk included males (HR = 1.73, 95% CI: 1.05, 2.85), whites/Asians (HR = 1.68, 95% CI: 1.04, 2.72), and higher income students (HR = 2.20, 95% CI: 1.06, 4.57). The authors speculate that small classes might produce behavior changes that increase mortality through young adulthood that are stronger than the protective effects of enhanced cognition

Welfare Programs That Target Workforce Participation May Negatively Affect Mortality

During the 1990s reforms to the US welfare system introduced new time limits on people’s eligibility to receive public assistance. These limits were developed to encourage welfare recipients to seek employment. Little is known about how such social policy programs may have affected participants’ health. We explored whether the Florida Family Transition Program randomized trial, a welfare reform experiment, led to long-term changes in mortality among participants. The Florida program included a 24–36-month time limit for welfare participation, intensive job training, and placement assistance. We linked 3,224 participants from the experiment to 17–18 years of prospective mortality follow-up data and found that participants in the program experienced a 16 percent higher mortality rate than recipients of traditional welfare. If our results are generalizable to national welfare reform efforts, they raise questions about whether the cost savings associated with welfare reform justify the additional loss of life

Do Response Times Matter? The Impact of EMS Response Times on Health Outcomes

The introduction of technology aimed at reducing the response times of emergency medical services has been one of the principal innovations in crisis care over the last several decades. These substantial investments have typically been justified by an assumed link between shorter response times and improved health outcomes. But, current medical research does not actually show a significant relationship between response time and mortality. In this study, I explain the discrepancy between conventional wisdom and current medical research; existing research fails to account for the endogeneity of incident severity and response time. Analyzing detailed call-level information from the state of Utah's Bureau of Emergency Medical Services, I measure the impact of response time on mortality and hospital utilization using the distance of the incident from the nearest EMS agency headquarters as an instrument for response time. I find that response times significantly affect mortality, but not hospital utilization. A cost benefit analysis suggests that the anticipated benefits of a response time reduction exceed the costs and I discuss free-rider problems that might be responsible for the inefficiently high response times I observe

The Effects of Female Sports Participation on Alcohol Behavior

Most existing research on the effects of girls¿ participation in high school sports focuses on short term outcomes without accounting for selection effects. In this research, I examine the effect of athletic participation in high school on longer term outcomes, using Title IX as a source of exogenous variation in athletic participation. I use the change in girls¿ sports participation between cohorts within high schools surveyed by the High School and Beyond Survey to measure the effect of participation in high school sports on women's later alcohol behavior. I find that several years after high school, women in cohorts within high schools exposed to more athletics, drink substantially more alcohol than women within the same high school exposed to less athletics. Relative to the mean alcohol behavior of the sample, these differences are both statistically significant and sizable

Institute for Research on Poverty Discussion Paper no. 1242-02 How Close Is Close Enough? Testing Nonexperimental Estimates of Impact against Experimental Estimates of Impact with Education Test Scores as Outcomes

propensity-score-matching procedures and useful comments on earlier drafts. IRP publications (discussion papers, special reports, and the newsletter Focus) are available on the Internet. The IRP Web site can be accessed at the following address

The Effect of Small Class Sizes on Mortality Through Age 29 Years: Evidence From a Multicenter Randomized Controlled Trial

Limiting the number of students per classroom in the early years has been shown to improve educational outcomes. Improved education is, in turn, hypothesized to improve health. The authors examined whether smaller class sizes affect mortality through age 29 years and whether cognitive factors play a role. They used data from the Project Student Teacher Achievement Ratio, a 4-year multicenter randomized controlled trial of reduced class sizes in Tennessee involving 11,601 students between 1985 and 1989. Children randomized to small classes (13–17 students) experienced improved measures of cognition and academic performance relative to those assigned to regular classes (22–25 students). As expected, these cognitive measures were significantly inversely associated with mortality rates (P < 0.05). However, through age 29 years, students randomized to small class size nevertheless experienced higher mortality rates than those randomized to regular size classes (hazard ratio (HR) = 1.58, 95% confidence interval (CI): 1.07, 2.32). The groups at risk included males (HR = 1.73, 95% CI: 1.05, 2.85), whites/Asians (HR = 1.68, 95% CI: 1.04, 2.72), and higher income students (HR = 2.20, 95% CI: 1.06, 4.57). The authors speculate that small classes might produce behavior changes that increase mortality through young adulthood that are stronger than the protective effects of enhanced cognition

The effect of class size in grades K-3 on adult earnings, employment, and disability status: evidence from a multi-center randomized controlled trial

Background. Early education interventions have been forwarded as a means for reducing social disparities in income and health in adulthood. We explore whether a successful early education intervention, which occurred between 1985 and 1989, improved the employment rates, earnings and health of blacks relative to whites through 2008. Methods. We used data from Project STAR (Student Teacher Achievement Ratio), a four-year multi-center randomized controlled trial of reduced class sizes in Tennessee involving 11,601 students. Students were initially randomized within 79 schools to classes with 22-25 or 13-17 students. We linked subject records to Social Security Administration (SSA) earnings and disability data collected between 1997 and 2008—when the majority of subjects were between the ages of 18 and 28. We focused our analysis on annual, rather than cumulative, measures of earnings and employment because educational attainment after high school might reduce earnings through age 23. We considered three or more years of statistically significant positive (or negative) annual impacts to be a meaningful effect. Results. Project STAR improved cognition and high school graduation rates. These benefits were primarily realized among low-income and minority students. These early education benefits did not translate into reduced disability claims in adulthood for treated subjects. However, exposure to small class size increased employment for blacks, and increased earnings for black males (p<0.05). Exposure to small classes also led to an increase in earnings for white males. However, white females exposed to small classes experienced a net decline in earnings and employment across the later years of follow up (p<0.05), offsetting any gains by white males. Conclusions. Exposure to small class size in grades K-3 appears to improve earnings and employment for black males and earnings for white males, while reducing employment and earnings among white females