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Promoting Health Equity Through Education Programs and Policies: Full-Day Kindergarten Programs

Task Force Finding

The Community Preventive Services Task Force recommends full-day kindergarten programs to improve the health prospects of low-income and racial and ethnic minority children, based on strong evidence that full-day programs substantially improve reading and mathematics achievement–determinants of long-term academic and health-related outcomes (e.g., reduced teen pregnancy and risk behaviors)–when compared with half-day kindergarten or full-day kindergarten on alternating days.

The achievement gains apparent at the beginning of first grade do not, themselves, guarantee academic achievement in later years. Ongoing school environments that support learning and development are essential.

Because academic achievement is linked with long-term health, and because full-day kindergarten programs are commonly implemented in racial and ethnic minority or low-income communities, these programs are likely to improve health equity. Equity in health is the widespread, achievable, equality in health and in the major social determinants of health in all the principal social divisions of a population.

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Intervention Definition

Full-day kindergarten is a formal program offered for children aged 4 to 6 years in a school or school-like setting, during the school year prior to entering first grade. Activities are organized, developed, and supervised by at least one adult. Full-day kindergarten programs run 5 days a week and last 5 to 6 hours per day. The goals of kindergarten are to prepare children academically, socially, and emotionally for effective participation in the educational system.

Children in low-income families often experience delays in language and other development by the age of three. Compensating for these delays before children begin regular schooling can be critical to providing them with equal opportunities for lifelong employment, income, and health.

About the Systematic Review

The Task Force finding is based on evidence from a systematic review published in 2010 (Cooper et al., 55 studies, search period through 2009). The search for more recent evidence (search period through March 2011) did not identify additional studies about full-day kindergarten programs. The systematic review team also reviewed studies of the long term effects of early childhood education to draw inferences about the possible long term effects of full-day kindergarten.

The effectiveness evidence is based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to the use of educational interventions for the promotion of health equity.


Short Term Effects
  • Full-day kindergarten led to statistically significant effects among children:
    • Improvement in scores on standardized achievement tests or assigned grades by the end of kindergarten or the beginning of first grade (50 studies). Compared with half-day kindergarten enrollees, math scores among full-day enrollees improved by 0.24 standard deviations (Cohen's d; 95% CI=0.06, 0.43), verbal scores by 0.46 standard deviations (Cohen's d; 95% CI=0.32, 0.61).
    • Increased ability to work and play with others—an indicator of social-emotional health (1 study; Cohen's d;=1.06; 95% CI=0.63, 1.49).
  • Early academic achievement is an established determinant of long-term academic and health-related outcomes; thus improvements in academic achievement among low-income and racial and ethnic minority children can be expected to improve their long-term health.
Long-Term Effects
  • In the Cooper et al. review, studies that considered whether full-day kindergarten had lasting effects showed inconsistent results by the time children reached the end of third or fourth grade.
  • A larger body of evidence including systematic reviews of the long term effects of early childhood education showed longer-term benefits associated with pre‑kindergarten educational programs. Greater benefits were seen when children went on to attend high quality primary schools as opposed to lower quality primary schools, emphasizing the importance of on-going school environments that support learning and development.
Study Characteristics
  • Included studies compared full-day kindergarten with either half-day kindergarten or alternating–day full-day kindergarten. Several studies compared half-day kindergarten with alternating-day full-day kindergarten and found no clear difference.
  • No randomized control studies were included in the review.
  • Among studies reporting program location, 69% were in urban locations, 31% in non‑urban locations.
  • Programs were more likely to be offered in the southern region of the U.S. than in other regions.
  • Full-day programs provide more instruction in math and reading as compared with half-day programs. Based on a national survey, FDK students were reported to receive 30-31% more instruction per day in math and reading than students in HDK (Walston & West, 2004).
  • Information on race and ethnicity was recorded in the meta-analysis if the population was reported to be "homogeneous." While criteria for this assessment are not given, if stringently applied, they may have excluded information in many studies.


While information on applicability of findings by race/ethnicity and SES was limited in the meta-analysis—perhaps because of stringent definitional criteria—other studies of full-day kindergarten generally report increased benefit for minority and low-income populations. Programs were effective in both urban and non-urban settings.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

  • Training and retaining teachers is a critical challenge for programs as they develop and implement full-day kindergarten programs.
  • Children whose academic performance has improved because of full-day kindergarten programs may receive less attention in elementary school if their teachers give more attention to classmates with achievement problems. To maintain the beneficial effects, full-day kindergarten programs must be followed with high quality schooling.

Economic Evidence

Six studies were included in the economic review. One study addressed the costs and benefits of full-day kindergarten versus half-day kindergarten; five studies provided information about costs; one study provided information about a single economic benefit and not about other potential benefits.

  • The six identified studies did not give a clear picture about costs beyond the broad finding that full-day kindergarten is relatively more expensive than half-day kindergarten. Additional evidence on the cost effectiveness of full-day kindergarten is needed.
  • Results from one study showed full-day kindergarten could be cost-beneficial if additional programs were undertaken to ensure maintenance of the short term academic gains. Researchers noted, however, that costs of additional programs not included in their estimates would have to be taken into account.
  • One study indicated substantial economic benefits of full-day kindergarten associated with the reduction of the proportion of children retained in class and required to repeat a grade.

Supporting Materials


Hahn RA, Rammohan V, Truman BI, Milstein B, Johnson RL, Muntañer C, Jones CP, Fullilove MT, Chattopadhyay SK, Hunt PC, Abraido-Lanza AF, Community Preventive Services Task Force. Effects of full-day kindergarten on the long-term health prospects of children in low-income and racial/ethnic-minority populations. A Community Guide systematic review. Adobe PDF File [PDF - 799 kB] Am J Prev Med 2014;46(3):312–23.

Edelman MW. Full-day kindergarten and long-term health prospects of low-income and minority children. A commentary. Adobe PDF File [PDF - 79 kB] Am J Prev Med 2014;46(3):e39–40.

Community Preventive Services Task Force. Recommendation for full-day kindergarten for children of low-income and racial/ethnic-minority families. Adobe PDF File [PDF - 162 kB] Am J Prev Med 2014;46(3):324–6.

Read other Community Guide publications about Promoting Health Equity in our library.

Promotional Materials

Community Guide News

More promotional materials for Community Guide reviews about Promoting Health Equity Through Education Programs and Policies.


Cooper H, Batts Allen A, Patall EA, Dent AL. Effects of full-day kindergarten on academic achievement and social development. Review of Educational Research 2010;80:34.

Walston J, West J. Full-day and half-day kindergarten in the United States: findings from the Early Childhood Longitudinal Study, Kindergarten Class of 1998−99 (NCES 2004-078). U.S. Department of Education, National Center for Education Statistics, Institute of Education Sciences. Washington, DC: U.S. Government Printing Office, 2004.


The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Promoting health equity through education programs and policies: full-day kindergarten programs. Last updated: MM/DD/YYYY.

Review completed: December 2011