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Social Determinants of Health: Full Day Kindergarten Programs


What the CPSTF Found

About The Systematic Review

The CPSTF 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.

Studies of the long term effects of early childhood education also were reviewed to draw inferences about the possible long term effects of full-day kindergarten.

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to promoting health equity.


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.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 270 kB].

Short Term Effects

  • Full-day kindergarten led to statistically significant effects among children.
    • Scores on standardized achievement tests or assigned grades improved 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, and verbal scores improved by 0.46 standard deviations.
    • Students showed an increased ability to work and play with others—an indicator of social-emotional health (1 study).
  • 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 that included 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 low-quality primary schools, emphasizing the importance of on-going school environments that support learning and development.

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 270 kB].

The economic review included six studies. 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 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.
  • 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 a reduction of the proportion of children retained in class and required to repeat a grade.


Based on populations and settings in the included studies, the finding should be applicable to all children in the United States living in urban and non-urban areas. Studies reported greater benefits, however, for minority and low-income populations.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • What are the long terms effects of full-day vs. half-day kindergarten? How do subsequent schooling and family and community environments affect long term outcomes?
  • What are the differential effects of full-day kindergarten on low-income and minority children vs. higher income non-minority children?
  • What is the cost-benefit ratio of full-day vs. half-day kindergarten?

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 and 31% were in non urban locations.
  • Programs were more likely to be offered in the southern region of the United States 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, students in full-day kindergarten were reported to receive 30-31% more instruction per day in math and reading than students in half-day (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 were not given, if stringently applied, they may have excluded information in many studies.