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Emerging Infectious Diseases Journal


Volume 5: No.  2, April 2008

Preventing School Dropouts Should Start in Preschool


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Suggested citation for this letter: Fiscella K. Preventing school dropouts should start in preschool [letter]. Prev Chronic Dis 2008;5(2). Accessed [date].

To the Editor:

In “Reframing School Dropout as a Public Health Issue” (1), Freudenberg and Ruglis make a succinct, yet compelling, case. Arguably, reducing racial, ethnic, and socioeconomic disparities in educational achievement (including disparities related to graduating from high school by age 18 years) is key to reducing not only disparities in adult incarceration and socioeconomic position but also to reducing disparities in adult health.

It is time to include school dropout rates (by race, ethnicity, and parental education and poverty level) among the national health objectives for 2010 (2). On the education side of the public health-education divide, it is equally important to acknowledge the contribution of child health (3) to the success of No Child Left Behind (4) in eliminating disparities in academic achievement (5).

Uniform national measures of school readiness (stratified by race, ethnicity, and parental education and poverty levels) should also be included among current national health objectives and tracked through No Child Left Behind. Such measures would underscore the relevance of children’s emotional and cognitive health to academic achievement (and the relevance of academic achievement to adult health). It would also provide schools with baselines for assessing students’ academic growth, beginning in kindergarten. Most importantly, it would offer a national benchmark for assessing progress toward the national goal of ensuring that every child starts elementary school with the necessary skills to succeed and eventually graduate from high school by age 18.

To the list of recommendations cited by the authors (1) for reducing school dropout rates, I strongly emphasize the need to add high-quality early-childhood interventions to reduce well-documented racial, ethnic, and socioeconomic disparities in school readiness (6,7). School dropouts, including those precipitated by adolescent pregnancy, often have their antecedents in inadequate readiness for school (8). Effective early childhood interventions exist (9); we just need the national will to fund their full implementation.

Early childhood interventions are critical to reducing school dropouts over the long term. These programs are highly cost effective (10) and may prove to be one of the most powerful tools for reducing upstream causes of disparities in adult health.


Kevin Fiscella, MD, MPH
Associate Professor, Family Medicine, Community & Preventive Medicine and Oncology, University of Rochester, Rochester NY

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  1. Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis 2007;4(4). Accessed October 12, 2007.
  2. U.S. Department of Health and Human Services. Healthy People 2010. 2 vols. Washington (DC): Government Printing Office; 2000.
  3. Currie J. Health disparities and gaps in school readiness. Future Child 2005;15(1):117-38.
  4. No Child Left Behind Act, 20 USC §6301 (2002).
  5. Lee J, Grigg WS, Donahue PL. The Nation’s report card: reading 2007. National assessment of educational progress at grades 4 and 8. Washington (DC): U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics; 2007. Accessed October 12, 2007.
  6. Fryer RG, Levitt SD. Understanding the black-white test score gap in the first two years of school. Rev Econ Stat 2004;86(2):447-64.
  7. Table 2. Percentage of 3- to 5-year-old children not yet enrolled in kindergarten with specific reported school readiness skills, by selected child and family characteristics: 1993 and 1999. In: Nord CW, Lennon J, Liu B, Chandler K. Home literacy activities & signs of children's emerging literacy, 1993 and 1999. Washington (DC): U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics; 1999. Accessed October 12, 2007.
  8. Garnier HE, Stein JA, Jacobs JK. The process of dropping out of high school: a 19 year perspective. Am Educ Res J 1997;34:395-419.
  9. Proven benefits of early childhood interventions. Santa Monica (CA): RAND Corporation; 2005.* Accessed October 12, 2007.
  10. Heckman JJ, Masterov DV. The productivity argument for investing in young children. Proceeding of the Allied Social Sciences Association Meeting. 2007 Jan 5-7; Chicago, IL.* Accessed October 12, 2007.

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


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