From 2008-09 through 2018-19, economically disadvantaged students in California scored 2.7 grade levels below their peers on academic achievement tests administered in grades 3 through 8, on average. Nationally, academic achievement gaps are best explained by differences in school readiness, as the achievement gap evident at kindergarten entry does not appear to change as students progress through later grades (Reardon and Portilla, 2016). California’s 2010 Kindergarten Readiness Act established the universal Transitional Kindergarten (TK) program to better prepare all students for elementary school. In the 2012-13 school year, California began implementing TK to serve children whose fifth birthday fell in the fall. By 2018-19, over 100,000 children enrolled in TK at a cost to the state of roughly $1 billion.

Chapter 1 of this dissertation examines the overall impact of TK participation on kindergarten English reading assessment performance among all students who entered kindergarten in the study district from 2015-16 through 2018-19. I use a regression discontinuity design to compare children who were eligible for TK to their kindergarten-cohort peers who would have been eligible but for having been born on slightly later dates. To assess whether TK participation ameliorates socioeconomic gaps in school readiness, I estimate the difference in TK impacts on kindergarten reading scores between socioeconomically disadvantaged students and their peers. No prior study of TK has examined this issue. I find that TK participation had a positive effect on midyear reading assessment scores which did not persist into the spring. I find stronger and more persistent effects among students from socioeconomically disadvantaged neighborhoods and Latino students. Despite these results, I am unable to reject the hypothesis that TK affected all students equally.

In Chapter 2, I study variation in kindergarten English reading assessment performance across multiple early learning sequences experienced by students in the same large urban public school district. TK is an academic-oriented program that uses a modified kindergarten curriculum and was explicitly designed to serve as a “bridge” from preschool to kindergarten as part of a multi-year early learning sequence. In a study sample designed to be representative of the state, 77 percent of children who attended TK were first enrolled in center-based preschool (Manship et al., 2017). The district in this study administers two state-funded pre-K programs: Transitional Kindergarten (TK) and the California State Preschool Program (CSPP). CSPP is a targeted program serving socioeconomically disadvantaged three- and four-year-olds. 19 percent of students in the analytical sample attended CSPP before enrolling in TK. I use a regression discontinuity design to interrogate TK’s “bridge” model and examine potential synergies between TK and CSPP. Research on dynamic complementarity between investments in early childhood development suggests that the impacts of early learning investments moderate and are moderated by the impacts of subsequent educational experiences (Aizer and Cunha, 2012; García and Gallegos, 2017; Johnson and Jackson, 2019). I find that TK had strong and persistent effects on CSPP participants. I find no effect of TK participation on the reading assessment performance of students who did not first attend early CSPP. TK impacts on kindergarten reading assessment performance in the spring were 0.447 (p=0.051) standard deviations higher for CSPP participants than they were for other students who attended TK. This study falls short of identifying complementarity between CSPP and TK as I am unable to isolate exogenous variation in CSPP participation. Thus I do not disentangle the influence of CSPP programming on TK effects from that of factors governing selection into the program.

The results of this study suggest that estimates of a given pre-K program’s effects on children’s outcomes depend on the sequence of early educational experiences those children would have had but for enrolling in that pre-K program. In 2018, half of all three-year-olds were enrolled in pre-K (Friedman-Krauss et al., 2019). Future studies of one-year pre-K programs and curricula will be more informative if they are able to characterize children’s counterfactual care sequences.

Schools recruit exclusionary discipline—such as suspensions and expulsions—to deter students from misbehaving, and to protect students from the harms associated with exposure to student misbehavior. While often implemented with good intentions, recent research indicates that exposure to discipline increases (rather than deters) misbehavior; increases risks of dropout, juvenile involvement, and adult incarceration; and exerts secondary harms, reducing school climate among those whose peers are suspended.

Black students bear the brunt of school discipline. Across student subgroups and school contexts, Black students are far more likely to be suspended or expelled. Whether one looks at female students, economically disadvantaged students, preschool students, or students in charter schools, Black students are overrepresented among those disciplined. Research demonstrates that stark racial disparities in discipline are not merely a function of racial disparities in student misbehavior, nor of how students sort into schools. Instead, disparities are largely driven by school practices. The harmfulness and unevenness of school discipline thus present a pressing equity issue: how can schools ameliorate racial disparities in discipline?

In reply, scholars have suggested, and schools have implemented, restorative practices, which include proactive practices to inculcate conflict resolution skills and strengthen community bonds (e.g., community building circles) and responsive practices to resolve conflicts and repair relationships (e.g., harm repair circles). Proponents argue that because these practices address a root cause of student discipline, they have the potential to ameliorate racial disparities while enhancing school climates, academic engagement, and academic performance.

However, a review of extant quantitative research surfaces a critical distinction between restorative programs and restorative practices. Restorative programs are systems of hiring, training, and support that are designed to encourage school community members to engage in restorative practices. Restorative practices are the specific actions that community members might engage in in a restorative school, and that theoretically can accrue to certain benefits for students, staff, and community members. Research has focused almost exclusively on the impact of restorative programs and has shown mixed results. This research also suffers from a core challenge: programs often do not accrue to students being exposed to restorative practices. Prior research thus leaves unclear whether restorative practices can have intended impacts.

This study merges and leverages multiple forms of California administrative data to track school practices and student outcomes over space and time, and finds that students who gain exposure to restorative practices see declines in discipline and increases in academic achievement, and declines in related racial disparities. It also finds that schools that increase their use of restorative practices see declines in misbehavior, gang membership, victimization, depressive symptoms, and substance abuse; and improvements in GPA and school climate. Taken together, results present a strong case for the effectiveness of restorative practices at improving outcomes for students and schools. However, if these analyses answer one question about restorative practices, then they suggest another: how can schools increase student exposure to these potent practices?

A review of implementation guides surfaces insights for employing restorative programming that can engender student exposure to restorative practices. Districts and states can empower schools to persevere in their implementation of restorative practices by providing sustained funding. Schools, meanwhile, can take three approaches. First, they can commit to culture change by reducing reliance on exclusionary discipline. Second, they can preempt caregiver concerns via proactive communication about the psychological benefits of restorative approaches (and the potential harms of punitive ones). And, finally, schools can ensure widespread utilization (and exposure) by providing staff throughout the school with training regarding how to implement restorative practices in varied situations and when interacting with students of all backgrounds—and by empowering and incentivizing staff to use these practices.

This dissertation is comprised of three article-length essays, all of which concern important issues in early-life health and well-being. All three essays focus on the decision to formula feed or breastfeed--one of the first decisions a mother makes in her child's life. Two of the papers--one quantitative and one qualitative--study the environment of the Neonatal Intensive Care Unit and the potential effect of hospital policy and procedures on breast milk feeding. The remaining paper investigates a large federal policy and the consequences of altering the costs of infant formula relative to breast milk. All papers are tied together by an eye towards the plasticity of these early life experiences, as well as the troubling persistence of health disparities by race, class and maternal education.

Essay One: Breast milk feeding in the Neonatal Intensive Care Unit (NICU) is associated with a host of improved health outcomes. However, breast milk feeding rates differ by socioeconomic status, race, ethnicity and maternal education indicating that these results are vulnerable to selection bias. Qualitative work by this author and others suggests that women giving birth in the late-night hours are less likely to begin a successful milk expression regimen due to the lack of experienced clinicians working during these shifts. Using the hour of birth as an instrument for breast milk feeding, this study attempts to isolate the effects of breast milk feeding on incidence of deadly conditions in the NICU, as well as the infant's growth patterns and length of stay. This study also uses innovative measures of the indications for delivery type in order to construct a sub-sample whose distribution of delivery times is the most random, thereby increasing the validity of the analysis. The first-stage of the analysis revealed no significant relationship between late-night births and breast milk feeding at discharge, contrary to the claims of clinicians and mothers interviewed in a separate study. C-Section delivery and shorter maternal lengths of stay significantly predictive of decreased breast milk feeding at discharge, even after controlling for potential confounders. The reduced-form analysis suggests that infants born in the evening (5pm-Midnight) are roughly 2-4% more likely to contract Necrotizing Enterocolitis at some point during their stay in the NICU. The majority of associations between hour of birth and other health outcomes were insignificant. Evidence of heterogeneity in hour of birth effect size by birth weight, gestational age, race/ethnicity and maternal age were also explored.

Essay Two: It is impossible in most countries to randomize assignment into child health programs that may offer benefits. In the absence of this gold standard of program evaluation, researchers face the threat of selection bias--the possibility that there are unmeasured differences, relevant to outcomes, between those who are treated and those to whom they are compared. A common concern is that people who are eligible for a program but choose not to enroll may differ from those who do enroll. Because policies geared towards a country's most vulnerable people are determinants of health inequities, it is imperative that sources of selection bias be identified and that evaluation methods minimize the impact of selection bias on our estimations of treatment effects. Using a case study of a large Federal nutrition program in the United States, this study reviews how researchers have attempted to minimize selection bias and presents an analysis illustrating how the decision to take up the program can highlight sources of this bias. Relying on data from a longitudinal study of mothers and infants, I show that prenatal attitudes and beliefs may determine postnatal program enrollment, and that the direction of the bias differs by demographic variables. Further, I show that magnitude of supposed program effects vary significantly as a function of these prenatal beliefs. In sum, this paper makes the case for more careful study of the factors that determine take-up of a program, and inclusion of those factors in an evaluation of the program

Essay Three: The third paper in this series diverges from the methodology of the first two essays. This paper is the culmination of a year-long survey data collection effort; the work is a collaboration between UC Berkeley, UC San Francisco and Alta Bates Summit Medical Center (Berkeley, CA). The objective of this study was to investigate determinants of breast milk feeding in the NICU, and to try and account for the pervasive racial, ethnic, socioeconomic and language disparities in breast milk outcomes. The survey was developed by the authors of this essay based on established theories of decision making about infant feeding. Over the course of the study period, mothers giving birth at less than 32 weeks gestational age were invited to participate in the study, either through filling out a survey in the hospital, participating in a one-on-one interview, or both. This essay focuses on the results from the survey which were later linked to medical outcome data of the infant upon discharge home. An innovation of this study is the collection of breast milk exclusivity--that is, if a dose-response relationship between breast milk and outcomes did exist, our data collection method would be able to capture it. Results indicate that mothers who participated in the study were less likely to breast milk feed if they were: of black race, non-Hispanic (any race), low-income, or living a long distance from the NICU. Measures of social support, peer effects, and attitudes towards breast milk feeding also predicted the proportion of an infant's feeding that was breast milk.. Implications of these findings are discussed, as are the lessons learned from pursuing this type of study.

Using nationally representative data from the US, this study provides evidence on the relationship between early life conditions and cognition, human capital accumulation, labor market outcomes, and health status in adulthood. We find that poor health at birth and limited parental resources (including low income, lack of health insurance, and unwanted pregnancy) interfere with cognitive development and health capital in childhood, reduce educational attainment, and lead to worse labor market and health outcomes in adulthood. These effects are substantial, and they are robust to the inclusion of sibling fixed effects and an extensive set of controls. The results reveal that low birth weight ages you by 12 years, increases the odds of dropping out of high school by one-third, lowers labor force participation by 5 percentage points, and reduces labor market earnings by roughly 15 percent. Not only are socioeconomic factors determinants of poor birth outcomes, but they also influence the lasting impacts of poor infant health when it occurs. In particular, the negative long-run consequences of low birth weight are larger among children whose parents did not have health insurance. While poor birth outcomes reduce human capital accumulation, this consequence explains only 10% of the total effect of low birth weight on labor market earnings. The study also finds that racial differences in adult health can be explained by a few early life factors: birth weight, parental income, and parental health insurance coverage. Finally, the paper sheds light on the well known strong relationship between education and health outcomes; we find that sibling models that account for time-invariant family factors reduce the effects of education on health substantially, but the remaining effects are large. Taken together, the evidence is consistent with a negative reinforcing intergenerational transmission of disadvantage within the family; parental economic status influences birth outcomes, birth outcomes have long reaching effects on health and economic status in adulthood, which in turn leads to poor birth outcomes for one’s own children.

School quality exerts a significant impact on children well beyond their school-age years. High quality primary and secondary schools improve educational attainment, reduce criminal behavior, and increase labor market performance. Decades of federal and state policy efforts have sought to ensure broad access to effective schools. Two of the most consequential reform efforts of the past thirty years, school accountability and financial adequacy reforms, have been moderately successful at raising average performance on standardized tests of literacy and numeracy, yet critics contend that these gains mask serious limitations. In the pages that follow, I address salient concerns of each policy by analyzing the impact of No Child Left Behind on social emotional development and the impact of California’s recent school finance reform, the Local Control Funding Formula. I conclude with an assessment of publication bias in policy-relevant scholarship.