Role of NYC's universal pre-K expansion on the health and education of children - improving upstream components of health is critical for assuring improvement in longer term health and wellbeing

Award Details: New York University School of Medicine received a $4.1 million Project Grant from the National Institute of Nursing Research (NINR) under the Nursing Research program (CFDA 93.361), awarded September 4, 2025, with completion targeted for August 31, 2029. The research is conducted in New York City and includes sub-awards to the University of Delaware (awarded March 6, 2026), New York City Health and Hospitals Corporation (awarded February 9, 2026), and Syracuse University (awarded January 20, 2026).

Research Objectives and Deliverables: The project examines the health and education impacts of New York City's 2014 Universal Pre-Kindergarten (UPK) expansion, which more than tripled available slots within two years. Using the NYC Student Population Health Registry—a longitudinal database linking all NYC public school students with health and education data—the research will deliver comparative analyses across three primary aims: (1) determining UPK's influence on child health outcomes (mental health, asthma, vision/hearing, obesity) by comparing children entering school before and after the expansion; (2) assessing education outcomes (test scores, attendance, retention); and (3) evaluating health and education impacts across population subgroups. The project produces population-level evidence on the effects of large-scale universal pre-kindergarten programs on children's long-term health and academic outcomes through 12th grade, addressing a significant gap in research on citywide universal program expansion versus smaller-scale interventions.

This is particularly relevant for pre-kindergarten education. While evidence exists on smaller scale programs that are not universal in nature, we have a paucity of information on the role of true universal expansions, at the level of a large city, on health or education outcomes for children at the population level. In 2014, new york city (NYC) launched a universal pre-kindergarten (UPK) expansion, more than tripling the number of slots available in 2 years. We will examine the role that his program had in both health and education outcomes for children in NYC through the school years, through 12TH grade. UPK could influence a wide variety of health (e.g., mental health, asthma, vision/hearing, obesity) and education (e.g., test scores, attendance, retention) outcomes. The research leverages the NYC student population health registry (SPHR), a uniquely inclusive, longitudinal database of all NYC public school students, created jointly by the NYC department of health and mental hygiene and NYC department of education to examine these and other outcomes. SPHR links multiple data sources at the child-level, allowing US to examine the influence of UPK on myriad outcomes. The specific aims are: aim 1: determine the influence of NYC's citywide UPK expansion on child health outcomes. H1: relative to children who entered public school before UPK expansion, children who entered school after UPK expansion will have improved health outcomes. Aim 2: determine the influence of NYC's citywide UPK expansion on child education outcomes. H2: relative to children who entered public school before UPK expansion, children who entered school after UPK expansion will have improved education outcomes. Aim 3: determine the influence of NYC's citywide UPK expansion on health and education for all children. H3: different groups of children will see differential impacts from UPK on health and education outcomes.