Bryan L. Williams, Ph.D. Associate Professor

1. Association of Prematurity,Birthweight by Gestational Age, and AcademicAchievement Among First Grade Students in Georgia Bryan L. Williams, Ph.D. Associate Professor

2. Student Achievement • What is it? • Who or what is responsible for it? • What are the consequences of poor achievement?

3. Understanding Student Achievement • Wide-spread attention to teacher quality in the education literature (Borman & Kimball, 2005; Darling-Hammond, 2006; Hopkins & Stern, 1996; Newton et al., 2010). • Value-Added Modeling (VAM) of the effect of teacher quality: some evidence that teacher quality and effectiveness are positively related to changes in performance over course of an academic year (Newton et al., 2010; Wayne & Youngs, 2003).

4. Consequences of High Stakes Assessment • Grade retention • Referral • High school drop out

5. Maybe it takes more than a teacher… • Maybe we should consider maternal and child health… • Maybe prematurity, low birth weight, and maternal risk factors account for a significant proportion of unexplained, within-classroom variance in student achievement.

6. The Importance of Maternal and Child Health • The adverse consequences of prematurity and low birth weight (< on the child and family are well-documented (Agarwal and Lim, 2003; Davis, et al., 2003; Goldani, et al., 2004; Kilbride, et al., 2004; Pleacher, et al., 2004; Brown, et al., 2003). • Intrauterine growth restriction may be associated with ADHD (Heinonen, et al., 2010) and other learning, cognitive, and attentional problems later in life O'Keeffe, et al., 2003). • Jain (2008) points out, “Needless to say, the growing brain and body are deceptively capable of keeping adverse effects masked until cognitive and motor functions can be meaningfully tested”. • Measuring developmental outcomes of premature infants is subject to error and misinterpretation (Hack, 2011).

7. Preliminary Specific Aims • To compare scaled and criterion referenced CRCT test scores among extremely premature, late term premature and full term infants. • To compare scaled and criterion referenced CRCT test scores among low birthweight, normal birthweight, and small for gestational age term infants. • To examine the relationship between maternal risk factors and labor complications including preeclampsia, premature rupture of membrane, spontaneous preterm labor, scaled, and criterion referenced CRCT test scores among infants.

8. Research Question • What is the relationship between prematurity, birthweight for gestational age, and performance on thestandardized test among children born in Georgia?

9. Methods – Data Birth Data School Data GA Criterion Referenced Competency Test (CRCT) Minimum competency test - to discriminate between children who do or do not meet minimum age-specific competency Test data for all Georgia public school attendees 2005-2009 Math Reading English Language Arts (ELA) • Georgia birth certificates for 1998-2002 • All singleton live births to Georgia residents

10. Data Sets Mother-Infant Hospital Discharge Data

11. Matching • Deterministic linkage: Birth records were matched to student data based upon a unique ID created from child’s social security number, child’s name or DOB, and mother’s last name. • Non-matches: Records that could not be matched were excluded from the analysis. • We are describing sociodemographic characteristics of matches vs. non-matches and conducting a sensitivity analysis and an independent data review for quality control purposes.

12. Limitations Inherent truncated variability of minimal competency tests Inability to obtain non-resident births Incomplete or inaccurate maternal and infant records Lack of earlier outcome measure (i.e., Pre-K) Inability to assess longitudinal changes in achievement

13. Methods – Data Linkage • 331,710 or 53% were successfully linked to their first grade standardized test scores.

14. Possible reasons for non-linkage • Out of state migration • (~12-15% of cohort) • In state migration • In private school • (~10-15% of cohort) • Home schooled (~2-5% of cohort) • Linkage error • Linked births similar to total cohort with some variation • Mothers with 4+ years of college less likely to link (44%)

15. Inclusion Criteria • Georgia births that have matching student information • Singleton births • Infants with birth weight 400 g to 5000 g • Infants of gestational age 20 to 43 weeks • Infants without recorded congenital anomalies and chromosomal defects

16. Sample Description

17. What did we find?

18. 1st Grade CRCT English Language Arts Failure Rate by Gestational Age Category X2=972.95;df=8; p. < .0001 N=354,781

19. 1st Grade CRCT Reading Failure Rate by Gestational Age Category X2=1092.2df=8; p. < .0001 N=354,815

20. 1st Grade CRCT Math Failure Rateby Gestational Age Category X2=1587.5;df=8; p. < .0001 N=354,764

21. Prematurity and Risk of CRCT Failure aOR for Association Of Gestational Age With Child’s 1st Grade CRCT Failure English Language Arts Math Reading Adjusted for maternal age at birth, maternal education, maternal race/ethnicity, child race/ethnicity, sex of child, and year of birth

22. Impact of the Addition of Maternal and Infant Factors on Risk of Failure

23. aOR for Association of the Interaction Between Birthweight for Gestational Age and Prematurity on Failure of the ELA Test Only SGA AGA SGA AGA SGA AGA AGA SGA Prematurity and Birthweight by Gestational Age on ELA Failure Adjusted for maternal age at birth, maternal education, maternal race/ethnicity, child race/ethnicity, sex of child, and year of birth

24. Birthweight for Gestational Age by Standardized CRCT Test Scores

25. Birthweight forGestational Age by Standardized CRCT test Scores Among Term InfantsControlling for Maternal Covariates Covariates appearing in the model are evaluated at the following values: Mothers Age In Years = 26.11.

26. Summary • Being born ‘preterm’ versus ‘term’ increases a first-grade child’s risk of failure of all three components of the CRCT. • Small for gestational age infants scored significantly lower on all three components of the CRCT. • Being small for gestational age significantly increases afirst-grade child’s risk of failure on the English Language Arts test among those born extremely, moderately, and late preterm.

27. What this really means… • Prematurity may be thought of as an injury that can hurt a child for a very long time • Not all premature infants are injured in the same way • We need a better understanding of the nature of the injury

28. Implications for Educational Policy • Teacher/school variables vs. maternal/infant variables as predictor of school performance • Factors under schools’ control • Fairness of high stakes testing

29. Next Steps • Linkage of non population based data to existing data set • Pregnancy Risk Assessment Monitoring System (PRAMS) • Birth logs (e.g., corticosteroid use) • Behavioral and emotional screenings (e.g., BASC-2) • Spatial data for multi-level modeling • Investigate clinical risk factors for poor first grade standardized test performance • Including clinical presentation of the pregnancy; labor, delivery, and neonatal course;