California After School Programs Ballot Proposition

Authors: UCLA Health Impact Assessment Project, Robert Wood Johnson Foundation, Partnership for Prevention

Location: California, United States

Completion Date: February 2003

HIA Report: Health Impact Assessment of California's Proposition 49: After School Education and Safety Act of 2002

Summary of the HIA

Proposed Policy or Project

Ballot Proposition 49, “The After School Education and Safety Program Act of 2002” proposed expanding California state funding of after-school programs to $550 million per year and modifying the grant-based system for distributing these funds to local after-school program providers. Proposition 49 also proposed several changes to the eligibility criteria for after-school program grant applicants. For instance, it would allow any city, county or non-profit organization in partnership with a local educational agency to apply for funds. Under the Proposition, after-school programs eligible for funding would no longer be limited to school grounds or adjacent recreation areas. Eligible after-school program sites could include any site meeting the regulatory (e.g. safety) requirements applicable to similar school-based programs. Before-school programs would receive the lowest funding priority. A majority of voters approved the proposition in November 2002. The HIA was completed on or near election day and was not made public before the election.

Background and Policy Context

This HIA was conducted as part of a project funded by the Robert Wood Johnson Foundation and the Partnership for Prevention, with the goal to assess the feasibility and usefulness of health impact assessments (HIAs) in policy-making. Measurable goals included assessing the feasibility, usefulness, and limitations of HIAs for policy decision-making, developing an approach for health impact statements; and completing illustrative HIAs. Using estimates of the effects of health insurance and income on mortality from the published literature, a statistical model was constructed to estimate and compare potential reductions in mortality due to the increases in wage and changes in health insurance status among workers covered by the Los Angeles City Living Wage Ordinance. The Ordinance mandated employers to: Pay workers covered by the Ordinance at least $7.99/hour; Contribute at least $1.25 per hour worked toward covered employees’ health insurance premiums or pay an additional $1.25/hour if health insurance is not provided; To provide covered workers with at least 12 paid days off each year."

Scope and Methods

For this HIA, an analysis of the literature was conducted to assess each of the hypothesized causal pathways stemming from after-school care to health. The educational literature was the primary source of information on these putative effects. We identified six major areas in which after-school programs could potentially affect health status:

  • improved socio-economic status associated with increased educational attainment,
  • crime reduction
  • substance abuse prevention,
  • increased physical activity,
  • improved mental health,
  • reduced risk of teen pregnancy and sexually transmitted disease related to early onset sexual activity.

Summary of Findings

The six major pathways through which after-school programs affect health occur through three primary mechanisms. First, by offering academically focused activities, such as tutoring and additional classes, after-school programs may boost educational attainment, which could improve students’ career opportunities and later income, thereby enabling them to live and work in a healthier environment and to have better access to health-enhancing goods and services. Second, after-school programs may benefit youth by providing custodial care in a relatively safe place in the after-school hours, thereby reducing their exposure to high-risk situations. Instead of being left in unsupervised self-care where they might be exposed to dangerous influences or situations with increased risks of crime victimization, crime perpetration, substance abuse and sexual activity, youth would be in settings with adult supervision. Third, the content of after-school programs could provide knowledge, skills and motivation that impact students’ health-related behaviors, such as violent behavior, substance abuse, long-term patterns of physical activity, and sexual activity. Review of the literature found that evaluations of large-scale after-school programs, those most generalizable to the scope of programs to be funded under Proposition 49, have little evidence of effect of after-school programs on any of the aforementioned pathways, thus contributing little to health. This is not to say that there is zero potential health benefit from after-school programs. The potential benefits of after-school program in terms of health and other outcomes, such as education, will be largely contingent on targeting. Impacts could be substantially greater if high-risk students are recruited and retained. Without provisions for generating new revenue, mandated increases in after-school program funding could have significant negative health impacts as a result of cutbacks in other state programs. Despite this evidence, the limited public opposition to the initiative tended to focus on questions of law-making practice without questioning claimed benefits.

Background Reports


Brian Cole, Dr.PH

UCLA, Box 651772, Rm 61-253 CHS
Los Angeles

(310) 206-4253