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Item Open Access Adult Spinal Deformity Surgery Is Associated with Increased Productivity and Decreased Absenteeism From Work and School.(Spine, 2022-02) Durand, Wesley M; Babu, Jacob M; Hamilton, David K; Passias, Peter G; Kim, Han Jo; Protopsaltis, Themistocles; Lafage, Virginie; Lafage, Renaud; Smith, Justin S; Shaffrey, Christopher; Gupta, Munish; Kelly, Michael P; Klineberg, Eric O; Schwab, Frank; Gum, Jeffrey L; Mundis, Gregory; Eastlack, Robert; Kebaish, Khaled; Soroceanu, Alex; Hostin, Richard A; Burton, Doug; Bess, Shay; Ames, Christopher; Hart, Robert A; Daniels, Alan H; International Spine Study Group (ISSG)Study design
Retrospective cohort study.Objective
We hypothesized that adult spinal deformity (ASD) surgery would be associated with improved work- and school-related productivity, as well as decreased rates of absenteeism.Summary of background data
ASD patients experience markedly decreased health-related quality of life along many dimensions.Methods
Only patients eligible for 2-year follow-up were included, and those with a history of previous spinal fusion were excluded. The primary outcome measures in this study were Scoliosis Research Society-22r score (SRS-22r) questions 9 and 17. A repeated measures mixed linear regression was used to analyze responses over time among patients managed operatively (OP) versus nonoperatively (NON-OP).Results
In total, 1188 patients were analyzed. 66.6% were managed operatively. At baseline, the mean percentage of activity at work/school was 56.4% (standard deviation [SD] 35.4%), and the mean days off from work/school over the past 90 days was 1.6 (SD 1.8). Patients undergoing ASD surgery exhibited an 18.1% absolute increase in work/school productivity at 2-year follow-up versus baseline (P < 0.0001), while no significant change was observed for the nonoperative cohort (P > 0.5). Similarly, the OP cohort experienced 1.1 fewer absent days over the past 90 days at 2 years versus baseline (P < 0.0001), while the NON-OP cohort showed no such difference (P > 0.3). These differences were largely preserved after stratifying by baseline employment status, age group, sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis (PI-LL), and deformity curve type.Conclusion
ASD patients managed operatively exhibited an average increase in work/school productivity of 18.1% and decreased absenteeism of 1.1 per 90 days at 2-year follow-up, while patients managed nonoperatively did not exhibit change from baseline. Given the age distribution of patients in this study, these findings should be interpreted as pertaining primarily to obligations at work or within the home. Further study of the direct and indirect economic benefits of ASD surgery to patients is warranted.Level of Evidence: 3.Item Open Access Child welfare agency ties to providers and schools and substance abuse treatment use by adolescents.(Journal of substance abuse treatment, 2011-01) Wells, R; Chuang, E; Haynes, LE; Lee, IE; Bai, YPolicy makers and advocates are increasingly encouraging child-serving organizations to work together. This study examined how child welfare agency ties with substance abuse treatment providers and schools correlated with substance abuse treatment for adolescents receiving child protective services. A sample of adolescents with substance use risk was extracted from a national survey of families engaged with child welfare. Logistic regressions with adjustments for complex survey design used child welfare agency ties to substance abuse treatment providers and schools to predict treatment. As expected, adolescents were more likely to report treatment when child protective services and substance abuse treatment were in the same agency and when child welfare agency directors reported joint planning with schools. However, child welfare agency agreements with substance abuse treatment providers were negatively associated with treatment. This unexpected finding implies that agencies may sometimes cooperate to address problems and to improve service utilization.Item Open Access Design thinking teaching and learning in higher education: Experiences across four universities.(PloS one, 2022-01) McLaughlin, Jacqueline E; Chen, Elizabeth; Lake, Danielle; Guo, Wen; Skywark, Emily Rose; Chernik, Aria; Liu, TsailuA growing body of literature highlights the increasing demand on college graduates to possess the problem finding, problem framing, and problem-solving skills necessary to address complex real-world challenges. Design thinking (DT) is an iterative, human-centered approach to problem solving that synthesizes what is desirable, equitable, technologically feasible, and sustainable. As universities expand efforts to train students with DT mindsets and skills, we must assess faculty and student DT practices and outcomes to better understand DT course experiences. Understanding how DT is taught and experienced within higher education can help schools promote student learning and align their training programs with professional, personal, and civic needs. In this study, surveys were completed by 19 faculty and 196 students from 23 courses at four universities. DT teaching and learning was characterized by three DT practices and five outcomes. Statistically significant differences were found by discipline of study and student type (i.e., graduate vs undergraduate), but not by gender or race/ethnicity. These results can be used to inform the development of classroom-based DT teaching and learning strategies across higher education institutions and disciplines.Item Open Access Energy/Water Efficiency at Glenwood Elementary(2014-04-24) Kuestner, HollyThis project focuses on reducing the energy and water footprint of Glenwood Elementary School in Chapel Hill, North Carolina. I inventoried energy and water consumption, modeled costs and benefits of several efficiency upgrades, and implemented those that were possible within a $1000 grant I received from the Kathryn Hoenig Gift. Glenwood is currently responsible for annual emissions of approximately 398 metric tons of CO2 equivalent and 871 kilo gallons of water consumption. Last year, this energy and water consumption carried a price tag of $80,940, of which most ($75,709) was attributable to electricity and natural gas. The energy and water upgrades I chose to implement are low-cost with rapid payback periods. They are very cost-effective, though the magnitude of their impact is small compared to Glenwood’s energy and water consumption as a whole. These measures will save the Chapel Hill-Carrboro City Schools approximately $750, more than 6800 kWh of electricity, and 44,700 gallons of water annually. Because the upgrades were purchased with grant money, this is essentially an annual $750 donation toward helping the school district meet its educational goals. Implementing such initiatives will also avoid 7,089 pounds of carbon dioxide equivalent (CO2e) emissions annually. Efficient energy and water use provide financial and environmental benefits, a sometimes elusive partnership. Approximately $850 of the $1000 grant covered the costs of these upgrades. The remaining funds purchased additional lighting timers for the district to use elsewhere and three Kill-A-Watt energy meters for the Glenwood science teacher (a sustainability advocate) to use in teaching her students about energy efficiency.Item Open Access Hostile attributional bias and aggressive behavior in global context.(Proc Natl Acad Sci U S A, 2015-07-28) Dodge, Kenneth A; Malone, Patrick S; Lansford, Jennifer E; Sorbring, Emma; Skinner, Ann T; Tapanya, Sombat; Tirado, Liliana Maria Uribe; Zelli, Arnaldo; Alampay, Liane Peña; Al-Hassan, Suha M; Bacchini, Dario; Bombi, Anna Silvia; Bornstein, Marc H; Chang, Lei; Deater-Deckard, Kirby; Di Giunta, Laura; Oburu, Paul; Pastorelli, ConcettaWe tested a model that children's tendency to attribute hostile intent to others in response to provocation is a key psychological process that statistically accounts for individual differences in reactive aggressive behavior and that this mechanism contributes to global group differences in children's chronic aggressive behavior problems. Participants were 1,299 children (mean age at year 1 = 8.3 y; 51% girls) from 12 diverse ecological-context groups in nine countries worldwide, followed across 4 y. In year 3, each child was presented with each of 10 hypothetical vignettes depicting an ambiguous provocation toward the child and was asked to attribute the likely intent of the provocateur (coded as benign or hostile) and to predict his or her own behavioral response (coded as nonaggression or reactive aggression). Mothers and children independently rated the child's chronic aggressive behavior problems in years 2, 3, and 4. In every ecological group, in those situations in which a child attributed hostile intent to a peer, that child was more likely to report that he or she would respond with reactive aggression than in situations when that same child attributed benign intent. Across children, hostile attributional bias scores predicted higher mother- and child-rated chronic aggressive behavior problems, even controlling for prior aggression. Ecological group differences in the tendency for children to attribute hostile intent statistically accounted for a significant portion of group differences in chronic aggressive behavior problems. The findings suggest a psychological mechanism for group differences in aggressive behavior and point to potential interventions to reduce aggressive behavior.Item Open Access Inclusion of the Autism Population in Churches, Schools and Communities(2021) Mapson, Charlrean BattenAbstract
There is a population of individuals classified as having Autism Spectrum Disorder (ASD). This group of people should be included in places of worship, the schools they attend and the communities where they reside. Consequently, they are sometimes excluded from some occurrences that others experience.
Utilizing personal stories (of successes and sometimes failures), ASD parent interviews and research, I will offer suggestions for inclusion and enlighten the areas where there tends to be exclusion. My focus is the church and how church leaders may become involved in the lives of ASD parishioners to enhance inclusion in not only the church, but the school and the community as well.
My research shows that ASD parents would like their children to experience church as they have. Although willing, most churches, may lack the ability to oblige for various reasons. Schools where inclusion is not encouraged, rests primarily on the shoulders of the principals. Like pastors in churches, principals in schools have influence and can spearhead inclusion efforts in their respective entities. Community entities are willing to accommodate ASD clientele and have done so when approached to comply.
I contend where any of these entities are not willing to foster inclusion, then the church can and most often should become involved to assist, with the necessary training. In other words, the church must do what the church has always done – stand up for those who are unable to do so for themselves.
Keywords: Autism, church, community, inclusion, parents, school
Item Open Access Inclusion of the Autism Population in Churches, Schools and Communities(2021) Mapson, Charlrean BattenAbstract
There is a population of individuals classified as having Autism Spectrum Disorder (ASD). This group of people should be included in places of worship, the schools they attend and the communities where they reside. Consequently, they are sometimes excluded from some occurrences that others experience.
Utilizing personal stories (of successes and sometimes failures), ASD parent interviews and research, I will offer suggestions for inclusion and enlighten the areas where there tends to be exclusion. My focus is the church and how church leaders may become involved in the lives of ASD parishioners to enhance inclusion in not only the church, but the school and the community as well.
My research shows that ASD parents would like their children to experience church as they have. Although willing, most churches, may lack the ability to oblige for various reasons. Schools where inclusion is not encouraged, rests primarily on the shoulders of the principals. Like pastors in churches, principals in schools have influence and can spearhead inclusion efforts in their respective entities. Community entities are willing to accommodate ASD clientele and have done so when approached to comply.
I contend where any of these entities are not willing to foster inclusion, then the church can and most often should become involved to assist, with the necessary training. In other words, the church must do what the church has always done – stand up for those who are unable to do so for themselves.
Keywords: Autism, church, community, inclusion, parents, school
Item Open Access Media Framing of Public School Diversity Policy Changes, Wake County, N.C., 1975-2010(2010-12-10) Klein, AlexAmerican public education commands a workforce of millions of people, a budget in the trillions of dollars, and a significant share of one’s childhood. It is a vast, complex system run simultaneously by local, state, and federal government, each of which has different goals from the others. The media have an amazing number of topics to explore but limited time and space to do so. This giant educational system—one that affects anyone with a child, a teaching degree, a taxable home, a niece, a competing interest, an innovative idea—is not easily pushed in one direction. To the extent that the acquisition of knowledge changes an individual’s mind, and that change affects a group of citizens, and that group affects the status quo, the news media occupy an important slice of the educational system in America. Which educational issues the news media choose to cover, and with which “slant,” “angle,” or “frame,” can have an important influence on political decision-makers and the general public. This undergraduate thesis seeks to show how local coverage of public school diversity policies in Wake County, North Carolina, was framed during three times of great policy change. The (Raleigh, N.C.) News & Observer, a regional newspaper that primarily covers the city of Raleigh, Wake County, and state politics, is the news source of interest for this project. Three specific changes—all covered in detail by the News & Observer—are used to focus the study.Understanding how the news media couched their coverage of each of these three pivotal periods in the history of Wake County public schools has the potential to generate insights into both why decisions were made to change the system and how the news media might have played a role.Item Open Access Pairing nurses and social workers in schools: North Carolina's school-based Child and Family Support Teams.(J Sch Health, 2010-02) Gifford, EJ; Wells, RS; Miller, S; Troop, TO; Bai, Y; Babinski, LItem Open Access Selectivity of physiotherapist programs in the United States does not differ by institutional funding source or research activity level.(J Educ Eval Health Prof, 2016) Riley, Sean P; Covington, Kyle; Landry, Michel D; McCallum, Christine; Engelhard, Chalee; Cook, Chad EPURPOSE: This study aimed to compare selectivity characteristics among institution characteristics to determine differences by institutional funding source (public vs. private) or research activity level (research vs. non-research). METHODS: This study included information provided by the Commission on Accreditation in Physical Therapy Education (CAPTE) and the Federation of State Boards of Physical Therapy. Data were extracted from all students who graduated in 2011 from accredited physical therapy programs in the United States. The public and private designations of the institutions were extracted directly from the classifications from the 'CAPTE annual accreditation report,' and high and low research activity was determined based on Carnegie classifications. The institutions were classified into four groups: public/research intensive, public/non-research intensive, private/research intensive, and private/non-research intensive. Descriptive and comparison analyses with post hoc testing were performed to determine whether there were statistically significant differences among the four groups. RESULTS: Although there were statistically significant baseline grade point average differences among the four categorized groups, there were no significant differences in licensure pass rates or for any of the selectivity variables of interest. CONCLUSION: Selectivity characteristics did not differ by institutional funding source (public vs. private) or research activity level (research vs. non-research). This suggests that the concerns about reduced selectivity among physiotherapy programs, specifically the types that are experiencing the largest proliferation, appear less warranted.Item Open Access Seminary Students and Physical Health: Beliefs, Behaviors, and Barriers.(Journal of religion and health, 2022-04) Johnston, Erin F; Eagle, David E; Corneli, Amy; Perry, Brian; Proeschold-Bell, Rae JeanAs an occupational group, clergy exhibit numerous physical health problems. Given the physical health problems faced by clergy, understanding where physical health falls within the priorities of seminary students, the ways students conceptualize physical health, and how seminary students do or do not attend to their physical health in the years immediately prior to becoming clergy, can inform intervention development for both seminary students and clergy. Moreover, understanding and shaping the health practices of aspiring clergy may be particularly impactful, with cascading effects, as clergy serve as important role models for their congregants. Drawing on 36 in-depth, qualitative interviews with first-year seminary students, this study examines the complex dynamics between religious frameworks related to physical health, explicit intentions to maintain healthy practices, and reported physical health behaviors. Our findings suggest that even students who deploy religious frameworks in relation to their physical health-and who, as a result, possess positive intentions to implement and maintain healthy behaviors-often report being unable to live up to their aspirations, especially in the face of barriers to health practices posed by the seminary program itself. After reviewing these findings, we offer suggestions for physical health focused interventions, including action and coping planning, which could be implemented at seminaries to reduce the intention-behavior gap and improve clergy health.Item Open Access Test-to-Stay After Exposure to SARS-CoV-2 in K-12 Schools.(Pediatrics, 2022-05) Campbell, Melissa M; Benjamin, Daniel K; Mann, Tara; Fist, Alex; Kim, Hwasoon; Edwards, Laura; Rak, Zsolt; Brookhart, M Alan; Anstrom, Kevin; Moore, Zack; Tilson, Elizabeth Cuervo; Kalu, Ibukunoluwa C; Boutzoukas, Angelique E; Moorthy, Ganga S; Uthappa, Diya; Scott, Zeni; Weber, David J; Shane, Andi L; Bryant, Kristina A; Zimmerman, Kanecia O; ABC SCIENCE COLLABORATIVEObjectives
We evaluated the safety and efficacy of a test-to-stay program for unvaccinated students and staff who experienced an unmasked, in-school exposure to someone with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serial testing instead of quarantine was offered to asymptomatic contacts. We measured secondary and tertiary transmission rates within participating schools and in-school days preserved for participants.Methods
Participating staff or students from universally masked districts in North Carolina underwent rapid antigen testing at set intervals up to 7 days after known exposure. Collected data included location or setting of exposure, participant symptoms, and school absences up to 14 days after enrollment. Outcomes included tertiary transmission, secondary transmission, and school days saved among test-to-stay participants. A prespecified interim safety analysis occurred after 1 month of enrollment.Results
We enrolled 367 participants and completed 14-day follow-up on all participants for this analysis. Nearly all (215 of 238, 90%) exposure encounters involved an unmasked index case and an unmasked close contact, with most (353 of 366, 96%) occurring indoors, during lunch (137 of 357, 39%) or athletics (45 of 357, 13%). Secondary attack rate was 1.7% (95% confidence interval: 0.6%-4.7%) based on 883 SARS-CoV-2 serial rapid antigen tests with results from 357 participants; no tertiary cases were identified, and 1628 (92%) school days were saved through test-to-stay program implementation out of 1764 days potentially missed.Conclusion
After unmasked in-school exposure to SARS-CoV-2, even in a mostly unvaccinated population, a test-to-stay strategy is a safe alternative to quarantine.Item Open Access Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools.(Pediatrics, 2022-11) Campbell, Melissa M; Benjamin, Daniel K; Mann, Tara K; Fist, Alex; Blakemore, Ashley; Diaz, Kylee S; Kim, Hwasoon; Edwards, Laura J; Rak, Zsolt; Brookhart, M Alan; Moore, Zack; Tilson, Elizabeth Cuervo; Kalu, Ibukun; Boutzoukas, Angelique E; Moorthy, Ganga S; Uthappa, Diya; Scott, Zeni; Weber, David J; Shane, Andi L; Bryant, Kristina A; Zimmerman, Kanecia OObjectives
We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 transmission.Methods
Close contacts of those with confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for enrollment in the TTS program if exposure to a nonhousehold contact occurred between November 11, 2021 and January 28, 2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at prespecified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion.Results
A total of 1675 participants tested positive or received at least 1 negative test between days 5 and 7 and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% confidence interval: 6%-19%), and 7272 (89%) of potentially missed days were saved through TTS implementation. We estimated 1 additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period.Conclusions
Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.Item Open Access Test-to-Stay in Kindergarten Through 12th Grade Schools After Household Exposure to Severe Acute Respiratory Syndrome Coronavirus 2.(The Journal of school health, 2023-05) Scott, Zeni; Uthappa, Diya M; Mann, Tara K; Kim, Hwasoon; Brookhart, MA; Edwards, Laura; Rak, Zsolt; Benjamin, Daniel K; Zimmerman, Kanecia O; ABC Science CollaborativeBackground
Test-to-stay (TTS) is a strategy to limit school exclusion following an exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the use of TTS within universally masked kindergarten through 12th grade (K-12) school settings following household SARS-CoV-2 exposure.Methods
Three hundred twenty-two participants were enrolled. Serial rapid antigen testing was performed up to 15 days post-exposure. Analysis-eligible participants completed the 15-day testing protocol, tested positive any time during the testing window, or received a negative test on or after day 9. Primary outcomes included within-school tertiary attack rate (TAR) (test positivity among close contacts of positive TTS participants), and school days saved among TTS participants.Results
Seventy-three of 265 analysis-eligible participants tested positive for SARS-CoV-2 (secondary attack rate of 28% [95% CI: 16-63%]). Among 77 within-school close contacts, 2 were positive (TAR = 3% [95% CI: 1-5%]). Participant absences were limited to 338 days, resulting in 82% of 1849 school days saved.Implications for school health policy, practice, and equity
TTS facilitates continued in-person learning and can greatly reduce the number of missed school days.Conclusions
Within universally masked K-12 schools, TTS is a safe alternative to school exclusion following household SARS-CoV-2 exposure.Item Open Access The Parents’ Rights Movement’s Effect on School Board Functioning(2024-04-10) Greenberg, JosephSchool board meetings across the country have become battlegrounds for political debate. Once civil, these forums have devolved into chaotic scenes fueled by truculent speeches against race-conscious policies, protecting LGBTQ+ students, and updates to history curricula. These are often made by parents, acting as foot soldiers for the “Parents’ Rights Movement,” who package their activism as a campaign for increased transparency. Their efforts have derailed hundreds of meetings by escalating tensions, all the while eclipsing good faith community stakeholders who want to address impediments to student achievement and school success. The rise of “parents’ rights” activism has come at a time when the American education system is plagued by numerous crises. Average test scores for reading and math are the lowest they have been in decades; in the last recorded school year, more than 2.7 million students received an out-of-school suspension at least once,¬¬ while over 100,000 were expelled; schools, experiencing the residual effects of the pandemic, are seeing record high rates of absenteeism across all demographic groups––potentially related to the sharp rise in depression and anxiety diagnoses among children nationwide; and, the looming teacher shortage has been exacerbated by a shrinking pool of substitutes, nurses, and school social workers. While districts desperately try to navigate the issues above, “parents’ rights” groups have made identity (i.e. race, gender, and sexual orientation) the focal point of their crusade. Their rhetoric against race-conscious and transgender-affirming content in schools notably omits students who are targeted based on their race, gender, and sexual orientation on school campuses. In my paper, I hypothesize that a movement to ban library materials and censor curricular content has forced school boards to spend valuable time on issues that align with “parents’ rights” values, which I deem “political,” and away from addressing the aforementioned crises, which I deem “constructive.” By measuring the number of constructive and political comments from board meetings in three districts with a large “parents’ rights” activist presence––and comparing trends before and after the rise of such activism––this paper demonstrates how the Parents’ Rights Movement has hindered school districts’ ability to properly function.Item Open Access The Prevalence of School Resource Officers in North Carolina's Public Schools(2021-05-03) Dukes, KatieNo one knows how many of North Carolina’s public schools have school resource officers (SROs) assigned to them or the impact their presence has on students. For the last decade, policymakers have expanded funding and support for increasing the presence of SROs statewide, yet the state’s Department of Public Instruction does not collect information about SRO assignment from school districts. To address this crucial data need, this report assesses the prevalence of SROs in North Carolina and analyzes it based on school characteristics. To determine which schools had SROs assigned on a full-time, part-time, or rotating basis, I contacted every school district in the state. With 95 of 115 districts responding, I estimated the percentage of schools with SROs and the percentage of the state’s students attending those schools. I also estimated the prevalence of SROs based on schools’ racial demographics, rates of economic disadvantage and chronic absenteeism, and school level (elementary, middle, high). Approximately 79 percent of schools — serving 84 percent of North Carolina’s students — have SROs assigned on at least a rotating basis. It can be said with certainty that between 62 and 84 percent schools — serving between 66 and 87 percent of students — have SROs. Almost all middle and high schools have SROs assigned, along with two-thirds of elementary schools. SROs appear to be more prevalent at majority white schools and schools with high rates of chronic absenteeism than at majority non-white schools and schools with low chronic absenteeism. SRO prevalence is similar at schools with high and low rates of economic disadvantage. Determining the prevalence of SROs statewide is the first step in determining the impact of their presence on students. Existing empirical evidence suggests the presence of SROs does not improve middle school safety and increases the criminalization of student behavior, contributing to the school-to-prison pipeline. Stakeholders should use this report as a starting point to evaluate whether this holds true for all of North Carolina’s students, informing decisions about whether to add or remove SROs from the state’s public schools.Item Open Access Understanding Heterogeneity in the Impact of Public Preschool Programs.(Monographs of the Society for Research in Child Development, 2023-06) Watts, Tyler W; Jenkins, Jade M; Dodge, Kenneth A; Carr, Robert C; Sauval, Maria; Bai, Yu; Escueta, Maya; Duer, Jennifer; Ladd, Helen; Muschkin, Clara; Peisner-Feinberg, Ellen; Ananat, ElizabethWe examine the North Carolina Pre-K (NC Pre-K) program to test the hypothesis that observed variation in effects resulting from exposure to the program can be attributed to interactions with other environmental factors that occur before, during, or after the pre-k year. We examine student outcomes in 5th grade and test interaction effects between NC's level of investment in public pre-k and moderating factors. Our main sample includes the population of children born in North Carolina between 1987 and 2005 who later attended a public school in that state, had valid achievement data in 5th grade, and could be matched by administrative record review (n = 1,207,576; 58% White non-Hispanic, 29% Black non-Hispanic, 7% Hispanic, 6% multiracial and Other race/ethnicity). Analyses were based on a natural experiment leveraging variation in county-level funding for NC Pre-K across NC counties during each of the years the state scaled up the program. Exposure to NC Pre-K funding was defined as the per-4-year-old-child state allocation of funds to a county in a year. Regression models included child-level and county-level covariates and county and year fixed effects. Estimates indicate that a child's exposure to higher NC Pre-K funding was positively associated with that child's academic achievement 6 years later. We found no effect on special education placement or grade retention. NC Pre-K funding effects on achievement were positive for all subgroups tested, and statistically significant for most. However, they were larger for children exposed to more disadvantaged environments either before or after the pre-k experience, consistent with a compensatory model where pre-k provides a buffer against the adverse effects of prior negative environmental experiences and protection against the effects of future adverse experiences. In addition, the effect of NC Pre-K funding on achievement remained positive across most environments, supporting an additive effects model. In contrast, few findings supported a dynamic complementarity model. Instrumental variables analyses incorporating a child's NC Pre-K enrollment status indicate that program attendance increased average 5th grade achievement by approximately 20% of a standard deviation, and impacts were largest for children who were Hispanic or whose mothers had less than a high school education. Implications for the future of pre-k scale-up and developmental theory are discussed.