Assessment of Exposure to High-Performing Schools and Risk of Adolescent Substance Use

Abstract

Importance Although school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown. Objective To test whether exposure to high-performing schools reduces risky adolescent health behaviors. Design We used admission lotteries—which mimic random assignment—to estimate the causal effect of school environments on adolescent health. We surveyed 1270 students who applied to high-performing public charter schools in low-income minority communities in Los Angeles. We followed lottery “winners” (Intervention) and “losers” (Control) from the end of 8th grade/beginning of 9th grade through the end of 11th grade. Intent-to-Treat (ITT) and Instrumental Variables (IV) techniques estimate the effects of “winning” the lottery and attending high-performing schools on health behaviors and whether effects varied by gender. Setting: Charter and non-charter public high schools in Los Angeles. Participants: Students applying to one of the 5 public charter schools in Los Angeles where the majority enrolled were economically disadvantaged, the school’s academic performance ranked in the top tertile of LA County public high schools, there were at least 50 more applicants than seats available, and they used an admissions lottery. Main Outcomes and Measures: Primary outcomes were 30-day marijuana use and high-risk marijuana use. Additional health outcomes included 30-day alcohol use, alcohol misuse, ever being in a fight, ever having sex and past year delinquency. We also examined potential intermediate factors (time studying, truancy, school mobility, school culture, school order, teacher support, and proportion of substance using peers in students’ social networks). Results Intent-to-treat analysis showed that lottery “winners” (n=694) reported less marijuana misuse than loterry “losers” (n=576), as well as fewer substance using peers, more time studying, less truancy, greater teacher support, more orderly schools, and less school mobility(all p<0.05). Stratified analyses suggest more consistent effects for boys with treatment effects noted as early as 9th grade. Conclusions and Relevance This natural experiment provides evidence that school environments can improve risky behaviors for low-income minority adolescents.

Sex‐Related Differences in Adolescent Cannabis Use: Influences of School Context and School Connectedness

“…Our findings are congruent with previous studies showing that attachment to a group influences the effect of sex on deviant behavior 9,34 . They also support previous research observing that girls' risk of substance use is more influenced by school‐related social factors than is that of boys, 14,15,35,36 although this was not found in all studies 37,38 . This heterogeneity of findings could potentially be explained by how school connectedness is measured, individually and globally, and what substances were studied.…”

The Social Economics of Adolescent Behavior and Measuring the Behavioral Culture of Schools

“…(Cullen et al 2006;Sanbonmatsu et al 2006) Procedure For this study, we analyzed data from the Reducing Inequities through Social and Educational change follow-up (RISE Up) Study, which is a longitudinal natural experimental study that was originally designed to examine the impact of attending a high performing public school on risky health behaviors. Additional details of the original study design and sampling are provided elsewhere (Dudovitz et al 2018;Guerrero et al 2016). The human subjects research review board approved all research activities (IRB#16-001512).…”

College affirmative action bans and smoking and alcohol use among underrepresented minority adolescents in the United States: A difference-in-differences study

“…On the one hand, bans could induce students to attempt to maximize their admission probabilities [24] by engaging in fewer health risk behaviors. On the other hand, bans may intensify exposure to academic stress [25,26] or demoralize adolescents faced with competition they perceive to be insurmountable [27,28], either of which could increase their risk of engaging in health risk behaviors. Adolescent health risk behavior may be particularly sensitive to these mechanisms, given that adolescence is a critical developmental period for forming, and acting on, beliefs about society and about the future [29–31].…”