Study Links College Affirmative Action Bans to Smoking Among Minority Youth

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Authors say more work is needed to understand the mechanisms behind their findings.

Banning colleges from making admission decisions based on affirmative action can have many consequences, but a new study from Penn Medicine has uncovered one that may not be obvious.

Would you believe that ending affirmative action can increase smoking?

Findings of the study, which appeared in the journal PLoS Medicine, suggest that when 9 states banned affirmative action for college admissions there were unanticipated effects. These included higher smoking rates among minority high school students affected by the bans, compared with similar teens who lived elsewhere.

The researchers examined data from the 1991-2015 US National Youth Risk Behavior Survey to study health risk behaviors, specifically tobacco and alcohol use, that lasted for more than 30 days for underrepresented minority teens. They compared changing rates of self-reported cigarette smoking or alcohol use among 35,000 youth living in states that banned affirmative action in admissions between 1996 and 2013—including Texas, Florida, Michigan, and California—and states that lack such laws.


The study found that self-reported smoking rates among minority students in 11th and 12th grade rose 3.8 percentage points in the same years each of the affected states discussed and enacted the bans. Although this finding was not statistically significant, the authors separately found—in a different data set—that the apparent effects of the bans on smoking lingered into adulthood.

“We also found evidence of apparent increases in alcohol use and binge drinking after exposure to affirmative action bans, thought the estimates did not remain statistically significant at conventional thresholds after adjustment for multiple comparisons,” they wrote.

Alcohol use rose 5.9% among underrepresented minority youth, and binge drinking rose 3.5%.

The authors say their have 2 key policy implications: First, they suggest that “health behaviors respond to changes in socioeconomic opportunities driven by changes in social policy.”

“Our findings provide rare evidence supporting new hypotheses about the importance of economic opportunity for population health,” the authors wrote.

Second, while there has been considerable debate about the effects of affirmative action on educational and economic opportunities, the effects on health have not been well studied—but perhaps merit more attention.

“We know that affirmative action bans reduce the likelihood of underrepresented high school students being admitted to selective colleges,” the study’s lead author, Atheendar Venkataramani, MD, PhD, assistant professor of Medicine and Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania, said in a statement. “What this study shows us is that reducing their chances to attend a top college—and potentially undermining their expectations of upward mobility, more generally—may also increase their risk of engaging in unhealthy behaviors, such as smoking or excessive alcohol use.”

The authors say that while the underlying mechanisms behind their findings merit more study, they did find several possible factors at work: Affirmative action bans serve as a signal to minority youth that they are less valued and that structural racism is not going away. Increased competition for limited slots also adds to stress, they said.

“The findings align with a growing evidence base that social policy is health policy,” senior author Alexander C. Tsai, MD, PhD, associate professor of psychiatry at Massachusetts General Hospital and Harvard Medical School, said in the statement.


Venkataramani AS, Cook E, O’Brien Rl, Kawachi I, Jena AB, Tsai AC. College affirmative action bans and smoking and alcohol use among underrepresented minority adolescents in the United States: a difference-in-differences study [published online July 18, 2019]. PLoS Med. doi: 10.1371/journal.pmed.1002821.