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

Date Published: June 18, 2019

Publisher: Public Library of Science

Author(s): Atheendar S. Venkataramani, Erin Cook, Rourke L. O’Brien, Ichiro Kawachi, Anupam B. Jena, Alexander C. Tsai, Sanjay Basu

Abstract: BackgroundCollege affirmative action programs seek to expand socioeconomic opportunities for underrepresented minorities. Between 1996 and 2013, 9 US states—including California, Texas, and Michigan—banned race-based affirmative action in college admissions. Because economic opportunity is known to motivate health behavior, banning affirmative action policies may have important adverse spillover effects on health risk behaviors. We used a quasi-experimental research design to evaluate the association between college affirmative action bans and health risk behaviors among underrepresented minority (Black, Hispanic, and Native American) adolescents.Methods and findingsWe conducted a difference-in-differences analysis using data from the 1991–2015 US national Youth Risk Behavior Survey (YRBS). We compared changes in self-reported cigarette smoking and alcohol use in the 30 days prior to survey among underrepresented minority 11th and 12th graders in states implementing college affirmative action bans (Arizona, California, Florida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington) versus outcomes among those residing in states not implementing bans (n = 35 control states). We also assessed whether underrepresented minority adults surveyed in the 1992–2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who were exposed to affirmative action bans during their late high school years continued to smoke cigarettes between the ages of 19 and 30 years. Models adjusted for individual demographic characteristics, state and year fixed effects, and state-specific secular trends. In the YRBS (n = 34,988 to 36,268, depending on the outcome), cigarette smoking in the past 30 days among underrepresented minority 11th–12th graders increased by 3.8 percentage points after exposure to an affirmative action ban (95% CI: 2.0, 5.7; p < 0.001). In addition, there were also apparent increases in past-30-day alcohol use, by 5.9 percentage points (95% CI: 0.3, 12.2; p = 0.041), and past-30-day binge drinking, by 3.5 percentage points (95% CI: −0.1, 7.2, p = 0.058), among underrepresented minority 11th–12th graders, though in both cases adjustment for multiple comparisons resulted in failure to reject the null hypothesis (adjusted p = 0.083 for both outcomes). Underrepresented minority adults in the TUS-CPS (n = 71,575) exposed to bans during their late high school years were also 1.8 percentage points more likely to report current smoking (95% CI: 0.1, 3.6; p = 0.037). Event study analyses revealed a discrete break for all health behaviors timed with policy discussion and implementation. No substantive or statistically significant effects were found for non-Hispanic White adolescents, and the findings were robust to a number of additional specification checks. The limitations of the study include the continued potential for residual confounding from unmeasured time-varying factors and the potential for recall bias due to the self-reported nature of the health risk behavior outcomes.ConclusionsIn this study, we found evidence that some health risk behaviors increased among underrepresented minority adolescents after exposure to state-level college affirmative action bans. These findings suggest that social policies that shift socioeconomic opportunities could have meaningful population health consequences.

Partial Text: Socioeconomic factors have long been recognized as critical determinants of individual and population health [1–4]. In this vein, recent work has demonstrated a robust link between access to economic opportunities, health behaviors, and health outcomes [5–9]. Public policies that influence socioeconomic opportunities may have profound effects on health risk behaviors among adolescents [10], particularly those belonging to underrepresented minority groups (i.e., racial and ethnic minorities that are underrepresented in higher education), who face both elevated risks of morbidity and mortality [11] and restricted prospects for upward economic mobility [12].

Institutional review board approval for this study was not required per University of Pennsylvania policy given the use of publicly available, deidentified data. This study did not have a prespecified analysis plan, but specification of all outcomes and exposures, the estimation sample, and statistical analyses were based on ex ante hypotheses (see S1 Appendix for further details). The datasets and code used for this project are posted at Harvard Dataverse (

In this nationally representative study of US adolescents, we found that rates of cigarette smoking among underrepresented minority adolescents increased after exposure to affirmative action bans. Concern about these acute and contemporaneous adverse effects was corroborated and further magnified by our finding, in a separate dataset, that the apparent effects of affirmative action bans on smoking persisted into young adulthood. We also found evidence of apparent increases in alcohol use and binge drinking after exposure to affirmative action bans, though the estimates did not remain statistically significant at conventional thresholds after adjustment for multiple comparisons. As expected, we found no evidence of changes in health risk behaviors after affirmative action bans in our falsification sample of non-Hispanic White individuals, and results were robust to several other specification checks designed to probe the key causal identification assumptions of our difference-in-differences model.



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