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Pediatrics. 2014 Aug;134(2):e389-96. doi: 10.1542/peds.2013-3573.

Successful schools and risky behaviors among low-income adolescents.

Author information

  • 1University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
  • 2University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
  • 3RAND Corporation, Santa Monica, California;
  • 4Act, Inc, Iowa City, Iowa; and.
  • 5Teachers College, Columbia University, New York, New York.



We examined whether exposure to high-performing schools reduces the rates of risky health behaviors among low-income minority adolescents and whether this is due to better academic performance, peer influence, or other factors.


By using a natural experimental study design, we used the random admissions lottery into high-performing public charter high schools in low-income Los Angeles neighborhoods to determine whether exposure to successful school environments leads to fewer risky (eg, alcohol, tobacco, drug use, unprotected sex) and very risky health behaviors (e.g., binge drinking, substance use at school, risky sex, gang participation). We surveyed 521 ninth- through twelfth-grade students who were offered admission through a random lottery (intervention group) and 409 students who were not offered admission (control group) about their health behaviors and obtained their state-standardized test scores.


The intervention and control groups had similar demographic characteristics and eighth-grade test scores. Being offered admission to a high-performing school (intervention effect) led to improved math (P < .001) and English (P = .04) standard test scores, greater school retention (91% vs. 76%; P < .001), and lower rates of engaging in ≥1 very risky behaviors (odds ratio = 0.73, P < .05) but no difference in risky behaviors, such as any recent use of alcohol, tobacco, or drugs. School retention and test scores explained 58.0% and 16.2% of the intervention effect on engagement in very risky behaviors, respectively.


Increasing performance of public schools in low-income communities may be a powerful mechanism to decrease very risky health behaviors among low-income adolescents and to decrease health disparities across the life span.

Copyright © 2014 by the American Academy of Pediatrics.


disparities; education; risk-taking behavior

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[Available on 2015-08-01]
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