Opportunity for Health

College Affirmative Action Bans and Smoking and Alcohol Use Among Underrepresented Minority Adolescents: A Difference-in-Differences Study

Atheendar S. Venkataramani, MD, PhD · Alexander C. Tsai, MD, PhD · Rourke L. O’Brien, PhD · Erin Cook · Ichiro Kawachi · Anupam B. Jena
PLOS Medicine · June 27, 2019


College affirmative action programs seek to expand socioeconomic opportunities for under- represented 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 findings

We 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 smok- ing 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, Flor- ida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington) versus out- comes 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 underrepre- sented 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). Under- represented 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 num- ber of additional specification checks. The limitations of the study include the continued poten- tial 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.


In this study, we found evidence that some health risk behaviors increased among under- represented 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.