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Apparent increase in tobacco smoking in minority teens after college affirmative action bans


Self-reported rates of cigarette smoking increased in minority 11th and 12th graders after affirmative action bans were implemented in their state, according to a new study published this week in PLOS Medicine by Atheendar Venkataramani of the University of Pennsylvania, and colleagues.

Between 1996 and 2013, nine US states banned race-based affirmative action in college admissions. In the new study, researchers used data from the 1991-2015 US National Youth Risk Behavior Survey to investigate health behaviors, comparing changes in self-reported cigarette and alcohol use among students residing in states implementing such bans and those residing in states without bans. The dataset included information on more than 35,000 high school students.

Rates of cigarette smoking in the 30 days prior to the survey apparently increased by 3.8 percentage points in under-represented minority students after affirmative action bans were enacted (95% CI 2.0-5.7; p<0.001), but there was no change in smoking in non-Hispanic White students. There were also apparent increases in rates of past-month alcohol use, by 5.9 percentage points (95% CI 0.3-12.2; p=0.041), and of past-month binge drinking, by 3.5 percentage points (95% CI -0.1-7.2; p=0.058) in minority students, but null findings could not be ruled out after adjustment for multiple statistical comparisons. In a separate dataset of 71,000 minority young adults aged 19-30 years old, the researchers found that those who were 16 years old at the time of an affirmative action ban were 1.8 percentage points more likely to report current smoking (95% CI 0.1-3.6; p=0.037).

"Our study suggests that ongoing efforts to ban affirmative action programs in college admissions may have unanticipated adverse effects on health risk behaviors and health status within under-represented minority populations," the authors say. "In doing so, they may exacerbate short- and long-run disparities in health outcomes." The authors also note that their results, more generally, illustrate the importance of policies that shift socioeconomic opportunities as a key determinant of health.


Research Article


This project was supported by a grant from the Robert Wood Johnson Foundation, Evidence for Action Program (MPI: ASV and ACT; Grant Number: 74424): The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests: ABJ reports receiving consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, and Analysis Group. ACT receives a stipend as a Specialty Consulting Editor for PLOS Medicine and serves on the journal's Editorial Board.


Venkataramani AS, Cook E, O'Brien RL, Kawachi I, Jena AB, Tsai AC (2019) College affirmative action bans and smoking and alcohol use among underrepresented minority adolescents in the United States: A difference-in-differences study. PLoS Med 16(6): e1002821.

Image Credit: rawpixel, Pixabay

Author Affiliations:

Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Analysis Group, Boston, Massachusetts, United States of America
La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America

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