Banning the use of affirmative action in college admissions can harm the health of minority high school students, a new study from the University of Pennsylvania’s Perelman School of Medicine suggests.

The study, published Tuesday in PLOS Medicine, found that in states with a ban, smoking among black, Hispanic, and Native American high school students increased nearly 4 percent after those bans were put in place. Some students continued smoking for years into adulthood.

The bans had no significant effect on white students’ behavior, the study found.

“Educational policies can have these unintended health consequences,” said Atheendar Venkataramani, a co-author of the study and an assistant professor of health policy at Penn. “Social policies really matter for health, and it’s worth talking about.”

Affirmative action in higher education first stirred national debate in the 1960s and ’70s. But it has come to the forefront again in recent years, as Harvard University faces a lawsuit claiming it discriminates against Asian Americans and a widespread college admissions scandal revealed that wealthy parents falsified students’ test scores and paid to get them into elite universities. Both events have rekindled the contentious debate around the fairness of college admissions and how it contributes to rising economic inequality in America.

Venkataramani said the research is not meant to take a stance on affirmative action policy. Rather, its goal is to add health information to a debate that is currently focused on education. “We can’t discuss social policy in a vacuum,” he said.

Atheendar Venkataramani is an assistant professor of medical ethics and health policy at the University of Pennsylvania's Perelman School of Medicine.
Courtesy Atheendar Venkataramani
Atheendar Venkataramani is an assistant professor of medical ethics and health policy at the University of Pennsylvania's Perelman School of Medicine.

The study analyzed 16 years of data from the U.S. National Youth Risk Behavior Survey, which asks high school students how often they drink or smoke. Researchers looked at the answers of students before and after affirmative action bans went into place in nine states: Arizona, California, Florida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington. (Washington lifted its ban this year.)

The authors did not include Asian American students in this study because there was not enough data on their drinking and smoking behaviors.

The researchers found that self-reported rates of smoking went up among minority 11th and 12th graders in the same years that each of those states discussed, passed, and implemented bans. Students also reported increased alcohol use and binge drinking, but the findings for those behaviors didn’t reach statistical significance.

Minority students in states that did not have affirmative action bans did not report an increase in smoking or drinking.

In their analysis, the authors controlled for a number of variables, including differences between states’ socioeconomic and political characteristics, different cigarette and alcohol taxes, and rates of unemployment.

“If I was teaching a methodological course in social sciences, I would use this article as an example of a really well-done study,” said Michael Shwartz, professor emeritus at Boston University’s Questrom School of Business and a deputy editor of Medical Care, a health services research journal.

It’s not possible to say affirmative action bans caused the increase in smoking, Shwartz said, because that would require an experiment in a controlled laboratory setting. But the fact that the researchers controlled for a multitude of variables and ran several different tests increases confidence in their findings, he said.

As with any research, though, the study has its limitations. It can’t say anything about how affirmative action bans in the workplace or other settings might impact health, or what effect bans might have on behaviors other than smoking and drinking. And the research cannot demonstrate whether lifting a ban is linked to less smoking or drinking.

Still, Venkataramani said, the study makes a strong case that “affirmative action policy materially affects the way students live their lives.”

Previous research provides clues as to why that might be the case.

An emerging field of research has shown that experiencing racism can harm the physical and mental health of minorities.

Affirmative action bans are one aspect of maintaining systemic racism, said Camara Phyllis Jones, a senior fellow at Morehouse School of Medicine’s Satcher Health Leadership Institute, and a former president of the American Public Health Association.

When minority youth hear their states are banning race-based affirmative action for college admissions, but not altering preferential admissions for children of alumni or those whose parents make large donations, it sends a clear message, she said.

“The message is: ‘We don’t think there’s genius in your community, and we’re not interested in attracting you to our school,’” Jones said.

Camara Phyllis Jones is a senior fellow at Morehouse School of Medicine's Satcher Health Leadership Institute.
Courtesy Camara Phyllis Jones
Camara Phyllis Jones is a senior fellow at Morehouse School of Medicine's Satcher Health Leadership Institute.

Students can internalize that and start seeing themselves as unworthy or viewing their future as hopeless, which can lead to self-destructive behaviors like smoking and drinking.

“You shouldn’t just focus on if kids are smoking or drinking,” Jones said. “You should ask why. And ‘why’ is never simply answered at the individual level. ‘Why’ has everything to do with the context of their lives.”

Another part of that context is economic opportunity, Venkataramani said.

Research has shown that affirmative action bans lead to fewer minority students entering elite colleges. So when a ban goes into place, some students may think their chances at a good education and successful career are slimmer, he said.

The increased competition for a spot at the top can lead to unhealthy stress-related behaviors in some. Others might decide the benefits of healthy actions are no longer valuable, since their future is bleak anyway.

One way to combat that might be giving students hope about their prospects, Venkataramani said.

A 2011 study found a $1,000 reduction in tuition and fees at two-year colleges in a youth’s state of residence was linked with a decline in the number of sexual partners the youth had, how often they smoked cigarettes, and how often they used marijuana.

Another study that looked at Americans of all ages found an increase in economic opportunity was associated with a 16 percent decline in mortality. The change was largest for black Americans, but a similar theme has been seen among middle-aged white adults. Researchers have suggested that the increasing suicide rate among white men, especially in rural or low-income areas, is linked to concerns that this generation will not be better off than their parents — a reduction in perceived opportunity.

Changing affirmative action policies has effects far beyond education, Venkataramani said. “We can’t ignore that.”