Research Questions

  1. Does exposure to high-performing schools reduce the rates of risky health behaviors among low-income minority adolescents?
  2. If so, is this due to better academic performance, peer influence, or other factors?


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 (eg, 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.

Key Findings

Successful Public Charter High Schools in Low-Income Neighborhoods Might Have Early Beneficial Health and Other Effects

  • Improvements included better standardized test scores and fewer dropouts and transfers.
  • Rates of engagement in very risky behaviors were lower, such as drinking at school, gang participation, and use of alcohol or drugs with sex.

The Same Cannot Be Said for Less Risky Health Behaviors, Such as the Use of Tobacco, Alcohol, or Marijuana

  • For example, while the use of tobacco was slightly lower among those in the charter school group, the difference was not statistically significant.

A Variety of Factors May Contribute to the Improvements

  • Improving cognitive skills may improve health outcomes by improving health knowledge and decisionmaking.
  • The school environment may play a role by reducing exposure to “risky” peers but also by improving persistence, resilience, and other noncognitive skills.
  • Better academic achievement may improve student's outlook for the future.
  • Simply being in a demanding school may leave less time and opportunity to engage in risky behaviors.

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