Is it possible that attending a high-performing school may help young people live healthier lives? An intriguing new paper from the American Medical Association’s JAMA Network open access journal says yes, though with some important caveats. A research team lead by Dr. Mitchell Wong from UCLA followed more than 1,000 students for six years—through high school and beyond—and surveyed them annually on issues such as substance use, delinquency, and physical and mental health. Those who attended a high-performing charter school generally reported far fewer injurious behaviors and negative health outcomes than similar peers, with one major exception.
Dr. Wong and his team leveraged the natural experiment created by lottery-only admission at five charter schools in Los Angeles. These schools were chosen because they were among the thirty highest-performing high schools in the city, served predominantly low-income students, and reported at least fifty more applicants than available spots at the start of the project in October 2012. The initial treatment group consisted of 694 students who won spots via lottery to start ninth grade at one of the five schools; the control group consisted of 576 students who were not offered spots. (Students who were admitted on the basis of sibling preference and those who moved out of Los Angeles County were excluded.) Slightly more than half the sample was female, and nearly 90 percent was Hispanic. Treatment and control groups were nearly identical at the start, including eighth grade GPA (approximately 70 percent in each group had earned a C or better), eighth grade test scores (more than half of each group scored proficient in math and English), and family structure (more than 83 percent reported two-parent families and an “average” parenting style—somewhere between “authoritative” and “neglectful”).
Students in the study were surveyed annually between March 2013 and November 2021. That is, from the end of eighth grade through high school completion and up to age twenty-one. Surveys prior to graduation were conducted in person; subsequent surveys were conducted in person or over the phone. The outcomes of interest were self-reported and included patterns of alcohol and cannabis use, physical and mental health, delinquent behaviors, and body mass index (BMI).
Participants who attended a high-performing charter school had a 53.3 percent lower rate of hazardous or dependent alcohol use disorder at age twenty-one, compared with those in the control group. Among male participants, the intervention group had a 42.1 percent lower rate of self-reported fair or poor physical health at age twenty-one and a 32.9 percent lower rate of obesity or overweight status as measured via BMI. Among female participants, however, the results were opposite. Girls who attended a high-performing charter reported a 16.8 higher rate of fair or poor physical health at age twenty-one than their non-charter peers, and a 19.3 percent higher rate of overweight or obesity status.
Differences in cannabis misuse were significantly lower for both males and females in the treatment group in the early years of the survey, but showed no statistical difference by twenty-one. The proportion of participants who reported engaging in one or more delinquent behaviors (such as graffiti, damaging property, shoplifting or stealing, driving a car without the owner’s permission, burglary, selling illicit drugs, or gang activity) was significantly lower for treatment group students at ages twenty and twenty-one than for their comparison peers; however, the two groups were generally similar in reported delinquent behaviors in all earlier surveys. Few differences in mental health outcomes were reported at any point. Adjusting for educational outcomes—such as actual graduation versus dropping out—did not significantly change the findings. The research team notes the limitations of self-reported data and the potential for social-desirability bias in students’ responses, although they are able to partially compensate in their modeling and by comparing other relevant research that does not use self-reported responses.
Overall, the news is good. Lowering the rates of delinquent behaviors and misuse of alcohol and cannabis among young people is hugely positive, especially in low-income communities. And the positive influence of a high-performing school on young men’s physical health is a welcome addition.
Dr. Wong and his team speculate as to the mechanisms by which attendance at a high-performing charter school would lead to these results—more adult monitoring of student behavior due to smaller school size, favorable staffing configuration, exposure to peers focused on academics and not risky behaviors, but also with the possibility of higher academic stressors detracting from young women’s physical health—but do not have data to really lock anything down. Family structure could be part of the equation, as well. While schools cannot and should not be charged with solving all societal ills, it is possible that simply engaging in more and more rigorous academic work during high school can help students focus on learning and the future while ignoring some of the more pernicious negative influences around them.
SOURCE: Mitchell D. Wong, MD, et al., “Association of Attending a High-Performing High School With Substance Use Disorder Rate and Health Outcomes in Young Adults,” JAMA Network Open (October 2022).
