title: Successful schools and risky behaviors among low-income adolescents.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 (e.g., 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California; mitchellwong@mednet.ucla.edu.
authors: Mitchell D
authors: MD
authors: Wong
authors: University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
authors: Karen M
authors: KM
authors: Coller
authors: University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
authors: Rebecca N
authors: RN
authors: Dudovitz
authors: RAND Corporation, Santa Monica, California;
authors: David P
authors: DP
authors: Kennedy
authors: Act, Inc, Iowa City, Iowa; and.
authors: Richard
authors: R
authors: Buddin
authors: University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
authors: Martin F
authors: MF
authors: Shapiro
authors: University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
authors: Sheryl H
authors: SH
authors: Kataoka
authors: University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
authors: Arleen F
authors: AF
authors: Brown
authors: University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
authors: Chi-Hong
authors: CH
authors: Tseng
authors: Teachers College, Columbia University, New York, New York.
authors: Peter
authors: P
authors: Bergman
authors: University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California;
authors: Paul J
authors: PJ
authors: Chung
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology*; D015438:Health Behavior; D006801:Humans; D057194:Intention to Treat Analysis; D008385:Marijuana Smoking / Q000453:epidemiology*; D011203:Poverty; D012309:Risk-Taking; D012574:Schools; D012907:Smoking / Q000453:epidemiology*; D013334:Students; D019966:Substance-Related Disorders / Q000453:epidemiology*
keywords: disparities; education; risk-taking behavior