Study: Students at High-Achieving Public Charter School Have Lower Rates of Substance Use Disorder, Better Health Outcomes

Male students admitted into a high-performing public charter school found to have better physical health and lower body mass index than their female counterparts.

Attending a high-performance public charter school was found to be associated with lower rates of substance use disorder and an improved range of health and behavior outcomes; however, better academic achievement was not associated with these outcomes, according to a study published in JAMA Network Open.

At the high-performing public charter schools, male students reported better physical health and lower body mass index (BMI), whereas female patients self-reported having worse physical outcomes in young adulthood.

“Schools are a potent social determinant of health and an important target for future health interventions,” the study authors wrote. “School is an everyday part of almost every child’s life, and it starts fortuitously at an early life stage when its long-term role in health trajectories can be shaped.”

Previous studies have observed associations between poverty, health and well-being, and childhood education with improved health outcomes. However, researchers identified a deficit in studies examining the association between improved health outcomes from better education.

Due to this lack of evidence, researchers conducted the Reducing Inequities Through Social and Educational Change Follow-up (RISE-Up) Study in Los Angeles. The study looked at students from low-income neighborhoods who attended high-performing public charter high schools.

The current study evaluated the longer-term results of the RISE-up study in students, now age 21. Researchers looked specifically at the association between attending high-performing public charter high schools and rates of substance use disorder, physical, and mental health.

Students in the intervention group were selected from a lottery to attend the charter high school, and the control group consisted of wait-listed students. Students were surveyed until they reached 21 years of age, 3 years after graduating from high school.

Overall, the risk of abuse for certain substances was observed to be 53.33% lower among those in the high-performing public charter high school compared to those who were not. This was independent of academics, however.

“We found that attending a high-performing high school was associated with substantial benefits across several health and behavioral outcomes. Specifically, we observed lower rates of hazardous or dependent AUD, cannabis misuse, and delinquent behaviors,” study authors said in the report.

Male students in the intervention group self-reported higher rates of better health and a 32.94% lower rate of obesity than the control.

Female participants reported the opposite. Females in the intervention group had a 2-fold higher percentage that reported worse physical health outcomes, and 19.30% reported higher rates of overweight and obesity by age 21 compared to the control group.

Limitations of this study include use of self-reported data that may lead to social desirability bias, and inconsistent attendance among control participants may skew health estimations. Additionally, findings cannot be generalized to students enrolled in a traditional high school, and researchers also did not analyze all types of school performance metrics.

Researchers suggest that this educational model may “play a role in reducing the rates of substance use disorder and, for male students, reducing incidence of obesity or overweight, 2 substantial and intransigent public health problems.” However, they suggest more research into adverse physical effects on females.

In general, “improving schools is a potentially effective and scalable strategy to improve health,” the study authors wrote in the report.


Wong, Mitchell, Meza, Benjamin, Dosanjh, Kulwant, et al. Association of Attending a High-Performing High School With Substance Use Disorder Rate and Health Outcomes in Young Adults. JAMA Netw Open. 2022;5(10):e2235083. doi:10.1001/jamanetworkopen.2022.35083