Enrollment Gap Research Articles

Medicaid and newborn care: challenges and opportunities.

Since its creation in 1965, Medicaid has operated as a federal-state partnership that provides a robust set of medical benefits to low-income families, including pregnant people and infants. In many ways, Medicaid has met its initial promise. However, medical benefits, provider payments, and key administrative procedures regarding eligibility, enrollment, and access to care vary substantially among state Medicaid programs. These variations have created profound inequities across states in the care of parents and children, particularly during pregnancy and in the postpartum and neonatal periods. Here we review select aspects of the Medicaid program pertinent to newborns and infants that contribute to eligibility and enrollment gaps, variations in benefits coverage and payment rates, and racial disparities in both access to healthcare and infant health outcomes. We outline a number of structural reforms of the Medicaid program that can improve newborn and infant access to care and outcomes and redress existing inequities.

The Impact of Free Primary Education in Kenya

In 2003, Kenya initiated free primary education, receiving mixed public opinions. Despite numerous studies, the program's impact on schools of different socioeconomic backgrounds remains understudied. This study aims to understand the effects of Kenya's free primary education on various schools. Using data from the Harvard Dataverse and World Bank, it evaluates factors like enrollment rates, education quality, and government expenditure. The data reveals a significant rise in enrollment rates, particularly among historically underrepresented groups. However, the implications for education quality are mixed. While the gender gap in enrollment has decreased, challenges in maintaining educational quality persist. Enhancing education quality requires investments in teacher training, resources, and infrastructure. For continued progress, sustained government funding is essential

Explaining Course Enrollment Gaps in High School: Examination of Gender-Imbalance in the Applied Sciences

Federal policy in the United States has urged high schools to expand offerings in career and technical education (CTE) coursework to address persistent gender inequities in science, technology, engineering, mathematics, and medical (STEMM) fields. Unfortunately, gender composition in engineering and health sciences CTE enrollment is highly imbalanced and reflects postsecondary and labor market trends. Using data from the High School Longitudinal Study of 2009, we use decomposition techniques to examine which student, family, and school factors explain gender-imbalanced enrollment in STEMM-focused CTE courses. The results indicate student occupational expectations were the largest contributor to gender gaps across content areas.

Reconsidering Rural-Nonrural College Enrollment Gaps: The Role of Socioeconomic Status in Geographies of Opportunity.

The online version contains supplementary material available at 10.1007/s11162-023-09737-8 .

Wealth Status and Health Insurance Enrollment in India: An Empirical Analysis.

Since 2005, health insurance (HI) coverage in India has significantly increased, largely because of the introduction of government-funded pro-poor insurance programs. As a result, the determinants of HI enrollment and their relative importance may have changed. Using National Family Health Survey (NFHS)-4 data, collected in 2015-2016, and employing a Probit regression model, we re-examine the determinants of household HI enrollment. Then, using a multinomial logistic regression model, we estimate the relative risk ratio for enrollment in different HI schemes. In comparison to the results on the determinants of HI enrollment using the NFHS data collected in 2005-2006, we find a decrease in the wealth gap in public HI enrollment. Nonetheless, disparities in enrollment remain, with some changes in those patterns. Households with low assets have lower enrollments in private and community-based health insurance (CBHI) programs. Households with a higher number of dependents have a higher likelihood of HI enrollment, especially in rural areas. In rural areas, poor Scheduled Caste and Scheduled Tribe households are more likely to be enrolled in public HI than the general Caste households. In urban areas, Muslim households have a lower likelihood of enrollment in any HI. The educational attainment of household heads is positively associated with enrollment in private HI, but it is negatively associated with enrollment in public HI. Since 2005-2006, while HI coverage has improved, disparities across social groups remain.

The effect of the pandemic on the transition to tertiary education in Chile: A focus on students with disabilities

Using a rich set of administrative data, we study the effect of the COVID-19 pandemic on the transition to tertiary education for students with disabilities in Chile. Enrollment rates in primary and secondary education in Chile differ by less than 2 percentage points for students with or without disabilities, but there is an approximately 17 percentage point gap in enrollment in tertiary education. Our difference in differences analysis finds that the pandemic significantly decreased the probability of students with disabilities taking the admission test to tertiary education and enrolling in high-quality tertiary institutions, increasing the inequality in tertiary education. While the pandemic affected the transition to higher education for all students in Chile, students with disabilities were more adversely affected. Understanding how the pandemic has affected opportunities for students with disabilities is critical for informing policies of inclusion.

Disparity in high school enrollment between native and immigrant children in Japan

AbstractUsing nonlinear decomposition, this study examines the gap in high school enrollment between native and immigrant children based on data from the 2010 Population Census. The school attendance probability of immigrant children is significantly lower than that of native children. Factors contributing to the gap are the length of stay in Japan, parental employment status, and home ownership. The total explained part of all observable factors is approximately 30% in the comparison between native and immigrant children whose parents are both foreigners. Furthermore, immigrant children who do not attend high school are more likely to be unemployed.

Cycling for Education? Heterogeneous Preferences for Academic Tracks at Secondary School

Using a unique data set from the Netherlands, I estimate a discrete choice demand model under congestion effects to recover preferences for secondary school tracks between parents with different socioeconomic status (SES) but equally proficient children. I find that highly educated parents are willing to let their offspring commute longer distances to attend tracks that grant direct admission to university. Valuation heterogeneity for such options explains more than half of the observed enrollment gap between students from different SES divides. These results suggest that low-SES children sort into academic tracks with lower economic prospects, even in schooling systems with negligible choice restrictions.

Themed section introduction: Emerging research on racial/ethnic inequality in Canada.

Themed section introduction: Emerging research on racial/ethnic inequality in Canada.

A Glass Ceiling at the Playhouse? Gender Gaps in Public and Private Preschool Enrollment in India

A Glass Ceiling at the Playhouse? Gender Gaps in Public and Private Preschool Enrollment in India

Student Mobility between Charter and Traditional Public School Sectors: Assessing Enrollment Patterns among Major Charter Management Organizations in Texas

Student enrollment and transfer patterns between the traditional public and charter school sectors help shape the role of charter schools in the broader educational ecosystem, especially as related to the enrollment and segregation of low-income students, English learners, students of color, and students in special education. We examine patterns of student transfer between traditional public schools and charter schools among four of Texas’s largest charter networks, which cumulatively make up over one-third of Texas charter students. We find that these schools serve fewer special education students than traditional public schools, but a greater share of low-income and English learners. Transfers between sectors contribute to enrollment gaps in special education and other classifications, but the findings do not apply uniformly across charter districts, student enrollment classifications, or grade levels. These findings highlight nuanced enrollment patterns between the charter sector and traditional public schools, suggesting that differences in student characteristics between sectors likely stem from a range of sources. Policymakers should acknowledge this nuance, consider alternatives to blanket enrollment regulation policies, and conduct similar analyses of enrollment patterns among charter districts.

Latina/o Postsecondary Education: Trends in Racial/Ethnic Education Gaps and the Role of Citizenship in Access to Higher Education.

Black-Latina/o and White-Latina/o bachelor's degree gaps persist in the United States despite substantial increases in Latina/o educational attainment since the late 1950s. The Latina/o population has grown rapidly in recent decades and currently comprises more than 20% of the U.S. population; however, barriers to citizenship have grown in tandem and have limited access to higher education. Using data from the U.S. Census (1950-2010) and the American Community Survey (2015-2017), we examine trends in Black-Latina/o and White-Latina/o college completion gaps and factors that may explain them. We find that college enrollment differences explain the majority of the bachelor's degree gaps. We then decompose enrollment gaps by differences in enrollment by citizenship and find that if the Latina/o population had the same citizenship rate as the White and Black populations, the Black-Latina/o enrollment gaps would effectively disappear and the White-Latina/o enrollment gaps would be reduced by up to 75%. Our findings indicate that the Latina/o population's relatively low college completion rates are partially explained by restricted access to citizenship. The high proportion of Latina/o noncitizens has also masked the considerable educational progress Latina/o citizens have made in recent decades.

Comparative Effectiveness of Empagliflozin vs Liraglutide or Sitagliptin in Older Adults With Diverse Patient Characteristics

Limited evidence is available on the comparative effectiveness of empagliflozin vs alternative second-line glucose-lowering agents in patients with type 2 diabetes (T2D) receiving routine care who have a broad spectrum of cardiorenal risk. To evaluate the association of empagliflozin with cardiovascular outcomes relative to liraglutide and sitagliptin, stratified by age, sex, baseline atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). This retrospective comparative effectiveness cohort study used deidentified Medicare claims data from August 1, 2014, to September 30, 2018, with follow-up from drug initiation until treatment changes, death, or gap in Medicare enrollment (>30 days). Data analysis was performed from October 1, 2021, to April 30, 2022. Medicare fee-for-service beneficiaries older than 65 years with T2D were included. A total of 45 788 patients (22 894 propensity score-matched pairs initiating treatment with either empagliflozin or liraglutide) were included in cohort 1, and 45 624 patients (22 812 propensity score-matched pairs initiating treatment with either empagliflozin or sitagliptin) were included in cohort 2. Empagliflozin vs liraglutide (cohort 1) or empagliflozin vs sitagliptin (cohort 2). Primary outcomes were (1) modified major adverse cardiovascular events (MACEs), including a composite of myocardial infarction, stroke, and all-cause mortality, and (2) hospitalization for heart failure (HHF). Hazard ratios (HRs) and rate differences (RDs) per 1000 person-years were estimated, adjusting for 143 baseline covariates using 1:1 propensity score matching. Among 45 788 patients in cohort 1, the mean (SD) age was 71.9 (5.1) years; 23 396 patients (51.1%) were female, 22 392 (48.9%) were male, and 38 049 (83.1%) were White. Among 45 624 patients in cohort 2, the mean (SD) age was 72.1 (5.1) years; 21 418 patients (46.9%) were female, 24 206 (53.1%) were male, and 37 814 (82.9%) were White. Relative to patients initiating liraglutide, those initiating empagliflozin had a similar risk of the modified MACE outcome (HR, 0.90; 95% CI, 0.79-1.03) and a reduced risk of HHF (HR, 0.66; 95% CI, 0.52-0.82). Across subgroups, empagliflozin was associated with a lower risk of the modified MACE outcome in patients with a history of ASCVD (HR, 0.83; 95% CI, 0.71-0.98) and HF (HR, 0.77; 95% CI, 0.60-1.00) compared with liraglutide, and potential heterogeneity in estimates was observed by sex (male: HR, 0.85 [95% CI, 0.71-1.01]; female: HR, 1.16 [95% CI, 0.94-1.42]; P = .02 for homogeneity). However, reductions in the risk of HHF were observed across most subgroups (eg, ASCVD: HR, 0.66 [95% CI, 0.51-0.85]; HF: HR, 0.66 [95% CI, 0.49-0.88]). Compared with sitagliptin, empagliflozin was associated with reduced risks of the modified MACE outcome (HR, 0.68; 95% CI, 0.60-0.77) and HHF (HR, 0.45; 95% CI, 0.36-0.56), which were consistent across all subgroups. Absolute benefits of empagliflozin vs sitagliptin were larger in patients with a history of ASCVD (modified MACE: RD, -17.6 [95% CI, -24.9 to -10.4]; HHF: RD, -16.7 [95% CI, -21.7 to -11.9]), HF (modified MACE: RD, -41.1 [95% CI, -59.9 to -22.6]; HHF: RD, -50.4 [95% CI, -67.5 to -33.9]), or CKD (modified MACE: RD, -26.7 [95% CI, -41.3 to -12.3]; HHF: RD, -31.9 [95% CI, -43.5 to -20.8]). In this comparative effectiveness study of older adults, empagliflozin was associated with a lower risk of HHF (relative to both liraglutide and sitagliptin) and the modified MACE outcome (relative to sitagliptin), with larger absolute benefits in patients with established cardiorenal diseases. These findings suggest that older adults with T2D might benefit more from empagliflozin vs liraglutide or sitagliptin with respect to the risk of HHF; with respect to the risk of MACEs, empagliflozin might be preferable to liraglutide only in patients with cardiovascular disease history and to sitagliptin across all patient subgroups.

Aiming too high or scoring too low? Heterogeneous immigrant–native gaps in upper secondary enrollment and outcomes beyond the transition in France

Abstract The children of immigrants usually make more ambitious enrolment choices than native students with comparable socioeconomic status and academic achievement. Less is known about how ethnic choice effects vary by socioeconomic status and previous achievement simultaneously, and whether they only hold true for some immigrant–native comparisons. Moreover, few studies investigate outcomes after the educational transition, so the consequences of ambitious choices remain unclear. I investigate immigrant–native gaps in the decision to enroll in academic upper secondary education and in outcomes after the transition for two cohorts of French students. I find that ethnic choice effects are positive only for students with an intermediate or working class background, and are largest for those with lower to middle achievement from the working class. Migrant disadvantages in outcomes after the transition were reduced between cohorts. In the latest cohort, immigrant-origin and native students enrolled in academic upper secondary were equally likely to complete the track and enroll in tertiary education. However, immigrant-origin students were still disadvantaged in terms of graduation track, grades, and timing. Using counterfactual reweighting strategies, I show that similar and substantial portions of these disadvantages were explained by the ambitious academic choices and lower prior performance of immigrant-origin students. However, while their ambitious choices also increase enrolment rates and hence overall attainment for immigrant-origin students, their lower prior performance reduces both. I suggest that policies should reduce immigrant disadvantages in early achievement to allow high-aspiring, yet often disadvantaged, immigrant-origin students to succeed in ambitious educational paths.

Patient education intervention to improve diversity in breast cancer clinical trials.

104 Background: Patient education has been shown to improve clinical trial participation. Medically underserved, racial, and ethnic minorities have a lower participation rate in cancer clinical trials (CCT) than patients of high socioeconomic status (SES). Our comprehensive cancer center is notable for providing equal access to breast CCT (BCCT) through a private system (McNair) and a public safety net hospital system, Smith Clinic (SC). Our prior research has shown that SC cancer patients, who are 60% uninsured, predominantly low SES, and >80% racial minorities, are 40% less likely to enroll into BCCT compared to McNair patients who are > 95% insured and largely White. Methods: We developed a 7-minute video with testimonies of our current patients (who are of diverse racial and linguistic backgrounds) about their BCCT experience and testimonies of our research team discussing misconceptions surrounding BCCT and biospecimen collection. The video was designed to be culturally sensitive and used simplified terms in English, Spanish, and Vietnamese. We modified a validated questionnaire by UT Health San Antonio, Institute for Health Promotion Research to assess participants’ attitudes towards CCT participation before and after watching the video. We used a Wilcoxon Signed Rank test to measure the effect of the video on a 5-point Likert scale with 5 indicating “Extremely likely”, 3 “Moderately Likely” and 1 “Not Likely at all”. The primary outcome was a shift in likelihood of participation in a CCT by 1. Other outcomes included assessing the effects of English proficiency, residing in United States (US) for at least 10 years, race, stage of breast cancer diagnosis (high risk vs. early stage vs. metastatic disease) using Chi-squared tests. With 200 survey respondents, the study had 97% power to detect the desired primary outcome. The project was supported by a Pfizer education grant. Results: A total of 200 patients (73 at McNair and 127 at SC) watched the video and completed the surveys. 93 identified as Hispanic, 50 as African American, 14 as Asian, 47 as White, and 7 as other races. The mean pre-intervention score for likelihood of willingness to participate in a CCT was 3.34 (SD 1.45) at McNair and 2.81 (SD 1.28) at SC. The mean post-intervention score was 3.89 (SD 1.28) at McNair and 3.44 (SD 1.22) at SC. While the pre- and post-intervention scores were significantly different across the two sites (p = 0.01 and p = 0.015 respectively), the study did not meet its primary objective. English proficiency, residing in US for at least 10 years, race, and stage of breast cancer diagnosis were not significantly associated with the outcome. Conclusions: Our patient education video did not improve our patients’ willingness to participate in BCCT as much as we had hoped. This suggests that a comprehensive approach is required to improve our community’s engagement and close the disparity gap in BCCT enrollment.

Explaining Caste-Based Disparities in Enrollment for National Health Insurance Program in India: a Decomposition Analysis.

Caste plays a significant role in individual healthcare access and health outcomes in India. Discrimination against low-caste communities contributes to their poverty and poor health outcomes. The Rashtriya Swasthya Bima Yojana (RSBY), a national health insurance program, was created to improve healthcare access for the poor. This study accounts for caste-based disparities in RSBY enrollment in India by decomposing the contributions of relevant factors. Using the data from the 2015-2016 round of the National Family Health Survey, we compare RSBY enrollment rates of low-caste and high-caste households. We use a non-linear extension of Oaxaca-Blinder decomposition and estimate two models by pooling coefficients across the comparison groups and all caste groups. Enrollment differentials are decomposed into individual- and household-level characteristics, media access, and state-level fixed effects, allowing 2000 replications and random ordering of variables. The analysis of 480,766 households show that scheduled tribe households have the highest enrollment (18.85%), followed by 14.13% for scheduled caste, 10.67% for other backward caste, and 9.33% for high caste. Household factors, family head's characteristics, media access, and state-level fixed effects account for a 32% to 52% gap in enrollment. More specifically, the enrollment gaps are attributable to differences in wealth status,educational attainment, residence, family size, dependency ratio, media access, and occupational activities of the households. Weaker socio-economic status of low-caste households explains their high RSBY enrollments.

Equity Gaps in Dual Enrollment

This article examined root causes of the equity gaps in dual enrollment through a systematic literature review of peer-reviewed literature, public scholarship, and practitioner perspectives. Root causes identified include access barriers, lack of advising and support, lack of awareness, and financial barriers for underrepresented students, all of which contribute to lower participation rates for Black and Latinx students when compared with White and Asian students. This article serves to provide community college practitioners with a deep understanding of the factors that contribute to this problem so that they can identify interventions that will address these root causes. Suggestions for mitigating equity gaps in dual enrollment for underrepresented students through the use of targeted messaging campaigns are discussed.

Educational intervention for providers addressing the diversity gap in cervical cancer clinical study participation (579)

Objectives: Every year, over 570,000 women worldwide are diagnosed with cervical cancer. Cervical cancer accounts for 7.5% of female cancer deaths, and 85% of those deaths occur in low- to moderate-income countries. In the US, it is estimated that Black women have a 30% higher incidence of cervical cancer than White women. Additionally, Hispanic women are 40% more likely to be diagnosed with cervical cancer than non-Hispanic women. In 2020, the US Food and Drug Administration issued industry guidance for enhancing the diversity of clinical study participants, highlighting the critical need for representative studies that reflect the current US population demographics. This study aims to conduct an educational intervention aimed at cervical cancer investigators and patients to increase ethnocultural diversity in clinical study recruitment in a cervical cancer research program. Methods: This educational intervention implemented a pre-post study design of clinical investigators participating in both global Phase 2 and Phase 3 cervical cancer studies. The Phase 3 clinical study serves as the parent foundational study to the Phase 2 study (ongoing study, NCT04646005), as 77% of the clinical investigators participating in Phase 2 clinical study overlap with the Phase 3 study. The ongoing Phase 2 study will educate investigators on ethnocultural diversity, and the inclusion of the two studies will be compared from pre-intervention (Phase 3) to post-intervention (Phase 2). Education will be provided as a one-time virtual training and a supplementary pamphlet and will cover the incidence and mortality differences across races, current enrollment gaps, barriers to including diverse populations, and guidance for the broader inclusion of women in our sponsored studies. Race and ethnicity demographic data for the Phase 2 trial (post-intervention) will be compared with the Phase 3 trial (pre-intervention) using the chi-square statistical test. Assuming significant results, a Z-test will then be used to assess the proportions of each race and ethnicity group. Objectives: Every year, over 570,000 women worldwide are diagnosed with cervical cancer. Cervical cancer accounts for 7.5% of female cancer deaths, and 85% of those deaths occur in low- to moderate-income countries. In the US, it is estimated that Black women have a 30% higher incidence of cervical cancer than White women. Additionally, Hispanic women are 40% more likely to be diagnosed with cervical cancer than non-Hispanic women. In 2020, the US Food and Drug Administration issued industry guidance for enhancing the diversity of clinical study participants, highlighting the critical need for representative studies that reflect the current US population demographics. This study aims to conduct an educational intervention aimed at cervical cancer investigators and patients to increase ethnocultural diversity in clinical study recruitment in a cervical cancer research program. Methods: This educational intervention implemented a pre-post study design of clinical investigators participating in both global Phase 2 and Phase 3 cervical cancer studies. The Phase 3 clinical study serves as the parent foundational study to the Phase 2 study (ongoing study, NCT04646005), as 77% of the clinical investigators participating in Phase 2 clinical study overlap with the Phase 3 study. The ongoing Phase 2 study will educate investigators on ethnocultural diversity, and the inclusion of the two studies will be compared from pre-intervention (Phase 3) to post-intervention (Phase 2). Education will be provided as a one-time virtual training and a supplementary pamphlet and will cover the incidence and mortality differences across races, current enrollment gaps, barriers to including diverse populations, and guidance for the broader inclusion of women in our sponsored studies. Race and ethnicity demographic data for the Phase 2 trial (post-intervention) will be compared with the Phase 3 trial (pre-intervention) using the chi-square statistical test. Assuming significant results, a Z-test will then be used to assess the proportions of each race and ethnicity group.

Potential Channeling Bias in the Evaluation of Cardiovascular Risk: The Importance of Comparator Selection in Observational Research.

BackgroundComparator selection is an important consideration in the design of observational research studies that evaluate potential associations between drug therapies and adverse event risks. It can affect the validity of observational study results, and potentially impact data interpretation, regulatory decision making, and patient medication access.ObjectiveThe aim of this study was to assess the impact of comparator selection bias using two real-world case studies evaluating an increased rate of acute myocardial infarction (AMI).MethodsData from the Truven Health Analytics MarketScan® electronic medical claims database were used to conduct two retrospective observational cohort studies, utilizing a cohort new-user design, comparing AMI risk between testosterone replacement therapy (TRT) and phosphodiesterase-5 inhibitors (PDE5is) in men treated for hypogonadism, and triptans versus other prescribed acute treatments for migraine in adults. All patients were enrolled continuously in a health plan (no enrollment gap > 31 consecutive days) for ≥ 1 year before index. Baseline period was defined as 365 days prior to index. Exposure was defined by prescription and outcome of interest was defined as occurrence of AMI. Using Cox proportional hazard models, primary analysis for the TRT cohort compared AMI risk between propensity score (PS)-matched TRT-treated and untreated patients; secondary analysis evaluated risk between PS-matched TRT-treated and PDE5i-treated patients. For the triptan cohort, primary analysis compared AMI/ischemic stroke risk between PS-matched triptan-treated and opiate-treated patients; secondary analysis evaluated risk between PS-matched triptan-treated and nonsteroidal anti-inflammatory drug (NSAID)-treated patients and PS-matched non-prescription-treated migraine patients and general patients.ResultsNo significant association between TRT and AMI was observed among TRT-treated (N = 198,528, mean age 52.4 ± 11.4 years) versus PDE5i-treated men (N = 198,528, mean age 52.3 ± 11.5 years) overall (adjusted hazard ratio [aHR] 1.01; 95% CI 0.95–1.07; p = 0.80). Among patients with prior cardiovascular disease (CVD), risk of AMI was significantly increased for TRT-treated versus PDE5i-treated patients (aHR 1.13; 95% CI 1.03–1.25). The triptan study included three comparisons (triptans [N = 436,642] vs prescription NSAIDs [N = 334,152], opiates [N = 55,234], and untreated migraine [N = 1,168,212]), and a positive control (untreated vs general non-migraine patients [N = 11,735,009]). Analyses of MI risk in migraine patients prescribed triptans versus NSAIDs/opiates had mixed results: the point estimate ranged from 0.33 to 0.84 depending on chosen study window.ConclusionsCardiovascular outcomes were not worse in hypogonadism patients with TRT versus PDE5i; however, a potential association with AMI was found in patients with prior CVD receiving TRT versus PDE5i. Findings pointed to a pseudo-protective effect of triptans versus untreated migraine patients or those potentially older and less healthy patients exposed to prescription NSAIDs or opiates. Triptan users should not be compared with those using other anti-migraine prescriptions when evaluating cardiovascular outcomes in migraine patients. Presence of high cardiovascular risks may contribute to channeling bias—healthier subjects being selected to receive treatment—highlighting the importance of choosing comparators wisely in observational studies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40290-022-00433-z.

Racial Diversity and Measuring Merit: Evidence from Boston's Exam School Admissions

Abstract The impact of admissions process design on the racial diversity of schools and colleges has sparked heated debates. We study the pipeline into Boston's three public exam schools to understand racial gaps in enrollment. Admission to these schools has historically been based on a combination of grade point average (GPA) and a score on an optional test from a private developer. We document racial gaps in test-taking rates, test scores, GPAs, preferences for the most selective school, and ultimate admission rates to all three schools. These gaps persist even among students with similarly high baseline achievement as measured by the state's mandatory standardized test. Substantial numbers of high-achieving Black and Hispanic students do not apply to the exam schools and to the most selective school in particular. The choice of standardized test used to measure academic merit strongly affects who is admitted.