Adolescent Health and Later School

Start TimesAshland School Start Times Committee

Isha Ann Emhoff, MD FACS

Later School Start Times

“Given that the primary focus of education is to maximize human

potential, then a new task before us is to ensure that the conditions in

which learning takes place addresses the very biology of our

learners.” Mary Carskadon, PhD Brown University

Circadian Rhythm• Circa Diem: around the day

• Biologic endogenous time: “built in clock”o Genetic

o Brain hypothalamus

• Suprachiasmatic Nucleus (SCN)

• What is the purpose?o Allows anticipation and preparation for precise and regular

environmental changes

o Regulates metabolic processes

o Brain wave activity

o Temperature regulation

o Hormone production (cortisol)

Melatonin Secretion Changes Child to Adolescent

Rhythmic Sleepy Time

Source: Adapted from data given byNational Sleep Foundation

Why Does Melatonin Rhythm Matter?

• Waking a teenager

at 7:00 am is like

waking an adult at

4:00 am

Pubertal Time Bending

• Sleep-Wake Phase Delayo 2 hour delay relative to mid-childhood

o Fall asleep later and wake up later

• Delayed nocturnal melatonin secretiono Shift in circadian phase preference

o Cannot just go to bed earlier – they cannot fall asleep

o High level of alertness at 8 PM, even higher at 10 PM

• Altered sleep driveo Pressure to fall asleep accumulates more slowly

o Takes longer to fall asleep

o Difficulty falling asleep until after 11:00 PM

Sleep Time Delay• Students lose up to 120 minutes of sleep per school

night1

• Weekend Catch-up Sleepo Moves their inner clock even further away from the external clock

o Worsens morning sleepiness at school

• Keep the weekday schedule on weekends

• No napping

• Equivalent to 5 hours jet lag on Monday morning

1. Martha Hansen, et al. The Impact of School Daily Schedule on Adolescent SleepPediatrics 2005; 115:6 1555-1561

Optimal Timing• 8.5-9.5 hours per night

• 11:00 PM bedtime

• 8:00 AM wake time

Where do the Hours Go?Late school start time

scheduleo Alarm sounds at 7:30am

o Bus stop 8:20am

o School 9:00am to 3:50pm

o Stay at school

o Load buses for travel to away

game at 4:30pm

o Game 7:00pm to 9:00pm

o Home between 9:45 pm to

10:30pm

o Homework 10:30pm to 12:30am

o Bed 12:30 am or 1:00am

• Sleep 6.5 to 7 hours

Early school start time

scheduleo Alarm sounds 5:30am

o Bus stop 6:20am

o School 7:00am to 1:50pm

o Return home on bus 2:15pm

o Back to school to travel to

away game 4:30pm

o Game 7:00pm to 9:00pm

o Home between 9:45pm to

10:30pm

o Homework 10:30pm to 12:30am

o Bed 12:30 or 1:00am

• Sleep 4.5 to 5 hours

• Cognitive deficits

• Impaired executive function

• Deficits in abstract thinking and verbal skills/creativity

• Decreased performance efficiency and output

• Lower academic achievement

• Poor school attendance

• Increased dropout rates

• Drowsy driving

• Increased sports injuries

• Increased Anxiety, Depression, Suicidal Ideation

• Poor impulse control

• Increased risk-taking behavior

• Emotional Dysregulation, lowered affect

• Impaired interpretation of Social Cues

• Increased stress vulnerability

• Decreased motivation

• Increased obesity risk

• Metabolic

• Hypercholesterolemia

• DM2

• Increased CV morbidity

• Non-medical use of stimulants

• Reduced physical activity

Physical Mental

AcademicSafety

Academics

Data from USAFA Policy Changes

• Starting the school day 50

minutes later has a

significant positive effect on

student achievement

• Improved performance is

not just a “wake up” effect

from later start.

• Improvement persists in all

classes throughout the day.

Carrell, Scott E., Teny Maghakian, and James E. West. "A's from Zzzz's? The causal effect of school start time on the academic achievement of adolescents." American Economic Journal: Economic Policy 3, no. 3 (2011): 62-81.

Teen Safety• Automotive Crash

Rateso Crash rates reduced 65-70%

(Wahlstrom et al, Univ. MN, 2014)

o Crash rates reduced 16.5%

while rest of state actually

increased 7.8% over the same

period. (Danner & Phillips, J. Clin Sleep

Med, 2008)

Teen Injuries

• Less than 8 hours sleep

1.7 times more likely to

suffer sports injury

• Risk increases 1.4 times

for each year grade

increase (7-12)o Milewski J Pediatr Orthop. 2014

ADOLESCENT SLEEP WORKING GROUP, COMMITTEE ON ADOLESCENCEand COUNCIL ON SCHOOL HEALTH

Pediatrics 2014;134;642; originally published online August 25, 2014; DOI: 10.1542/peds.2014-1697http://pediatrics.aappublications.org/content/134/3/642.full.html

• Aim for 8.5 – 9 .5 hours of sleep

• Middle and high school start 8:30 a.m. or later

“The AAP is making a definitive and powerful statement about the importance of sleep to the health, safety, performance and well-being of our nation's youth,”

“By advocating for later school start times for middle and high school students, the AAP is both promoting the compelling scientific evidence that supports school start time delay

as an important public health measure, and providing support and encouragement to

those school districts around the country contemplating that change. Judith Owens, MD, FAAP, lead author of the policy statement

Ohio Schools and Cost-Savings or Cost-Neutrality in Moving toward Healthier Start Times(2013 data, per school websites)

Hudson City Schools, Ohio: Suburban NE Ohio - total student enrollment: 4,7004 elementary schools, 1 middle school, 1 high schoolPercentage of graduates attending college or university: 95%In 2010 school year: Moved high school from 7:30 to 8:00 and middle school from 7:20 to 7:50 amSaved money by moving from three bus tiers to two, consolidating runs, and switching to an external vendor

Dublin City Schools, Ohio: Suburban Central Ohio (near Columbus) - student enrollment in excess of: 14,50010th largest district in the state12 elementary schools, 4 middle schools, 3 high schoolsMinority student population: 30.7%Average ACT score of 25.2In 2011 school year: Moved middle school from 8:15 am to 8:43am, high school from 7:25 am to 8am The move was cost-neutral in relation to start times, but saved money due to other transportation changes made

Kenston Local Schools, Ohio: Rural NE Ohio - total student enrollment: 3,1403 elementary schools, 1 middle school, 1 high schoolPercentage of graduates attending college or university: 94%In 2012 school year: Moved middle and high school start times from 7:20 am to 7:50 am The end of the school day for middle and high school was moved to 5 minutes laterThe move was cost-neutral

Westlake City Schools, Ohio: Suburban NE Ohio (Greater Cleveland Metropolitan Area) - student enrollment approximate: 4,0004 elementary schools, 1 intermediate school, 1 middle school, 1 high schoolIn top 4% of districts in state scorecard rankingsIn 2011 school year: Moved high school start times from 7:30 to 7:55amThe move was cost-neutral

Perrysburg Schools, Ohio: Suburban NW Ohio - student enrollment in excess of: 4,9004 elementary schools, 1 junior high school, 1 high schoolAverage ACT score 23.8In 2011 school year: Moved high school from 7:40 to 8:00am, middle school from 7:25 to 7:45 amThe move was cost-neutral

Parma City School District:Suburban NE Ohio (Greater Cleveland Metropolitan Area) - total student enrollment: 11,4708 elementary schools, 3 middle schools, 3 high schoolsIn 2012 school year: High school moved from 7:35 to 8:10 am, middle school from 8:00 to 8:20 amMove was driven by financial considerations and building consolidation, not driven by the research, although the research was ‘not discouraging’ in decision-making processes