1
|
Jung J, Fenelon A. Do later school start times improve adolescents' sleep and substance use? A quasi-experimental study. Prev Med 2024; 185:108028. [PMID: 38849057 PMCID: PMC11269004 DOI: 10.1016/j.ypmed.2024.108028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE A later school start time policy has been recommended as a solution to adolescents' sleep deprivation. We estimated the impacts of later school start times on adolescents' sleep and substance use by leveraging a quasi-experiment in which school start time was delayed in some regions in South Korea. METHODS A later school start time policy was implemented in 2014 and 2015, which delayed school start times by approximately 30-90 minutes. We applied difference-in-differences and event-study designs to longitudinal data on a nationally representative cohort of adolescents from 2010 to 2015, which annually tracked sleep and substance use of 1133 adolescents from grade 7 through grade 12. RESULTS The adoption of a later school start time policy was initially associated with a 19-minute increase in sleep duration (95% CI, 5.52 to 32.04), driven by a delayed wake time and consistent bedtime. The policy was also associated with statistically significant reductions in monthly smoking and drinking frequencies. However, approximately a year after implementation, the observed increase in sleep duration shrank to 7 minutes (95% CI, -12.60 to 25.86) and became statistically nonsignificant. Similarly, the observed reduction in smoking and drinking was attenuated a year after. CONCLUSIONS Our findings suggest that policies that increase sleep in adolescents may have positive effects on health behaviors, but additional efforts may be required to sustain positive impacts over time. Physicians and education and health policymakers should consider the long-term effects of later school start times on adolescent health and well-being.
Collapse
Affiliation(s)
- Jilli Jung
- Department of Education Policy Studies, Pennsylvania State University, PA, USA.
| | - Andrew Fenelon
- School of Public Health, University of Minnesota-Twin Cities, MN, USA
| |
Collapse
|
2
|
Alfonsi V, Carbone A, Scarpelli S, Gorgoni M, Luchini A, D’Andrea P, Cherubini S, Costarelli C, Couyoumdjian A, Laghi F, De Gennaro L. The Impact of Delayed School Start Times During COVID-19 on Academic Performance: A Longitudinal Naturalistic Study in Italian High Schools. Nat Sci Sleep 2023; 15:1129-1138. [PMID: 38152440 PMCID: PMC10752017 DOI: 10.2147/nss.s437958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023] Open
Abstract
Background Delaying school start times has been proposed as a potential solution to address chronic sleep curtailment among adolescents and its negative consequences on their physical and mental well-being. This study investigates the impact of delayed school start times due to the COVID-19 pandemic on academic achievement. Subjects and Methods Two separate observational studies were conducted involving high school students from the first/second year (n=232) (Study 1) and from the final year (n=39) (Study 2). Multivariate Analyses of Covariance were performed to assess for statistical differences in academic performance (ie, global, humanistic, and scientific performance) and absenteeism (ie, number of school absences). Two main factors were considered: "school start time" (ie, standard-8:00 AM vs late-9:40 AM) and "time interval" (ie, first academic semester vs second academic semester), controlling for the school year (Study 1) and circadian preference (Study 2). Results Delaying school start times was positively associated with better academic performance in scientific subjects among first/second-year students (F1,229=6.083, p=0.026) and global academic performance among last-year students (F1,35=4.522, p=0.041). Furthermore, first/second-year students significantly increased their school achievement (F1,229>29.423, p<0.001) and school absences (F1,229=66.160, p<0.001) during the second semester of the academic year. No significant effect of "school start time" on school attendance was observed. Additionally, circadian preference was found to be a significant covariate among last-year students, with early chronotypes exhibiting better academic performance (r>0.369, p<0.025). Conclusion These findings confirm past evidence about the beneficial effects of delayed school start times on academic outcomes, with the additional advantage of observing them within a natural context that emerged during the pandemic. Further research is needed to explore the phenomenon more systematically and take into account the broader implications of implementing this change.
Collapse
Affiliation(s)
| | - Agostino Carbone
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | | | | | | | | | - Fiorenzo Laghi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| |
Collapse
|
3
|
Arrona-Palacios A, Díaz-Morales JF, Duffy JF. The influence of a permanent double-shift school start time on adolescent sleep and chronotype across different age groups. Chronobiol Int 2023; 40:850-863. [PMID: 37212086 DOI: 10.1080/07420528.2023.2215343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/27/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
The main objective of this study was to explore the differences in sleep habits and chronotype across different age groups in Mexican adolescents attending a permanent double-shift school system. This cross-sectional study consisted of 1,969 (1,084 girls) students from public elementary, secondary, and high schools, as well as undergraduate university students from Mexico. Age range was 10-22 [15.33 ± 3.28 (mean ± SD)] years, 988 morning shift and 981 afternoon shift students. Questions regarding usual self-reported bedtime and rise time were collected, and from that, estimates for time in bed, midpoint of sleep, social jetlag, and chronotype were evaluated. Afternoon shift students reported later rise times, bedtimes, midpoint of sleep, and longer time in bed on school days than morning shift students, as well as less social jetlag. Overall, afternoon shift students reported a later chronotype than morning shift students. Peak lateness of chronotype in afternoon shift students was at age 15, with girls peaking at age 14 and boys at age 15. Meanwhile, morning shift students reported peak lateness of chronotype around age 20. In this study, adolescents from different age ranges attending an extremely delayed school start time reported adequate sleep compared with adolescents attending a fixed morning school start time. In addition, the analysis presented in this study seems to suggest that the peak of late chronotype may be influenced by school start times.
Collapse
Affiliation(s)
- Arturo Arrona-Palacios
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Writing Lab, Institute for the Future of Education, Tecnologico de Monterrey, Monterrey, Mexico
| | - Juan F Díaz-Morales
- Department of Social Psychology, Work and Individual Differences, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Widome R, Erickson DJ, Laska MN, Berger AT, Lenk KM, Iber C, Kilian G, Lammert S, Wahlstrom KL. Impact of delaying high school start times on weight and related behaviors - the START study. Prev Med 2023; 172:107548. [PMID: 37201593 PMCID: PMC10319406 DOI: 10.1016/j.ypmed.2023.107548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
In the US, few adolescents get adequate school night sleep, largely due to early school start times. In the START study we aimed to test the following hypothesis: That following the implementation of later high school start times students have lesser longitudinal increases in body mass index (BMI) and shift to more healthful weight-related behaviors relative to students attending schools that retain early start times. The study enrolled a cohort of students (n = 2426) in five high schools in the Twin Cities, MN metro. Heights and weights were measured objectively, and surveys were administered annually from 9th through 11th grades (2016-2018). All study schools started early (either 7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), two schools delayed their start times by 50-65 min, while three comparison schools started at 7:30 am throughout the observation period. Using a difference-in-differences natural experiment design, we estimated differences in changes in BMI and weight-related behaviors over time between policy change and comparison schools. Students' BMIs increased in parallel in both policy change and comparison schools over time. However relative to changes in comparison schools after the start time shift, students in policy change schools had a modestly more healthful profile of weight-related behaviors - for instance they had a relatively greater probability of eating breakfast, having supper with their family, getting more activity, eating fast food less frequently, and eating vegetables daily. Later start times could be a durable, population-wide strategy that promotes healthful weight behaviors.
Collapse
Affiliation(s)
- Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA.
| | - Darin J Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Aaron T Berger
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Kathleen M Lenk
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Conrad Iber
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, MN, USA
| | - Gudrun Kilian
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Sara Lammert
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Kyla L Wahlstrom
- Department of Organizational Leadership, Policy and Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
5
|
James SA, Erickson DJ, Lammert S, Widome R. School start time delays and high school educational outcomes: Evidence from the START/LEARN study. J Adolesc 2023; 95:751-763. [PMID: 36793198 PMCID: PMC10257742 DOI: 10.1002/jad.12151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Delaying high school start times extends adolescents' nightly sleep, but it is less clear how it affects educational outcomes. We expect links between school start time delays and academic performance because getting enough sleep is a key input to the cognitive, health, and behavioral factors necessary for educational success. Thus, we evaluated how educational outcomes changed in the 2 years following a school start time delay. METHODS We analyzed 2153 adolescents (51% male, 49% female; mean age 15 at baseline) from START/LEARN, a cohort study of high school students in the Minneapolis-St. Paul, MN, USA metropolitan area. Adolescents experienced either a school start time delay ("policy change schools") or consistently early school start times ("comparison schools"). We compared patterns of late arrivals, absences, behavior referrals, and grade point average (GPA) 1 year before (baseline, 2015-2016) and 2 years after (follow-up 1, 2016-2017 and follow-up 2, 2017-2018) the policy change using a difference-in-differences analysis. RESULTS A school start time delay of 50-65 min led to three fewer late arrivals, one fewer absence, a 14% lower probability of behavior referral, and 0.07-0.17 higher GPA in policy change schools versus comparison schools. Effects were larger in the 2nd year of follow-up than in the 1st year of follow-up, and differences in absences and GPA emerged in the second year of follow-up only. CONCLUSIONS Delaying high school start times is a promising policy intervention not only for improving sleep and health but for improving adolescents' performance in school.
Collapse
Affiliation(s)
- Sarah A James
- Minnesota Population Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Darin J Erickson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara Lammert
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
6
|
Biller AM, Molenda C, Obster F, Zerbini G, Förtsch C, Roenneberg T, Winnebeck EC. A 4-year longitudinal study investigating the relationship between flexible school starts and grades. Sci Rep 2022; 12:3178. [PMID: 35210437 PMCID: PMC8873390 DOI: 10.1038/s41598-022-06804-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
The mismatch between teenagers' late sleep phase and early school start times results in acute and chronic sleep reductions. This is not only harmful for learning but may reduce career prospects and widen social inequalities. Delaying school start times has been shown to improve sleep at least short-term but whether this translates to better achievement is unresolved. Here, we studied whether 0.5-1.5 years of exposure to a flexible school start system, with the daily choice of an 8 AM or 8:50 AM-start, allowed secondary school students (n = 63-157, 14-21 years) to improve their quarterly school grades in a 4-year longitudinal pre-post design. We investigated whether sleep, changes in sleep or frequency of later starts predicted grade improvements. Mixed model regressions with 5111-16,724 official grades as outcomes did not indicate grade improvements in the flexible system per se or with observed sleep variables nor their changes-the covariates academic quarter, discipline and grade level had a greater effect in our sample. Importantly, our finding that intermittent sleep benefits did not translate into detectable grade changes does not preclude improvements in learning and cognition in our sample. However, it highlights that grades are likely suboptimal to evaluate timetabling interventions despite their importance for future success.
Collapse
Affiliation(s)
- Anna M Biller
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany.
- Graduate School of Systemic Neurosciences, Ludwig Maximilian University Munich, Munich, Germany.
- Institute of Psychology, Bundeswehr University Munich, Munich, Germany.
| | - Carmen Molenda
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Fabian Obster
- Statistical Consulting Unit, Department of Statistics, Ludwig Maximilian University Munich, Munich, Germany
- Department of Business Administration, Bundeswehr University Munich, Munich, Germany
| | - Giulia Zerbini
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
- Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
| | - Christian Förtsch
- Biology Education, Faculty of Biology, Ludwig Maximilian University Munich, Munich, Germany
| | - Till Roenneberg
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
- Institute and Polyclinic for Occupational-, Social- and Environmental Medicine, Ludwig Maximilian University Munich, Munich, Germany
| | - Eva C Winnebeck
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany.
- Chair of Neurogenetics, Faculty of Medicine, Technical University of Munich, and Institute of Neurogenomics, Helmholtz Center Munich, Munich, Germany.
| |
Collapse
|