Morningness–eveningness and sleep patterns of adolescents attending school in two rotating shifts

The relationship between chronotype video game addiction and sleep quality in school-age children: A structural equation modeling approach

This study aimed to investigate the relationship between chronotype, video game addiction, and sleep quality in school-age children using structural equation modeling. It was performed using structural equation modeling, with 545 secondary school students in northern Turkey meeting the inclusion criteria. Data were collected through face-to-face interviews utilizing the Personal Information Form, the Morningness Eveningness Scale for Children (MESC), the Video Game Addiction Scale for Children (VASC), and the Sleep Quality Scale. The findings revealed that the average video game addiction score of children was 55.22, which was associated with poor sleep quality and efficiency. Additionally, chronotype was found to mediate the relationship between video game addiction and both sleep quality (β = 0.024; p < 0.001) and sleep efficiency (β = -0.068; p < 0.001). The model was found to be close to acceptable levels for the variables according to the fit indices.

Associations between social loneliness trajectories and chronotype among adolescents

Late chronotype during adolescence is a critical risk factor for poor physical and mental health among adolescents. While social loneliness is confirmed to negatively influence sleep behaviors, the long-term effect of social loneliness on chronotype remains unknown. This study aims to investigate whether social loneliness trajectories from middle childhood to adolescence are associated with chronotype in late adolescence and examine the potential sex differences in these associations. Data were obtained from 2398 adolescents who participated in the Child and Adolescent Behaviors in Long-Term Evolution project. Chronotype was calculated as the midpoint of sleep on free days adjusted for sleep debt. Group-based trajectory modeling and multiple linear regression were employed to establish social loneliness trajectories and determine their associations with chronotype. Social loneliness trajectories were significantly associated with chronotype and varied by sex. Specifically, boys following a high-decreasing trajectory had earlier chronotype during late adolescence than did those following a low-decreasing trajectory (B =  - 0.07; p < 0.05). By contrast, girls following a low-to-moderate-increasing trajectory exhibited later chronotype than did those following a low-stable trajectory (B = 0.07; p < 0.01). Social loneliness trajectories, especially those displaying significant fluctuations over time, are critical indicators influencing chronotype among adolescents. Furthermore, these trajectories and their associations with chronotype display sex differences. These findings highlight the need for early interventions for psychological factors such as social loneliness to ensure that the late chronotype can be prevented. In addition, sex variations must be considered.

Age, sex and race distribution of accelerometer-derived sleep variability in US school-aged children and adults

Sleep variability (e.g. intra-individual variabilities in sleep duration or sleep timing, social jetlag, and catch-up sleep) is an important factor impacting health and mortality. However, limited information is available on the distribution of these sleep parameters across the human life span. We aimed to provide distribution of sleep variability related parameters across lifespan by sex and race in a national representative sample from the U.S. population. The study included 9981 participants 6 years and older from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, who had 4-7 days of valid 24-h accelerometer recording with at least one day obtained during weekend (Friday or Saturday night). Of the study participants, 43% showed ≥ 60 min sleep duration standard deviation (SD), 51% experienced ≥ 60 min catch-up sleep, 20% showed ≥ 60 min sleep midpoint SD, and 43% experienced ≥ 60 min social jetlag. American youth and young adults averaged greater sleep variability compared to other age groups. Non-Hispanic Blacks showed greater sleep variability in all parameters compared to other racial groups. There was a main effect of sex on sleep midpoint SD and social jetlag with males averaging slightly more than females. Our study provides important observations on sleep variability parameters of residents of the United States by using objectively measured sleep patterns and will provide unique insights for personalized advice on sleep hygiene.

Evaluation of social jetlag and chronotypes in Indian school-going adolescents

Background

School-going students' school time acts as a zeitgeber during the weekdays, and in the weekends, due to the absence of the zeitgeber, they show free run and wake up late in the morning. This may result in poor health hazards in adolescents.

Objective

The aim of this study was to assess the prevalence of social jetlag along with the distribution of their chronotype in school-going adolescents.

Materials and Methods

This is a cross-sectional study conducted between May and June 2019 with the help of the MCTQ (Munich Chronotype Questionnaire) and MEQ (Morningness and Eveningness Questionnaire) in the adolescent population (N = 1154).

Statistical Analysis

The study was performed using the Mann-Whitney U test to compare continuous variables of sleep parameters between workdays and free days. The significance was taken at P < 0.05.

Results

The results showed that out of the total population, 81% were morning type and 67% of adolescents were socially jetlagged. There was a significant delay in the time to bed on free days by 1.88 hours and a significant delay in the wake-up time by 2.46 hours. The total sleep duration was also significantly higher on free days by 1.88 hours in the population.

Conclusion

This is our first study in the Indian population to show that morning-type individuals showed irregular sleep timings and were more socially jetlagged. This needs to be focused on by the school authorities and government to keep a flexible school timing for the students on the basis of their chronotype for their better academic performance.

Light Therapy for Adolescent Depression: A Scoping Review

PURPOSE

Depressive disorders in adolescents are a major health concern associated with developmental, social, and educational impairment. Bright Light Therapy (BLT) is a feasible and effective treatment for depressive disorders in adults, but few controlled trials have been conducted with children or adolescents. This scoping review focuses on the current state of knowledge for BLT in the treatment of adolescent depression. We reviewed the literature for novel data and methodologic approaches using BLT and pediatric and young adult populations.

RECENT FINDINGS

BLT is a tolerable treatment with few side effects. However, there is a marked lack of well-powered studies to support BLT as a treatment for depressive disorders in adolescent populations. Given evidence of tolerability and positive treatment effect on depression in the adult literature, research is needed to establish the efficacy, feasibility, and acceptability of BLT in adolescents.

Early morning university classes are associated with impaired sleep and academic performance

Attending classes and sleeping well are important for students' academic success. Here, we tested whether early morning classes are associated with lower attendance, shorter sleep and poorer academic achievement by analysing university students' digital traces. Wi-Fi connection logs in 23,391 students revealed that lecture attendance was about ten percentage points lower for classes at 08:00 compared with later start times. Diurnal patterns of Learning Management System logins in 39,458 students and actigraphy data in 181 students demonstrated that nocturnal sleep was an hour shorter for early classes because students woke up earlier than usual. Analyses of grades in 33,818 students showed that the number of days per week they had morning classes was negatively correlated with grade point average. These findings suggest concerning associations between early morning classes and learning outcomes.

A developmental perspective on sleep consistency: Preschool age through emerging adulthood

OBJECTIVE/BACKGROUND

Beyond sleep duration, the regularity of sleep patterns (e.g., sleep consistency), including variability in sleep timing (e.g., bedtime, wake time) and duration, is a critical marker of sleep health. Sleep consistency is captured using a variety of methods within the literature (e.g., sleep intraindividual variability, social jetlag), but most of the research focuses on adolescents.

METHODS

Drawing on a developmental perspective, this narrative review highlights how normative changes at the individual (e.g., biological, cognitive, and social) and contextual (e.g., home, school, sociocultural) levels may contribute to inconsistent sleep patterns across development.

RESULTS AND CONCLUSIONS

This review emphasizes how inconsistent sleep may increase across pivotal transitions throughout development (e.g., elimination of naps, puberty, summertime, entering college). Finally, recommendations for measuring sleep consistency and areas to address in future research are discussed.

Match or mismatch between chronotype and sleep-wake cycle and their association with lean body mass gain among male high-school baseball players

For athletes, it is important to acquire lean body mass (LBM) involving the skeletal muscle mass during their growth periods; however, the influence of chronotype on LBM gain remains unclear. We therefore aimed to investigate whether chronotype, sleep-wake cycle on weekdays (SWC-W), and their interaction contribute to LBM gain among adolescent male athletes in a 4-month intervention study. The participants were 45 male high-school baseball players. The intervention, including exercise menu (running and muscle strength training) and nutritional education, was conducted during a 4-month period of season-off training. The chronotype, body composition, lifestyle, and dietary intake were investigated before intervention (baseline) and after 4 months. Among the participants [Morningness (n = 14), Eveningness (n = 15), Intermediate (n = 16); ME score based on the Morningness/Eveningness Scale for Children (MES-C)], the midpoint of sleep on weekdays (MSW) was calculated in the "Morningness" and "Eveningness" participants, respectively. They were divided into 4 groups based on a match/mismatch with the chronotype: Type M-match (n = 8), Type M-mismatch (n = 6), Type E-match (n = 7), and Type E-mismatch (n = 8) groups. The data were compared among the 4 groups. Moreover, multiple regression analysis was conducted using an increase (kg) LBM gain as a response variable. When comparing the data between the "Morningness" and "Eveningness" participants, there were no differences in nutrient intake, the duration of training, or each parameter of body composition (per body weight) at baseline or after 4 months. There were also no differences in the rates of change in the body weight or each parameter of body composition. In groups in which the chronotype was consistent with the SWC-W (the Type M-match and Type E-match groups), the LBM gain were slightly greater than in the Type M-mismatch and Type E-mismatch groups (Type M-match: 3.5 ± 2.0 kg, Type M-mismatch: 1.6 ± 1.7 kg, Type E-match: 3.4 ± 2.2 kg, and Type E-mismatch: 1.2 ± 1.8 kg, p = .057). Multiple regression analysis revealed that an extent of the LBM gain was associated with a match between the chronotype and SWC-W (ß = 0.37, p = .030), independent of a long duration of training (ß = 0.52, p = .004). The results suggested that training-related LBM gain is associated with interactions between the chronotype and SWC-W in adolescent male athletes.Abbreviations: LBM: Lean body mass; SWC-W: Sleep-wake cycle on weekdays; ME score: Morningness-eveningness score; MES-C: Morningness/Eveningness Scale for Children; MSW: Midpoint of sleep on weekdays; MSF: Midpoint of sleep on free days; MSFsc: Midpoint of sleep on free days corrected for sleep debt accumulated through weekdays.

Afternoon School Start Times Are Associated with a Lack of Both Social Jetlag and Sleep Deprivation in Adolescents

The delayed circadian timing of adolescents creates a conflict with early school start times (SSTs). We used wrist actimetry to compare sleep parameters and routine nighttime activities in middle school students attending either a morning (0700 to 1200 h) or an afternoon (1230 to 1730 h) school shift. On school days, students from both shifts (n = 21 for morning shift, n = 20 for afternoon shift, ages 12-14 years) had a similar sleep onset, but morning-shift students had an earlier sleep offset and a 1 h 45 min shorter sleep duration than their afternoon peers, who slept the recommended 8 to 10 h of daily sleep. Only morning-shift students had afternoon naps, but this afternoon sleep was not sufficient to overcome sleep deprivation. On weekends, sleep onsets and offsets did not differ between shifts. Because only morning-shift students woke up later and slept longer (2 h 3 min) on weekends, they were also the only ones who experienced social jetlag. Daily surveys on their nighttime (from 1800 to 0600 h) activities indicated there was no difference between shifts in the time spent on leisure or using electronic media during school days, but students from both shifts spent more time in these activities during the weekend. Our study confirms that early SST in adolescents is associated with sleep deprivation and suggests that schedules that start much later than typically considered may be needed to eliminate sleep deprivation in adolescents.

Temporal associations between morningness/eveningness, problematic social media use, psychological distress and daytime sleepiness: Mediated roles of sleep quality and insomnia among young adults

The extant literature has suggested relationships between an individual's chronotype (in relation to morningness/eveningness) and several outcomes, including addictive disorders, psychological distress and daytime sleepiness. Moreover, sleep quality has been proposed to be a mediator in the aforementioned relationships. Consequently, the aim of the present study was to investigate the complex relationship between morningness/eveningness, problematic social media use, psychological distress and daytime sleepiness, with the potential mediators of sleep quality and insomnia. All participants (N = 1,791 [30.1% males]; mean age = 27.2 years, SD = 10.1) completed a battery of psychometric scales, including a reduced version of the Morningness-Eveningness Questionnaire (at baseline), the Pittsburgh Sleep Quality Index and Insomnia Severity Index (1 month after baseline assessment), the Bergen Social Media Addiction Scale, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale (2 months after baseline assessment). The impacts of morningness-eveningness on problematic social media use, anxiety, depression and daytime sleepiness were found in the mediation models. Furthermore, the mediated effects of insomnia and sleep quality were observed. The present study's results emphasize the importance of promoting healthy sleep habits and sleep hygiene behaviours, and that of early detection of sleep problems among individuals who have the eveningness chronotype, because this would significantly improve their health outcomes.

Measures of circadian preference in childhood and adolescence: A review

Purpose

To review the psychometric properties of the questionnaires commonly filled in by children and adolescents to measure circadian preference.

Methods

We examined the Morningness-Eveningness Questionnaire for Children and Adolescents (MEQ-CA), the Morningness-Eveningness Scale for Children (MESC) and the Composite Scale of Morningness (CSM). We critically analyzed the reliability, in term of internal consistency (through the Cronbach's alpha) and test-retest reliability (through the correlation coefficient), and the type of validation against external criteria (objective assessment of the sleep/wake cycle, body temperature, hormones and other questionnaires). Fifty studies that reported these data were included in the review: 7 studies used the MEQ-CA, 28 used the MESC and 15 used the CSM.

Results

The percentage of studies reporting at least acceptable levels of internal consistency was high and similar between the three questionnaires. Evidence for test-retest reliability was scant, since only 3 studies were available; it was at least acceptable for the MESC (two studies with a time interval of 1 month), not acceptable for the MEQ-CA (one study with a time interval of 6 months), while no information was available for the CSM. As regards the validation evidence, the MEQ-CA has been validated by the highest number of external criteria (actigraphy, oral body temperature and other questionnaires), followed by the CSM (cortisol sampling and other questionnaires). The MESC has been validated only against self-report measures.

Conclusions

The present state of the art would suggest the use of the MEQ-CA to assess circadian preference in children and adolescents.

Weekly alternation of morning and afternoon school start times: implications for sleep and daytime functioning of adolescents

Study objectives

To examine sleep patterns of adolescents attending school on alternating morning schedule (MS) and afternoon schedule (AS) and to explore the contribution of sleep characteristics on the AS to prediction of adolescents’ daytime functioning.

Methods

The Croatian adaptation of the School Sleep Habits Survey for a two-shift school system was completed by 2,033 students (11–18 years old, 54 per cent females) whose school start times alternated weekly between 08:00 am and 14:00 pm.

Results

All age groups of adolescents reported delayed sleep when on the school week with an AS as compared with a MS. The average delay of bedtime was 36 minutes, and delay of wake-up time 121 minutes, which resulted in average sleep durations from 9.80 hours in 11-year olds to 8.39 hours in 18-year olds. Having more delayed wake-up times on the AS predicted more substance use and poorer grades. Having more delayed bedtimes not only predicted poorer grades but also predicted less depressed mood. Obtaining relatively longer sleep on AS predicted lower sleepiness, less depressed mood, and less frequent substance use.

Conclusions

The afternoon school start time enables sleep duration that is in line with adolescent sleep biology and contributes positively to daytime functioning. In many cases, a large delay in wake-up time is observed. At least part of that delay is not associated with adolescents’ circadian biology and contributes negatively to some indices of their daytime functioning. Further research of factors associated with extreme delays of sleep and/or interventions that could limit extreme sleep irregularity is required.

How Young “Early Birds” Prefer Preservation, Appreciation and Utilization of Nature

Since the 1990s, the Two Major Environmental Value model (2-MEV) has been applied to measure adolescent environmental attitudes by covering two higher order factors: (i) Preservation of Nature (PRE) which measures protection preferences and (ii) Utilization of Nature (UTL) which quantifies preferences towards exploitation of nature. In addition to the 2-MEV scale, we monitored the Appreciation of Nature (APR) which, in contrast to the UTL, monitors the enjoyable utilization of nature. Finally, we employed the Morningness–Eveningness Scale for Children (MESC) which monitors the diurnal preferences and associates with personality and behavioral traits. In this study, we analyzed data from 429 Irish students (14.65 years; ±1.89 SD) with the aim of reconfirming the factor structure of the 2-MEV+APR and monitoring the relationship between the MESC and the environmental values (PRE, UTL, APR). Our findings identified a significant association between PRE and APR with MESC. In addition, we observed a gender difference. Our results suggest that morningness preference students are more likely to be protective of and appreciative towards nature. Recommendations for outreach programs as well as conclusions for environmental education initiatives in general are discussed.

High and low use of electronic media during nighttime before going to sleep: A comparative study between adolescents attending a morning or afternoon school shift

This study compared the effects of time spent on electronic media devices during nighttime before going to sleep on the sleep-wake cycle, daytime sleepiness, and chronotype in 568 Mexican students (288 girls, mean age = 14.08) attending a double school shift system (287 from morning shift and 281 from afternoon shift). Students completed anonymous self-report questionnaires. Results suggest that high exposure to an electronic media device may have an impact on their sleep-wake cycle, regardless of their school shift. Adolescents from the afternoon shift reported more time spent on devices. Those from the morning shift reported daytime sleepiness with the use of MP3 player, and from the afternoon shift with the use of computer, MP3 player, and television. Both school shifts reported an intermediate chronotype with all electronic media devices, but the afternoon shift with a tendency towards eveningness with the use of the computer, smartphone, and MP3 player.

Time to learn: How chronotype impacts education

A growing body of literature has linked chronotype and sleep to school performance. Chronotype is under the control of the circadian clock and refers to sleep timing and diurnal preferences. Chronotype changes with age and is latest during adolescence, giving rise to a mismatch between the (late) circadian clock and the (early) school clock. In general, evening (late) chronotypes obtain lower grades. School performance is influenced by many other factors, such as motivation, intelligence, and conscientiousness. Some of these factors also relate to chronotype. The present paper reviews the literature on the relationship between chronotype and school performance, with the aim of suggesting hypotheses about the mechanisms behind this complex phenomenon and exploring solutions for an optimized school system. Based on the literature reviewed, we hypothesize that chronotype has both a direct and an indirect effect on school performance. The indirect effect is mediated by factors such as conscientiousness, learning/achieving motivation, mood, and alertness. In addition, time of day of testing plays an important role since the chronotype effect on grades is strongest in the morning and disappears in the afternoon. Strategies to decrease the mismatch between the adolescent circadian clock and the school clock could involve light interventions to advance the students' sleep timing, delays in school starting times, and rearrangements of test schedules (tests later in the day).

Later school start times for supporting the education, health, and well-being of high school students

BACKGROUND

A number of school systems worldwide have proposed and implemented later school start times as a means of avoiding the potentially negative impacts that early morning schedules can have on adolescent students. Even mild sleep deprivation has been associated with significant health and educational concerns: increased risk for accidents and injuries, impaired learning, aggression, memory loss, poor self-esteem, and changes in metabolism. Although researchers have begun to explore the effects of delayed school start time, no one has conducted a rigorous review of evidence to determine whether later school start times support adolescent health, education, and well-being.

OBJECTIVES

We aimed to assess the effects of a later school start time for supporting health, education, and well-being in high school students.Secondary objectives were to explore possible differential effects of later school start times in student subgroups and in different types of schools; to identify implementation practices, contextual factors, and delivery modes associated with positive and negative effects of later start times; and to assess the effects of later school start times on the broader community (high school faculty and staff, neighborhood, and families).

SEARCH METHODS

We conducted the main search for this review on 28 October 2014 and updated it on 8 February 2016. We searched CENTRAL as well as 17 key electronic databases (including MEDLINE, Embase, ERIC, PsycINFO, and Sociological Abstracts), current editions of relevant journals and organizational websites, trial registries, and Google Scholar.

SELECTION CRITERIA

We included any randomized controlled trials, controlled before-and-after studies, and interrupted time series studies with sufficient data points that pertained to students aged 13 to 19 years and that compared different school start times. Studies that reported either primary outcomes of interest (academic outcomes, amount or quality of sleep, mental health indicators, attendance, or alertness) or secondary outcomes (health behaviors, health and safety indicators, social outcomes, family outcomes, school outcomes, or community outcomes) were eligible.

DATA COLLECTION AND ANALYSIS

At least two review authors independently determined inclusion and exclusion decisions through screening titles, abstracts, and full-text reports. Two review authors independently extracted data for all eligible studies. We presented findings through a narrative synthesis across all studies. When two or more study samples provided sufficient information to permit effect size calculations, we conducted random-effects meta-analyses to synthesize effects across studies.

MAIN RESULTS

Our search located 17 eligible records reporting on 11 unique studies with 297,994 participants; the studies examined academic outcomes, amount and quality of sleep, mental health indicators, attendance, and student alertness. Overall, the quality of the body of evidence was very low, as we rated most studies as being at high or unclear risk of bias with respect to allocation, attrition, absence of randomization, and the collection of baseline data. Therefore, we cannot be confident about the effects of later school start times.Preliminary evidence from the included studies indicated a potential association between later school start times and academic and psychosocial outcomes, but quality and comparability of these data were low and often precluded quantitative synthesis. Four studies examined the association between later school start times and academic outcomes, reporting mixed results. Six studies examined effects on total amount of sleep and reported significant, positive relationships between later school start times and amount of sleep. One study provided information concerning mental health outcomes, reporting an association between decreased depressive symptoms and later school start times. There were mixed results for the association between later school start times and absenteeism. Three studies reported mixed results concerning the association between later school start times and student alertness. There was limited indication of potential adverse effects on logistics, as the qualitative portions of one study reported less interaction between parents and children, and another reported staffing and scheduling difficulties. Because of the insufficient evidence, we cannot draw firm conclusions concerning adverse effects at this time.It is important to note the limitations of this evidence, especially as randomized controlled trials and high-quality primary studies are difficult to conduct; school systems are often unwilling or unable to allow researchers the necessary control over scheduling and data collection. Moreover, this evidence does not speak to the process of implementing later school starts, as the included studies focused on reporting the effects rather than exploring the process.

AUTHORS' CONCLUSIONS

This systematic review on later school start times suggests several potential benefits for this intervention and points to the need for higher quality primary studies. However, as a result of the limited evidence base, we could not determine the effects of later school start times with any confidence.

Characteristics Associated with Sleep Duration, Chronotype, and Social Jet Lag in Adolescents

Sleep is a complex behavior with numerous health implications. Identifying sociodemographic and behavioral characteristics of sleep is important for determining those at greatest risk for sleep-related health disparities. In this cross-sectional study, general linear models were used to examine sociodemographic and behavioral characteristics associated with sleep duration, chronotype, and social jet lag in adolescents. One hundred and fifteen participants completed Phase I (self-reported sleep measures), and 69 of these participants completed Phase II (actigraphy-estimated sleep measures). Black adolescents had shorter free night sleep than Hispanics. Youth with later chronotypes ate fewer fruits and vegetables, drank more soda, were less physically active, and took more daytime naps. Based on these findings, recommendations for individual support and school policies are provided.

Advancing a biopsychosocial and contextual model of sleep in adolescence: a review and introduction to the special issue

Sleep problems in adolescence have been identified as an international public health issue. Over the past few decades, notable advances have been made in our understanding of the patterns and consequences of sleep in adolescence. Despite these important gains, there is much about the role of sleep in adolescence that remains to be understood. This Special Issue brings together studies that examine sleep as it specifically pertains to adolescent development and adjustment. In this introductory article, we argue for the importance of grounding the study of sleep and adolescence in developmental science and a developmental psychopathology framework. First, a review of the literature is used to outline a biopsychosocial and contextual model of sleep in adolescence. Second, attention-deficit/hyperactivity disorder (ADHD) is used as an exemplar of the proposed model given the pervasiveness of sleep problems among youth with ADHD and the likelihood that sleep problems and ADHD symptoms are interconnected in complex ways. Finally, a brief introduction to the empirical articles included in the Special Issue is provided, with particular attention given to how these articles fit within the proposed biopsychosocial and contextual model. Along with the framework proposed in this article, the studies included in this Special Issue advance the current literature and point to critical directions for future research.

Adolescent crash rates and school start times in two central Virginia counties, 2009-2011: a follow-up study to a southeastern Virginia study, 2007-2008

BACKGROUND AND OBJECTIVE

Early high school start times (EHSST) may lead to sleep loss in adolescents ("teens"), thus resulting in higher crash rates. (Vorona et al., 2011). In this study, we examined two other adjacent Virginia counties for the two years subsequent to the above-mentioned study. We again hypothesized that teens from jurisdictions with EHSST (versus later) experience higher crash rates.

METHODS

Virginia Department of Motor Vehicles supplied de-identified aggregate data on weekday crashes and time-of-day for 16-18 year old (teen) and adult drivers for school years 2009-2010 and 2010-2011 in Henrico and Chesterfield Counties. Teen crash rates for counties with early versus later school start-times were compared using two-sample Z-tests and these compared to adult crash rates using pair-wise tests.

RESULTS

Henrico teens manifested a statistically higher crash rate of 48.8/1000 licensed drivers versus Chesterfield's 37.9/1000 (p = 0.04) for 2009-2010. For 2010-2011, HC 16-17 year old teens demonstrated a statistically significant higher crash rate (53.2/1000 versus 42.0/1000), while for 16-18 teens a similar trend was found, albeit nonsignificant (p = 0.09). Crash peaks occurred 1 hour earlier in the morning and 2 hours earlier in the afternoon in Chesterfield, consistent with commute times. Post hoc analyses found significantly more run-off road crashes to the right (potentially sleep-related) in Chesterfield teens. Adult crash rates and traffic congestion did not differ between counties.

CONCLUSIONS

Higher teen crash rates occurred in jurisdictions with EHSST, as in our prior study. This study contributes to and extends existing data on preventable teen crashes and high school start times.