Florida PTA Proposed Resolution

Transcription

1 Florida PTA Proposed Resolution Later School Start Times for Teens Submitted by: Palm Beach County Council of PTA/PTSAs Sandy Roth, President, Laura Fellman, Legislative Chair,

2 Table of Contents Resolution... 3 Rationale... 5 References... 6 Background Materials... 8 Whereas Whereas Whereas Whereas Whereas Whereas Whereas Whereas Whereas

3 Resolution Later School Start Times for Teens 1Whereas, 2Whereas, 3Whereas, 4Whereas, 5Whereas, 6Whereas, 7Whereas, 8Whereas, 9Whereas, Research shows that adolescents require between 8.5 and 9.5 hours of sleep per night, yet more than two-thirds of U.S. teens average fewer than 8 hours of sleep on school nights, and Natural sleep rhythms change as children grow into adolescence, such that adolescents simultaneously need more sleep yet do not feel sleepy until later in the evening; and Studies have demonstrated that duration of sleep has a positive relationship with academic outcomes for secondary school students; and Early school start times have been identified as an important external factor that can restrict adolescents sleep and therefore negatively affect their ability to learn; and establishing later start times has proven to increase their duration of sleep; and Schools are seeking solutions to problems that hamper their students progress and development such as absenteeism, tardiness and inattentiveness, and establishing later school start times provides a cost-effective means of addressing those problems and improving student performance; and Research also shows that inadequate sleep threatens students well-being, in that they are more likely to exhibit risk factors such as depression and suicidality, as well as engage in risky behaviors including, but not limited to, tobacco use, alcohol use, drug use, and sexual activity; and Adolescents are at particularly high risk of driving while impaired by sleepiness, and later school start times have been linked to reduced accident rates; and Inadequate sleep is associated with obesity in adolescence as well as with subsequent risk of cardiovascular disease, metabolic dysfunction (such as type 2 diabetes mellitus) and other physical health problems in adulthood; and Efforts to establish later school start times are more successful when stakeholders are educated regarding the sleep needs of and the impact of early school start times on adolescents; and be it therefore 3

4 Resolved, Resolved, That Florida PTA and its constituent associations educate parents, administrators, teachers, school board members, legislators, state board of education members, the governor, and communities about the importance of quality sleep and the positive impact of later secondary school start times for adolescents on their health, safety, and productivity; and be it further That Florida PTA and its constituent associations urge policy makers at federal, state and local levels to include stakeholders and to create policies that support and fund implementing secondary school start times that meet the optimum health requirements for adolescent sleep needs. 4

5 Rationale Our schools need to support the health and welfare of teens, including setting schedules such that teens are able to meet their sleep needs. Adolescents need between 8.5 and 9.5 hours of sleep per night. Based on their biological development, they don t become sleepy until late in the evening and waking up a teen at 7 a.m. is equivalent to waking up an adult at 4 a.m. With approximately 43% pf the public high schools in the US starting prior to 8:00 a.m., these sleep needs are not being met. When the school day begins after 8 a.m. students use the extra time getting more sleep and do not compensate by staying up later at night. Optimally for teens, schools should start at 8:30 a.m. or later. Currently, in a national study 68.3% of high school students slept less than 8 hours on school nights. With chronic sleep loss, teens are more likely to engage in risky behavior, be absent from school, be involved in car crashes, be depressed or suicidal, develop health problems, and perform worse academically. Delaying secondary school start times is a cost effective method to increase student performance and promote student well-being. The delayed start times correlate with better classroom and test performances. A later start time by 50 minutes has the equivalent benefit as raising teacher quality by roughly one standard deviation. This performance increase is the same as would be achieved by reducing class sizes by one third, a much more costly solution. The increase in student performance by the delayed start time is correlated with an increase of $17,500 for the student s future earnings. Seventy school districts consisting of approximately 1,000 urban, suburban and rural schools throughout the US have already changed their schedules to meet these sleep needs and were surveyed. Education and consensus building were key to their successful implementation of the schedule change. In the survey of their experiences changing the schedule, the top five benefits were identified as increased daily attendance, cost savings, reduced tardiness, improved standardized test scores and improved grades. Notably, all schools listed cost savings as a benefit. Many saw financial savings from restructuring the transportation system for these changes. Furthermore, none of the schools had athletic programs that were adversely impacted by the changes. A number of schools found that, after the schedule change, more students participated in athletics and the teams performed better too. A special thanks to Washington State PTA and Virginia PTA for sharing their resolutions on the same subject. 5

6 References 1. McKnight-Eily, Lela R., Eaton, Danice K., Lowry, Richard Croft, Janet B., Presley-Cantrell, Letitia, Perry, Geraldine S., (2011) Relationships between hours of sleep and health-risk behaviors in US adolescent students. Preventative Medicine, 2011, pp 1-3. Web. 2. Wahlstrom, Kyla L., Dretzke, B., Gordon, M. Peterson, K. Edwards, K. & Gdula, J. (2014) "Examining the Impact of Later High School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study." Center for Applied Research and Educational Improvement, St. Paul, MN: University of Minnesota. Feb Web. e%20final%20report.pdf;jsessionid=a11a ad098e6c6da?sequence=1 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web Owens, J., D. Drobnich, A. Baylor, and D. Lewin. (2014) "School Start Time Change: An In-Depth Examination of School Districts in the United States." School Start Time Change: An In-Depth Examination of School Districts in the United States 8 (2014): n. p Mind, Brain, and Education pdf 5. Owens, Judith. (2014) "Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences." Pediatrics, 25 Aug Web Vorona, Robert D., M.D. (2014) "Dissimilar Teen Crash Rates in Two Neighboring Southeastern Virginia Cities with Different High School Start Times." Journal of Clinical Sleep Medicine, 15 Apr Web. 1 Nov Jacob, Brian A., and Jonah E. Rockoff. (2011) "Organizing Schools to Improve Student Achievement: Start Times, Grade Configurations, and Teacher Assignments." Brookings.edu. The Hamilton Project, Web. 6

7 _organize_jacob_rockoff_paper 8. Edwards, Finley. "Early to Rise? The Effect of Daily Start times on Academic Performance." Economics of Education Review 31.6 (2012): Web Beebe, Dean W., Rose Douglas, and Amin, Raouf. (2010) Attention, Learning, and Arousal of Experimentally Sleep-restricted Adolescents in a Simulated Classroom. Journal of Adolescent Health, Volume 47, Issue 5, November 2010, pp Web Carrell, Scott E., Maghakian, Teny, and West, James E. (2011) A's from Zzzz's? The Causal Effect of School Start Time on the Academic Achievement of Adolescents. American Economic Journal: Economic Policy, Volume 3, Number 3, August 2011, pp Web Cappuccio, Francesco P., Taggart, Frances M., Kandala, Ngianga-Bakwin, Currie, Andrew, Peile, Ed, Stranges, Saverio, and Miller, Michelle A. Meta-Analysis of Short Sleep Duration and Obesity in Children and Adults. Sleep, May 1, 2008; 31(5): Web Kann, Laura, PhD., Steve Kinchen, and Shari L. Shanklin, MPH, et al. "Youth Risk Behavior Surveillance United States, 2013." Morbidity and Mortality Weekly Report: Surveillance Summaries 63.4 (2014): Web. 31 Oct "Media Advisory." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 26 Sept Web. 01 Nov

8 Background Materials Whereas 1 Research shows that adolescents require between 8.5 and 9.5 hours of sleep per night, yet more than two-thirds of U.S. teens average fewer than 8 hours of sleep on school nights, and 1. McKnight-Eily, Lela R., Eaton, Danice K., Lowry, Richard Croft, Janet B., Presley-Cantrell, Letitia, Perry, Geraldine S., (2011) Relationships between hours of sleep and health-risk behaviors in US adolescent students. Preventative Medicine, 2011, pp 1-3. Web. Pg. 1 Many adolescents are chronically sleep-deprived due to social, employment, recreational, and academic pressures as well as biological changes in the sleep/wake cycle. Pg 2 More than two-thirds (68.9%) reported insufficient sleep (<8h) on an average school night. Pg. 3 More than two-thirds of US high school students report insufficient sleep on an average school night 2. Wahlstrom, Kyla L., Dretzke, B., Gordon, M. Peterson, K. Edwards, K. & Gdula, J. (2014) "Examining the Impact of Later High School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study." Center for Applied Research and Educational Improvement, St. Paul, MN: University of Minnesota. Feb Web. e%20final%20report.pdf;jsessionid=a11a ad098e6c6da?sequence=1 Pg 3 While an estimated 9 hours 20 minutes may be ideal for adolescents, results from many studies have found that, on average, adolescents report sleeping less than 8 hours on school nights. Pg. 18 Recommended amount of sleep for teens ranges from 9 to 9.5 hours of sleep. Pg. 19 Majority of high school students across the country obtain less than 7 hours of sleep, on average. 8

9 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web. Pg. 642 The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep ( hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life. Pg. 643 Several studies from different perspectives indicate that adolescent sleep needs do not decline from preadolescent levels, and optimal sleep for most teenagers is in the range of 8.5 to 9.5 hours per night. A recent National Sleep Foundation poll found that 59% of sixth- through eighth-graders and 87% of high school students in the United States were getting less than the recommended 8.5 to 9.5 hours of sleep on school nights. 5. Owens, Judith. (2014) "Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences." Pediatrics, 25 Aug Web. Pg. 922 Increase the proportion of students in grades 9 through 12 who get sufficient sleep (defined as 8hours) By the 12th grade, 75% of students self-reported sleep durations of less than 8 hours of sleep per night compared with 16% of sixth graders. Furthermore, al-though 30% to 41% of sixth through eighth graders were getting 9 or more hoursofsleep,only3%of12thgraders reported doing so. Adolescents often attempt to address the accumulated weekday sleep debt during the week-end, when oversleep (the difference be-tween weekday and weekend sleep durations) of up to 2 or more hours is commonly reported. 12. Kann, Laura, PhD., Steve Kinchen, and Shari L. Shanklin, MPH, et al. "Youth Risk Behavior Surveillance United States, 2013." Morbidity and Mortality Weekly Report: Surveillance Summaries 63.4 (2014): Web. 31 Oct pg. 42 Nationwide, 31.7% of students got 8 or more hours of sleep on an average school night. 9

10 13. "Media Advisory." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 26 Sept Web. 01 Nov Responses were categorized into insufficient sleep (less than 8 hours), and sufficient sleep (8 or more hours of sleep) as the recommended number of hours of sleep suggested for this age group by the National Sleep Foundation Researchers found that 68.9 percent of adolescent responders reported insufficient sleep on an average school night. 10

11 Whereas 2 Natural sleep rhythms change as children grow into adolescence, such that adolescents simultaneously need more sleep yet do not feel sleepy until later in the evening; and 2. Wahlstrom, Kyla L., Dretzke, B., Gordon, M. Peterson, K. Edwards, K. & Gdula, J. (2014) "Examining the Impact of Later High School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study." Center for Applied Research and Educational Improvement, St. Paul, MN: University of Minnesota. Feb Web. e%20final%20report.pdf;jsessionid=a11a ad098e6c6da?sequence=1 Pg. 1 Recent research on the sleep-wake cycle of teens has identified changes in specific biological processes that occur with the onset of puberty that cause adolescents not only to need more sleep but also to feel sleepy at a later time. 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web. Pg From a biological perspective, at about the time of pubertal onset, most adolescents beginto experience a sleep wake phase delay (later sleep onset and wake times), manifested as a shift of up to 2 hours relative to sleep wake cycles in middle childhood. Two principal biological changes in sleep regulation are thought to be responsible for this phenomenon. One factor is delayed timing of nocturnal melatonin secretion across adolescence that parallels a shift in circadian phase preference from more morning type to more evening type, which consequently results in difficulty falling asleep at an earlier bedtime. The second biological factor is an altered sleep drive across adolescence, in which the pressure to fall asleep accumulates more slowly, as demonstrated by the adolescent brain s response to sleep loss and by a longer time to fall asleep after being awake for 14.5 to 18.5 hours in postpubertal versus prepubertal teenagers. Thus, these 2 factors typically make it easier for adolescents to stay awake later. At the same time, several studies from different perspectives indicate that adolescent sleep needs do not decline from preadolescent levels. 11

12 5. Owens, Judith. (2014) "Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences." Pediatrics, 25 Aug Web. Recent data have indicated that another process involved in regulating sleep timing seems to be altered to favor late nights across adolescent development. This process, called sleep wake homeostasis, can be thought of as the system that accounts for greater pressure to sleep as one stays awake longer. Data collected with 2 different paradigms to estimate the rate of buildup of sleep pressure in pre-pubertal versus post-pubertal adolescents indicate that more mature adolescents accumulate this sleep pressure at a slower rate. Maturational changes to these 2 bio-regulatory processes begin in adolescents as young as middle school and present a major challenge for young people to fall asleep in the early evening and to wake refreshed/restored in the early morning to attend school. 12

13 Whereas 3 Studies have demonstrated that duration of sleep has a positive relationship with academic outcomes for secondary school students; and 2. Wahlstrom, Kyla L., Dretzke, B., Gordon, M. Peterson, K. Edwards, K. & Gdula, J. (2014) "Examining the Impact of Later High School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study." Center for Applied Research and Educational Improvement, St. Paul, MN: University of Minnesota. Feb Web. e%20final%20report.pdf;jsessionid=a11a ad098e6c6da?sequence=1 Pg. 6 Academics. While the evidence pertaining to consequences of not enough sleep in adolescents as related to academic outcomes (grades, test scores, attendance) is still emerging, the general consensus of research indicates that good sleep has a positive relationship with academic outcomes for students in middle school all the way through college (Wolfson & Carskadon, 2003; Edwards, 2012; Wahlstrom, 2002; Carrell, Maghakian, & West, 2011). Additionally, if students do not obtain enough sleep before beginning their school day, they will have more difficulty understanding material taught that day and struggle to complete an assignment or test, regardless of the amount of time spent studying. Pg. 7 studies where the variables in the methodology could be adequately controlled do show a relationship between amount of sleep and GPA (Carrell et al., 2011; Perkinson-Gloor et al., 2013). 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web. Pg. 642 A substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. 13

14 9. Beebe, Dean W., Rose Douglas, and Amin, Raouf. (2010) Attention, Learning, and Arousal of Experimentally Sleep-restricted Adolescents in a Simulated Classroom. Journal of Adolescent Health, Volume 47, Issue 5, November 2010, pp Web. These pilot data complement previous correlational reports by showing that chronic sleep restriction during adolescence can cause inattention, diminished learning, and lowered arousal in a simulated classroom. Findings support the assertion that chronic sleep restriction during adolescence causes inattentive behaviors, poorer learning, and diminished arousal in the classroom. Coupled with previous questionnaire findings, these results suggest that the adverse effects of adolescent sleep restriction extend beyond basic sleepiness to include attention regulation and learning. 14

15 Whereas 4 Early school start times have been identified as an important external factor that can restrict adolescents sleep and therefore negatively affect their ability to learn; and establishing later start times has proven to increase their duration of sleep; and 2. Wahlstrom, Kyla L., Dretzke, B., Gordon, M. Peterson, K. Edwards, K. & Gdula, J. (2014) "Examining the Impact of Later High School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study." Center for Applied Research and Educational Improvement, St. Paul, MN: University of Minnesota. Feb Web. e%20final%20report.pdf;jsessionid=a11a ad098e6c6da?sequence=1 Pg. 1 Because the sleep-wake cycle changes as children grow into adolescents, early high school start time has been identified as an important external factor that could restrict sleep and negatively affect academic learning. Pg. 4 One of the most commonly cited and researched societal factors influencing adolescent sleep is that of school start times. In the United States in particular, as students get older, school start times tend to be earlier (Wolfson & Carskadon, 2005). However, this pattern of earlier morning obligations is in direct opposition to the students natural sleep patterns. It has repeatedly been shown that when middle or high school start times are pushed later, students still tend to go to bed about the same time, but, due to waking up later, increase their sleep Pg. 6 Studies have shown when school start times are pushed back, an increase in amount of sleep, as well as attendance and decrease in tardies to first period are observed. 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web. Pg. 642 Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 AM)as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. 15

16 The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep ( hours) and to improve physical (e.g., reduced obesity risk) and mental (e.g., lower rates of depression) health, safety (e.g., drowsy driving crashes), academic performance, and quality of life. Pg. 643 Insufficient sleep also takes a toll on academic performance. In the National Sleep Foundation poll cited previously,20 28% of students reported falling asleep in school at least once a week, and more than 1 in 5 fell asleep doing homework with similar frequency. Many studies show an association between decreased sleep duration and lower academic achievement at the middle school, high school, and college levels, as well as higher rates of absenteeism and tardiness and decreased readiness to learn. Pg. 644 Numerous studies have demonstrated that early start times impede middle and high school students ability to get sufficient sleep. Studies comparing high schools with start times as little as 30 minutes earlier versus those with later start times demonstrate such adverse consequences as shorter sleep duration, increased sleepiness, difficulty concentrating, behavior problems, and absenteeism. For example, in one key school transition study, evaluated the effects of a 65-minute advance (ie, move earlier) in school start time from grade 9 to grade 10 in 40 students. They found a delay in the biological markers of circadian timing but also objectively measured daytime sleepiness levels typical of patients with sleep disorders. Because circadian-based phase delays emerge at around the time of pubertal onset, they also affect younger adolescents, who increasingly are subject to many of the same environmental and lifestyle competing priorities for sleep as older teenagers. Recent re-search shows that delaying school start times for middle school students is accompanied by positive outcomes similar to those found in high schools, including later rise times, more school night total sleep, less daytime sleepiness, decreased tardiness rates, improved academic performance, and better performance on computerized attention tasks. In a study involving grades 6 through 12 in a school district that delayed high school start times by 1 hour (7:30 to 8:30 AM), students aver-aged 12 to 30 minutes more nightly sleep, and the percentage of students who reported 8 hours of sleep in-creased from 37% to 50%. 52 Owens in a study of adolescents attending an independent school that instituted a start time delay of 30 minutes (from 8:00 to 8:30 AM), reported that average bedtimes actually shifted earlier by an average of 18 minutes, and mean selfreported school night sleep duration increased by 45 minutes. In addition, the percentage of students getting less than 7 hours of sleep decreased by 79%, and those reporting at least 8 hours of sleep increased from 16% to 55%. Finally, in a 3-year study of >9000 students from 8 public high schools in 3 states (Colorado, Wyoming, and Minnesota), the percentage of students sleeping 8 hours per night was dramatically higher in those schools that had a later start time (e.g., 33% at 7:30 AM vs 66% at 8:55 AM). 16

17 10. Carrell, Scott E., Maghakian, Teny, and West, James E. (2011) A's from Zzzz's? The Causal Effect of School Start Time on the Academic Achievement of Adolescents. American Economic Journal: Economic Policy, Volume 3, Number 3, August 2011, pp Web. Pg This study identifies the causal effect of school start time on student academic achievement using data from the United States Air Force Academy (USAFA) to take advantage of the randomized assignment of students to courses and instructors as well as two policy changes in the school start time over a three-year period. Random assignment, mandatory attendance, along with extensive background data on students, allows us to examine how school start time affects student achievement without worrying about confounding factors or self-selection issues that bias existing estimates. USAFA s grading structure for core courses allows for a consistent measure of student achievement; faculty members teaching the same course in each semester use an identical syllabus and give the same exams during a common testing period, allowing for standardized grades within a course-semester. We find that early school start times negatively affect student achievement students randomly assigned to a first period course earn lower overall grades in their classes on the same schedule day compared to students who are not assigned a first period class on that day. We verify that this negative effect is not solely a result of poor performance during first period courses. Although students perform worse in first period classes compared to other periods, those with first period Pg. 15 classes also perform worse in their subsequent classes on that schedule day. These estimates are robust to professor by year by M/T day fixed effects and individual student fixed effects. Our findings have important implications for education policy; administrators aiming to improve student achievement should consider the potential benefits of delaying school start time. A later start time of 50 minutes in our sample has the equivalent benefit as raising teacher quality by roughly one standard deviation. Hence, later start times may be a cost-effective way to improve student outcomes for adolescents. Pg. 16 Note: Study pertains to adolescents. See pg. 3: Despite our use of university-level data, we believe our findings are applicable to the high school student population more generally because we consider only freshmen students in their first semester at USAFA. Like high school seniors, first semester college freshman are still adolescents and have the same biological sleep patterns and preferences as those in their earlier teens. However, we recognize that USAFA students are not the average teen; they were high-achievers in high school and chose to attend a military service academy. Although we do not know for certain if school start times affect highachievers or military-types differently than teenagers in the general population, we have no reason to believe that the students in our sample would be more adversely affected by early start times. Because the students in our study self-selected into a regimented lifestyle, if anything, we believe our estimates may be a lower-bound of the effect for the average adolescent. 17

18 Whereas 5 Schools are seeking solutions to problems that hamper their students progress and development such as absenteeism, tardiness and inattentiveness, and establishing later school start times provides a costeffective means of addressing those problems and improving student performance; and 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web. Pg. 644 According to the US Department of Education statistics for ,49 approximately 43% of the over public high schools in the United States currently have a start time before 8:00 AM. Pg. 645 Moving school start later by 1 hour can have an impact on standardized test scores comparable to decreasing the class size by one-third. Pg. 646 In addition, as outlined in a recent Brookings Institute Report ( Organizing Schools to Improve Student Achievement: Start Times, Grade Configurations, and Teacher Assignments ), economists have suggested that delaying school start times would have a substantial benefit-to-cost ratio (9:1). This finding is based on a conservative estimate of both costs per student ($0 $1950, largely related to transportation) and the increase in projected future earnings per student in present value because of test score gains related to moving start times 1 hour later (approximately $17 500). Finally, because the appropriation of federal dollars for schools is partially dependent on student attendance data, reducing tardiness and absenteeism levels could result in increased funding and further offset costs related to moving start times later. 4. Owens, J., D. Drobnich, A. Baylor, and D. Lewin. (2014) "School Start Time Change: An In-Depth Examination of School Districts in the United States." School Start Time Change: An In-Depth Examination of School Districts in the United States 8 (2014): n. pag. Mind, Brain, and Education. Web pdf Pg. 13 The top five identified benefits were: (1) increased daily attendance, (2) cost savings, (3) reduced tardiness rates, (4) improved standardized test scores, and (5) improved grades. 18

19 All schools listed cost savings as a benefit, likely attributable to adaptation of an increased number of busing tiers. In regards to perceived costs, no districts identified loss of community support, changes in traffic patterns, or a reduction in student involvement in extracurricular activities as a consequence. Pg. 27 Transportation of students determines most start time schedules and is typically the largest cost and logistical factor that districts consider. However, in many district, transportation is actually the main driver for seeking changes in an attempt to lower costs by adopting a multi-tiered bus delivery schedule. Districts that already employ a multi-tiered delivery schedule may have to use more creative strategies to find transportation savings. One strategy that is commonly used to overcome potential transportation costs is what is commonly referred to as flipping secondary/high school and elementary bell schedules. This may have the added benefit of being more in sync with circadian rhythms in both groups (e.g. younger children typically fall asleep earlier and wake earlier). 7. Jacob, Brian A., and Jonah E. Rockoff. (2011) "Organizing Schools to Improve Student Achievement: Start Times, Grade Configurations, and Teacher Assignments." Brookings.edu. The Hamilton Project, Web _organize_jacob_rockoff_paper Pg. 6 TABLE 1 Estimated Cost-Benefit Ratios for Organizational Reforms Organizational Test Score Gains Lifetime Earnings Cost per student Benefit/Cost Ratio Reform Gains Per Student Convert K-5/6-8 to K SD $10,000 $50 to $250 40:1 to 200:1 Middle/Upper Grades SD $17,500 $0 to $1,950 9:1 or more Start 1 Hour Later Managing Teacher 0.02 SD $2000 $0 financial, Assignments but other costs hard to measure Source: Transportation share expenditures taken from National Center for Education Statistics (NCES; ). (Table 1 was prepared June 2010.) Per pupil spending data are taken from NCES (2010), Table 190, Columns 2 and 3, for the school year Pg Would the Benefits of Later Starting Times Outweigh the Costs? The estimates from Carrell and his colleagues (2011) and Edwards (2011) suggest that moving start times one hour later for students in Grades 6 through 12 would increase student achievement by roughly standard deviations on average, with even larger benefits for disadvantaged students (Table 1).7 In order to translate this achievement gain into a dollar value, we follow the methodology used in Krueger (2003). A 1.0 standard deviation rise in test scores raises future earnings by 8 percent, 19

20 which we match to the age-earnings profile in the Current Population Survey (2008) and assume a 1 percent growth rate for real wages and productivity. We calculate the present value of lost wages for an increase in achievement of standard deviations and a discount rate of 4 percent. Doing so, we estimate that moving start times one hour later would result in roughly $17,500 in increased future earnings per student in present value. How Much Would This Cost Districts? Changing the ordering of elementary and high schools in a tiered system would have little, if any, direct financial costs to school districts, whereas moving from a tiered to a single system would entail an increase in transportation expenditures.4 In his study of Wake County, North Carolina, Edwards (2011) estimates that it would cost roughly $150 per student to allow all students to start at 9:15 a.m. 5 If we aggregate costs of $150 per student per year over the thirteen years a student is in a K 12 system, we arrive at an increase in transportation costs of $1,950 over the student s school career. However, in recent years, some districts have eliminated or cut back on transportation services, particularly for secondary school students. In such cases, the financial cost of shifting the school day would be negligible. Another option that might be feasible for some urban districts would be to have older students use public transportation to get to and from school. 8. Edwards, Finley. "Early to Rise? The Effect of Daily Start times on Academic Performance." Economics of Education Review 31.6 (2012): Web. Pg. 4 Students who begin school later have fewer absences, watch less television and spend more time on homework each week. These factors may also explain why later-starting students have higher test scores. Later start times also have the potential to be a cost effect method of increasing test scores. For example, Krueger (1999) find similar increases in test scores from smaller class sizes, but at cost an order of magnitude larger than the cost of changing start times. Pg The existing start times literature tends to find that students in early-starting schools are both more likely to be tardy to school and to be absent than other students. 26 The data set used in this paper only includes information on absences for two years: the and school years. Since no schools had changes in start time between those two years (there was one new school), I can only consider variation in start times across schools. Column 3 of table 10 presents the results of a regression of days absent per year on start time and a full set of covariates. Students who start school one hour later have 1.3 fewer absences (the median student has five absences). Reduced absences may explain why later starting students have higher test scores. Students who have an early start time miss more school (which may or may not be a result of getting less sleep) and as a result perform worse on standardized tests. 20

21 Using variation in start times both within and across schools, I find that an increase in start times by one hour would lead to a 3 percentile point gain in both math and reading test scores for the average student. Using only variation within schools the effect is 2 percentile points for math and 1.5 percentile point for reading. The impact of middle school start times on test scores persists into the tenth grade. The effect is larger for the lower end of the distribution of test grades. I find evidence supporting reduced sleep, in combination with the adolescent hormonal cycle as a mechanism through which later start times may affect test scores. 21

22 Whereas 6 Research also shows that inadequate sleep threatens students well-being, in that they are more likely to exhibit risk factors such as depression and suicidality, as well as engage in risky behaviors including, but not limited to, tobacco use, alcohol use, drug use, and sexual activity; and 1. McKnight-Eily, Lela R., Eaton, Danice K., Lowry, Richard Croft, Janet B., Presley-Cantrell, Letitia, Perry, Geraldine S., (2011) Relationships between hours of sleep and health-risk behaviors in US adolescent students. Preventative Medicine, 2011, pp 1-3. Web. Pg. 1 Objective. To examine associations between insufficient sleep (b8 h on average school nights) and health risk behaviors. Methods National Youth Risk Behavior Survey data of U.S. high school students (n=12,154) were analyzed. Associations were examined on weighted data using multivariate logistic regression. Results. Insufficient sleep on an average school night was reported by 68.9% of students. Insufficient sleep was associated with higher odds of current use of cigarettes (age-adjusted odds ratio [AOR], 1.67; 95% confidence interval [CI], ), marijuana (AOR, 1.52; 95% CI, ), and alcohol (AOR, 1.64; 95% CI, ); current sexual activity (AOR, 1.41; 95% CI, ); seriously considered attempting suicide (AOR, 1.86; 95% CI, ); feeling sad or hopeless (AOR, 1.62; 95% CI, ); physical fighting (AOR, 1.40; 95% CI, ), not being physically active at least 60 min 5 days in the past 7 days (AOR, 1.16; 95% CI, ), using the computer 3 h/day (AOR, 1.58; 95% CI, ), and drinking soda/pop N1 time/day (AOR, 1.14; 95% CI, ). 2. Wahlstrom, Kyla L., Dretzke, B., Gordon, M. Peterson, K. Edwards, K. & Gdula, J. (2014) "Examining the Impact of Later High School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study." Center for Applied Research and Educational Improvement, St. Paul, MN: University of Minnesota. Feb Web. e%20final%20report.pdf;jsessionid=a11a ad098e6c6da?sequence=1 Pg. 5 Sleep problems in childhood are known to be predictive of the development of anxiety and depressive symptoms as the child matures (Beebe, 2011). This negative effect of sleep problems appears to carry on into adolescence, where teens are more likely to have lower self-esteem (Frediksen, Rhodes, 22

23 Reddy & Way, 2004), have a more negative attitude towards life (Perkinson-Gloor, Lemola, & Grob, 2013), more problems regulating their emotions (Dahl, 1999; Dahl & Lewin, 2002), higher rates of mood disorders (Harvey et al., in press), and thoughts of suicide. Pg. 6 Many people who have mood disorders such as depression also tend to use drugs and alcohol more. Teens who report having insufficient sleep have been found to be more likely to smoke cigarettes, use marijuana, engage in sexual activity, and drink alcohol (McKnight-Eily et al., 2011; Dahl & Lewin, 2002). Furthermore, older adolescents and college students who are at the late end of the morningnesseveningness continuum are more likely to habitually use drugs and alcohol. Pg. 52 However, given the analyses summarized here, there are clear benefits for students whose high schools start at 8:30 AM or later. This would include, for teens who reported they got at least 8 hours of sleep per night, that they were more likely to say they have good overall health and were less likely to report being depressed or using caffeine and other substances (e.g., alcohol, tobacco, other drugs). 5. Owens, Judith. (2014) "Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences." Pediatrics, 25 Aug Web. Pg It is important to recognize that the causes and consequences of chronic sleep loss in adolescents are often closely intertwined in complex ways, further exacerbating the situation. For example, alcohol consumption can lead to insufficient and poor-quality sleep and subsequent daytime sleepiness. In turn, chronic sleep loss has been linked to an increased risk of alcohol and drug use. Similarly, compensatory oversleep behavior on weekends provides some temporary relief from sleepiness generated by insufficient sleep on weekdays, but it also leads to disrupted sleep wake cycles, exacerbation of the normal adolescent circadian phase delay, and perpetuation of compromised weekday alertness. Moreover, consequences such as poor judgment, lack of motivation, and inattention and affective dysregulation resulting from sleep loss, as well as the effect of insufficient sleep on decision-making skills, further compound the potential negative effects in adolescents. In particular, higher level cognitive executive functions, for which adolescence is a critical period of evolution, are selectively affected by sleep loss. It has long been recognized that mood disorders (especially major depressive disorder) in clinical samples of adults exhibit a bidirectional relationship with sleep disturbances, and the presence of sleep problems has been shown to both increase the relative risk of developing depression90 and to be a predictor of relapse. Similar findings have emerged in the child and adolescent population, particularly with regard to an association between insomnia (difficulty initiating and/or maintaining sleep) and clinically diagnosed depression. Recent studies have shown that addressing insomnia will greatly improve treatment of depression. Although studies examining sleep architecture in depressed adolescents have not consistently replicated differences in polysomnographic findings in depressed adults (i.e. increased REM sleep, decreased REM onset latency), there may be other sleep 23

24 electroencephalographic markers, such as sleep spindle activity and cyclic alternating patterns that have more relevance for the adolescent population. Sleep debt in college students has been shown to be associated with a higher risk of reporting depressive symptoms. Similarly, in high school students, shorter school-night total sleep time has been associated with both daytime sleepiness and depressive symptoms, whereas increased risk-taking behaviors were associated with irregular sleep patterns and self-reported sleep problems rather than sleep loss. These outcomes are similar to the findings of a large longitudinal adolescent health study in which symptoms of possible insomnia (i.e. trouble sleeping, morning tiredness) predicted risk behaviors (e.g., drinking and driving, smoking, delinquency) after controlling for depression symptoms. There is evidence that other sleep-related parameters may also have a significant effect on mood; for example, adolescent self-reported sleep variables (including trouble sleeping, tiredness, nightmares, and being a long sleeper) have been found to be significantly associated with psychological symptoms, including anxiety/depression, and withdrawal. Circadian factors may also play a role in mood regulation; increased self-reported eveningness, a marker of circadian phase delay, has also been associated with depression and lower behavior activation/positive affect. A number of recent studies have focused on the possible relationship between sleep and suicidal ideation. Sleeping less than 8 hours at night seems to be associated with an almost threefold increased risk of suicide attempts after controlling for a number of confounding variables. Not only do adolescents with insufficient sleep have an increased risk of suicidal ideation, but the risk may be similarly increased in adolescents whose parents also have insufficient sleep, raising some interesting questions about multigenerational environmental and/or genetic factors. A similar relationship has been found in middle and high school students; adolescents with parental-set bedtimes of midnight or later are significantly more likely to suffer from depression and to have suicidal ideation compared with adolescents with parental-set bedtimes of 10:00 PM or earlier. Earlier parentalset bedtimes, therefore, could potentially be protective against adolescent depression and suicidal ideation. Finally, both decreased ( 5 hours) or increased ( 10 hours) total sleep times may put adolescents at a significantly higher risk of suicidality compared with a total sleep time of 8 hours. However, increased risk of the most severe forms of suicidality (attempt requiring treatment) seems to be associated with significantly shorter sleep duration (total sleep time 4 hours). In summary, sleep has an important influence on mood and the development of depressive symptoms in adolescents. Although insufficient sleep and daytime sleepiness seem to have the most robust relationship with mood dysregulation, poor-quality sleep and irregular sleep patterns are also associated with depressed mood. Importantly, from a clinical standpoint, improvements in sleep may lead to improvements in mental health functioning (and vice versa). The association between sleep loss and increased suicidality in adolescents is particularly troubling and is clearly important for pediatricians to recognize 24

25 13. "Media Advisory." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 26 Sept Web. 01 Nov Students who reported insufficient sleep were more likely to engage in the health-risk behavior than students who reported sufficient sleep. There was no association found between insufficient sleep and watching 3 or more hours of television per day. Insufficient sleep was associated with the 10 health-risk behaviors examined below: Drank soda or pop 1 or more times per day (not including diet soda or diet pop) Did not participate in 60 minutes of physical activity on 5 or more of the past 7 days Used computers 3 or more hours each day In a physical fight 1 or more times Current cigarette use Current alcohol use Current marijuana use Currently sexually active Felt sad or hopeless Seriously considered attempting suicide Many adolescents are not getting the recommended hours of sleep they need on school nights. Insufficient sleep is associated with participation in a number of health risk behaviors including substance use, physical fighting, and serious consideration of suicide attempt, said Lela McKnight Eily, PhD, Division of Adult and Community Health. Public health intervention is greatly needed, and the consideration of delayed school start times may hold promise as one effective step in a comprehensive approach to address this problem. 25

26 Whereas 7 Adolescents are at particularly high risk of driving while impaired by sleepiness, and later school start times have been linked to reduced accident rates; and 2. Wahlstrom, Kyla L., Dretzke, B., Gordon, M. Peterson, K. Edwards, K. & Gdula, J. (2014) "Examining the Impact of Later High School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study." Center for Applied Research and Educational Improvement, St. Paul, MN: University of Minnesota. Feb Web. e%20final%20report.pdf;jsessionid=a11a ad098e6c6da?sequence=1 Pg. 6 Ability to focus is important not only for learning of new information, but also for safe completion of activities such as driving. The level of inattentive behavior has been found to be higher for students who have had less sleep (Beebe et al., 2010; Lufi, Tzischinsky, & Hadar, 2011). Additionally, reaction times improve in students who have had more sleep (Lufi et al., 2011; Vedaa et al., 2012). Given that reaction time is an important factor when driving in order to avoid having an accident, it is no surprise that there is a high prevalence of teen automobile accidents. Lower quality sleep has been shown to be associated with higher prevalence of self-reported accidents among teen drivers (Pizza et al., 2010), as well as lower quantity (Danner & Phillips, 2008). A study that used DMV records of teen automobile accidents found that adolescent automobile accidents occurred at a higher rate in a city which had an earlier high school start time than its neighboring, but demographically similar city (Vorona et al., 2011). Because of the extensive research indicating that students who start school later get more sleep, it may be reasonable to assume that this difference in crash rates is in part due to differences in sleep amounts for teens in the two cities. Pg Discussion of Car Crash Results. In two of the four communities for which we had crash data and which had instituted a later start time for their high schools, the rate of car crashes for high school age drivers dropped by 65-70%. Another district saw a slight decrease of 6%, and the fourth experienced an increase of 9%. The district with the increase, St. Louis Park, is a first-ring suburb of Minneapolis. St. Louis Park contains many major highway routes between the city of Minneapolis and other neighboring second- and third-ring suburbs. This may be a contributing factor in the increase in crash rates there, as those crashes may involve teens who attend local high schools in other nearby districts with earlier start times. The data that were provided did not enable us to identify which high schools the teens involved in crashes were attending. 26

27 Cottage Grove and Woodbury are communities that are considered second- or third-ring suburbs and are significantly distant from the central cities of Minneapolis and St. Paul. In addition, Cottage Grove and Woodbury are both experiencing high growth rates. They have combined into one school district called South Washington County. Their crash rate decreased by 6%. Mahtomedi is the other Minnesota school district, a second-ring suburb, and their crash rate dropped by 65%. We believe that the crash data also need to be viewed within additional geographic lenses. For example, the geographic sizes of Cottage Grove and Woodbury, together as one school district, are 73 square miles in size, and are 6 to 12 times larger than either St. Louis Park (10.8 sq. mi) or Mahtomedi (5.5 sq. mi), and thus the driving distances are greater. Prior research has shown that the longer the distances for driving, the greater the problem with drowsy driving (Maclean et al., 2003). The Teton County (Wyoming) School District had the latest school start time of the four districts involved in this portion of the research study and had a substantial reduction in car crashes during the school year after the later start time was initiated. The number dropped from 23 to 7 for drivers 16 to 18 years of age, which is a crash rate reduction of 70%. The fact that over 66% of Jackson Hole High School students now obtain more than 8 hours of sleep each school night may be the reason for the significant drop. Finally, police officers on the scene of any crash make certain subjective assessments of contributing factors, the subjectivity of which makes an initial comparison of causal factors somewhat speculative. However, the time of day is factual information, and it can be seen that crashes during the school year with the earlier start for the high school were three times more likely to happen in the time period between end of the school day and bedtime. After the later start time change, not only were there fewer crashes, but the proportion of crashes happening before school versus after school was about evenly split. Also, the factor of having greater driving distances for the Jackson Hole area, which is over 500 square miles, and which has the largest geographic size of all districts studied, makes the reduction of crashes by 70% all the more remarkable, given what was noted above about the link between drowsy driving and longer distances. Finally, with Jackson Hole High School being the only major high school in Teton County, this allows for greater confidence that the drop in the crash rate is not influenced by other changes in other high schools nearby, since theirs is the only high school in the area. Pg. 52 The clear and consistent message is that middle and high school students are not getting enough sleep and that this issue is a chronic problem worldwide. In addition, the health and behavioral outcomes linked to restricted sleep, as further detailed in the following sections, are alarming. Other positive findings include a significant reduction in local car crashes. 27

28 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web. Pg. 643 Adolescents are also at greater risk of drowsy driving related crashes as a result of insufficient sleep. Pg. 645 Furthermore, adolescents are at particularly high risk of driving while impaired by sleepiness, and young drivers aged 25 years or younger are involved in more than one-half of the estimated police-reported, fatigue-related traffic crashes each year.60 Danner and Phillips52 examined the relationship between automobile crash records for students 17 to 18 years of age and high school start times. Car crash rates for the county that delayed school start times decreased by 16.5% over the 2 years before and after the school-start change, whereas those for the state as a whole increased by 7.8%across the same time period. In an-other recent study conducted in 2 adjacent, demographically similar cities, there were significantly in-creased teen (16- to 18-year-olds) crash rates over a 2-year period in the city with earlier high school start times (2007: 71.2 per 1000 vs 55.6 per 1000; 2008: 65.8 per 1000 vs 46.6 per 1000 [P <.001]), and teen drivers morning crash peaks occurred 1 hour earlier.61 Finally, the recent study by Wahlstrom et al54 found a crash rate reduction in 16- to 18-year-olds of 65% and 70%, respectively, in 2 of the 4 high schools studied; notably, the high school with the latest start time (Jackson Hole, WY) had the largest decline in car crashes. 5. Owens, Judith. (2014) "Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences." Pediatrics, 25 Aug Web. Pg. 923 These outcomes include increased risk of car crashes. The clear and consistent message is that middle and high school students are not getting enough sleep and that this issue is a chronic problem worldwide. In addition, the health and behavioral outcomes linked to restricted sleep, as further detailed in the following sections, are alarming. These outcomes include increased risk of car crashes Pg. 924 Danner and Phillips33 demonstrated that delaying school start times in 1 community in Kentucky decreased the average crash rate for teenaged drivers by 16.5%, while the state as a whole increased by 7.8% in the same time period. In another recent study conducted in 2 adjacent, demographically similar cities, there were significantly increased teenaged (16- to 18-year-olds) crash rates over a 2-year period in the city with earlier high school start times Pg. 928 It is now well recognized that daytime sleepiness and fatigue are associated with an increased rate of motor vehicle crashes. The fact that sleepiness could be a major factor in individuals without known sleep disorders was not universally accepted until the landmark paper by Pack et al in This 28

29 group reviewed crash reports from the state of North Carolina between 1990 and 1992 in which the driver was judged to have fallen asleep behind the wheel. In the 85% of crashes in which intoxication was not thought to be a contributing factor, the majority (55%) occurred in individuals 25 years or younger. Crashes in this younger age range generally occur at night, unlike crashes with older adults, which typically occur during the mid-afternoon, and tend to occur predominantly when the drowsy driver is alone. In addition, young male drivers are more likely to be involved in sleep-related crashes than are young female drivers. Sleepiness while driving is a common complaint among adolescents and college students. In a study of high school students with driver s licenses, one-fifth reported poor-quality sleep, almost two-thirds complained of daytime sleepiness, 40% reported having sleepiness while driving, and 11% reported having had an automobile crash in which sleepiness was the main cause. Being sleepy behind the wheel and poor-quality sleep at night also seem to increase the risk of having an automobile crash in college students. Countermeasures may potentially help prevent traffic accidents in this age range. Avoidance of driving when sleep deprived and not drinking alcohol before getting behind the wheel are obvious solutions. Other countermeasures that have some empiric support in adults and may be effective in adolescents include planned napping. 6. Vorona, Robert D., M.D. (2014) "Dissimilar Teen Crash Rates in Two Neighboring Southeastern Virginia Cities with Different High School Start Times." Journal of Clinical Sleep Medicine, 15 Apr Web. 1 Nov A potential critical consequence of insufficient sleep in teens is drowsy driving. Fall-asleep crashes tend to be severe, and, of these, 55% have been found to occur in individuals who are 25 years or younger. 7 For the years 2007 and 2008, individuals aged years had the highest injury rate from motor vehicle crashes. 8 While individuals aged 15 to 20 years represented only 9% of the U.S. population and 6% of licensed drivers for 2007, 19% of all fatalities in the United States were related to young-driver crashes. Early high school start times could contribute to insufficient sleep in teenagers 10 and increased motor vehicle crashes. One study found start time to be the main determinant of wake times in adolescents. 11 A recent study revealed that a 30-min delay in high school start time was associated with 45 min of additional sleep on weekday nights and reduced sleepiness. 12 Thus, later high school start times could result in more sleep and better synchronicity with the circadian phase delay found in teens. Our findings may indicate that Virginia Beach teenagers are sleep restricted. An increased pressure to sleep may explain the increased rate of teen crashes when school start times are more than an hour earlier. In addition, early start times such as are seen in Virginia Beach conflict with neurophysiology. For 29

30 a teen arising at 06:00 to achieve at least 9 hours of sleep, he or she would have to go to bed by 21:00. Beyond the impracticality of getting a high school student in bed by 21:00, teen delayed circadian rhythms work against such an early bedtime. These teens may suffer from circadian delays in addition to sleep deprivation, which may place them at a heightened risk for crashes. Sleep deprivation may also be related to increased risk-taking proclivity, 5 which might relate to increased crash rates. 30

31 Whereas 8 Inadequate sleep is associated with obesity in adolescence as well as with subsequent risk of cardiovascular disease, metabolic dysfunction (such as type 2 diabetes mellitus) and other physical health problems in adulthood; and 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web. Chronic sleep restriction increases subsequent risk of both cardiovascular disease and metabolic dysfunction, such as type 2 diabetes mellitus. An association between short sleep duration and obesity in children and adolescents has been demonstrated in several cross-sectional and prospective studies, underscoring how chronic sleep restriction can undermine health. TABLE 1 Impact of Chronic Sleep Loss in Adolescents Physical health and safety Increased obesity risk Metabolic dysfunction (hypercholesterolemia, type 2 diabetes mellitus) Increased cardiovascular morbidity (hypertension, increased risk of stroke) 4. Owens, J., D. Drobnich, A. Baylor, and D. Lewin. (2014) "School Start Time Change: An In-Depth Examination of School Districts in the United States." School Start Time Change: An In-Depth Examination of School Districts in the United States 8 (2014): n. pag Mind, Brain, and Education. Web pdf Pg. 3 Chronic sleep restriction increases subsequent risk of both cardiovascular disease and metabolic dysfunction such as type 2 diabetes ( 5 ). An association between short sleep duration and obesity in children and adolescents has been demonstrated in several cross-sectional and prospective studies, underscoring how chronic sleep restriction can undermine the health of our nation s youth. 31

32 5. Owens, Judith. (2014) "Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences." Pediatrics, 25 Aug Web. Pg Insufficient Sleep and Obesity Risk A considerable body of evidence now links short sleep duration in both adults and children with an increased risk of obesity, an association that obviously has long-range health implications. With regard to mechanisms, experimental studies of sleep restriction in healthy adult volunteers have shown that there are alterations in metabolic profiles (e.g. insulin, ghrelin, leptin, cortisol) associated with sleep loss, which result in insulin resistance, increased sympathetic nervous system activity, and increased hunger and decreased satiety. As a result, sleep restricted subjects consume more calories, exercise less, and consume a higher percentage of calories from fat. In 1 earlier study, it was estimated that for each hour sleep lost, the odds of being obese increased in adolescents by 80%. Furthermore, there is evidence of a dose response inverse relationship between sleep and weight, with odds ratios of overweight increasing with decreasing sleep duration (<5 hours, 5 6 hours, 6 7 hours, and 7 8 hours compared with students sleeping >8 hours). The increased risk of obesity associated with insufficient sleep seems to be equivalent to or higher than the risk associated with other factors strongly correlated with weight, such as parental obesity and television viewing. Early sleep patterns may influence BMI in adolescents and young adults as well. Longitudinal data suggest that children who sleep less, have later bedtimes, or get up earlier subsequently have higher BMIs and are more likely to be overweight, even after controlling for baseline BMI. This association may be established early in life; for example, an increased BMI and high prevalence of obesity in young adults was found in individuals whose mothers had reported sleeping problems ( irregular or troubled sleeping) at ages 2 to 4 years (although sleep duration was not specified)compared with those who had not had sleeping problems. Although the underlying potential mechanisms for the relationship between sleep and weight in adolescents have yet to be elucidated, metabolic alterations associated with sleep loss similar to those observed in adults are likely to play an important role. In particular, perturbations in the levels of neurohormones known to be associated with hunger and satiety (eg, adiponectin, ghrelin) as well as increased insulin resistance (as measured by the homeostatic model assessment [HOMA]) have been demonstrated in adolescents sleeping <5 hours per day. These short sleepers were also found to have a higher percentage of carbohydrate intake according to a dietary questionnaire. In summary, despite a number of methodologic limitations, the body of evidence from studies assessing the relationship between short sleep and increased overweight/obesity risk in adolescents is both compelling and potentially far-reaching in its public health implications. More research is urgently needed to identify specific metabolic, inflammatory, and hormonal mechanisms as well as the 32

33 interactions among sleepiness and activity levels, mood, cognition, and behavioral responses in this complex equation. 11. Cappuccio, Francesco P., Taggart, Frances M., Kandala, Ngianga-Bakwin, Currie, Andrew, Peile, Ed, Stranges, Saverio, and Miller, Michelle A. Meta-Analysis of Short Sleep Duration and Obesity in Children and Adults. Sleep, May 1, 2008; 31(5): Web. Pg. 625 The findings of our analysis suggest that whilst sustained sleep curtailment and ensuing excessive daytime sleepiness are undoubtedly cause for concern, the link to obesity is of interest but still to be proven as a causal link. Many questions still need an answer to determine causality. Prospective studies in which weight, height, waist measurements. and adiposity are measured at baseline and again at subsequent data collection times together with more accurate objective measurement of sleep duration (including naps) and confounding factors or mediators such as depression are needed. 33

34 Whereas 9 Efforts to establish later school start times are more successful when stakeholders are educated regarding the sleep needs of and the impact of early school start times on adolescents; and be it therefore 3. American Academy of Pediatrics, (2014) POLICY STATEMENT School Start Times for Adolescents. Pediatrics, Volume 134, Number 3, September 2014, pp Web. Pg. 646 One of the biggest challenges school districts face is the need to inform com-munity stakeholders (e.g., parents, teachers and administrators, coaches, students, bus drivers, businesses that employ students, law enforcement officials) about the scientific rationale underpinning the merits of delaying school start times; the threats to health, safety, and academic success posed by insufficient sleep; and the potential benefits for adolescents of school start time delay. Thus, education and community engagement are equally key components in increasing the likelihood of success. The American Academy of Pediatrics lends its strong support to school districts contemplating delaying school start times as a means of optimizing sleep and alertness in the learning environment and encourages all school administrators and other stakeholders in communities around the country to review the scientific evidence regarding school start times, to initiate discussions on this issue, and to systematically evaluate the community-wide impact of these changes (eg, on academic performance, school budget, traffic patterns, teacher retention). 4. Owens, J., D. Drobnich, A. Baylor, and D. Lewin. (2014) "School Start Time Change: An In-Depth Examination of School Districts in the United States." School Start Time Change: An In-Depth Examination of School Districts in the United States 8 (2014): n. pag. Mind, Brain, and Education. Web pdf Pg After reviewing all of the available information on the process of school start time change from a wide variety of sources as described above, including the in-depth case examples, the CNMC team has complied a summary of the most common and salient points to best inform school districts, such as Fairfax County, that are actively contemplating a change in bell schedules. 34

35 2. Education of the Entire Community Change agents and stakeholders should have a working knowledge of the research on adolescent sleep and early start times in order to effectively communicate the rationale for changing bell schedules (Arlington, VA). It is important for school district leadership (i.e., superintendents, school board members, principals) to refute misconceptions (e.g., if school starts later, teens will just stay up later and won t get more sleep ) while also responding to the legitimate concerns of students, parents, and teachers. Community members and staff may either discount the scientific literature or choose to focus on perceived (whether or not valid) complications related to logistical or personal convenience concerns; thus, the more educated that district staff becomes about the sleep science, the more persuasive they will be in communicating these messages. It is extremely important to emphasize the health and safety benefits associated with providing students the opportunity to get more sleep and that the potential benefits go far beyond academic improvements. When communicating the short and long-term consequences of chronic sleep loss (and, by implication, the potential dangers associated with failing to delay high school start times), it should be emphasized that these extend not only beyond the school grounds (e.g., drowsy driving, depression, obesity) but very well may set students up for debilitating (e.g., insomnia) or life- Pg. 26 threatening medical conditions (e.g., cardiovascular consequences such as hypertension or metabolic dysfunction such as type 2 diabetes) in the future. Districts should seek to provide appropriate targeted education for the entire community (students, parents, teachers, school nurses) on sleep, sleep disorders, and the consequences of sleep deprivation. Efforts should be made to work with local sleep centers and hospitals to provide medically accurate information and to present that information in a variety of forums (e.g., fact sheets, slide presentations, webinars) for a range of audiences, and include ample time for discussion and addressing questions (Albany, CA; Fayette, KY). Teachers and other school personnel, especially health and counseling professionals, should be well educated about adolescent sleep needs and patterns, taught to recognize the signs of sleep-related difficulties among their students, and report such symptoms to parents and school health providers ( 20, 21 ). Superintendents, school boards and principals should consider integrating sleep-related education into curricula so students can learn about the physiology of sleep, the consequences of sleep deprivation, and the importance of sleep to their overall health. This education can be provided in science, health and athletic classes. Finally, it is particularly important that information be provided to support families throughout the implementation phase in culturally sensitive ways. This includes translating basic print educational materials into multiple languages, providing translation services at community-wide online forums and reaching out to local press venues that serve minority communities. 35

36 8. Edwards, Finley. "Early to Rise? The Effect of Daily Start times on Academic Performance." Economics of Education Review 31.6 (2012): Web. Pg Later school start times have been often cited in the popular press as a way to increase student performance. However, there has not been much empirical evidence supporting this claim or calculating how large of an effect later start times might have. Using variation in start times both within and across schools, I find that an increase in start times by one hour would lead to a 3 percentile point gain in both math and reading test scores for the average student. Using only variation within schools the effect is 2 percentile points for math and 1.5 percentile point for reading. The impact of middle school start times on test scores persists into the tenth grade. The effect is larger for the lower end of the distribution of test grades. I find evidence supporting reduced sleep, in combination with the adolescent hormonal cycle as a mechanism through which later start times may affect test scores. I also find evidence supporting time at home with parents as a mechanism. These results suggest that delaying start times may be a cost-effective method of increasing student performance. Since the effect of later start times is stronger for the lower end of the distribution of test scores, later start times may be particularly effective in meeting accountability standards that require a minimum level of competency. If elementary students are not affected by later start times (which cannot be definitively determined from my data), it may be possible to increase test scores for middle school students at zero cost by having elementary schools start first. Alternatively, the entire schedule could be shifted later into the day. However, these changes may be politically infeasible due to childcare constraints for younger students and jobs and after school activities for older students. A third option would be to eliminate tiered busing schedules and have all schools begin at the same time. A plausible estimate of the cost of moving start times later is the additional cost of running a single tier bus system. The WCPSS Transportation Department estimates that over a ten year period from , using a three-tiered bus system saved roughly $100 million in transportation costs (Wake County Public School System Department of Transportation, 2004). With approximately 100,000 students per year divided into three tiers, it would cost roughly $150 per student each year to move each of the 66,000 students in the two earliest start time tiers to the latest start time. In comparison, Krueger (1999) finds that reducing early elementary class size by one third increases test scores by 4 percentile ranks in the first year at a cost of $2151 per student per year. If the same class size effect holds for middle school students, and the effect is linear, it would cost seven times as much to obtain a two percentile point increase by reducing class size than by starting school one hour later. While very rough, these calculations suggest that increased spending on bus transportation, in order to delay the beginning of the school day, may be substantially cheaper than reducing class size to gain a comparable improvement in test scores. 36