The Relationship of School Start Times, Sleep Duration and Mental Health among a Representative Sample of High School Students in Colorado, 2019.

Lucas M Neuroth,Ming Ma,Motao Zhu,Ashley Brooks-Russell

doi:10.3390/ijerph18115708

Abstract

This cross-sectional study utilized responses from 46,537 students enrolled in grades 9 through 12 in 166 high schools across the state of Colorado via the 2019 Healthy Kids Colorado Survey to: (1) quantify the association between high school start times and student sleep duration and (2) investigate the associations between school start times and student mental health. Descriptive and bivariate analyses were used to investigate associations between school start times and self-reported demographic, sleep, and mental health factors. Survey-weighted multivariate regression modeling was used to investigate associations between school start times, sleep duration, and mental health. Schools with late start times (≥8:30 a.m.) saw 32.2% (95% Confidence Interval: 29.5–35.0) of students sleeping 8 h or more relative to 23.2% (22.0–24.4) in schools with very early start times (<8:00 a.m.). For every 15 min later school start time, students’ sleep duration was 4.6 (3.4–5.9) min longer. Students attending schools with very early start times had 1.10 (0.95–1.27) times the odds of attempting suicide compared to those attending schools with later start times, while students at schools with early starts (8:00–8:29 a.m.) were associated with 1.11 (0.98–1.27) times the odds. Schools with later school start times had a statistically significantly higher proportion of students sleeping 8+ hours. Schools with start times before 8:30 a.m. had 10–11% higher odds of students attempting suicide compared to schools with late start times, though these differences were not statistically significant. Student mental health should continue to be investigated when assessing the potential impacts of delayed school start times.

Highlights

The proportion of adolescents achieving adequate sleep is cause for concern.While over 60% of adolescents are achieving adequate sleep in countries such as Sweden, Canada, Norway, and Belgium, only 30–40% of adolescents reach this amount of sleep in Poland, Greece, and Estonia [1]
Race/ethnicity was not associated with school start time, though schools with late start times had a higher proportion of nonHispanic White students compared to schools with early or very early start times
We found that student maternal education, school urbanicity, and school free and reduced lunch (FRL) status were associated with school start times

Summary

Introduction

The proportion of adolescents achieving adequate sleep is cause for concern.While over 60% of adolescents are achieving adequate sleep in countries such as Sweden, Canada, Norway, and Belgium, only 30–40% of adolescents reach this amount of sleep in Poland, Greece, and Estonia [1]. The proportion of adolescents achieving adequate sleep is cause for concern. Within the United States, the proportion of adolescents achieving adequate sleep, defined as 8 to 10 h per night for 13- to 18-year-olds by the American Academy of Sleep Medicine [2], is even lower. There are disparities in sleep duration across grade levels, with high school seniors (12th graders) having the lowest proportion of adequate sleepers and freshman (9th graders) having the highest [4]. These findings are concerning when considering the numerous negative health outcomes, both physical and mental, that are associated with inadequate sleep in adolescents

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