C. Medical Intervention: Minnesota, Connecticut, & Rhode Island

“The results were stunning. There’s no other word to use. We didn’t think we’d get that much bang for the buck.” (547)—Patricia Moss, Ph.D., M.A., Assistant Head of School and Head of the Latin Department, St. George’s School, Rhode Island, after start times were delayed from 8 a.m. to 8:30 a.m.

cdc-logoAs previously discussed (see, §§ III.G., IV, supra), CDC scientists endorse later high school start times as a means of addressing the “deleterious impact of school times on our teenagers.” (18) Janet Croft, Ph.D., a senior CDC epidemiologist, has referred to early high school start times as “an unrealistic burden on children and their families. … It can change lives to change school start times.” (18)

The Maryland State Medical Society (643) and the American Lung Association of New England (4) encourage schools to delay start times as a means of addressing teen sleep deficiency. According to Dr. Heidi Connolly, Associate Professor of Psychiatry and Pediatric Sleep Medicine at the University of Rochester Medical Center in New York, “Sleep medicine specialists have long known that delaying high school start times helps teenagers sleep better.” (600)

While there may be many instances of sleep experts stepping into the educational arena to affect a delay in start times (e.g., Fayette County, Ky.; (31, 47, 48, 644, 645) Deerfield Academy, Mass.), (646) those noted below may be distinguishable insofar as much of the local impetus for change appears to have been generated by the scientists themselves. Given, as previously noted (see, § IV, supra), sleep scientists’ uniform support of later start times, (2, 11, 12, 13, 14, 15, 16, 17, 18, 19, 2023, 26, 30, 52, 63, 103, 315, 317, 352, 423, 523, 567) arguably whenever science informs a schedule change, medicine has intervened.

Edina & Minneapolis, Minnesota

In 1994, the Minnesota Medical Association wrote to every school superintendent in the state of Minnesota, requesting school start times be pushed later to comport with adolescent sleep cycles. (8, 10, 20, 650As in other jurisdictions where medical professionals have attempted to intervene (317, Tammen, Area doctors press for later start for high schools (Nov. 15, 2011) NewsHerald.com), many Minnesota districts simply ignored the message. (403Educators in Edina Public Schools (6,800 students) and Minneapolis Public Schools (50,000 plus students) were listening, however. (644) In Edina, high school start times were delayed from 7:20 a.m. to 8:30 a.m.; (3) in Minneapolis, from 7:15 a.m. to 8:40 a.m. (3, 37

In what remains among the most comprehensive studies to date, CAREI researchers found that in Edina and Minneapolis, student health, well-being, and performance (including SAT scores) (62, 142improved in every respect. (3, 37Smolensky & Lamberg, The Body Clock: Guide to Better Health (Henry Holt & Co., 2000) [teachers of and elementary school children and young middle school students (ages 10-12) felt their students missed prime learning time by delaying morning classes to 9:40 a.m.] p. 89.) The study demonstrated multiple benefits to the students as a result of the delayed schedule: increased daily attendance and reduced tardiness, increased rates of continuous enrollment and graduation, and overall improvement in student academic performance. (37) It should be noted Hinrichs challenges the accuracy of CAREI’s attendance determinations, (356) however, reports from other jurisdictions also reflect improved attendance following a start time delay. (2, 30, 41, 44, 47, 48see, discussion n. 578, infra.)

Surveys of teachers demonstrated a qualitative leap in the school morale as a result of the later schedule, with comments like “there is an alertness in the students coming into school that I haven’t seen in many, many years.” (343) Administrators reported the school seemed “calmer” and were impressed with the attendance changes. (343Reductions were reported in classroom sleeping, and student visits to school counselors for behavioral issues. (37, 341) Students reported fewer symptoms of depression and increased feelings of positive self-efficacy. (3, 37, 341Students were reported to be more even-tempered at home. (37, 341)  

welcome to realityGregor Feige, a senior on his way to attend Johns Hopkins University, said everyone used to be sleepy during his freshman year, before the start time was pushed back. (651) “They just had kind of blank expressions on their faces[.] They just kind of laid their heads down.” (651) Gregor, who sings in the chorus, leads a community social service club and works part-time at a golf course, said the change merely reflected hard reality. (651) “None of these kids are ever going to go to bed at 10[.] They just can’t. It doesn’t happen.” (651)

Edina researchers also found “marked improvement in student behavior, students felt more alert and well rested during the first hour of class and less tired at the end of the day, students had less erratic sleep behaviors, after-school activities were not negatively affected, there was a significant reduction in school dropout rates, less depression was evidenced, higher grades were reported, and teachers reported positive effects on both their professional and personal lives.” (47Edina superintendent Ken Dragseth reported, “Kids used to walk around half asleep with a can of Coke or some coffee[.] After the switch, it was like night and day.” (651)

High-School-Football-FieldMinneapolis “[c]oaches and activity leaders were generally supportive of the change because they saw students who were less tired and seemingly more mentally alert at the end of the day. A few coaches whose sports involved long practices and traveling long distances for events were outspoken about their dislike of the later start and dismissal time for the school day.” (37) Parents “commented that they were having more actual conversations with their teenage children in the morning, finding that they had new ‘connection time’ with their child.” (37) Parents also cited some of the challenges, like “eats dinner later because of sports, no time for a job,” but also “less stressful mornings,” “breakfast never missed,” and “the later start time is very beneficial, both relative to grades and to energy level.” Many parents commented “fix the middle schools too!” (2, 343)

Prior to the delay, parents predicted adjusting start times would interfere with after-school sports and transportation. (3, 37) Afterward, however, 92% of the parents decided they favored the new schedule. (3, 37The vast majority of the students also approved. (2, 343Five years into the study, researchers found students in Minneapolis high schools continued to get 60 minutes more sleep on weeknights than did their peers whose school began at 7:30 a.m. (341”[T]he positive benefits continued to persist over time.” (341) “In short, an hour more of sleep improved students’ quality of life.” (62)

In 2010, CAREI Director Kyla Wahlstrom pointed out that Edina is a “very stable, wealthy suburb, while Minneapolis is highly urban, with 67% students of color and 83% of students qualifying for free/reduced lunch. Although the districts were vastly different, the outcomes and effects were essentially the same.” (554)

medical symbol Wilton, Connecticut

In Connecticut, physicians from the Thoracic Society allied with the League of Women Voters, (565assembled a task force to both raise awareness and advocate for the change to later start times. (4654) As a result, in 2003, about 4,300 Wilton, Connecticut students in grades 6-12 had their start times delayed 40 minutes to 8:15 a.m. Students weeknight sleep increased by 34 minutes, or 83 percent of the available additional time. (2) Although the response was “overwhelmingly positive” among parents, teachers, and students, Norwalk Hospital sleep scientists concluded, “it is likely that a longer delay in start time than was adopted in Wilton could have an even greater benefit for students, given the number of teens who reported continuing to experience significant sleepiness. However, it is reassuring that the new schedule did result in increased sleep and the impact was so widely apparent.” (2)

trophies_sports_awards -- printing factoryWilton’s teachers reported students “were more awake, had better attitudes, and were overall more pleasant. In addition, the number of students who said they had no trouble with daytime sleepiness doubled and there has been a trend toward higher grades. Wilton’s athletic coaches, who had been worried they wouldn’t be able to hold practices because of the time change, reported that their teams had one of the best athletic seasons ever, winning several state championships.” (47)

In 2009, Lisa Bogan, former Vice Chair of the Wilton Board of Education, offered a brief summary of the outcome.

“Even when the bus schedules were adjusted slightly to accommodate bus schedules, there was never any desire by any constituency to return to the old start time structure. [¶] All sports organizations were tough opponents to change, insisting that a later start/end time would lead to expulsion of Wilton teams from the athletic conference. This has not happened – the other towns in the conference have accommodated Wilton’s later arrival at games and many are looking at making the change themselves. Participation in athletic programs has continued to rise. [¶] Six years later, no one is even looking back at what our start times used to be. Our students are happier, performing at the highest levels academically, and our sports teams continue to be among the best in the state.” (655)

Middletown, Rhode Island

onllinerxIn 2009, Judith Owens, M.D., M.P.H., the Director of Sleep Medicine at Children’s National Medical Center, persuaded (351the headmaster of her daughter’s boarding school, St. George’s School, to push back start times from 8 a.m. to 8:30 a.m. (41, 563) Researchers characterized the impact as “striking and broad in scope,” but noted “it fell far short of achieving the ideal, and additional schedule modifications and education of students regarding the impact of sleep loss and fatigue should be considered.” (41In assessing the evidence, Dr. Owens concluded, “Probably, 9 o’clock would be the ideal start time for high schools.” (634)

As in Minnesota, (3, 37fewer depressive symptoms were reported among students following the change. (41) Again, researchers found this “particularly noteworthy[,]” given the relationship between depression and suicidal ideation in adolescents. (41In addition, students reported feeling more motivated to participate in a variety of activities and were less likely to seek medical attention for fatigue-related concerns. (41

Students got to bed 15 minutes earlier following the change to later start times, increasing their nightly sleep total by an average of 45 minutes. (41) The percentage of students getting less than 7 hours of sleep decreased by 79.4%, and those reporting at least 8 hours of sleep increased from 16.4% to 54.7%. (41Students reported significantly more satisfaction with sleep. (41

Alertness increased, daytime sleepiness and fatigue were reduced. (41Food Services data showed a substantial increase in consumption of hot foods (i.e., eggs and breakfast meats) at breakfast (35 vs. 83 servings a month). (41Teacher-reported first class absences/tardies decreased by 45 percent. (41) Grades rose slightly, but the differences were not statistically significant. (41)

Participation in after-school activities remained high. (41) Despite “considerable resistance” from faculty and athletic coaches before the change, students and faculty voted “overwhelmingly” to retain the 8:30 a.m. start time. (41) One faculty member wrote, “I have found the 8:30 start to be the single most positive impact to my general quality of life at [the school] since I started 12 years ago.” (41“At the end of the experimental period, there was not a single faculty member, student or administrator who wanted to go back to the old start time.” (600

unanimous vote --wikipedia

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