Review aims
This review aimed to examine the effects of later school start times for academic outcomes, amount and quality of sleep, mental health indicators, attendance, and alertness in high school students.
Background
High school students are at a greater risk of sleep deprivation than other groups, both due to their changing brain chemistry and the many demands on their time, including school start times. For this reason, we wanted to determine if delaying school start times was associated with academic benefits, greater sleep duration, better mental health, increased student attendance, or student alertness, as well as secondary outcomes such as diet and exercise, accidents, social aspects of school, changing family dynamics, school enrollment, or changes in the community.
Study characteristics
The evidence included in this review is current as of February 2016 and is based on 17 reports representing 11 unique studies in 297,994 high school students. The studies examined a range of changes to school time (for example, moving the start time fifteen minutes later, moving the start time an hour later) and a range of intervention durations (one as short as two weeks, others lasting a year), but all focused on natural settings (students already in schools, rather than in a laboratory setting). Although 5 of the 11 studies were funded, the funding sources were academic and research institutions, rather than agencies with a commercial interest in program evaluation results.
Key results
Because of the limited and very low-quality evidence, we could not determine the effects of later school start times with any confidence. We found that later school start times may provide academic benefits, but results of four studies provided mixed findings. Later school starts were associated with an increase in school-night sleep for students based on the synthesis of two studies, and evidence from six other studies also supported the relationship between later school starts and increased sleep duration. One study reported that students in later starting schools reported fewer depressive symptoms than their peers in earlier starting schools. Different studies reported mixed findings regarding the association between later school start times and increased attendance and student alertness. These interventions may also have 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. Again, because of the limited and very low-quality evidence, we cannot draw any firm conclusions about the adverse effects of later school start times.
Quality of evidence
The quality of this evidence was very low, and thus we cannot assume the findings reflect the true beneficial or adverse effects of later school start times.
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.
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.
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).
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.
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.
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.
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.