Self-report surveys of student sleep and well-being: a review of use in the context of school start times

Published:September 30, 2017DOI:


      A large body of literature supports the need to delay high school starting times to improve student health and well-being by allowing students an opportunity to get sufficient and appropriately timed sleep. However, a dearth of uniform and standardized tools has hampered efforts to collect data on adolescent sleep and related health behaviors that might be used to establish a need for, or to evaluate outcomes of, bell time delays. To assess validated tools available to schools and contrast them with tools that schools have actually used, we identified and reviewed published, validated self-report surveys of adolescent sleep and well-being, as well as unpublished surveys, used to assess student sleep and related health measures in US high schools considering later high school start times. Only three of the surveys reviewed had adequate psychometric properties and covered an appropriately wide range of health and academic questions to allow for discernment of outcomes in pre-post educational settings. The surveys exhibited marked variability in numerous areas, including focus, terminology, calculation of sleep duration, mode of administration, context of administration, and follow-up procedures. Our findings provide sleep researchers and school administrators with an overview of surveys that school districts have used, along with a deeper understanding of the challenges of choosing, designing, and administering self-report surveys in the context of changing school schedules. They also highlight the opportunities presented by these instruments to assess outcomes of delaying bell times, compare communities meaningfully, and establish the need for later school start times in individual school districts.


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        • Owens J.
        • Drobnich D.
        • Baylor A.
        • Lewin D.
        School start time change: an in-depth examination of school districts in the United States.
        Mind Brain Educ. 2014; 8: 182-213
        • Minnesota Sleep Society
        Minnesota Medical Association 1994 policy statement on school start time.
        • Wolfson A.R.
        • Carskadon M.A.
        Sleep schedules and daytime functioning in adolescents.
        Child Dev. 1998; 69: 875-887
        • Wahlstrom K.
        School start time study final report, volume 2: analysis of student survey data. Analysis of Student Survey Data.
        Date: 1998
        Date accessed: July 8, 2017
        • Wahlstrom K.
        • Dretzke B.
        • Gordon M.
        • Peterson K.
        • Edwards K.
        • Gdula J.
        Examining the impact of later school start times on the health and academic performance of high school students: a multi-site study.
        • Wahlstrom K.L.
        • Berger A.T.
        • Widome R.
        Relationships between school start time, sleep duration, and adolescent behaviors.
        Sleep Health. 2017; 3: 216-221
        • Lewin D.S.
        • Wang G.
        • Chen Y.I.
        • et al.
        Variable school start times and middle school student's sleep health and academic performance.
        J Adolesc Health. 2017; 61: 205-211
        • Boergers J.
        • Gable C.J.
        • Owens J.A.
        Later school start time is associated with improved sleep and daytime functioning in adolescents.
        J Dev Behav Pediatr. 2014; 35: 11-17
        • Owens J.A.
        • Belon K.
        • Moss P.
        Impact of delaying school start time on adolescent sleep, mood, and behavior.
        Arch Pediatr Adolesc Med. 2010; 164: 608-614
        • Danner F.
        • Phillips B.
        Adolescent sleep, school start times, and teen motor vehicle crashes.
        J Clin Sleep Med. 2008; 4: 533-535
        • McKeever P.M.
        • Clark L.
        Delayed high school start times later than 8:30am and impact on graduation rates and attendance rates.
        Sleep Health. 2017; 3: 119-125
        • Thacher P.V.
        • Onyper S.V.
        Longitudinal outcomes of start time delay on sleep, behavior, and achievement in high school.
        Sleep. 2016; 39: 271-281
        • Perez-Lloret S.
        • Videla A.J.
        • Richaudeau A.
        • et al.
        A multi-step pathway connecting short sleep duration to daytime somnolence, reduced attention, and poor academic performance: an exploratory cross-sectional study in teenagers.
        J Clin Sleep Med. 2013; 9: 469-473
        • Lufi D.
        • Tzischinsky O.
        • Hadar S.
        Delaying school starting time by one hour: some effects on attention levels in adolescents.
        J Clin Sleep Med. 2011; 7: 137-143
        • Urrila A.S.
        • Artiges E.
        • Massicotte J.
        • et al.
        Sleep habits, academic performance, and the adolescent brain structure.
        Sci Rep. 2017; 7: 41678
        • Groeger J.A.
        Youthfulness, inexperience, and sleep loss: the problems young drivers face and those they pose for us.
        Inj Prev. 2006; 12: i19-24
        • Owens J.
        • Adolescent Sleep Working Group Committee on Adolescence
        Insufficient sleep in adolescents and young adults: an update on causes and consequences.
        Pediatrics. 2014; 134: e921-932
        • Vorona R.D.
        • Szklo-Coxe M.
        • Wu A.
        • Dubik M.
        • Zhao Y.
        • Ware J.C.
        Dissimilar teen crash rates in two neighboring southeastern Virginia cities with different high school start times.
        J Clin Sleep Med. 2011; 7: 145-151
        • Vorona R.D.
        • Szklo-Coxe M.
        • Lamichhane R.
        • Ware J.C.
        • McNallen A.
        • Leszczyszyn D.
        Adolescent crash rates and school start times in two central Virginia counties, 2009-2011: a follow-up study to a southeastern Virginia study, 2007-2008.
        J Clin Sleep Med. 2014; 10: 1169-1177
        • Wheaton A.G.
        • Olsen E.O.
        • Miller G.F.
        • Croft J.B.
        Sleep duration and injury-related risk behaviors among high school students--United States, 2007-2013.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 337-341
        • Meininger J.C.
        • Gallagher M.R.
        • Eissa M.A.
        • Nguyen T.Q.
        • Chan W.
        Sleep duration and its association with ambulatory blood pressure in a school-based, diverse sample of adolescents.
        Am J Hypertens. 2014; 27: 948-955
        • Chaput J.P.
        • Dutil C.
        Lack of sleep as a contributor to obesity in adolescents: impacts on eating and activity behaviors.
        Int J Behav Nutr Phys Act. 2016; 13: 103
        • Kelly N.R.
        • Shomaker L.B.
        • Radin R.M.
        • et al.
        Associations of sleep duration and quality with disinhibited eating behaviors in adolescent girls at-risk for type 2 diabetes.
        Eat Behav. 2016; 22: 149-155
        • Krueger P.M.
        • Reither E.N.
        • Peppard P.E.
        • Burger A.E.
        • Hale L.
        Cumulative exposure to short sleep and body mass outcomes: a prospective study.
        J Sleep Res. 2015; 24: 629-638
        • Winsler A.
        • Deutsch A.
        • Vorona R.D.
        • Payne P.A.
        • Szklo-Coxe M.
        Sleepless in Fairfax: the difference one more hour of sleep can make for teen hopelessness, suicidal ideation, and substance use.
        J Youth Adolesc. 2015; 44: 362-378
        • McKnight-Eily L.R.
        • Eaton D.K.
        • Lowry R.
        • Croft J.B.
        • Presley-Cantrell L.
        • Perry G.S.
        Relationships between hours of sleep and health-risk behaviors in US adolescent students.
        Prev Med. 2011; 53: 271-273
        • Shochat T.
        • Cohen-Zion M.
        • Tzischinsky O.
        Functional consequences of inadequate sleep in adolescents: a systematic review.
        Sleep Med Rev. 2014; 18: 75-87
        • Owens J.A.
        • Dearth-Wesley T.
        • Lewin D.
        • Gioia G.
        • Whitaker R.C.
        Self-regulation and sleep duration, sleepiness, and chronotype in adolescents.
        Pediatrics. 2016; 138
        • Iglowstein I.
        • Jenni O.G.
        • Molinari L.
        • Largo R.H.
        Sleep duration from infancy to adolescence: reference values and generational trends.
        Pediatrics. 2003; 111: 302-307
        • Carskadon M.A.
        • Wolfson A.R.
        • Acebo C.
        • Tzischinsky O.
        • Seifer R.
        Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days.
        Sleep. 1998; 21: 871-881
        • Fredriksen K.
        • Rhodes J.
        • Reddy R.
        • Way N.
        Sleepless in Chicago: tracking the effects of adolescent sleep loss during the middle school years.
        Child Dev. 2004; 75: 84-95
        • Thorleifsdottir B.
        • Bjornsson J.K.
        • Benediktsdottir B.
        • Gislason T.
        • Kristbjarnarson H.
        Sleep and sleep habits from childhood to young adulthood over a 10-year period.
        J Psychosom Res. 2002; 53: 529-537
        • Carskadon M.A.
        • Acebo C.
        Regulation of sleepiness in adolescents: update, insights, and speculation.
        Sleep. 2002; 25: 606-614
        • Jenni O.G.
        • Achermann P.
        • Carskadon M.A.
        Homeostatic sleep regulation in adolescents.
        Sleep. 2005; 28: 1446-1454
        • Eaton D.K.
        • McKnight-Eily L.R.
        • Lowry R.
        • Perry G.S.
        • Presley-Cantrell L.
        • Croft J.B.
        Prevalence of insufficient, borderline, and optimal hours of sleep among high school students—United States, 2007.
        J Adolesc Health. 2010; 46: 399-401
        • American Medical Association
        Insufficient sleep in adolescents.
        • Adolescent Sleep Working Group Committee on Adolescence and Council on School Health
        School start times for adolescents.
        Pediatrics. 2014; 134: 642-649
        • Watson N.F.
        • Martin J.L.
        • Wise M.S.
        • et al.
        Delaying middle school and high school start times promotes student health and performance: an American Academy of Sleep Medicine position statement.
        J Clin Sleep Med. 2017; 13: 623-625
        • Schott P.
        Forum speakers call for later start times at GHS. Greenwich Time October 13, 2015.
      1. Anne Arundel to host forums on school start, dismissal times. WBAL-TV January 13, 2016.
        • Liverpool Central School District
        Results of a student survey.
      2. San Ramon Valley High School. SRVHS challenge success survey.
        • Cherry Creek School District
        School start times.
        • Defranco T.
        Tri-town surveys says kids need more sleep, later start to school. Wicked Local Boxford September 23, 2016.
        • Falleta G.
        EG survey will show effects of later start time. East Greenwich Pendulum December 12, 2015.
        • Barnett D.E.
        Healthy Youth Survey shows kids not getting enough sleep. The Issaquah Press November 18, 2015.
        • Schott P.
        Parents upset about school start time survey. Greenwich Time May 30, 2015.
        • Pegher K.
        Task force survey supports changing school start times. Annapolis Capital December 10, 2014.
        • Dunietz G.L.
        • Matos-Moreno A.
        • Singer D.C.
        • Davis M.M.
        • O'Brien L.M.
        • Chervin R.D.
        Later school start times: what informs parent support or opposition?.
        J Clin Sleep Med. 2017; 13: 889-897
        • Morgenthaler T.I.
        • Hashmi S.
        • Croft J.B.
        • Dort L.
        • Heald J.L.
        • Mullington J.
        High school start times and the impact on high school students: what we know, and what we hope to learn.
        J Clin Sleep Med. 2016; 12: 1681-1689
        • Marx R.
        • Tanner-Smith E.E.
        • Davison C.M.
        • et al.
        Later school start times for supporting the education, health, and well-being of high school students.
        Cochrane Database Syst Rev. 2017; 7: CD009467
        • Wheaton A.G.
        • Chapman D.P.
        • Croft J.B.
        School start times, sleep, behavioral, health, and academic outcomes: a review of the literature.
        J Sch Health. 2016; 86: 363-381
      3. Start school later. About us.
        • Merikangas K.
        • Avenevoli S.
        • Costello J.
        • Koretz D.
        • Kessler R.C.
        National comorbidity survey replication adolescent supplement (NCS-A): I. Background and measures.
        J Am Acad Child Adolesc Psychiatry. 2009; 48: 367-369
        • Stanford Graduate School of Education
        School surveys.
        • Kandel D.B.
        • Davies M.
        Epidemiology of depressive mood in adolescents: an empirical study.
        Arch Gen Psychiatry. 1982; 39: 1205-1212
        • Carskadon M.A.
        • Vieira C.
        • Acebo C.
        Association between puberty and delayed phase preference.
        Sleep. 1993; 16: 258-262
        • School Sleep Habits Survey
        Sleep for science: sleep research lab.
        • Centers for Disease Control and Prevention
        Youth risk behavior surveillance system (YRBSS) overview.
        Date: 2016
        Date accessed: May 25, 2017
        • Centers for Disease Control and Prevention
        YRBSS frequently asked questions.
        • Centers for Disease Control and Prevention
        • Brener N.D.
        • Kann L.
        • et al.
        Methodology of the Youth Risk Behavior Surveillance System—2013.
        MMWR Recomm Rep. 2013; 62: 1-20
        • Centers for Disease Control and Prevention
        National Youth Risk Behavior Survey.
        • Wheaton A.G.
        • Ferro G.A.
        • Croft J.B.
        School start times for middle school and high school students—United States, 2011-12 school year.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 809-813
        • Fairfax County VA
        Fairfax County Youth Survey.
        Date: 2017
        Date accessed: May 25, 2017
        • Fairfax County VA
        Fairfax County Youth Survey FAQs.
        • Fairfax County VA
        Youth survey of 8th, 10th, and 12th grade students.
        • Thellman K.E.
        • Dmitrieva J.
        • Miller A.
        • Harsh J.R.
        • LeBourgeois M.K.
        Sleep timing is associated with self-reported dietary patterns in 9- to 15-year-olds.
        Sleep Health. 2017; 3: 269-275
        • Park S.
        • Lee Y.
        • Lee J.H.
        Association between energy drink intake, sleep, stress, and suicidality in Korean adolescents: energy drink use in isolation or in combination with junk food consumption.
        Nutr J. 2016; 15: 87
        • Owens J.A.
        • Mindell J.
        • Baylor A.
        Effect of energy drink and caffeinated beverage consumption on sleep, mood, and performance in children and adolescents.
        Nutr Rev. 2014; 72: 65-71
        • Centers for Disease Control and Prevention
        Energy drink consumption and its association with sleep problems among U.S. service members on a combat deployment—Afghanistan, 2010.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 895-898
        • Faris M.A.E.
        • Jahrami H.
        • Al-Hilali M.M.
        • et al.
        Energy drink consumption is associated with reduced sleep quality among college students: a cross-sectional study.
        Nutr Diet. 2017; 74: 268-274
        • Cella D.
        • Yount S.
        • Rothrock N.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH roadmap cooperative group during its first two years.
        Med Care. 2007; 45: S3-S11
        • Meltzer L.J.
        • Avis K.T.
        • Biggs S.
        • Reynolds A.C.
        • Crabtree V.M.
        • Bevans K.B.
        The Children's Report of Sleep Patterns (CRSP): a self-report measure of sleep for school-aged children.
        J Clin Sleep Med. 2013; 9: 235-245
        • Bevans K.B.
        • Riley A.W.
        • Forrest C.B.
        Development of the healthy pathways child-report scales.
        Qual Life Res. 2010; 19: 1195-1214
        • Youth Risk Behavior Surveillance System (YRBSS)
        A Guide to Conducting Your Own Youth Risk Behavior Survey.
        • Spilsbury J.C.
        • Drotar D.
        • Rosen C.L.
        • Redline S.
        The Cleveland Adolescent Sleepiness Questionnaire: a new measure to assess excessive daytime sleepiness in adolescents.
        J Clin Sleep Med. 2007; 3: 603-612
        • Drake C.
        • Nickel C.
        • Burduvali E.
        • Roth T.
        • Jefferson C.
        • Pietro B.
        The Pediatric Daytime Sleepiness Scale (PDSS): sleep habits and school outcomes in middle-school children.
        Sleep. 2003; 26: 455-458
        • LeBourgeois M.K.
        • Giannotti F.
        • Cortesi F.
        • Wolfson A.R.
        • Harsh J.
        The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents.
        Pediatrics. 2005; 115: 257-265
      4. Monitoring the future.
        Date: 2017
        Date accessed: July 30, 2017
        • Morgenthaler T.
        • Alessi C.
        • Friedman L.
        • et al.
        Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007.
        Sleep. 2007; 30: 519-529
        • Wolfson A.R.
        • Carskadon M.A.
        • Acebo C.
        • et al.
        Evidence for the validity of a sleep habits survey for adolescents.
        Sleep. 2003; 26: 213-216
        • Wahlstrom K.
        Changing times: findings from the first longitudinal study of later high school start times.
        NASSP Bull. 2002; 86: 3-21