Thirty-five local and regional health professionals sent a letter to the Palo Alto school board and superintendent Wednesday, urging the district to align itself with the American Academy of Pediatrics (AAP) recommendation that high schools students start their days no earlier than 8:30 a.m. The number of signatures has since grown to 80.
Calling it a "necessary public health measure," these pediatricians, psychiatrists, therapists and professors from private practices, the Stanford School of Medicine, Lucile Packard Children's Hospital, University of California at San Francisco (UCSF) and elsewhere (and many with children in the school district) wrote that they endorse this recommendation, described by the AAP as "an effective countermeasure to chronic sleep loss" that "has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement."
"The Academy notes in an accompanying technical report a nearly threefold increase in the risk of suicide attempts among adolescents who sleep less than 8 hours per night, even when controlling for confounding factors," the letter reads. "The policy statement concludes that 'both the urgency and the magnitude of the problem of sleep loss in adolescents and the availability of an intervention that has the potential to have broad and immediate effects are highly compelling.'
"We agree with this conclusion and recommendation and urge that our high schools begin no earlier than 8:30 a.m. for all students."
Both Palo Alto and Gunn high schools moved to later start times in 2010 and 2011, respectively, but now have additional courses offered during earlier zero periods. Just under 300 Gunn students are enrolled in both physical education and academic courses that begin at 7:20 a.m. and 102 Paly students have physical education at 7:10 a.m. The regular school day starts at Gunn at 8:25 a.m. and at Paly, 8:15 a.m.
The debate over the role that school-start times play in teen health and well-being has come front and center after the last school board meeting on March 10, when board member Ken Dauber proposed that the board develop a policy that prohibits academic classes during zero period.
Board member Camille Townsend said at the March 10 meeting that "options and choices in our school system is a great thing" and she plans to be a "strong proponent" for maintaining flexibility for students and families.
"I strongly believe in options because there is also research to show that when people feel they have flexibility in options, they feel more in control and there's less stress," Townsend said.
The board ultimately decided to place zero periods as an information item on the April 21 meeting agenda.
"What's important about this is that we have very clear, I would say, universal advice from the medical community, both locally and nationally, that starting school at 8:30 a.m. or later is a very effective intervention to increase sleep for kids," Dauber said Thursday. "It has a direct effect on a whole set of health and learning benefits including very significant reductions to suicide attempts, depression and so forth. To me, it's really clear that we should be taking that advice and providing that benefit to students."
Dauber said the letter sent Wednesday "resulted organically" after he both reached out to and was contacted by local doctors and health professionals who wanted to weigh in on the topic.
Naomi Bardach, assistant professor of pediatrics at UCSF, told the Weekly Thursday that the letter was shared with her by several Palo Alto pediatricians she trained with, and she felt compelled to support it, despite not being local.
"The evidence shows that they tend to have better mental health outcomes, meaning lower rates of anxiety and depression" with later start times, Bardach said. "It also shows that better sleep quality and longer duration is associated with lower rates of obesity and also better test scores. There's a good story to be told that really, it's going to be better for adolescents given that all those things are really important for us as a society, whether it's Palo Alto or other places."
Bardach added that as adolescents' physiology, as they go through puberty, makes it so they "tend to have a natural tendency to stay up later and sleep in later."
Some of the health professionals provided comments along with their signatures.
"I enforce the importance of sleep to my kids and patients daily," wrote Patricia Chang, a Los Altos pediatrician and mother of four children in the district, including one at Paly. "I am saddened when my teen patients tell me they sleep 4-6 hrs. Their brains and bodies are growing, memory is formed during sleep, and moods are affected by sleep. Thankfully my son didn't ask to take zero period PE and I would not have signed the form. The sleep in the early AM is critical to the well being of our students."
Psychiatrist Adam Strassberg, who has a local private practice and two teenagers in the district, however, wrote that he supports zero-period PE.
"There's a difference between getting up and taking economics exam and getting up and going for a beautiful run in the early morning air with your friends," he told the Weekly Thursday.
Kathleen Dong a clinical associate professor at Stanford, Northern California Psychiatric Society Professional Educational Committee chair and mother of a current PAUSD student wrote: "Also recommend decreasing stress & increasing autonomy by letting students exercise judgment to sleep in when necessary as long as work (is) kept up & taking attendance from noon on."
The ability for students to exercise their own judgment and choice about their school schedule has been defended by some high schoolers who want to keep zero period. Gunn sophomore Chloe Sorensen wrote in a Palo Alto Online guest opinion this week that zero period "allows many students to create balance in their lives rather than disrupt it," explaining that many students choose to and like taking the early-morning classes for the scheduling freedom they provide later in the day.
"I understand the research behind sleep, and I appreciate the actions of AAP, as well as the local medical community," Sorensen told the Weekly Thursday. "However, the majority of my peers are greatly distressed by the increasing removal of choice."
Sorensen circulated an online survey on zero period this week at Gunn and said that of the 356 students who responded, more than 90 percent do not want the early-morning option removed. Of those 356, 176 are currently enrolled in a zero-period class, Sorensen said.
Sorensen said 6 percent of the responders enrolled in zero period are taking an extra eighth class and around half of them noted that this class is a blended or after-school course such as stage tech, jazz band or chamber choir.
"Many students wake up earlier than others, and appreciate having the option to finish school earlier," Sorensen said. "If zero period is removed, I think the schools should look at other alternatives for students to have flexible schedules."
Dauber appreciates the student perspective on zero period, but said "we have to make policy based on what's healthy for all the students in our schools.
"When we have such clear medical advice on what the healthy choice is, I don't really see any reasonable alternative or any responsible alternative to making sure that the choices we do provide are healthy choices."
Makoto Kawai, a clinical instructor at Stanford's department of sleep medicine, psychiatry and behavioral science, said education on such choices will also be critical.
"I'm not saying a later school-start time will solve everything, but that is a first step and (teenagers) have to be educated on good sleep habits," Kawai said. "I think taking some action like that will give good information to them that we are taking this seriously."
Superintendent Max McGee said Thursday that "the science is indisputable," but hopes the conversation about teen health and sleep can be a holistic one that also includes discussions about the role that parents play, students who see zero period as a way to reduce their stress and the benefits of regular physical exercise.
"I don't think it's a good idea to have a start time for the whole school before 8:30 a.m. but if there are a few -- I'm going to emphasize a few -- students who do get their eight to nine hours of sleep and are ready to go earlier in the morning, frankly, and this reduces their stress, I think we ought to listen to their voices," McGee said.
"This issue is important, so let's give it the time it deserves for an inclusive, holistic conversation and discussion," he added.
The Palo Alto Weekly has created a Storify page to capture the numerous voices, opinions and our news coverage on teen well-being. This page will continue to be updated. To view it, go to Storify.com.