Most US middle and high schools start the school day too early

Students need adequate sleep for their health, safety, and academic success

Fewer than 1 in 5 middle and high schools in the U.S. began the school day at the recommended 8:30 AM start time or later during the 2011-2012 school year, according to data published today in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. Too-early start times can keep students from getting the sleep they need for health, safety, and academic success, according to the American Academy of Pediatrics.

CDC and U.S. Department of Education researchers reviewed data from the 2011-2012 Schools and Staffing Survey of nearly 40,000 public middle, high, and combined schools to determine school start times.

Schools that have a start time of 8:30 AM or later allow adolescent students the opportunity to get the recommended amount of sleep on school nights: about 8.5 to 9.5 hours. Insufficient sleep is common among high school students and is associated with several health risks such as being overweight, drinking alcohol, smoking tobacco, and using drugs – as well as poor academic performance. The proportion of high school students who fail to get sufficient sleep (2 out of 3) has remained steady since 2007, according to the 2013 Youth Risk Behavior Surveillance Report.

“Getting enough sleep is important for students’ health, safety, and academic performance,” said Anne Wheaton, Ph.D., lead author and epidemiologist in CDC’s Division of Population Health. “Early school start times, however, are preventing many adolescents from getting the sleep they need.”

Key findings:

• 42 states reported that 75-100 percent of the public schools in their respective states started before 8:30 AM.
• The average start time was 8:03 AM.
• The percentage of schools with start times of 8:30 AM or later varied greatly by state. No schools in Hawaii, Mississippi, and Wyoming started at 8:30 AM or later; more than 75 percent of schools in Alaska and North Dakota started at 8:30 AM or later.
• Louisiana had the earliest average school start time (7:40 AM), while Alaska had the latest (8:33 AM).

In 2014, the American Academy of Pediatrics issued a policy statement urging middle and high schools to modify start times to no earlier than 8:30 AM to aid students in getting sufficient sleep to improve their overall health. School start time policies are not determined at the federal or state level, but at the district or individual school level. Future studies may determine whether this recommendation results in later school start times.

Emerging Tobacco Products Gaining Popularity Among Youth

Increases in e-cigarette and hookah use show need for increased monitoring and prevention

Emerging tobacco products such as e-cigarettes and hookahs (water pipe) are quickly gaining popularity among middle- and high-school students, according to a report in this week’s Morbidity and Mortality Weekly Report.

While use of these newer products increased, there was no significant decline in students’ cigarette smoking or overall tobacco use. Data from the 2012 National Youth Tobacco Survey (NYTS) show that recent electronic cigarette use rose among middle school students from 0.6 percent in 2011 to 1.1 percent in 2012 and among high school students from 1.5 percent to 2.8 percent. Hookah use among high school students rose from 4.1 percent to 5.4 percent from 2011 to 2012.

The report notes that the increase in the use of electronic cigarettes and hookahs could be due to an increase in marketing, availability, and visibility of these tobacco products and the perception that they may be safer alternatives to cigarettes. Electronic cigarettes, hookahs, cigars and certain other new types of tobacco products are not currently subject to FDA regulation.  FDA has stated it intends to issue a proposed rule that would deem products meeting the statutory definition of a "tobacco product" to be subject to the Federal Food, Drug, and Cosmetic Act.

Another area of concern in the report is the increase in cigar use among certain groups of middle and high school students.  During 2011-2012, cigar use increased dramatically among non-Hispanic black high school students from 11.7 percent to 16.7 percent, and has more than doubled since 2009. Further, cigar use among high school males in 2012 was 16.7 percent, similar to cigarette use among high school males (16.3 percent).

“This report raises a red flag about newer tobacco products,” said CDC Director Tom Frieden, M.D., M.P.H. “Cigars and hookah tobacco are smoked tobacco – addictive and deadly. We need effective action to protect our kids from addiction to nicotine.”

It is important to note that the cigars category includes little cigars, many of which look almost exactly like cigarettes but are more affordable to teens because they are taxed at lower rates and can be sold individually, rather than by the pack.  Little cigars also can be made with fruit and candy flavors that are banned from cigarettes. A CDC study published last month showed more than one in three (35.9 percent) middle and high school students who smoke cigars use flavored little cigars.

“A large portion of kids who use tobacco are smoking products other than cigarettes, including cigars and hookahs, which are similarly dangerous,” said Tim McAfee, M.D., M.P.H., director of the CDC’s Office on Smoking and Health. “As we close in on the 50th anniversary of the first Surgeon General’s report on the dangers of smoking, we need to apply the same strategies that work to prevent and reduce cigarette use among our youth to these new and emerging products.”

Smoking remains the leading cause of preventable death and disease in the United States, killing more than 1,200 Americans every day. More than 8 million Americans live with a smoking-related disease.  Each day, more than 2,000 youth and young adults become daily smokers.  Smoking-related diseases cost Americans $96 billion a year in direct health care expenses, much of which come in taxpayer-supported payments.

40% of Middle and High Schoolers Smokers Used Flavored Little Cigars or Flavored Cigarettes

More than 40 percent of middle and high schoolers who smoke use flavored little cigars or flavored cigarettes

Flavored little cigar smokers less likely to think about quitting tobacco use

More than two out of every five middle and high school students who smoke report using either flavored little cigars or flavored cigarettes, according to a report by the Centers for Disease Control and Prevention published in the Journal of Adolescent Health. This article, using data from the 2011 National Youth Tobacco Survey (NYTS), is the first to measure how many American youth are using flavored little cigars and flavored cigarettes.

The study also shows that among youth cigar smokers, almost 60 percent of those who smoke flavored little cigars are not thinking about quitting tobacco use, compared with just over 49 percent among all other cigar smokers.

“Flavored or not, cigars cause cancer, heart disease, lung disease, and many other health problems.  Flavored little cigars appeal to youth and the use of these tobacco products may lead to disfigurement, disability, and premature death,” said CDC Director Tom Frieden, MD, MPH. ”We need to take comprehensive steps to reduce all tobacco use for all of our youth.”

The study found that 35.4 percent of current youth cigarette smokers reported using flavored cigarettes, which could include menthol cigarettes or flavored little cigars that students mistook for flavored cigarettes. In 2009, the Family Smoking Prevention and Tobacco Control Act was enacted and prohibited the use of flavors, except menthol, in cigarettes. However, flavored little cigars are still manufactured and sold with candy and fruit flavorings.

“Little cigars contain the same toxic and cancer-causing ingredients found in cigarettes and are not a safe alternative to cigarettes,” said Tim McAfee, MD, MPH, director of the CDC’s Office on Smoking and Health. “Many flavored little cigars appear virtually indistinguishable from cigarettes with similar sizes, shapes, filters, and packaging.”

In addition to offering a wide variety of flavors that appeal to young people, little cigars are taxed at a lower rate than cigarettes at the state level. Little cigars have become more popular in recent years; sales increased 240 percent from 1997 to 2007, with flavored brands making up almost 80 percent of the market share.

Smoking remains the leading cause of preventable death and disease in the United States.  The health consequences of tobacco use include heart disease, multiple types of cancer, pulmonary disease, adverse reproductive effects, and the exacerbation of chronic health conditions.Smoking and exposure to secondhand tobacco smoke kill an estimated 443,000 Americans each year.  And for every one death, there are 20 people suffering from a smoking-related disease.  In addition to the cost in human life, smoking has been estimated to cost $193 billion annually in direct health care expenses and lost productivity.  And 99 percent of all smokers start before they’re 26 years old.

Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as certain services to quit smoking that are covered with no additional costs. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more. Open enrollment in the Marketplace began October 1 and ends March 31, 2014. For those enrolled by December 15, 2013, coverage starts as early as January 1, 2014.