HLTH 5413 Module 1 Health Determinants Analysis Example

Too Little, Too Late: The Social, Economic and Personal Factors Behind Short Sleep Among Students at a Working-Class Suburban High School

Student Name

American College of Education

HLTH5413: Principles and Practice in Health Education

Module 1 Assignment

Instructor Name

October 5, 2026

Introduction

Sleep is rarely treated as a lifestyle choice in the way diet or exercise are, yet it is shaped by decisions made every night: when to put down the phone, whether to take the late shift, how much homework to finish. For teenagers, those decisions are made inside a set of conditions they did not choose. This paper examines short sleep on school nights among students at a composite high school of about 1,400 students in a working-class suburban district, where most families have two working parents, many students hold jobs and the first bell rings at 7:05 a.m. It asks how social, economic and personal factors combine to produce short sleep, and what that means for health educators who have usually addressed sleep with lessons on bedtime habits.

The Choice and Its Stakes

Teenagers aged 13 to 18 are advised to sleep 8 to 10 hours in every 24, and most do not. Using the 2015 Youth Risk Behavior Survey, Wheaton et al. (2018) found that 72.7% of U.S. high school students slept less than 8 hours on an average school night, with state estimates ranging from 61.8% to 82.5%. Insufficient sleep in adolescence is associated with obesity, diabetes, injuries, poor mental health, attention and behavior problems and lower academic performance. At the composite school, the most recent student survey found that 78% of students slept less than 8 hours on school nights and that a third slept 6 hours or less. The school nurse reports frequent visits for headaches and fatigue in first period, and teachers describe students asleep at their desks before 9 a.m.

Biology Sets the Stage

Any analysis of teenage sleep must begin with biology, because it explains why the problem is not simply a matter of discipline. During puberty, the body's internal clock shifts later, so that most adolescents do not feel sleepy until around 11 p.m. or later. A student who cannot fall asleep before 11 and must wake at 5:45 to catch a 6:25 bus has little chance of reaching 8 hours, however good her habits. The American Academy of Pediatrics identified early school start times, before 8:30 a.m., as a key modifiable contributor to insufficient sleep and to disruption of adolescents' circadian rhythms (Adolescent Sleep Working Group et al., 2014). The biological shift is not a factor educators can change, but it determines how every other factor plays out.

Economic Factors

Economic conditions shape sleep in several ways at the composite school. About a third of juniors and seniors work for pay during the school year, most in restaurants and retail, and closing shifts often end at 10 or 11 p.m., after which students still have homework. For many, the income helps the family pay bills or covers the student's own phone and car costs, so cutting hours is not a simple choice. Housing matters as well. In the district's older apartment complexes, siblings commonly share bedrooms, and a younger sibling's bedtime or an older sibling's late nights affect everyone. Parents who work evening or overnight shifts may not be home to set routines, and some students care for younger siblings until a parent returns.

The district's own finances also shape sleep. To save on transportation, the district runs a three-tier bus system in which the same buses serve high school first, then middle school, then elementary. High school routes therefore start earliest, with the first pickups before 6:30 a.m. The budget logic is sound, but its cost is borne in students' sleep.

Social Factors

Social life adds its own pressures. Friends are online late at night, and group chats and games continue past midnight; leaving early can mean missing plans or jokes discussed the next day. Sports practices and games, band rehearsals and club meetings often run into the evening, and away games return after 10 p.m. Students taking advanced courses report two to three hours of homework a night, much of it started after other obligations end. Families' expectations vary: some parents set and enforce bedtimes, while others, stretched by work, leave sleep to the teenager. Among peers, being tired is normal and even a sign of being busy and important, and few students describe sleep as something worth protecting.

Personal Factors

Personal habits and beliefs complete the picture. Nearly all students have phones in their bedrooms, and many use them in bed. Hale and Guan (2015), reviewing 67 studies of screen time and sleep in school-aged children and adolescents, found that screen time was adversely associated with sleep outcomes, mainly shorter sleep and later timing, in 90% of the studies, while noting that causal links had not been confirmed. Caffeine from energy drinks and coffee, popular for staying awake in the morning and during work shifts, can in turn delay sleep at night. Stress about grades, money or family problems keeps some students awake. Many students hold beliefs that make short sleep seem acceptable: that they function fine on 6 hours, that they can catch up on weekends or that sleep is time taken away from more important things.

How the Factors Interact

These factors do not act separately. Consider a junior who plays soccer until 6, works a restaurant shift from 6:30 to 10, starts homework at 10:30, answers messages from friends until midnight and wakes at 5:45 for the bus. Each factor alone might cost a little sleep; together they make adequate sleep nearly impossible. Or consider a sophomore who shares a room with two younger siblings, whose mother works nights and who scrolls on her phone because it is the only private space she has. For these students, advice to put the phone away and go to bed earlier addresses one factor while ignoring the others. The factors also cluster by income: students with jobs, crowded housing and parents on shift work are the same students whose families rely on the school bus, so the students with the most economic pressure often face the earliest schedules.

What Students Say

Short written reflections collected by the health teacher during a sleep unit add students' own voices. Asked why they did not get more sleep, students rarely mentioned laziness or lack of knowledge. They wrote about shifts that ran late because a coworker called in sick, about babysitting until a parent returned from work, about practices that ended after dark and about lying awake worrying. Many mentioned their phones, but often as a way to relax or to stay connected with friends they could not see during the day, not as idle scrolling. Several wrote that they knew sleep mattered but did not see how to fit more of it into their lives. A few described feeling that adults blamed them for being tired while also expecting them to work, play sports and take hard classes. These reflections support the analysis above: students experience short sleep less as a choice than as the result of competing demands, and they notice when adults ignore that.

Implications for Health Education

The analysis suggests that sleep education focused only on personal habits will have limited effect and may unfairly place the burden on students who have the least control. Health educators can still teach about sleep and screens, but they should pair that teaching with attention to schedules, work and policy. Later modules will examine the political side, especially school start time policy, identify barriers at each level and match them with strategies. The analysis also raises ethical questions: how to talk about sleep without blaming students who work to support their families, and how to advocate for policy change within a professional role. Those questions will be taken up in Module 4.

References

Adolescent Sleep Working Group, Committee on Adolescence, & Council on School Health. (2014). School start times for adolescents. Pediatrics, 134(3), 642-649. https://doi.org/10.1542/peds.2014-1697

Hale, L., & Guan, S. (2015). Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Medicine Reviews, 21, 50-58. https://doi.org/10.1016/j.smrv.2014.07.007

Wheaton, A. G., Jones, S. E., Cooper, A. C., & Croft, J. B. (2018). Short sleep duration among middle school and high school students: United States, 2015. MMWR. Morbidity and Mortality Weekly Report, 67(3), 85-90. https://doi.org/10.15585/mmwr.mm6703a1