When Stephen Miller left his primary care practice to work in public health a little under two years ago, he said, he was shocked by how many cases of syphilis the clinic was treating.

For decades, rates of the sexually transmitted infection were low. But the Hamilton County Health Department in Chattanooga — a midsize city surrounded by national forests and nestled into the Appalachian foothills of Tennessee — was seeing several syphilis patients a day, Miller said. A nurse who had worked at the clinic for decades told Miller the wave of patients was a radical change from the norm.

What Miller observed in Chattanooga is reflective of a trend that is raising alarm bells for health departments across the country.

Nationwide, syphilis rates . The Centers for Disease Control and Prevention that 207,255 cases were reported in 2022, continuing a steep increase over five years. Between 2018 and 2022, syphilis rates rose about 80%. The epidemic of sexually transmitted infections — especially syphilis — is “,” said the National Coalition of STD Directors.

The surge has been even more pronounced in Tennessee, where infection rates for the of syphilis between 2017 and 2021.

But this already difficult situation was complicated last spring by a shortage of a specific penicillin injection that is the go-to treatment for syphilis. The ongoing shortage is so severe that public health agencies have recommended that providers ration the drug — prioritizing pregnant patients, since it is the only syphilis treatment considered safe for them. Congenital syphilis, which happens when the mom spreads the disease to the fetus, can cause birth defects, miscarriages, and stillbirths.

Across the country, 3,755 cases of congenital syphilis were reported to the CDC in 2022 — that’s as the number a decade before, the recent data shows. Of those cases, 231 resulted in stillbirth and 51 led to infant death. The number of cases in babies swelled by 183% between 2018 and 2022.

“Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis,” said a released in November. “Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions.”

Hamilton County’s syphilis rates have mirrored the national trend, with an increase in cases for all groups, including infants.

In November, the maternal and infant health advocacy organization March of Dimes released its annual . It found that, nationwide, about 15.5% of pregnant people received care beginning in the fifth month of pregnancy or later — or attended fewer than half the recommended prenatal visits. In Tennessee, the rate was even worse, 17.4%.

But Miller said even those who attend every recommended appointment can run into problems because providers are required to test for syphilis only at the beginning of a pregnancy. The idea is that if you test a few weeks before birth, there is time to treat the infection.

However, that recommendation hinges on whether the provider suspects the patient was exposed to the bacterium that causes syphilis, which may not be obvious for people who say their relationships are monogamous.

“What we found is, a lot of times their partner was not as monogamous, and they were bringing it into the relationship,” Miller said.

Even if the patient tested negative initially, they may have contracted syphilis later in pregnancy, when testing for the disease is not routine, he said.

Two antibiotics are used to treat syphilis, the injectable penicillin and an oral drug called doxycycline.

Patients allergic to penicillin are often prescribed the oral antibiotic. But the World Health Organization strongly because it can cause severe bone and teeth deformities in the infant.

As a result, pregnant syphilis patients are often given penicillin, even when they’re allergic, using a technique called desensitization, said Mark Turrentine, a Houston OB-GYN. Patients are given low doses in a hospital setting to help their bodies get used to the drug and to check for a severe reaction. The penicillin shot is a one-and-done technique, unlike an antibiotic, which requires sticking to a two-week regimen.

“It’s tough to take a medication for a long period of time,” Turrentine said. The single injection can provide patients and their clinicians peace of mind. “If they don’t come back for whatever reason, you’re not worried about it,” he said.

The Metro Public Health Department in Nashville, Tennessee, began giving all nonpregnant adults with syphilis the oral antibiotic in July, said Laura Varnier, nursing and clinical director.

Turrentine said he started seeing advisories about the injectable penicillin shortage in April, around the time the antibiotic and physicians were using penicillin as a substitute, potentially precipitating the shortage, he said.

The rise in syphilis has created demand for the injection that manufacturer with, according to the American Society of Health-System Pharmacists. “There is insufficient supply for usual ordering,” the ASHP said in a memo.

Even though penicillin has been around a long time, manufacturing it is difficult, largely because so many people are allergic, said Erin Fox, associate chief pharmacy officer for the University of Utah health system and an adjunct professor at the university, who studies drug shortages.

“That means you can’t make other drugs on that manufacturing line,” she said. Only major manufacturers like Pfizer have the resources to build and operate such a specialized, cordoned-off facility. “It’s not necessarily efficient — or necessarily profitable,” Fox said.

In a statement, Pfizer confirmed the amoxicillin shortage and surge in syphilis increased demand for injectable penicillin by about 70%. Representatives said the company invested $38 million in the facility that produces this form of penicillin, hiring more staff and expanding the production line.

“This ramp up will take some time to be felt in the market, as product cycle time is 3-6 months from when product is manufactured to when it is available to be released to customers,” the statement reads. The company estimated the shortage would be significantly alleviated by spring.

In the meantime, Miller said, his clinic in Chattanooga is continuing to strategize. Each dose of injectable penicillin can cost hundreds of dollars. Plus, it has to be placed in cold storage, and it expires after 48 months.

Even with the dramatic increase in cases, syphilis is still relatively rare. More than 7 million people live in Tennessee, and in 2019, providers statewide .

Health departments like Miller’s treat the bulk of syphilis patients. Many patients are sent by their provider to the health department, which works with contact tracers to identify and notify sexual partners who might be affected and tests patients for other sexually transmitted infections, including HIV.

“When you diagnose in the office, think of it as just seeing the tip of the iceberg,” Miller said. “You need a team of individuals to be able to explore and look at the rest of the iceberg.”

This story is part of a partnership that includes , , and Ñî¹óåú´«Ã½Ò•îl Health News.

This <a target="_blank" href="/public-health/syphilis-penicillin-rationing-shortage-amoxicillin-doxycycline/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Just 10% of public schools nationwide , according to federal statistics. But in Nashville, classes start at 7:05 — a fact the new mayor, Freddie O’Connell, has been criticizing for years.

“It’s not a badge of honor,” he said when he was still a city council member.

Since his election in September, O’Connell has announced that pushing back school start times is a cornerstone of the education policy he is promoting. He and others around the country have been trying to stress that teenagers aren’t lazy or to blame for getting too little sleep. It’s science.

“All teenagers have this shift in their brain that causes them to not feel sleepy until about 10:45 or 11 at night,” said , a senior research fellow at the University of Minnesota in the College of Education and Human Development. She studies how education policy affects learning, and she used to be a teacher. “It’s a shift that is biologically determined.”

Sleep deprivation in teenagers is linked to mental health struggles, worse grades, traffic accidents, and more. That’s why states including California and Florida have mandated later start times. Individual districts across the country — including some in Tennessee — have made the same change.

But resistance to later starts is less about the science than it is about logistical and financial difficulties, especially with basics like busing.

State Rep. , a Nashville Democrat, tried to pass in 2022.

“I’m starting to experience this with one of my own children,” he said during a committee hearing on the bill. He dug into the biology, including the famous sleep hormone melatonin.

Melatonin makes people feel drowsy. The brain starts producing it when it gets dark outside, and its production peaks in the middle of the night. Adolescents’ brains start releasing melatonin about than adults’ and younger children’s brains, according to the American Chemical Society. When teens wake up early, their brains are still producing melatonin.

“Because of the way adolescents’ bodies release melatonin, waking a teen at 7 a.m. is akin to waking one of us at 4 a.m.,” Clemmons said.

He brought in a local parent, Anna Thorsen, who testified that later start time legislation could protect vulnerable kids like hers.

“My youngest daughter is a freshman who suffers from a rare genetic epilepsy that killed her older sister last year,” she said. “In fact, last March, my youngest daughter had a life-threatening seizure that was partially induced by sleep deprivation.”

, a Knoxville-area Republican, said almost all the feedback he heard on the bill came from Nashville.

“Go to your school board and tell them to change the rule, change the law, change their start times,” he said. “But to mandate [the rest of the state] do this because of one school board that doesn’t want to listen to their parents?”

Legislative leaders gave the bill one hearing. It didn’t pass into state law.

That leaves Nashville, a city that often calls itself the Silicon Valley of health care, to figure out its own path. O’Connell is now on the case. The mayor has some power over the school budget, which gives him influence in education policy. However, it’s up to the school board to determine start times.

“Early start times, particularly for adolescents, are problematic,” the mayor said. “We also know that making a change — even a 30-minute change — has a lot of logistics.”

A major concern has been busing. Even in normal times, districts use the same buses and drivers for students of all ages. They stagger start times to do that, with high schoolers arriving and leaving school earliest in the day. The idea is that they can handle being alone in the dark at a bus stop more readily than smaller children, and it also lets them get home first to help take care of younger siblings after school.

If high schools started as late as middle and elementary schools, that would likely mean strain on transportation resources. O’Connell said Nashville’s limited mass transit compounds the problem.

“That is one of the biggest issues to resolve,” he said.

Several years ago, Collierville, a district in suburban Memphis, launched a study on school start times. That district serves far fewer students — 9,000, compared with .

Collierville officials estimated in the study that busing costs associated with delayed start times could be as high as $1.4 million annually. That estimate assumed the district would need more drivers, more fuel and maintenance, more storage facilities, and additional support personnel — for example, an additional dispatcher and mechanic.

Despite that, the district did push back high school start times in 2018.

O’Connell said one of the concerns he has heard from parents is financial, such as that they need help with family-run businesses or they need their students to help generate household income at other jobs after school lets out.

The , a nonprofit that advocates for later start times, conducted a 2022 survey of parents, teachers, and other adults that found that only about one-third of the parents who responded wanted later starts. Adults as a whole and teachers responded slightly more favorably, but less than 40% of each group supported delaying the day.

A National Education Association found that many parents who oppose later start times don’t necessarily doubt the science; they’re concerned about scheduling.

Wahlstrom, the education researcher, said she fears parents underestimate how important sleep is to brain development and academic performance, especially on weeknights.

“Sometimes both parents and teens think that they can just catch up on their sleep on the weekend. That is a total false assumption,” said Wahlstrom, who equated sleep to food for the brain. “It’s like, ‘OK, we’re going to deprive ourselves of adequate food three days out of the week, but then we’re going to gorge on food on the weekend.’ That’s not healthy.”

She explained how a lack of sleep can impede scholastic success: The brain shifts memory into long-term storage during deep sleep, so missing out on that rest means retaining less material.

But — perhaps more importantly — sleep helps teenagers improve their mental health. U.S. Surgeon General Vivek Murthy has been raising alarm bells about youth mental health, noting that a third of teenagers overall and half of teenage girls have reported persistent feelings of hopelessness.

And Wahlstrom said teen sleep deprivation leads to worse mental and behavioral health, which can affect the whole family. She and her team conducted a study funded by the Centers for Disease Control and Prevention on the effects of later start times on ninth to 12th graders by surveying 9,000 students at eight high schools in Minnesota, Colorado, and Wyoming from 2010 to 2013. They found students who got at least eight hours of sleep were less likely to report symptoms of depression.

“We do know that there is greater use of drugs, cigarettes, and alcohol when a teen is getting less than eight hours,” she said. “We also know that there is a significant link between teenage depression and any sleep amount that is less than eight hours.”

More than surveyed in a Minnesota school district as part of one of her earlier studies responded that their teenager was easier to live with after the later start time went into effect.

“Many parents have anecdotally told me that their child is a different child. They are able to speak with them at breakfast. They are chatty in the car. They don’t have moody episodes and fly off the handle,” she said. “The parents are just saying it’s remarkable that this has made such a change in their child’s life and their family dynamics.”

This article is from a reporting partnership that includes and Ñî¹óåú´«Ã½Ò•îl Health News.

This <a target="_blank" href="/news/school-start-times-sleep-parents/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Wilson founded a nonprofit called Sunnyside Up Youth Pregnancy Services, which connects girls ages 13 to 19 with resources they need to care for their babies. After-hours, she looks for affordable Nashville apartments, books medical appointments, tries to find strollers and other baby supplies, and hosts conversations with pregnant teens about breastfeeding and preparing mentally for childbirth.

Since the overturning of Roe v. Wade just over a year ago, Wilson said, she is confident that more Tennessee teens will carry their pregnancies to term. “Because the access isn’t there,” she said. “I do anticipate that we’re going to get a lot more teens that are wanting to parent their babies rather than going to Illinois or Georgia or Florida.”

Demand for services like Wilson’s could rise in the coming years even though the national teen birth rate has declined dramatically over the past three decades. It’s still dropping, but preliminary data released in June by the Centers for Disease Control and Prevention shows the descent may be slowing.

Doctors, service providers, and advocates say they’re worried full CDC data released later this year — which will include state-by-state numbers — could show a rise in teen births in many , where rates remain among the highest in the country. They say several factors — including the to strike down federal protections for abortion rights, intensifying political , and on youth mental health — could start to unravel decades of progress.

“It’s absolutely concerning,” said Laura Andreson, an OB-GYN in Franklin, Tennessee. The women’s health practice where she works is treating more pregnant teenagers than in recent years, which she thinks could reflect an emerging trend.

“It’s probably going to take a little bit of time,” she said. “But I would venture to say we’re going to see it every year: It’s going to go up.”

Nationally, the rate of teen births has dropped by 78% since a modern-day peak in 1991 of 61.8 births per 100,000 people, according to the CDC. Starting in 2007, the rate had consistently dropped by about 8% until 2021, when the rate of decline slowed to about 2%.

“It certainly does stand in contrast to what we’ve seen in prior years,” said CDC researcher Brady Hamilton. He is working on the updated version of the national data released in June that will break it down by state. Hamilton said that he can’t comment on the recent social and political factors at play, but that the “phenomenal decline” in the teen birth rates over more than 15 years could be reaching a natural plateau as states achieved their goals.

“There are a lot of states that have very low birth rates,” he said. “So you kind of potentially run into a situation where they’re already low and you really can’t go lower.”

But advocates say this leveling off could be the writing on the wall, signaling the start of a rise in teen births.

“We know that young people came back from the pandemic with record levels of mental health struggles, which can be very tied to things like teen pregnancy,” said Jen Biundo, senior director of research and policy at Healthy Futures of Texas, a nonprofit that advocates for science-based education to curb teen pregnancy. A person with mental health issues may be more likely to form unhealthy relationships and engage in riskier sexual behaviors, she said.

And the unleashed a sea change of legislation across the nation affecting reproductive health and options for women. States like Tennessee enacted so-called trigger laws, overturning the right to most abortions. In August, an all-male South Carolina Supreme Court upheld what abortion opponents sometimes call a “,” which bans most abortions after about six weeks of pregnancy. The term is a misnomer because a fetus’ heart is not fully developed in the early stages of pregnancy.

The sudden shift in the reproductive health landscape concerns Hannah Lantos, a researcher who specializes in maternal and adolescent health for Child Trends, a nonprofit research center. She said changes in abortion policy likely won’t have major effects on teen birth statistics because most abortion patients aren’t teenagers. Teenagers account for only 9% of abortions and 6% of all pregnancies reported in the U.S. each year, according to a . Yet who do get pregnant in the U.S. will opt for an abortion, according to the Department of Health and Human Services.

Previous declines in the teen birth rate weren’t driven by access to abortions alone, Lantos said. Other factors like increased access to and more effective contraceptive methods and sex education contributed. Now, those tools also are under siege in many states.

In Texas, some school boards have amid backlash from parents. In New Hampshire, Republican state officials in federal sex ed funding, and officials in Miami-Dade County, Florida, banned new sex ed books. In Idaho, lawmakers told the state’s health departments the state would no longer fund adolescent pregnancy prevention programs.

Parents who oppose abortion could prevent their children from getting one. Even if the parents acquiesce, incentive for a teen is low, said Wilson of Sunnyside Up. People might need to for abortion care now. That’s particularly tricky for teenagers, who may be too young to make decisions independently.

“That car ride can be very excruciating,” Wilson said, noting that the drive from Nashville to the nearest abortion clinic — in Carbondale, Illinois — can take seven hours. “That’s seven hours of potential silence. That’s seven hours of tension. That’s seven hours of thinking about what’s next. And that is a long time to process something so difficult.”

The fear of a disapproving parent might also prevent a teenager who decides to keep the baby from revealing the pregnancy early on, Andreson said. That could lead to a lack of prenatal care, which is concerning for teens, given they are more likely to have complications than other expectant mothers.

“Their bodies aren’t designed to have babies yet,” she said. “And this doesn’t even go into all the issues that go on once the baby’s born.”

Wilson, from Sunnyside Up, noted that teenage parents face unique challenges taking care of newborns. “It’s a lot for them,” Wilson said of the teens who seek her help. “They need that hands-on, in-person support.”

And one of the greatest challenges is housing. Teenagers need a co-signer on a lease. Even when they find a place, the median rent in Nashville , and Tennessee observes the federal minimum wage of $7.25 an hour. Sunnyside Up has persuaded clients to become roommates.

“It’s like we’re literally having to stack families together in the same household for them to be able to pay basic living expenses,” Wilson said.

This story is part of a partnership that includes , , and .

This <a target="_blank" href="/courts/teen-pregnancy-birth-rate-trend-dobbs/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

When Stephen Miller left his primary care practice to work in public health a little under two years ago, he said, he was shocked by how many cases of syphilis the clinic was treating.

For decades, rates of the sexually transmitted infection were low. But the Hamilton County Health Department in Chattanooga — a midsize city surrounded by national forests and nestled into the Appalachian foothills of Tennessee — was seeing several syphilis patients a day, Miller said. A nurse who had worked at the clinic for decades told Miller the wave of patients was a radical change from the norm.

What Miller observed in Chattanooga is reflective of a trend that is raising alarm bells for health departments across the country.

Nationwide, syphilis rates . The Centers for Disease Control and Prevention that 207,255 cases were reported in 2022, continuing a steep increase over five years. Between 2018 and 2022, syphilis rates rose about 80%. The epidemic of sexually transmitted infections — especially syphilis — is “,” said the National Coalition of STD Directors.

The surge has been even more pronounced in Tennessee, where infection rates for the of syphilis between 2017 and 2021.

But this already difficult situation was complicated last spring by a shortage of a specific penicillin injection that is the go-to treatment for syphilis. The ongoing shortage is so severe that public health agencies have recommended that providers ration the drug — prioritizing pregnant patients, since it is the only syphilis treatment considered safe for them. Congenital syphilis, which happens when the mom spreads the disease to the fetus, can cause birth defects, miscarriages, and stillbirths.

Across the country, 3,755 cases of congenital syphilis were reported to the CDC in 2022 — that’s as the number a decade before, the recent data shows. Of those cases, 231 resulted in stillbirth and 51 led to infant death. The number of cases in babies swelled by 183% between 2018 and 2022.

“Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis,” said a released in November. “Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions.”

Hamilton County’s syphilis rates have mirrored the national trend, with an increase in cases for all groups, including infants.

In November, the maternal and infant health advocacy organization March of Dimes released its annual . It found that, nationwide, about 15.5% of pregnant people received care beginning in the fifth month of pregnancy or later — or attended fewer than half the recommended prenatal visits. In Tennessee, the rate was even worse, 17.4%.

But Miller said even those who attend every recommended appointment can run into problems because providers are required to test for syphilis only at the beginning of a pregnancy. The idea is that if you test a few weeks before birth, there is time to treat the infection.

However, that recommendation hinges on whether the provider suspects the patient was exposed to the bacterium that causes syphilis, which may not be obvious for people who say their relationships are monogamous.

“What we found is, a lot of times their partner was not as monogamous, and they were bringing it into the relationship,” Miller said.

Even if the patient tested negative initially, they may have contracted syphilis later in pregnancy, when testing for the disease is not routine, he said.

Two antibiotics are used to treat syphilis, the injectable penicillin and an oral drug called doxycycline.

Patients allergic to penicillin are often prescribed the oral antibiotic. But the World Health Organization strongly because it can cause severe bone and teeth deformities in the infant.

As a result, pregnant syphilis patients are often given penicillin, even when they’re allergic, using a technique called desensitization, said Mark Turrentine, a Houston OB-GYN. Patients are given low doses in a hospital setting to help their bodies get used to the drug and to check for a severe reaction. The penicillin shot is a one-and-done technique, unlike an antibiotic, which requires sticking to a two-week regimen.

“It’s tough to take a medication for a long period of time,” Turrentine said. The single injection can provide patients and their clinicians peace of mind. “If they don’t come back for whatever reason, you’re not worried about it,” he said.

The Metro Public Health Department in Nashville, Tennessee, began giving all nonpregnant adults with syphilis the oral antibiotic in July, said Laura Varnier, nursing and clinical director.

Turrentine said he started seeing advisories about the injectable penicillin shortage in April, around the time the antibiotic and physicians were using penicillin as a substitute, potentially precipitating the shortage, he said.

The rise in syphilis has created demand for the injection that manufacturer with, according to the American Society of Health-System Pharmacists. “There is insufficient supply for usual ordering,” the ASHP said in a memo.

Even though penicillin has been around a long time, manufacturing it is difficult, largely because so many people are allergic, said Erin Fox, associate chief pharmacy officer for the University of Utah health system and an adjunct professor at the university, who studies drug shortages.

“That means you can’t make other drugs on that manufacturing line,” she said. Only major manufacturers like Pfizer have the resources to build and operate such a specialized, cordoned-off facility. “It’s not necessarily efficient — or necessarily profitable,” Fox said.

In a statement, Pfizer confirmed the amoxicillin shortage and surge in syphilis increased demand for injectable penicillin by about 70%. Representatives said the company invested $38 million in the facility that produces this form of penicillin, hiring more staff and expanding the production line.

“This ramp up will take some time to be felt in the market, as product cycle time is 3-6 months from when product is manufactured to when it is available to be released to customers,” the statement reads. The company estimated the shortage would be significantly alleviated by spring.

In the meantime, Miller said, his clinic in Chattanooga is continuing to strategize. Each dose of injectable penicillin can cost hundreds of dollars. Plus, it has to be placed in cold storage, and it expires after 48 months.

Even with the dramatic increase in cases, syphilis is still relatively rare. More than 7 million people live in Tennessee, and in 2019, providers statewide .

Health departments like Miller’s treat the bulk of syphilis patients. Many patients are sent by their provider to the health department, which works with contact tracers to identify and notify sexual partners who might be affected and tests patients for other sexually transmitted infections, including HIV.

“When you diagnose in the office, think of it as just seeing the tip of the iceberg,” Miller said. “You need a team of individuals to be able to explore and look at the rest of the iceberg.”

This story is part of a partnership that includes , , and Ñî¹óåú´«Ã½Ò•îl Health News.

This <a target="_blank" href="/public-health/syphilis-penicillin-rationing-shortage-amoxicillin-doxycycline/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Just 10% of public schools nationwide , according to federal statistics. But in Nashville, classes start at 7:05 — a fact the new mayor, Freddie O’Connell, has been criticizing for years.

“It’s not a badge of honor,” he said when he was still a city council member.

Since his election in September, O’Connell has announced that pushing back school start times is a cornerstone of the education policy he is promoting. He and others around the country have been trying to stress that teenagers aren’t lazy or to blame for getting too little sleep. It’s science.

“All teenagers have this shift in their brain that causes them to not feel sleepy until about 10:45 or 11 at night,” said , a senior research fellow at the University of Minnesota in the College of Education and Human Development. She studies how education policy affects learning, and she used to be a teacher. “It’s a shift that is biologically determined.”

Sleep deprivation in teenagers is linked to mental health struggles, worse grades, traffic accidents, and more. That’s why states including California and Florida have mandated later start times. Individual districts across the country — including some in Tennessee — have made the same change.

But resistance to later starts is less about the science than it is about logistical and financial difficulties, especially with basics like busing.

State Rep. , a Nashville Democrat, tried to pass in 2022.

“I’m starting to experience this with one of my own children,” he said during a committee hearing on the bill. He dug into the biology, including the famous sleep hormone melatonin.

Melatonin makes people feel drowsy. The brain starts producing it when it gets dark outside, and its production peaks in the middle of the night. Adolescents’ brains start releasing melatonin about than adults’ and younger children’s brains, according to the American Chemical Society. When teens wake up early, their brains are still producing melatonin.

“Because of the way adolescents’ bodies release melatonin, waking a teen at 7 a.m. is akin to waking one of us at 4 a.m.,” Clemmons said.

He brought in a local parent, Anna Thorsen, who testified that later start time legislation could protect vulnerable kids like hers.

“My youngest daughter is a freshman who suffers from a rare genetic epilepsy that killed her older sister last year,” she said. “In fact, last March, my youngest daughter had a life-threatening seizure that was partially induced by sleep deprivation.”

, a Knoxville-area Republican, said almost all the feedback he heard on the bill came from Nashville.

“Go to your school board and tell them to change the rule, change the law, change their start times,” he said. “But to mandate [the rest of the state] do this because of one school board that doesn’t want to listen to their parents?”

Legislative leaders gave the bill one hearing. It didn’t pass into state law.

That leaves Nashville, a city that often calls itself the Silicon Valley of health care, to figure out its own path. O’Connell is now on the case. The mayor has some power over the school budget, which gives him influence in education policy. However, it’s up to the school board to determine start times.

“Early start times, particularly for adolescents, are problematic,” the mayor said. “We also know that making a change — even a 30-minute change — has a lot of logistics.”

A major concern has been busing. Even in normal times, districts use the same buses and drivers for students of all ages. They stagger start times to do that, with high schoolers arriving and leaving school earliest in the day. The idea is that they can handle being alone in the dark at a bus stop more readily than smaller children, and it also lets them get home first to help take care of younger siblings after school.

If high schools started as late as middle and elementary schools, that would likely mean strain on transportation resources. O’Connell said Nashville’s limited mass transit compounds the problem.

“That is one of the biggest issues to resolve,” he said.

Several years ago, Collierville, a district in suburban Memphis, launched a study on school start times. That district serves far fewer students — 9,000, compared with .

Collierville officials estimated in the study that busing costs associated with delayed start times could be as high as $1.4 million annually. That estimate assumed the district would need more drivers, more fuel and maintenance, more storage facilities, and additional support personnel — for example, an additional dispatcher and mechanic.

Despite that, the district did push back high school start times in 2018.

O’Connell said one of the concerns he has heard from parents is financial, such as that they need help with family-run businesses or they need their students to help generate household income at other jobs after school lets out.

The , a nonprofit that advocates for later start times, conducted a 2022 survey of parents, teachers, and other adults that found that only about one-third of the parents who responded wanted later starts. Adults as a whole and teachers responded slightly more favorably, but less than 40% of each group supported delaying the day.

A National Education Association found that many parents who oppose later start times don’t necessarily doubt the science; they’re concerned about scheduling.

Wahlstrom, the education researcher, said she fears parents underestimate how important sleep is to brain development and academic performance, especially on weeknights.

“Sometimes both parents and teens think that they can just catch up on their sleep on the weekend. That is a total false assumption,” said Wahlstrom, who equated sleep to food for the brain. “It’s like, ‘OK, we’re going to deprive ourselves of adequate food three days out of the week, but then we’re going to gorge on food on the weekend.’ That’s not healthy.”

She explained how a lack of sleep can impede scholastic success: The brain shifts memory into long-term storage during deep sleep, so missing out on that rest means retaining less material.

But — perhaps more importantly — sleep helps teenagers improve their mental health. U.S. Surgeon General Vivek Murthy has been raising alarm bells about youth mental health, noting that a third of teenagers overall and half of teenage girls have reported persistent feelings of hopelessness.

And Wahlstrom said teen sleep deprivation leads to worse mental and behavioral health, which can affect the whole family. She and her team conducted a study funded by the Centers for Disease Control and Prevention on the effects of later start times on ninth to 12th graders by surveying 9,000 students at eight high schools in Minnesota, Colorado, and Wyoming from 2010 to 2013. They found students who got at least eight hours of sleep were less likely to report symptoms of depression.

“We do know that there is greater use of drugs, cigarettes, and alcohol when a teen is getting less than eight hours,” she said. “We also know that there is a significant link between teenage depression and any sleep amount that is less than eight hours.”

More than surveyed in a Minnesota school district as part of one of her earlier studies responded that their teenager was easier to live with after the later start time went into effect.

“Many parents have anecdotally told me that their child is a different child. They are able to speak with them at breakfast. They are chatty in the car. They don’t have moody episodes and fly off the handle,” she said. “The parents are just saying it’s remarkable that this has made such a change in their child’s life and their family dynamics.”

This article is from a reporting partnership that includes and Ñî¹óåú´«Ã½Ò•îl Health News.

This <a target="_blank" href="/news/school-start-times-sleep-parents/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Wilson founded a nonprofit called Sunnyside Up Youth Pregnancy Services, which connects girls ages 13 to 19 with resources they need to care for their babies. After-hours, she looks for affordable Nashville apartments, books medical appointments, tries to find strollers and other baby supplies, and hosts conversations with pregnant teens about breastfeeding and preparing mentally for childbirth.

Since the overturning of Roe v. Wade just over a year ago, Wilson said, she is confident that more Tennessee teens will carry their pregnancies to term. “Because the access isn’t there,” she said. “I do anticipate that we’re going to get a lot more teens that are wanting to parent their babies rather than going to Illinois or Georgia or Florida.”

Demand for services like Wilson’s could rise in the coming years even though the national teen birth rate has declined dramatically over the past three decades. It’s still dropping, but preliminary data released in June by the Centers for Disease Control and Prevention shows the descent may be slowing.

Doctors, service providers, and advocates say they’re worried full CDC data released later this year — which will include state-by-state numbers — could show a rise in teen births in many , where rates remain among the highest in the country. They say several factors — including the to strike down federal protections for abortion rights, intensifying political , and on youth mental health — could start to unravel decades of progress.

“It’s absolutely concerning,” said Laura Andreson, an OB-GYN in Franklin, Tennessee. The women’s health practice where she works is treating more pregnant teenagers than in recent years, which she thinks could reflect an emerging trend.

“It’s probably going to take a little bit of time,” she said. “But I would venture to say we’re going to see it every year: It’s going to go up.”

Nationally, the rate of teen births has dropped by 78% since a modern-day peak in 1991 of 61.8 births per 100,000 people, according to the CDC. Starting in 2007, the rate had consistently dropped by about 8% until 2021, when the rate of decline slowed to about 2%.

“It certainly does stand in contrast to what we’ve seen in prior years,” said CDC researcher Brady Hamilton. He is working on the updated version of the national data released in June that will break it down by state. Hamilton said that he can’t comment on the recent social and political factors at play, but that the “phenomenal decline” in the teen birth rates over more than 15 years could be reaching a natural plateau as states achieved their goals.

“There are a lot of states that have very low birth rates,” he said. “So you kind of potentially run into a situation where they’re already low and you really can’t go lower.”

But advocates say this leveling off could be the writing on the wall, signaling the start of a rise in teen births.

“We know that young people came back from the pandemic with record levels of mental health struggles, which can be very tied to things like teen pregnancy,” said Jen Biundo, senior director of research and policy at Healthy Futures of Texas, a nonprofit that advocates for science-based education to curb teen pregnancy. A person with mental health issues may be more likely to form unhealthy relationships and engage in riskier sexual behaviors, she said.

And the unleashed a sea change of legislation across the nation affecting reproductive health and options for women. States like Tennessee enacted so-called trigger laws, overturning the right to most abortions. In August, an all-male South Carolina Supreme Court upheld what abortion opponents sometimes call a “,” which bans most abortions after about six weeks of pregnancy. The term is a misnomer because a fetus’ heart is not fully developed in the early stages of pregnancy.

The sudden shift in the reproductive health landscape concerns Hannah Lantos, a researcher who specializes in maternal and adolescent health for Child Trends, a nonprofit research center. She said changes in abortion policy likely won’t have major effects on teen birth statistics because most abortion patients aren’t teenagers. Teenagers account for only 9% of abortions and 6% of all pregnancies reported in the U.S. each year, according to a . Yet who do get pregnant in the U.S. will opt for an abortion, according to the Department of Health and Human Services.

Previous declines in the teen birth rate weren’t driven by access to abortions alone, Lantos said. Other factors like increased access to and more effective contraceptive methods and sex education contributed. Now, those tools also are under siege in many states.

In Texas, some school boards have amid backlash from parents. In New Hampshire, Republican state officials in federal sex ed funding, and officials in Miami-Dade County, Florida, banned new sex ed books. In Idaho, lawmakers told the state’s health departments the state would no longer fund adolescent pregnancy prevention programs.

Parents who oppose abortion could prevent their children from getting one. Even if the parents acquiesce, incentive for a teen is low, said Wilson of Sunnyside Up. People might need to for abortion care now. That’s particularly tricky for teenagers, who may be too young to make decisions independently.

“That car ride can be very excruciating,” Wilson said, noting that the drive from Nashville to the nearest abortion clinic — in Carbondale, Illinois — can take seven hours. “That’s seven hours of potential silence. That’s seven hours of tension. That’s seven hours of thinking about what’s next. And that is a long time to process something so difficult.”

The fear of a disapproving parent might also prevent a teenager who decides to keep the baby from revealing the pregnancy early on, Andreson said. That could lead to a lack of prenatal care, which is concerning for teens, given they are more likely to have complications than other expectant mothers.

“Their bodies aren’t designed to have babies yet,” she said. “And this doesn’t even go into all the issues that go on once the baby’s born.”

Wilson, from Sunnyside Up, noted that teenage parents face unique challenges taking care of newborns. “It’s a lot for them,” Wilson said of the teens who seek her help. “They need that hands-on, in-person support.”

And one of the greatest challenges is housing. Teenagers need a co-signer on a lease. Even when they find a place, the median rent in Nashville , and Tennessee observes the federal minimum wage of $7.25 an hour. Sunnyside Up has persuaded clients to become roommates.

“It’s like we’re literally having to stack families together in the same household for them to be able to pay basic living expenses,” Wilson said.

This story is part of a partnership that includes , , and .

This <a target="_blank" href="/courts/teen-pregnancy-birth-rate-trend-dobbs/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">