khs year 6 report_final

8/12/2019 KHS Year 6 Report_Final

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Health Status of Children Entering

Kindergarten in Nevada

This project was completed in collaboration with the following:All Nevada County School Districts

Nevada School District SuperintendentsNevada Division of Public and Behavioral Health

This publication was supported by the Nevada Division of Public and Behavioral Health Maternal andChild Health Program through Grant Number B04MC23393 from the Health Resources and Services

Administration. Its contents are solely the responsibility of the authors and do not necessarily representthe official views of the Nevada Division of Public and Behavioral Health nor the Health Resources and

Services Administration.

University of Nevada, Las Vegas

School of Community Health Sciences

Results of the

2013-2014(Year 6)

Nevada

Kindergarten

Health Survey

April 2014


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Nevada Institute for Childrens Research and Policy, UNLV April 2014

Results of the 2013-2014 Nevada Kindergarten Health Survey Page 2

The Nevada Institute for Children's Research and Policy (NICRP) is a not-for-profit, non-

partisan organization dedicated to advancing children's issues in Nevada.

As a research center within the UNLV School of Community Health Sciences, NICRP isdedicated to improving the lives of children through research, advocacy, and other specialized

services.

NICRP's History:NICRP started in 1998 based on a vision of First Lady Sandy Miller. Shewanted an organization that could bring credible research and rigorous policy analysis to

problems that confront Nevada's children. But she didn't want to stop there; she wanted totransform that research into meaningful legislation that would make a real difference in the lives

of our children.

NICRP's Mission: The Nevada Institute for Children's Research and Policy (NICRP) looks outfor Nevada's children. Our mission is to conduct community-based research that will guide thedevelopment of programs and services for Nevada's children. For more information regarding

NICRP research and services, please visit our website at: http://www.nic.unlv.edu

NICRP Staff Contributors:

Amanda Haboush-Deloye, Ph.D.Senior Research Associate

Dawn L. Davidson, Ph.D.Research Associate

Tara Phebus, M.A.

Interim Executive Director

Nevada Institute for Childrens Research and Policy

School of Community Health Sciences, University of Nevada, Las Vegas

4505 S. Maryland Parkway, 453030

Las Vegas, NV 89154-3030

(702) 895-1040

http://nic.unlv.edu


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TABLE OF CONTENTS

Executive Summary........................................................................................................................6

Introduction.....................................................................................................................................8Methodology ........................................................................................................................8Limitations to the Study .......................................................................................................9

Survey Results ...............................................................................................................................10Response Rates ....................................................................................................................10Demographics .....................................................................................................................13Insurance Status ..................................................................................................................18Access to Healthcare ............................................................................................................22Routine Care .......................................................................................................................24Care for Illness or Injury ......................................................................................................27

Medical Conditions .............................................................................................................29Dental Care .........................................................................................................................31Mental Health.......................................................................................................................32Weight and Healthy Behaviors ............................................................................................33

Appendix A: Summary of the 2013-2014 Survey Results by County ......................................47

Appendix B: Comparison Survey Results by Survey Year .......................................................52

Appendix C: Survey Instrument .................................................................................................61

Appendix D: References ...............................................................................................................63


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TABLE OF CONTENTS



Figure 10.10: Infant Feeding Habits ....................................................................................45Figure 10.11: Childs Weight Status Category by Infant Feeding Habits ...........................46


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EXECUTIVE SUMMARY

To gather additional data on the health status of children entering the school system and to better track

student health status, the Nevada Institute for Childrens Research and Policy (NICRP), in partnershipwith all Nevada School Districts and the Nevada Division of Public and Behavioral Health, conducted a

health survey of children entering kindergarten in Nevada. The goal of this study was to: longitudinally quantify the health status of children as they enter school,

identify specific areas for improvement to potentially increase academic success, and

provide local information to policy makers to guide decisions that impact childrens health.

In the Fall of 2013, NICRP distributed questionnaires to all public elementary schools in the State, exceptClark County School District, who requested we use a sample of their schools. The survey had an overallresponse rate of 29.1 percent (less than the previous year), with a total of 7,330 surveys received fromparents in all 17 school districts in Nevada. Survey respondents from Clark County comprised 60.2percent of the sample, while 13.4 percent were from Washoe County and 26.4 percent were from theremaining rural counties. The following tables contain some of the key findings of the survey.

Health Status:This year, as compared to last year, respondents reported that their children are engagingin fewer unhealthy behaviors such as watching television and drinking diet or non-diet sodas. However,more children, as compared to last year, are engaging in more computer/video game play. This year therewas a decrease in the percentage of children in the underweight category, and an increase in thepercentage of children in both the healthy and overweight/obese weight categories. Compared to lastyear, there was an increase in the percentage of parents who breastfed their child at three months and atsix months.

2012-2013 2013-2014 % Change *

Weight StatusUnderweight 15.4% 14.5% -5.8%

Healthy 54.9% 55.5% +1.1%

Overweight/Obese 29.6% 30.0% +1.4%Physical Activity

< 3 days per week of 30-minutes of physical activity 19.0% 17.6% -7.4%

Television Viewing on School Days2 hrs or less of television watched per school day 80.0% 80.5% +0.6%

3 hrs or more of television watched per school day 20.0% 19.4% -3.0%

Computer/Video Game Play on School Days< 1 hr of computer/video games played per school day 89.1% 86.6% -2.8%

Consumption of Non-Diet SodaNever drink non-diet soda 55.8% 59.9% +7.3%

Drink non-diet soda once a day or more 10.3% 9.3% -9.7%

Consumption of Diet Soda

Never drink diet soda 83.0% 85.5% +3.0%Drink diet soda once a day or more 2.8% 2.9% +3.6%

Infant Feeding BehaviorsBreastfed OnlyOne Month 47.3% 47.4% +0.2%Breastfed OnlyThree Months 33.6% 34.0% +1.2%Breastfed OnlySix Months 23.2% 23.7% +2.2%

Note. *Green arrows = positive change, red arrows = negative change, and yellow arrows = no change (< +.5%).


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EXECUTIVE SUMMARY



Household I ncome: The percentage of families in the lower income brackets decreased while thepercentage of families in the higher income brackets increased, representing an overall increaseStatewide.

2012-2013 2013-2014 % Change *

Household Income

Less than $25,000 per year 33.7% 33.0% -2.1%Less than $45,000 per year 55.5% 54.8% -1.3%$45,000 or more per year 44.5% 45.2% +1.6%


I nsurance Status: The percentage of uninsured children decreased from last year. This year, morechildren were covered by private insurance and Medicaid as compared to last year.

2012-2013 2013-2014 % Change *

Insurance StatusUninsured 13.5% 12.8% -5.2%Private Insurance 48.0% 50.6% +5.4%Medicaid 23.7% 25.3% +6.8%Nevada Check-up 6.1% 6.1% 0%


Routi ne Care:As compared to last year, the percentage of children receiving a routine check-updecreased; However a higher percentage of children have a primary care provider. As compared to lastyear, the percentage of children visiting the dentist in the past year did not change.

2012-2013 2013-2014 % Change *

Routine CareHad a routine medical checkup in last 12 months 86.1% 85.5% -0.7%

Have a primary care provider 83.2% 85.8% +3.1%

Have been to the dentist in past 12 months 74.6% 74.4% -0.3%


Access to Health Care:The same percentage of barriers to accessing healthcare were reported this year ascompared to last year. The barriers reported more frequently this year as compared to last year includethe lack of quality medical providers and the lack of transportation. Lack of insurance and lack of moneywere reported less frequently this year as compared to last year. While there was a decrease this year inthe percentage of respondents trying to access mental health care, there was an increase in the percentageof respondents having trouble obtaining these services.

2012-2013 2013-2014 % Change *

Barriers to Accessing Health Care**None 74.4% 74.8% +0.5%Lack of Transportation 2.9% 3.1% +6.9%Lack of Insurance 10.4% 10.1% -2.9%

Lack of Quality Medical Providers 5.3% 5.7% +7.5%Lack of Money/Financial Resources 14.8% 14.0% -5.4%Have tried to access mental health services 4.5% 4.4% -2.2%

Had trouble obtaining mental health services 32.4% 35.5% +9.6%

Note: *Green arrows = positive change, red arrows = negative change, and yellow arrows = no change (< +.5%).**Since respondents could select more than one barrier, totals may add up to more than 100%.

For more detailed information on all survey items, please see Appendix B of the full report.

Data for specific counties and/or schools may also be available upon request.

Please contact NICRP at (702) 895-1040 for additional information.


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INTRODUCTION

Academic achievement for children is vital to their success in life. Those that do well in schoolhave greater opportunities for post-secondary education, and later have better prospects foremployment. One of the major factors that can affect a childs academic achievement is his or

her health status. Academic outcomes and health conditions are consistently linked in theliterature (Eide, Showalter, & Goldhaber, 2010; Taras & Potts-Datema, 2005). Children withpoor health status, especially those with common chronic health conditions, have increasednumbers of school absences and more academic deficiencies than those students with a goodhealth status (Taras & Potts-Datema, 2005). In addition, children that have health insurance havefewer absences from school, as compared to children without health insurance (Yeung, Gunton,Kalbacher, Seltzer, & Wesolowski, 2010). In a study examining school absences, whencompared with children with low absenteeism, children with more absenteeism overall had loweracademic performance, and those with excused absences performed better than those withunexcused absences (Gottfried, 2009). Therefore, to increase the likelihood for academic successin children, we need to address their health concerns. Preventative care is crucial to a childs

ability to succeed in school.

According to data from the KIDS COUNT Data Center at the Annie E. Casey Foundation(2013), 13percent of Nevadas teens (ages 16-19) are not in school and are not working, and 42percent are not graduating on time compared to 8 percent and 22 percent nationally. The nationaldropout prevention center lists poor attendance and low achievement as two of the significantrisk factors for school dropout (Hammond, Linton, Smink, & Drew, 2007). Additionally, studiesexamining school dropout rates indicate that early intervention is necessary to prevent studentsfrom dropping out of school. Middle and high school students that drop out, likely stopped beingengaged in school much earlier in their academic career. Therefore, early prevention andintervention is crucial to improving graduation rates. Ensuring that children have their basic

needs met, including receiving adequate health care, can directly impact a childs academicachievement as well as increase their likelihood for high school graduation.

To gain information about the health status of children entering the school system and bettertrack student health status, in 2008, the Nevada Institute for Childrens Research and Policy(NICRP) partnered with the States 17 school districts, the Southern Nevada Health District, andthe Nevada Division of Public and Behavioral Health (NDPBH) to conduct an annual healthsurvey examining the health status as well as health insurance status of Nevadas childrenentering kindergarten. The goal of the study is to longitudinally quantify the health status ofchildren as they enter school so that specific areas for improvement can be identified andpotentially increase academic success among Nevadas students. This report reflects the results

of the sixth year of the Annual Kindergarten Health Survey.

METHODOLOGY

The original survey used in this study was created in 2008 in partnership with the Clark CountySchool District (CCSD) and the Southern Nevada Health District (SNHD). The survey wasintended to provide a general understanding of the overall health status of children when they


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INTRODUCTION



enter school. The original short questionnaire was developed in both English and Spanish andconsisted of 22 questions. Small revisions to the survey have occurred each year; therefore, datafor all items presented in this report may not be available for all five years. The current versionof the survey consists of 28 questions (13 demographic questions and 15 health relatedquestions) and, like the original survey, is available in both English and Spanish.

In the Fall of 2013, questionnaires were distributed to kindergarten teachers in all publicelementary schools in the state, with the exception of schools in the Clark County SchoolDistrict. The Clark County School District requested that only a sample of their schools beincluded in the survey to reduce burden on school staff. Therefore, surveys were sent to arandomly selected sample of schools (n= 141) in the district. This sample size was determinedbased on a 5 percent margin of error in survey results. In addition, schools were divided by TitleI status, and a representative random sample of both Title I eligible and non-Title I eligibleschools was selected. Schools qualify as Title I eligible when they serve large populations ofchildren from low income families (typically a minimum of 40%) and receive supplementalfederal funding from the Department of Education. Title I eligibility status was provided by the

Clark County School District. It was determined that 158 of the 217 elementary schools in thedistrict (72.8%) were Title I eligible schools. Ninety-nine schools (70 percent of the target 141schools in the sample) were randomly selected from a list of all Title I eligible schools using thestatistical analysis program PASW Statistics 21.0. The remaining 42 schools (30 percent of theneeded sample of 141) were randomly selected from a list of schools that were not Title Ieligible.

For all school districts in Nevada, surveys were distributed to parents during the first part of theschool year. Parents who chose to participate then turned in the survey to either the school officeor their childs teacher. The surveys were then returned to NICRP via mail. The parent couldalso mail the survey to NICRP directly. Each survey was assigned a unique identification

number by NICRP staff to aid in tracking of survey responses. All survey responses received asof January 31, 2014 were analyzed using PASW Statistics software version 21.0 (SPSS IBM,New York, U.S.A).

LIMITATIONSTOTHESTUDY

As in all research studies, there are limitations to the data collected. First, all informationcontained in this report was self-reported by each parent or guardian. The information providedrelies on the memory and honesty of the survey respondents. Additionally, several of theresponses were left blank on the surveys received. All of the surveys received were included inthe analyses, but it is important to note when reading percentages presented in the figures below

that not all respondents answered all questions. Some figures may have a total of 7,330(indicating all who responded to the question), while others may have a smaller number of totalcases because of respondents leaving that particular question blank. All percentages calculatedfor this report are based on the total number of people answering the question, rather than thetotal number of people who completed a survey.


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SURVEY RESULTS

Presented in the figures below are the basic frequencies (counts and percentages) for allquestions included in the survey. Cross tabulations were also calculated for selected variables toprovide additional information on specific topics. A chi-square statistic was also calculated to

test for the statistical significance of the differences provided in the cross tabulation tables.Percentage calculations as well as statistical significance are presented with figures, asappropriate. In addition, the 2013-2014 data were compared across counties for the current datacollection period (Clark, Washoe, Rural), and with data from the previous four years.

RESPONSERATES

Each school district involved in the study provided NICRP with the estimated number ofkindergarten students enrolled in their district for the 2012-2013 school year. The requestednumber of surveys (24,151) was sent out to participating schools. At the end of the datacollection period (January 2014), 7,330 surveys were received for a response rate of 29.1percent. While the response rate had steadily improved from 2008-2009 (36.0%) to 2009-2010(39.2%) and 2010-2011 (43.6%), the response rate for the past few years (2011-2012 = 36.3%;2012-2013 = 35.1%) has declined. Attempts were made this year to address the issue of latedissemination which occurred in 2012-2013, by ensuring school districts had their surveys inadvance of the start of the school year and schools who had not returned surveys by Novemberwere given a reminder call. However, this did not appear to affect the current response rate.Response rates for each school district (Table 1.1) ranged from 20.4% in Washoe County to 54%in Douglas County.

Table 1.1 Survey Response Rate by School District

School District # Surveys Sent Out # Surveys Returned Response Rate

Carson City 650 313 48.2Churchill County 400 126 31.5Clark County 15,963 4,413 27.6Douglas County 500 270 54.0Elko County 850 456 53.6Esmeralda County 30 14 46.7Eureka County 32 8 25.0Humboldt County 320 131 40.9Lander County 130 61 46.9Lincoln County 61 31 50.8Lyon County 800 295 36.9Mineral County 60 19 31.7Nye County 420 136 32.4Pershing County 54 21 38.9Storey County 30 13 43.3Washoe County 4,807 982 20.4White Pine County 90 41 45.6

All Districts 25,197 7,330 29.1


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RESPONSE RATES



For this years report, NICRP obtained the unaudited enrollment numbers for each school districtfrom the Department of Education. Using these numbers, NICRP was able to calculate aresponse rate based on the number of surveys returned and the number of kindergartners enrolledwithin each school district. This information would indicate how much of the actualkindergarten sample was surveyed. This unaudited enrollment response rate was then compared

to the response rate based on the number of surveys distributed within each school district.

For the majority of districts, the number of surveys distributed was similar, but slightly higherthan the unaudited enrollment data and the response rate varied between 5% and 10%. However,for Eureka County, Mineral County, and Esmeralda County, the response rate differed by almost50% with the the unaudited enrollment response rate being higher than the survey distributionresponse rate. This indicates that these counties overestimated their enrollment.

Despite the differences, the overall response rate for the unaudited enrollment response rate andthe survey distribution response rate only varied by 0.7 percentage points. Some deviationbetween estimated and actual enrollment numbers is expected, and based on the similarities in

response rates for the State as a whole, the response rate based on the survey distribution appearsto be valid for All Districts combined.

Table 1.2 Kindergarten Unaudited Enrollment and Response Rate by School District

School District

Unaudited

Enrollment

# Surveys

Sent Out

Unaudited Enrollment

Response Rate

Survey Distribution

Response Rate

Carson City 594 650 52.7% 48.2%

Churchill County 305 400 41.3% 31.5%

Clark County 15,388 15,963 28.7% 27.6%

Douglas County 417 500 64.7% 54.0%

Elko County 895 850 50.9% 53.6%

Esmeralda County 15 30 93.3% 46.7%Eureka County 21 32 38.1% 25.0%

Humboldt County 323 320 40.6% 40.9%

Lander County 125 130 48.8% 46.9%

Lincoln County 61 61 50.8% 50.8%

Lyon County 651 800 45.3% 36.9%

Mineral County 42 60 45.2% 31.7%

Nye County 373 420 36.5% 32.4%

Pershing County 57 54 36.8% 38.9%

Storey County 29 30 44.8% 43.3%

Washoe County 5,206 4,807 18.9% 20.4%White Pine County 118 90 34.7% 45.6%

All Districts 24,620 25,197 29.8% 29.1%


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RESPONSE RATES



Figure 1.1 illustrates the participation of Washoe, Clark, and Rural Counties. These rates arefairly consistent with the data received in previous school years. Because Clark County is thelargest school district in the state, it was expected that Clark County parents would comprise thevast majority (60.2 percent) of the respondents for this survey.

Figure 1.2 illustrates county-specific participation for onlyrural counties, which combined,represents 26.4 percent of the total respondents.

60.2%

13.4%

26.4%

Figure 1.1: Survey Participation by School District(2013-2014: n = 7,330)

Clark County

Washoe County

Rural Counties

16.2%

6.5%

14.0%

23.6%

0.7% 0.4%

6.8%

3.2%1.6%

15.2%

1.0%

7.0%

1.1% 0.7%

2.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Figure 1.2: Survey Response Rate Among

All Rural Counties(2013-2014: n= 1,935)


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DEMOGRAPHICS

The survey was created to be one page in length, with one side presented in English and thereverse side presented in Spanish. Of the 7,330 respondents that returned the surveys, 85.8percent completed the English version and14.2 percent completed the Spanish version.

Parents were asked to respond to questions regarding their annual household income, and theirchilds gender, race/ethnicity, and pre-school setting prior to kindergarten. Data for each of thesequestions are presented in Figures 2.1 through 2.3 below, with all percentages calculated usingthe total number of completed responses rather than the total number of returned surveys.

Gender

Among the kindergarten students for which gender was reported, the distribution was split nearlyequally between males (51.1 percent) and females (48.9 percent). These results are consistentwith survey results from 2008-2009 through 2012-2013.

Famil y Demographi csThe average age of the childs mother was 32.83 (SD = 6.79) and the average age of the fatherwas 35.46 (SD = 7.49). The average number of adults living in a house was 2.08 (SD = .77) andranged from 1 to 8. The number of children living in a house averaged 2.55 (SD = 1.21) andranged from 1 to 12. Approximately 30 percent of parents indicated that they were a singleparent or guardian. This information is consistent with the data for Clark County, WashoeCounty, and Rural Counties (see Appendix A, Table 11.1), and this information is consistentwith the data collected during the 2012-2013 school year.

Annual Household I ncome

According to the U.S. Census Bureau, Small Area Income and Poverty Estimates, the 2008-2012

estimated median household income in Nevada was $54,083. This median income represents themiddle value of a distribution, and is the best measure of central tendency to reduce the impact ofoutliers (very high or very low incomes) in the distribution. Compared to the median incomelisted for Nevada, 54.8 percent of all respondents reported an annual income below $45,000.


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DEMOGRAPHICS



Race/EthnicityCompared to the U.S. Census Bureau (2012b) for the entire population in Nevada, the reportedrace/ethnicity of the kindergartners in this survey included proportionally fewer people whoindicated they were African American, Asian/Pacific Islander, and Caucasian, and more peopleidentifying with multiple races (see Figure 2.2). It is important to note that the U.S. Census

Bureau reports race (White, African American/Black, Asian, Pacific Islander, AmericanIndian/Alaskan Native, two or more races) and ethnicity (White non-Hispanic / Hispanic)separately whereas the KHS does not.

These results are consistent with data received in 2012-2013. When comparing results acrosscounties for the 2013-2014 school year (refer to Table 11.1 in Appendix A), there is a higherpercentage of African American/Black and Asian/Pacific Islander children in Clark County ascompared to both Washoe and the Rural Counties. There is also a higher percentage of Hispanicchildren in Clark County and Washoe counties as compared to the Rural Counties. In addition,there are more Native American/Alaska Native children in the Rural Counties and Washoecounty as compared to Clark county.

Note. * Nevada state data from U.S. Census Bureau (2012b) http://quickfacts.census.gov.

AfricanAmerican/

Black

Asian/PacificIslander

Caucasian Hispanic

NativeAmerican/

AlaskaNative

OtherRace

MultipleRaces

Survey Sample 5.7% 5.7% 40.8% 31.8% 1.8% 0.8% 13.4%

Nevada* 8.9% 8.6% 52.9% 27.3% 1.6% 3.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Race/Ethnicity

Figure 2.2: Child's Race/Ethnicity(2013-2014: n= 7,235)


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DEMOGRAPHICS



Pre-school Setti ng

Respondents were asked to indicate the type of pre-school setting, if any, their kindergartnerattended in the past twelve months (see Figure 2.3). These categories were adjusted from the2012-2013 survey in order to capture more specific settings. Therefore, previous school yearsmight not have data for certain categories.

Compared to 2012-2013 data:

33.3 percent of respondents indicated that their kindergartner had stayed at home in theprior year, which is a 5.2 percentage point decrease from last year.

Attendance at Head Start has decreased in the past two years (approximately 6percentage points).

When comparing the 2013-2014 across counties (Table 11.1):

A higher percentage of children attended Head Start in Washoe County (11.3) and theRural counties (9.1) as compared to Clark County (5.6).

A higher percentage of children attended in school district run pre-schools in the Rural

counties (25.8) as compared to Washoe (20.9) and Clark (22.5) counties. A higher percentage of children in Clark County (40.0) did not attend preschool as

compared to Washoe County (32.8) and the Rural counties (27.1).

Note. Blank boxes indicate data are not available. For these categories, percents will not total100 because not allcategories for those years are available.

Head StartOther

Facility/Care

Home-BasedCare

UniversityCampus

Pre-School

SchoolDistrict

Pre-School

None/StayedHome

MultipleSites

Friends/Family/

NeighborCare

2009-2010 12.6% 8.2% 38.2% 2.8%

2010-2011 11.2% 10.5% 32.7% 1.9%

2011-2012 12.3% 5.9% 41.6% 1.0%

2012-2013 6.4% 25.1% 6.4% 1.3% 19.8% 38.5% 2.5%

2013-2014 6.8% 21.9% 5.7% 1.4% 21.7% 33.3% 3.9% 2.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Figure 2.3: Child's Type of Preschool Setting During Last Twelve Months(2009-2010: n= 9,258; 2010-2011: n= 10,217; 2011-2012: n= 8,294; 2012-2013:n = 8231;

2013-2014: n = 7,146)


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DEMOGRAPHICS



Average Hours of Preschool A ttendanceSince the 1950s there has been a drastic shift in the percentage of children who are spendingtime in non-parental child care settings (McGroder, 1988). Sixty percent of children under fivespend an average of 29 hours per week in some form of child care settings (Iruka & Carver,2011).Therefore, it is important to specifically understand how preschool environments affect

our children. Some of these effects, positive or negative, might be correlated with the time spentin non-parental care. Therefore, in addition to the preschool setting, a question was included inthe 2013-2014 survey to determine how many hours children spent in the preschool setting.

Results from Table 2.1 indicate that the majority of parents/guardians have their child insomeone elses care 20 hours or less per week (63.2 percent) and only 10 percent have them insomeone elses care more than 40 hours a week.

When comparing the results across counties (Table 11.1):

A higher percentage of children were in care 20 hours a week or less in the Ruralcounties (53.6) as compared to Clark (40.2) and Washoe (40.5) counties.

A higher percentage of children were in care more than 20 hours a week in WashoeCounty (29.2) as compared to Clark County (27) and the Rural Counties (21.1).

Table 2.1 Average Preschool Hours of Attendance (n=4,202)5-10HRS 10-15HRS 15-20HRS 20-30HRS 30-40HRS 40+HRS

KHS Sample 25.8% 23.7% 13.7% 10.9% 15.3% 10.6%


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INSURANCESTATUS

Background

Nevada has consistently placed near the bottom of nationwide rankings with regard to the percent ofchildren covered by health insurance. According to the U.S. Census Bureau American Community

Survey (2012a), approximately 7.2 percent of children under the age of 18 in the United States areuninsured compared to 16.6 percent of children under the age of 18 in Nevada.

A correlation exists between childrens health insurance status and access to health care services.Research indicates that uninsured children are less likely to have access to the care they need and aremore likely to have poorer health outcomes when compared to insured children. For example,uninsured children were nearly ten times as likely as insured children to have an unmet health need(Robert Wood Johnson Foundation, 2005). Nevada was ranked 46th when compared nationally acrossfour dimensions of health: healthcare access and affordability, prevention and treatment, avoidablehospital use and cost, equity, and healthy lives (Radley, McCarthy, Lippa, Hayes, & Schoen, 2014).

Status of Health I nsurance of Kindergarten StudentsIn the current study, respondents were asked to indicate their childscurrent health insurance coverage.Approximately 87.2 percent of respondent indicated that their child had some type of health insuranceand 12.8 percent of respondents stated that their child had no coverage. Compared to 2008-2009,the percentage of children with health insurance has increased by 6.4 percentage points however,Nevada still has the highest rates of uninsured children in the country (US Census AmericanCommunity Survey, 2012).

Of the health insurance options:

Half (50.6%) of the respondents indicated that their kindergartner had private health insurance.

Approximately 31.4% of the respondents indicated that their kindergartner had public health

insurance (either Medicaid or the states childrenshealth insurance program, Nevada CheckUp).

The statistics found in this study are similar to national trends in childrens health insurance coverage(Kaiser Family Foundation, 2011). However, even though there is a steady trend that appears toindicate that the number of children insured is increasing, it is important to note that therates ofchildren enrolled in private insurance are decreasing while enrollment in public insurance (e.g.,

Medicaid) is increasing. A recent study using data from the Kindergarden Health Survey suggests thataccess to health care is reduced for those receiving public insurance compared to private insurance(Haboush, Phebus, Hensley, Teramoto, & Tanata, 2013). Therefore, as the use of public insurancecontinues to increase, it is imperative that access to care and quality healthcare is offered through

public insurance programs.


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INSURANCE STATUS



Approximately 2.2percent of respondents indicated that their child had some other type of healthinsurance not listed on the survey questionnaire. Respondents indicated that these othertypes ofinsurance included coverage provided through tribal insurance and by discount companies (e.g.,Access to Healthcare). Unfortunately, some of the responses were illegible and thus could not bereported or recoded into another category. It is possible that some of these reponses could have beencoded as belonging to the private or public survey categories.

In addition, 3.0 percent of respondents selected multiple typesof health insurance for their

kindergartner. The majority of these respondents specified that their child had both Medicaid and aprivate form of health insurance, or Medicaid and Nevada Check Up.

Uninsured Private MedicaidNevadaCheck Up

OtherMultiple

Types

2008-2009 19.1% 58.6% 12.3% 7.0% 1.7% 1.3%

2009-2010 18.6% 47.6% 16.7% 6.1% 9.1% 1.9%

2010-2011 16.6% 39.5% 22.8% 5.8% 13.6% 1.7%

2011-2012 12.3% 48.8% 23.6% 6.4% 6.4% 2.5%

2012-2013 13.5% 48.0% 23.7% 6.1% 6.2% 2.5%

2013-2014 12.8% 50.6% 25.3% 6.1% 2.2% 3.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

%o

fRespondents

Figure 3.1: Types of Health Insurance Covering Children

by School Year(2008-2009: n= 10,626; 2009-2010: n= 9,110; 2010-2011: n= 10,183; 2011-2012: n= 8,462;

2012-2013: n = 8,384; 2013-2014: n= 7,250)


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INSURANCE STATUS



Race/Ethnici ty and I nsurance StatusFigure 3.3, detailing the relationship between race/ethnicity and insurance status, shows that nearly halfof children who are uninsured are Hispanic (48.4 percent) and almost a third are Caucasian (29.8percent).

While data has been fairly consistent over the past 2 survey years (Appendix B), compared to baselinedata in the 2008-2009 school year:

The percentage of uninsured Caucasian children has increased by 7.1 percentage points (2008-2009 = 22.7);

The percentage of uninsured Hispanic children has decreased by about 10.2 percentage points(2008-2009=58.6); however, Hispanic children are still more likely to be uninsured as comparedto other racial/ethnic groups.

Note. Percentages are calculated out of the number within each insurance category. Percentages may not add up to 100 dueto rounding.

Research indicates that in Nevada, and across the United States, Hispanic populations are much morelikely to be uninsured than Caucasian populations (Newport & Mendes, 2009). Approximately 31percent of Hispanics across the country are uninsured (Kaiser Family Foundation, 2012) This rate islikely to increase in states with large proportions of Hispanic immigrants like Nevada. Although manyof these Hispanic children are eligible for public health insurance, barriers to enrollment such aslanguage and past negative experiences, continue to impede parents/guardians from obtaining insurancecoverage for their children (Perry, Kannel, & Castillo, 2000).

AfricanAmerican

/ Black


Caucasian Hispanic

NativeAmerican/ AlaskaNative

OtherRace

MultipleRaces

Total

Uninsured 4.7% 4.9% 29.8% 48.4% 1.8% 0.4% 10.0% 100%

Insured 5.9% 5.8% 42.6% 29.1% 1.7% 0.8% 14.0% 100%

Total % ofRespondents

5.7% 5.7% 40.8% 31.8% 1.8% 0.7% 13.4% 100%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Race/Ethnicity

Figure 3.3: Child's Race/Ethnicity by Child's Insurance Status(2013-2014:Uninsured n = 921; Insured n = 6,238; Total n = 7,159)


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ACCESSTOHEALTHCARE

Bar ri ers to Accessing Healthcare

When asked about accessing health care for their child, of the 25.2 percent of respondents that

had experienced at least one barrier, the majority had difficulty due to either a lack ofmoneyor lack of insurancefor health care services.

Note. Percentages in chart are shown for odd years (09/10, 11/12, 13/14).

Of all respondents experiencing one or more barriers to accessing health care (approximately1800 respondents):

66% reported having health insurance (26.4% private, 25.5% Medicaid, 5.9%

Nevada Check Up, and 7.6% Other/Multiple); 62.4% had an annual household income of less than $35,000.

3.1%

10.1%

5.7%

14.0%

2.2%

3.1%

11.1%

4.6%

13.1%

1.5%

3.1%

10.1%

5.7%

14.0%

2.2%

0.0%

5.0%

10.0%

15.0%

Barriers

.

Figure 4.1: Types of Barriers When Accessing

Health Care for Child(2008-2009 n = 10,382; 2009-2010 n = 9,275; 2010-2011 n= 10,271; 2011-2012 n= 8,280;

2012-2013 n = 8,150; 2013-2014 n = 7,043 )

2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014


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ROUTINE CARE



In the current sample, approximately 90.9 percent of children with health insurance have aprimary care provider, while only 51.5 percent of children without insurance have a primary careprovider. These results clearly indicate that a childs insurance status is related to having aprimary care provider (see Figure 5.2).

Note. Percentages are calculated out of the number within each insurance category.

48.5%

9.1%

51.5%

90.9%

0.0%

10.0%

20.0%

30.0%40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Uninsured Insured

Insurance Status

Figure 5.2: Presence of Primary Care Provider by

Child's Insurance Status(2013-2014: Uninsured n = 913; Insured n= 6,259; Total n = 7,172)

PCP - No PCP - Yes


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ROUTINE CARE



Having a primary care provider is also related to whether or not a child has had a routine check-up in the past 12 months (see Figure 5.3).

Of the children that had a routine check-up, 91.1 percent had a primary care provider.

Of the children that had not had a routine check-up in the last year, 44.7 percent did nothave a primary care provider.

These findings are similar to those found in previous survey years (2008-2009 through2012-2013).

Note. Percentages are calculated out of the number within each PCP category.

44.7%

8.9%

55.3%

91.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Routine Check-Up - No Routine Check-Up - Yes

Presence of PCP

Figure 5.3: Child's Routine Check-Ups by Presence of

Primary Care Provider (PCP)(2013-2014: No PCP n = 995; Has PCP n= 6,074; Total n = 7,069)

PCP - No PCP - Yes


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CAREFORILLNESSORINJURY

In recent years, a growing number of uninsured children with minor, non-life-threateningconditions have accessed health care services at emergency care facilities (Garcia, Bernstein, &Bush, 2010). Most uninsured children come from lower-income families that cannot afford to

pay the high costs for medical care (Garcia et al., 2010). These families are often left with littleoption but to use hospital emergency rooms (ERs) or other urgent care facilities for non-life-threatening conditions because that is the only place that they can get the care they need.

Approximately 18.8 percent of respondents indicated they had visited an ER for a non-lifethreatening illness or injury for their child once or twice in the past year, which was fairlyconsistent with data from previous years (see Figure 6.1).

Note. Percentages may not add up to 100 due to rounding.

No Visits 1-2 Visits 3-5 Visits 6-9 Visits

10 or More

Visits Total

2008-2009 75.2% 22.6% 2.1% 0.2% 0.1% 100%

2009-2010 80.0% 18.6% 1.3% 0.0% 0.1% 100%

2010-2011 80.6% 18.1% 1.1% 0.1% 0.1% 100%

2011-2012 79.4% 18.8% 1.5% 0.2% 0.1% 100%

2012-2013 79.9% 18.5% 1.4% 0.1% 0.1% 100%

2013-2014 79.4% 18.8% 1.5% 0.2% 0.1% 100.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Figure 6.1: Number of Emergency Room Visits for

Non-Life-Threatening Care

(2008-2009 n= 10,970; 2009-2010 n= 10,970; 2010-2011 n= 10,380;2011-2012 n= 8,443; 2012-2013 n= 8,374; 2013-2014 n= 7,246)


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CARE FOR ILLNESS OR INJURY



Insurance status does not appear to be an indicator of usage of an ER. Figure 6.2shows thepercentage of ER visits by childsinsurance status. For both insured and uninsured groups, thevast majority of children had not been to an ER for a non-emergency in the past 12 months, andfor those that had 1-2 visits, almost 50% were either insured or uninsured.

No Visits 1-2 Visits 3-5 Visits 6-9 Visits10 or More

VisitsTotal

Uninsured 81.1% 18.0% 0.8% 0.1% 0.0% 100%

Insured 79.1% 19.0% 1.7% 0.2% 0.1% 100%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Number of Visits.

Figure 6.2: Percentage of Emergency Room Visits for Non-

Life-Threatening Care by Child's Insurance Status(2013-2014: Uninsured n = 922; Insured n = 6,262; Total n = 7,184)


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MEDICALCONDITIONS

Many of Nevadas children have special medical conditions. Treatment for these children isoften expensive and requires a team of medical care providers, led by a primary care physician,devoted to the treatment and maintenance of their conditions. Thus, health insurance coverage is

vital for children with special health conditions, as it improves their chances of having ongoingcare and treatment.

According to this yearssurvey results, 29.3 percent of parents indicated that their child hada medical condition (see Figure 7.1). Please note that it is likely that this percentage is higherthan previous years because the category Allergies was included for the first time this year.

7.5 percent of respondents reported that their child had asthma, which was the highestreported medical condition.

Diedhiou, Probst, Harding, Martin, and Xirasagar (2010), found thatapproximately 9% of 14,916 children with special health care needs that live inthe United States and have asthma lacked consistent health care coverage;

children aged 0 to 5 years represented 23.7% of that sample. Approximately 5.5 percent of respondents indicated that their child had an other

health condition not listed on the survey. Such other conditions included eczema,speech problems, and rare diseases or disorders.

Note. Blank cells indicate data is not available. Respondents can select multiple categories therefore the total percentwithin each year may exceed 100%.

ADD/ADHD

Allergies Asthma Autism Cancer DiabetesGlasses/Contacts

HearingAid/

Impaired

MentalHealth

PhysicalDisability

Other SeizuresNo

Medical

2009-2010 1.2% 8.2% 0.1% 0.2% 3.6% 0.4% 0.3% 0.3% 7.4% 0.9% 80.4%

2010-2011 1.0% 8.1% 0.1% 0.1% 4.2% 0.4% 0.3% 0.3% 7.4% 0.8% 80.3%

2011-2012 1.3% 7.2% 0.1% 0.1% 3.8% 0.4% 0.3% 0.2% 7.0% 0.6% 81.4%

2012-2013 1.5% 7.8% 0.4% 0.0% 0.2% 3.5% 0.3% 0.3% 0.3% 6.5% 0.5% 81.8%

2013-2014 1.6% 15.1% 7.5% 0.6% 0.1% 0.1% 5.4% 0.3% 0.5% 0.4% 5.5% 0.6% 70.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

Figure 7.1: Types of Medical Conditions in Children(2009-2010 n = 8,222; 2010-2011 n= 9,633; 2011-2012 n= 8,041; 2012-2013 n = 7,833;

2013-2014 n= 6375)


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MEDICAL CONDITIONS



Developmental Screeni ng

Developmental screening is a method used by child care providers (e.g. mental health providers,pediatricians, child care professionals) to assess whether a young child has delayed mental orphysical development. Early identification of developmental delay and implementation ofintervention programs can help to improve a childs overall well being as well as future

opportunities (Glascoe, 2000). Many children with developmental disabilities are not identifieduntil they have entered kindergarten or later, causing the child to miss out on crucial years ofintervention (Center for Disease Control and Prevention, 2014). Therefore, a question was addedto this years survey in which respondents were asked whether or not their child received adevelopmental screening in the past 12 months.

Overall, 46.2 percent of respondents (n=7,015) reported that their child did not have adevelopmental screening and 29.7% reported that they were unsure. When exploring differencesamong the counties, more respondents in Washoe County (30.9 percent) and in the RuralCounties (31.4 percent) reported that their child had been screened as compared to Clark County(19.4 percent).

When exploring race/ethnicity differences in screening (Figure 7.2), results indicate that thosethat classified themselves as Native American/Alaskan Native had the highest rate of reportedscreening, while those classified as Other Race, Hispanic, and Asian/Pacific Islander had thelowest screening rates.


African

American

Asian /

PacificIslander Caucasian Hispanic

NativeAmerican /

AlaskaNative

Other Race

Multiple

Races

Yes 25.8% 19.7% 28.0% 18.4% 39.7% 18.9% 24.1%

No 41.7% 56.7% 43.5% 50.0% 30.6% 54.7% 44.9%

Not Sure 32.5% 23.6% 28.5% 31.5% 29.8% 26.4% 31.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

PercentofRespondents

Figure 7.2 Developmental Screening by Child's

Race/Ethnicity2013-2014: African American n = 403; Asian/Pacific Islander n= 406; Caucasian n=

2905; Hispanic n= 2092; Native American/Alaska Native n= 121; Other n= 53; MultipleRaces n= 955)


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DENTALCARE

Background

Routine dental care is also important to childrens health and daily functioning. Children without

access to regular dental care are more likely to experience dental problems, such as dentalcavities and tooth abscesses. These children also miss more days of school than children withoutdental problems (Gift, Reisine & Larach, 1992). Research also indicates that uninsured childrenare much more likely to have unmet dental needs (e.g. teeth cleanings). One study found that 5percent of privately insured children and 6 percent of publicly insured children had an unmetdental need, whereas 22 percent of uninsured children had an unmet dental need (Child Trends,2011). Additionally, uninsured children are 1.5 times more likely to not have receivedpreventative care in the last year and 3 times more likely to have an unmet dental need thaninsured children (Liu et al., 2007).

Dental Care of Chil dren Enteri ng Kindergarten

To prevent oral health problems, it is generally recommended that children receive regular dentalcheck-ups every six months to a year as soon as they receive their first tooth, or when they are ayear old (American Academy of Pediatric Dentistry, 2014). In the current study, 25.6 percent ofsurvey respondents indicated that their kindergartner had NOT seen a dentist in the past twelvemonths, which was consistent with the 2012-2013 data, however, it was a decrease of 7percentagepoints from the 2008-2009 data (Figure 8.1). This indicates that the percentage ofchildren visiting a dentist may beslowly increasing.

32.5%

67.5%

29.7%

70.3%

28.9%

71.1%

27.1%

72.9%

25.4%

74.6%

25.6%

74.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

No Yes

Figure 8.1: Child's Dental Visit(2008-2009 n= 11,007; 2009-2010 n= 9,449; 2010-2011 n = 10,412;

2011-2012 n = 8,461; 2012-2013 n= 8,389; 2013-2014 n= 6,953)

2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014


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WEIGHTANDHEALTHYBEHAVIORS

Childhood obesity is a growing public health problem across the country (CDC, 2009).Epidemiologists have identified an increase in the number of children with Type II diabetes in recentyears (Narayan, Boyle, Thompson, Sorensen, & Williamson, 2003). Therefore, monitoring

childrens weight has become an important tool for analyzing potential health problems.

The current survey asked parents to write in their childs height and weight information. NICRPused this information to calculate a Body Mass Index (BMI) value for each child with valid heightand weight responses. BMI values were calculated using the standard formula employed by the CDCand other health agencies:

BMI = [(Weight in pounds) / Height in inches2]*703

However, to increase the validity of the data, several strict guidelines were implemented for thecalculation of BMI. First, if the respondent reported that the child was under the age of 4, or over the

age of 6, they were excluded from the analyses, as it is unlikely kindergartners would be outside ofthis age range. Age is an important determinant as it is used to determine weight status category andis strongly correlated with height. Second, if a childs reported height was outside of the 95%interval of average height of 4-6 year olds (based on the CDC, 2000), the child was excluded fromthe analysis. Finally, if a childs weight was reported under 20lbs, the child was excluded from theanalysis. This resulted in 2,734 children (37.3 percent of the entire sample) with a valid BMI value.

Once BMI was calculated, each child in the sample was assigned a weight status category based onCDC standards, which uses a childs age, gender, and BMIpercentile. Table 10.1, below, outlinesthe BMI percentile ranges for each weight status category.

Table 10.1: Weight Status Categories by BMI Percentile Ranges

Weight Status Category BMI Percentile Range

Underweight BMI less than the 5thpercentileHealthy Weight BMI from the 5thpercentile to less than the 85thpercentileOverweight BMI from the 85thpercentile to less than the 95thpercentileObese BMI equal to or greater than the 95thpercentileSource: Centers for Disease Control and Prevention (2011a). About BMI for Children and Teens. Retrievedfrom http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html#What is BMIpercentile


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WEIGHT AND HEALTHY BEHAVIORS



For the purpose of this study, NICRP used 10 different weight status formulas: one formula for girlsand one for boys in each of the following ages: 4.0, 4.5, 5.0, 5.5, and 6.0. Table 10.2 outlines thecalculations used to determine weight status categories.

Table 10.2: Weight Status Category Calculations Based on BMI Values

Females

Age

Weight Status Category

Underweight Healthy Weight Overweight Obese

4.0 0 < BMI < 13.725 13.725


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When comparing each childs race/ethnicity with his or her BMI, there are some differences indistributions across weight status categories for each race/ethnicity group. It is important to note thatthe total number of respondents included in this analysis is even fewer than those in the abovestatistics on valid BMIs within the sample, because some respondents did not provide informationon race/ethnicity.

The distribution of race/ethnicity for children with valid BMIs varies slightly from the race/ethnicitydemographics of the survey sample as a whole, with the greatest discrepancy being the percentage ofHispanic children with valid BMI data. Even though individuals who self-reported as Hispanic makeup 31.8% of the total sample, only 17.9% of the samples with a valid BMI are Hispanic. Figure 10.2illustrates the race/ethnicity data for children with a valid BMI.


African

American/Black

Asian/

PacificIslander

Caucasian Hispanic

Native

American/AlaskaNative

OtherRace MultipleRaces Total

% w/Valid BMI 4.2% 6.0% 55.2% 17.9% 1.6% 0.7% 14.3% 100%

% Total Sample 5.7% 5.7% 40.8% 31.8% 1.8% 0.8% 13.4% 100%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Figure 10.2: Race/Ethnicity of Participants with a

Valid Body Mass Index(2013-2014: Valid BMI & Valid Race n= 2,748; Total n= 7,235)


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As seen in Figure 10.3, the differences in BMI across racial/ethnic groups indicates that:

The highest precentages of obese children were Hispanic (34 percent) and NativeAmerican/Alaska Native children (31.8 percent); however, this is based on a very smallsample of Native American/Alaska Native children.

Only the Caucasian (24.3%) and Other Race (15.8%) kindergartners have a combinedoverweight/obese percentages lower than 30%. Hispanic (45.1%) and NativeAmerican/Alaska Native (40.9%) kindergartners have percentages over 40%.

Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicitycategory.

AfricanAmerican/Black


Caucasian Hispanic

Native

American/AlaskaNative

OtherRace

MultipleRaces

Underweight 18.4% 14.8% 15.0% 12.0% 18.2% 10.5% 13.9%

Healthy Weight 44.7% 54.9% 60.6% 42.9% 40.9% 73.7% 55.7%

Overweight 11.4% 11.7% 9.6% 11.1% 9.1% 0.0% 11.9%

Obese 25.4% 18.5% 14.7% 34.0% 31.8% 15.8% 18.6%

Total 100% 100% 100% 100% 100% 100% 100%

*Total % Valid BMI 4.2% 6.0% 55.2% 17.9% 1.6% 0.7% 14.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Race/Ethnicity

Figure 10.3: Child's Weight Status Category by

Child's Race/Ethnicity(2013-2014 n= 2,716)


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Behaviors Related to Healthy Weight in Young Children

Explanations for obesity in young children include a number of factors including behavior regimentssuch as level of physical activity, television viewing, time spent playing video games, and diet.Lower levels of physical activity, increased time spent participating in sedentary behaviors such as

watching television and playing video games, and increased consumption of products such as softdrinks have been found to be related to higher BMIs (Delva, Johnston & OMalley, 2007;Kumanyika, 2008). Therefore, the following questions were included on the Kindergarten HealthSurvey in order to determine these behaviors as children enter kindergarten.

Physical Activi tyParents/guardians were asked to report the number of times per week their child is physically activefor at least thirty minutes. Over half of the respondents (56.2%) indicated that their child wasphysically active 6-7 times a week for at least thirty minutes at a time.Figure 10.4 details therelationship between weight status category and amount of physical activity.

Overall, as physical activity per week increased, kindergartners were more likely to be in

the Healthy Weight Category. Children that were physically active less often (0-3 times per week) were more likely to

be overweight or obese, as compared to children that were physically active throughoutthe week (4-7 times per week).However, onlya very small percentage of children (1.4%)with a valid BMI were reported to engage in physical activity 0-1 times a week, and10.7% reported activity 2-3 times per week.

These results are consistent with the findings from the 2012-2013 school year.

Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each category for theamount of physical activity.

0-1 TimesPer Week

2-3 TimesPer Week

4-5 TimesPer Week

6-7 TimesPer Week

Underweight 10.5% 13.0% 13.8% 15.1%

Healthy Weight 50.0% 49.1% 53.1% 57.5%

Overweight 13.2% 11.6% 12.7% 9.2%

Obese 26.3% 26.3% 20.3% 18.2%

Total 100% 100% 100% 100%

*Total % Valid BMI 1.4% 10.7% 23.8% 64.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Amount of Physical Activity

Figure 10.4: Child's Weight Status Category by Amount of

Physical Activity Per Week(2013-2014 n = 2,734)


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To gain a better understanding of the barriers that parents are facing in regards to providing physicalactivities for their children, respondents that indicated that their child was physically active one timeor less per week, were asked to indicate barriers to them being more physically active. Of the 158respondents that met this criteria, 138 provided a response. The most frequently reported barrier wasweather (43.1%), followed by lack of time and/ or a busy work schedule (26.3%), lack of a safe play

space which included comments regarding air quality (9.6%), medical conditions (12%), lack offinancial resources (2.4%), and transportation (0.6%). Please note the response categories are notmutually exclusive; one respondent could have listed multiple barriers.

Television Viewing

In the current study, the majority of respondents reported that their child watches some television butless than 2 hours during a weekday. The 2011 National Survey of Children's Health reported dataregarding the amount of television or videos children ages 1-5 years watch (NSCH, 2011/2012).Compared to the national data:

Fewer respondents in the current sample reported that their child did not watch television,which could be due to the age difference in the samples.

Fewer respondents in the current sample reported that their child watches 4 or more hoursof television.

Table 10.3 Average Television Watched During a Weekday

None 1 hour or lessBetween 1hr

& 4 hrs

4 hours or

moreTotal %

Nationwide 6.3% 41.8% 40.3% 11.6% 100.0%

Nevada 4.7% 38.9% 41.9% 14.5% 100.0%

KHS Sample 2.1% 43% 49.1% 5.7% 100.0%

Note. Nationwide/Nevada data source: NSCH, 2011/2012. Pecentages may not add up to 100 due to rounding.

When comparing the amount of hours a child watches television per day with his or her BMI, it

appears that as TV viewing time increases, it is less likely that he/she will be of a healthy weight.


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Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each category.

Video Game Use

According to the 2013 High School Youth Risk Behavior Survey (Office of Public HealthInformatics and Epidemiology), 37.9 percent of youths in Nevada used computers 3 or more hoursper day for something that was not related to school in 2013, which was slightly above the mostrecent national average of 31.1 percent (CDC, 2011c). To determine similar activity in childrenentering kindergarten, this same question on video game use was included on the survey starting inthe 2011-2012 school year.

Results indicate that the majority of children either do not play video or computer games (32.9%) orplay one hour or less (53.7%) on an average school day. While these numbers are fairly consistentacross all counties, the percentage of children that do not play video games is less in Clark County(30%) compared to both Washoe (35.1%) and the Rural (38.5%) counties.

When looking at the amount of hours that children play video games per day, the percent of childrenin the obese category increases as the number of hours of video game play increases. Among thosekindergartners that reportedly play two or more hours of video games per day, 27.6% are obese,compared to 19% who reportedly do not play video games. However, for kindergartners that playless than 1 hour a day, there is a large decline in obesity compared to the other categories. This isconsistent with the data from 2012-2013.

NoneLess than

1 Hr aDay

1 Hr aDay

2 Hrs aDay

3 Hrs aDay

4 Hrs aDay

5+ Hrs aDay

Underweight 15.3% 14.0% 15.5% 13.3% 16.4% 14.1% 25.7%Healthy 62.7% 57.1% 57.1% 54.5% 51.7% 51.3% 42.9%

Overweight 6.8% 15.1% 10.9% 8.6% 10.6% 10.3% 2.9%

Obese 15.3% 13.8% 16.6% 23.6% 21.2% 24.4% 28.6%

*Total % Valid BMI 2.3% 14.7% 32.8% 34.7% 11.2% 3.0% 1.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%60.0%

70.0%

Hours of Television Watched

Figure 10.5: Child's Weight Status Category by Hours of

Television Watched on Average School Day(2013-2014 n= 2,613)


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Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicitycategory.

NoneLess than 1Hour a Day

1 Hour a Day2 + Hours a

Day

Underweight 16.4% 14.6% 13.8% 12.6%

Healthy 54.0% 57.9% 55.0% 52.6%

Overweight 10.6% 11.3% 9.8% 7.2%

Obese 19.0% 16.2% 21.4% 27.6%

Total 100% 100% 100% 100%

*Total % Valid BMI 30.8% 34.5% 23.7% 11.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Figure 10.6: Child's Weight Status Category by

Hours of Video Game Playing on Average School Day(2013-2014 n= 2,665)


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Soda Consumption: Non-D iet Soda

According to the 2013 High School Youth Risk Behavior Survey, 16.2 percent of youth in Nevadadrank a can, bottle, or glass of non-diet soda/pop at least one time per day, 7 days prior toadministration of the survey, which was below the national average of 29.2 percent (Office of PublicHealth Informatics and Epidemiology). To determine similar activity in children entering

kindergarten, this same question on soda consumption was included on the survey starting in the2011-2012 school year.

Results indicate that:

The majority of children either did not drink any non-diet soda/pop (59.9%) or drank some afew times per week (30.8%).

o These numbers are fairly consistent among all counties (Clark, Washoe, and theRural Counties),

6.6% of respondents reported that their child drank non-diet soda/pop once a day, and 2.7%indicated that their child drank non-diet soda/pop more than once a day.

o These proportions are slightly less in the Rural Counties as compared to the other

two counties, and highest in Clark County.

Figure 10.7 illustrates childs weight status category by number of non-diet sodas consumed in oneweeks time. Of the respondents with kindergartners having a valid BMI, most reported that theirchild had less than one non-diet soda a day (93.9%). The highest rates of obesity are seen in childrenwho drank non-diet soda a once day or more than once a day. Even though these children represent asmall percentage of the population, the percent of children who are obese does increase with non-diet soda consumption.

Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicity category.

NoneA FewTimes

One a DayMore thanOne a Day

Underweight 14.2% 14.9% 15.3% 16.7%

Healthy 58.0% 52.7% 45.9% 42.6%

Overweight 10.8% 9.3% 9.0% 11.1%

Obese 17.0% 23.1% 29.7% 29.6%

Total 100% 100% 100% 100%

*Total % Valid BMI 65.4% 28.5% 4.1% 2.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%


Figure 10.7: Child's Weight Status Category by Number of

Non-Diet Sodas Consumed in a Week(2013-2014 n =2,686)


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Diet SodaSimilarly, the survey asked the parents/guardians to indicate the level of consumption of diet sodaproducts in the past seven days. Although this question was asked on the High School Youth RiskBehavior Survey, this data was not available for comparison at the time of this report.

Results indicate that: The majority of children in the current study did not drink any diet soda/pop (85.5%). This

percentage was highest in Washoe County (89.1%) and lower in Clark County (85.4%) andthe Rural Counties (83.8%).

11.6 % reported that their child drank diet soda/pop a few times a week, 2.3% reported dailyconsumption, and 0.6% reported consumption more than once a day.

o In the Rural Counties, more children drank diet soda/pop a few times a week(13.5%), followed by Clark (11.4%) and Washoe County (9.1%). Clark County alsorepored slightly higher rates of diet soda/pop consumption once a day (2.7%)compared to Washoe County (1.4%) and the Rural Counties (1.9%).

Much like Figure 10.7, when looking at childrens weight status category by number of dietsodas/pop drank in one week, many of the same trends appear (Figure 10.8). The majority ofrespondents whose child had a valid BMI stated that their child drank no soda (87.3%), and over halfof those children were in the healthy range (56.7%). Again, obesity rates are highest in thosechildren who drink soda a few times a week or once a day. This year there were not any childrenwho were obese who drank soda more than once a day and the percentage of overweight children isslightly lower in this category as compared to children who drank soda once a day. This could bebecause there is a very low percentage of children who fit into this category (0.3%).


None A Few Times One a DayMore thanOne a Day

Underweight 14.8% 11.9% 14.3% 25.0%Healthy 56.7% 52.0% 31.4% 62.5%

Overweight 10.3% 9.5% 14.3% 12.5%

Obese 18.2% 26.5% 40.0% 0.0%

Total 100% 100% 100% 100%

*Total % Valid BMI 87.3% 11.1% 1.3% 0.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%



Diet Sodas Consumed in a Week(2013-2014 n =2,646)


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Juice ConsumptionParents and childcare providers often perceive fruit juice as a healthy alternative to sodas and othersugary beverages for children. Coupled by a wide variety of types of juices available, there has beenan increase in the consumption of fruit juices by children over the past 30 to 40 years. Baker,Dennison, and Rockwell (1997) have found that high levels of sugar in juice not being offset by

fiber, as found in whole fruit, has been linked to gastrointestinal issues in children. Research has alsofound that an excessive consumption of fruit juice among children may be a contributing factor toobesity (Baker et al.,1997). Because of the current debates over the impact of consumption of juiceon childrens health benefits, a question was added in the 2013-2014 survey year.

Results indicate that:

The majority of children in the current study did drank juice a few times a week (40.4%),once a day (27.6) or more than once a day (23.3%).

o Clark County reported a higher percentage of children who drank juice more thanonce a day (24.7%) compared to the Rural Counties (22.9%) and Washoe County(17.8%).

8.8 % reported that their child did not drink juice.o The Rural Counties reported that a higher percentage of children did not drink juice

(9.4%) as compared to Clark (8.6%) and Washoe (8.2%) counties.

When looking at childrens weight status category by number ofjuice drinks consumed in one week,many of the same trends appear (Figure 10.8). The majority of respondents whose child had a validBMI stated that their child drank juice at least a few times a week (90.7%). Even though juice isthought to be a healthy drink, there is a clear trend that as juice consumption increases, thepercentage of children in the healthy weight category decreases and the percentage of children in theobese category increases. Children who are overweight do not demonstrate a consistent pattern.


NoneA Few

Times

One a DayMore than

One a DayUnderweight 13.6% 15.2% 12.5% 16.4%

Healthy 58.8% 55.2% 58.0% 51.4%

Overweight 10.0% 11.5% 10.2% 8.7%

Obese 17.6% 18.1% 19.2% 23.5%

Total 100% 100% 100% 100%

*Total % Valid BMI 9.3% 42.1% 27.3% 21.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%



Juice Drinks Consumed in a Week(2013-2014 n =2,869)


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I nfant Feeding BehaviorsBreastfeeding has been shown to have many health benefits for both the breastfeeding mother andher child. Breastfeeding has been associated with reduced risk of cancer, diabetes, and postpartumdepression in mothers, and reduced risk of ear infections, gastrointestinal issues, allergies, SIDS,obesity, and diabetes in children (United States Breastfeeding Committee, 2002).

Starting in 2007, the Centers for Disease Control and Prevention has issued a Breastfeeding ReportCard that provides both national and state level data. According to the 2013 report card, Nevada is2.6 percentage points ABOVE the national average (76.5%) for babies who have ever beenbreastfed, and Nevada is slightly above the national average for exclusive breastfeeding at 6 months(US = 16.4%; NV = 18.6%) but below the national average at 3 months (US = 37.7%; NV = 33.9%)(CDC, 2013).

In order to obtain more detailed information about breastfeeding practices in Nevada, a new questionwas added to the 2012-2013 survey to determine feeding practices of children entering kindergartenwhen they were one, three, and six months old. As illustrated in Figure 10.10, 47.4% of respondents

indicated that their child was breastfed exclusively at one month old and this percentage declined atboth the three and six month time periods. These results are consistent with the data from 2012-2013. The Healthy People 2020 breastfeeding objectives are to increase the proportion of infantswho are breastfed ever (81.9%), and at 6 months nonexclusively (60.6%) (CDC, 2013). Accordingto the 2013-2014 KHS survey, 46% of children entering kindergarten in Nevada were breastfed at 6months nonexclusively, which is a slight increase from last year (45.2%).

Breast OnlyBreast andFormula

Formula OnlyOther (e.g.

Food)Not Sure

1 Month 47.4% 21.8% 29.0% 0.3% 1.4%

3 Months 34.0% 23.4% 40.8% 0.7% 1.1%

6 Months 23.7% 22.3% 46.0% 6.7% 1.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%


Figure 10.10: Infancy Feeding Habits(2013-2014: 1 month n = 5,205; 3 months n= 5,125; 6 months n= 5,073)


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There is mixed literature on the relationship between breastfeeding as a protective factor for obesity.Some research has indicated that breastfeeding has small preventative effects against obesity inchildren (Gubbels, Thijs, Stafleu, Von Buuren, & Kremers, 2011). Figure 10.11 illustrates childweight status categories by infant feeding behaviors. Children who received breast milk exclusivelyat all time periods tend to be at a healthy weight and are less likely to be obese, compared to those

children who received both breast milk and formula or formula only.

Note.Respondents were also given the response option of Other and Not Sure. However, for the purposes of this graph,those response options were not included because of the low number of responses in each of those categories.

It is important to note that there are many reasons that a child may not receive breast milkexclusively during the first six months (US Department of Health and Human Services, 2011). TheKHS expanded this year to capture information regarding barriers to breastfeeding. Of those whoreported barriers (775), the most frequently reported barrier was the inability to produce milk(30.8%), followed by medical conditions (allergies, premature birth, etc.; 27.3%), issues latchingonto the nipple (13%), and work/school (12.5%). Other barriers (


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APPENDIX A:

SUMMARY OF 2013-2014 SURVEY RESULTS BY COUNTY

Table 11.1 below outlines the percentages of responses for the 2013-2014 school year surveyresults by Clark County, Washoe County, and the Rural Counties. Even though a total of 7,330

surveys were received, not all respondents answered every question. All percentages calculatedare based on the total number of people answering the question, rather than the total number ofpeople who completed a survey. In addition, percentages are represented by county(ies);therefore percentages will total 100% within each county category and not across all countycategories.

Table 11.1 Comparison of 2013-2014 Data by County

Survey IndicatorState

(Percents)

Clark

County(Percents)

Washoe

County(Percents)

Rural

Counties(Percents)

Survey Parti cipation -- 60.2 13.4 26.4

Demographic I nformation

Gender of Kindergartner

Male 51.1 50.7 50.9 52.2

Female 48.9 49.3 49.1 47.8

Race/Ethnicity of Kindergartner

African American/Black 5.7 9.0 1.4 0.5

Asian/Pacific Islander 5.7 8.0 4.1 1.2

Caucasian 40.8 31.8 43.3 60.1

Hispanic 31.8 34.7 35.0 23.3

Native American/ AlaskaNative

1.8 0.7 2.7 3.8

Other Race 0.8 0.8 0.7 0.6

Multiple Races 13.4 14.9 12.7 10.5

Annual Household Income of Survey Respondents

$0-$14,999 17.6 18.4 17.8 15.9

$15,000-$24,999 15.4 15.1 17.0 15.1

$25,000-$34,999 12.3 13.0 12.4 10.6

$35,000-$44,999 9.5 9.7 9.7 8.9

$45,000-$54,999 7.5 8.0 5.9 7.4

$55,000-$64,999 6.8 6.8 6.1 7.1$65,000-$74,999 6.3 6.1 4.9 7.5

$75,000-$84,999 5.9 5.0 5.8 7.8

$85,000-$94,999 4.3 3.7 3.7 5.8

$95,000+ 14.4 14.1 16.6 14.0


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APPENDIX A: SUMMARY OF 2013-2014 SURVEY RESULTS BY COUNTY



Table 11.1continued


(Percents)

Clark

County(Percents)

Washoe

County(Percents)

Rural

Counties(Percents)

Type of School Child Attended in the Past 12 Months

Head Start 7.3 5.6 11.3 9.1

Other Facility/Center 23.4 22.1 24.5 26.0

Home-Based 6.1 5.9 6.5 6.4

School District Pre-School 23.2 22.5 20.9 25.8

UniversityCampusPreSchool 1.5 0.9 1.3 2.8

None/Stayed at Home 35.6 40.0 32.8 27.1

Friends/Family Care 2.9 3.0 2.8 2.9

Average Preschool Hours of Attendance

0 Hours 30.5 32.9 30.4 25.3

5-10 Hours 17.9 18.3 13.8 19.1

10-15 Hours 16.4 14.1 15.5 22.0

15-20 Hours 9.5 7.8 11.2 12.5

20-30 Hours 7.6 7.1 9.2 7.8

30-40 Hours 10.7 11.2 12.1 8.9

More than 40 Hours 7.4 8.7 7.9 4.4

Single Parent or Guardian 30.1 32.3 31.0 24.6

Average # of Children in Household

(Standard Deviation)

2.5 (1.2) 2.6 (1.2) 2.5 (1.2) 2.6 (1.2)

Average # of Adults in Household

(Standard Deviation)2.1 (0.7) 2.1 (0.8) 2.1 (0.8) 2.0 (0.6)

Average Age of Mother/Gardian


32.8(6.8)

33.0 (6.6) 33.2 (7.4) 32.3 (6.9)

Average Age of Father/Gardian


35.5(7.5)

35.7 (7.5) 35.7 (7.7) 35.0 (7.4)

Health I nsurance Status and Access to Health Care

Health Insurance Type

Uninsured 12.8 12.6 11.3 14.2

Private 50.6 49.8 49.4 25.9Medicaid 25.3 26.2 26.5 22.7

Nevada Check-up 6.1 6.8 7.2 4.1

Other 2.2 2.0 2.6 2.5

Multiple Types 3.0 2.7 3.1 3.7

Kindergartner Does NOT Have aPrimary Care Provider

14.2 13.0 12.5 17.9


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Table 11.1continued


(Percents)

Clark

County(Percents)

Washoe

County(Percents)

Rural

Counties(Percents)

Routine Care and Health of Kindergartner

Types of Barriers Experienced When Trying to Access Healthcare

Lack of Transportation 3.1 3.6 3.1 2.1

Lack of Insurance 10.1 9.9 10.8 10.1

Lack of Quality MedicalProviders

5.7 4.7 4.5 8.5

Lack of Money/FinancialResources

14.0 13.4 15.4 14.7

Other Barriers 2.2 2.0 2.3 2.5

Difficulties Accessing Mental

Health Services for Kindergartner 35.5 36.3 36.7 33.7Know how to access support

services45.3 39.9 48.5 55.6

Has Not Had Routine Check-Up 14.5 13.4 14.7 17.1

Has Not Visited a Dentist in the

Last Year25.6 27.7 18.3 24.6

Amount of Times the Kindergartner Has Gone to the ER for a Non-Life-ThreateningIllness or Injury in the Past 12 Months

None (0) 79.4 80.2 81.2 76.6

1 to 2 18.8 18.1 16.7 21.4

3 to 5 1.5 1.4 1.8 1.76 to 9 0.2 0.1 0.3 0.210 or More 0.1 0.1 0.0 0.1

Types of Medical Conditions Seen in Kindergartners

ADD/ADHD 1.6 1.0 1.6 2.8

Allergies 15.1 14.9 15.3 15.6

Asthma 7.5 8.5 6.1 6.2

Autism 0.6 0.4 0.8 0.9

Cancer 0.1 0.1 0.1 0.1

Diabetes 0.1 0.1 0.1 0.1

Glasses/Contacts 5.4 5.0 4.7 6.6Hearing Aid/Impairment 0.3 0.3 0.2 0.5

Mental Health Condition 0.5 0.2 0.9 0.8

Physical Disability 0.4 0.3 0.7 0.7

Seizures 0.6 0.6 0.6 0.6

Other Condition 5.5 4.8 6.7 6.4Received Developmental Screening inpast 12 months

24.1 19.4 30.9 31.4


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Table 11.1continued


(Percent)

Clark

County(Percent)

Washoe

County(Percent)

Rural

Counties(Percent)

Weight and Healthy Behaviors

Kindergartner's Weight Status

Underweight 14.5 16.0 13.6 12.0

Healthy Weight 55.5 53.7 59.3 57.1

Overweight 10.4 9.9 7.9 12.4

Obese 19.6 20.4 19.2 18.4

Amount of Times per Week that

khs year 6 report_final

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