health status of children entering kindergarten in nevadanic.unlv.edu/files/khs year 7...

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 Superintendents

Nevada Division of Public and Behavioral Health

This publication was supported by the Nevada State Division of Public and Behavioral Health through

Grant Number B04MC26680 from the U.S. Department of Health and Human Service, Health Resources

and Services Administration. Its contents are solely the responsibility of the authors and do not

necessarily represent the official views of the Division nor the U.S. Department of Health and Human

Service Health Resources and Services Administration.

University of Nevada, Las Vegas

School of Community Health Sciences

Results of the

2014-2015 (Year 7)

Nevada

Kindergarten

Health Survey

June 2015

Nevada Institute for Children’s Research and Policy, UNLV April 2015

Results of the 2014-2015 Nevada Kindergarten Health Survey

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 is

dedicated 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. She

wanted 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 to

transform 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 out

for Nevada's children. Our mission is to conduct community-based research that will guide the

development 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.

Chief Research Associate

Patricia Haddad

Research Assistant

Mirzah Trejo, BA

Research Assistant

Dawn L. Davidson, Ph.D.

Senior Research Associate

Tara Phebus, M.A.

Executive Director

Nevada Institute for Children’s 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



TABLE OF CONTENTS

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

Introduction .....................................................................................................................................8

Methodology ........................................................................................................................8

Limitations to the Study .......................................................................................................9

Survey Results ...............................................................................................................................11

Response Rates ....................................................................................................................11

Demographics .....................................................................................................................14

Insurance Status ..................................................................................................................19

Access to Healthcare ............................................................................................................23

Routine Care .......................................................................................................................25

Care for Illness or Injury ......................................................................................................28

Medical Conditions .............................................................................................................30

Dental Care .........................................................................................................................32

Mental Health.......................................................................................................................33

Weight and Healthy Behaviors ............................................................................................34

Appendix A: Summary of the 2014-2015 Survey Results by County ......................................50

Appendix B: Comparison of Survey Results by Survey Year ..................................................56

Appendix C: Survey Instrument .................................................................................................63

Appendix D: References ...............................................................................................................65

TABLE OF CONTENTS



List of Tables

Table 1.1: Survey Response Rate by School District .........................................................11

Table 1.2: Kindergarten Unaudited Enrollment and Response Rate by School District .....12

Table 2.1: Average Preschool Hours of Attendance ............................................................18

Table 10.1: Weight Status Categories by BMI Percentile Ranges .....................................34

Table 10.2: Weight Status Category Calculations Based on BMI Values ..........................35

Table 10.3: Average Television Watched During a Weekday ...........................................40

Table 10.4: Average Sleep per Night for the State of Nevada .............................................49

Table 11.1: Comparison of 2014-2015 Weighted Data by County .....................................50

Table 11.2: Comparison of 2012-2013 through 2014-2015 Weighted Data .......................56

List of Figures Figure 1.1: Survey Participation by School District ............................................................13

Figure 1.2: Survey Response Rate Among All Rural Counties ...........................................13

Figure 2.1: Weighted Survey Data by School District ........................................................14

Figure 2.2: Annual Household Income by School Year .....................................................15

Figure 2.3: Child’s Race/Ethnicity .....................................................................................16

Figure 2.4: Child’s Type of Preschool Setting During Last Twelve Months .....................17

Figure 3.1: Types of Children’s Health Insurance Coverage by School Year ....................19

Figure 3.2: Annual Household Income by Child’s Insurance Status ..................................21

Figure 3.3: Child’s Race/Ethnicity by Child’s Insurance Status ........................................22

Figure 4.1: Types of Barriers When Accessing Healthcare for Child .................................23

Figure 4.2: Access to Support Services by Child’s Race/Ethnicity .....................................24

Figure 5.1: Child’s Routine Check-Ups and Presence of Primary Care Provider ..............25

Figure 5.2: Presence of Primary Care Provider by Child’s Insurance Status .....................26

Figure 5.3: Child’s Routine Check-Ups by Presence of Primary Care Provider (PCP) ......27

Figure 6.1: Number of Emergency Room Visits for Non-Life-Threatening Care .............28

Figure 6.2: Percentage of Emergency Room Visits for Non-Life-Threatening Care by

Child’s Insurance Status ...................................................................................29

Figure 7.1: Types of Medical Conditions in Children .........................................................30

Figure 7.2: Developmental Screening by Child’s Race/Ethnicity ...................................... 31

Figure 8.1: Child’s Dental Visit ...........................................................................................32

Figure 9.1: Trouble Obtaining Mental Health Services by County ....................................33

Figure 10.1: Child’s Weight Status Category ......................................................................36

Figure 10.2: Race/Ethnicity of Participants with a Valid Body Mass Index .......................37

Figure 10.3: Child’s Weight Status Category by Child’s Race/Ethnicity ..........................38

Figure 10.4: Child’s Weight Status Category by Amount of Physical Activity

Per Week ........................................................................................................39

Figure 10.5: Child’s Weight Status Category by Hours of Television Watched on

Average School Day ......................................................................................41

Figure 10.6: Child’s Weight Status Category by Hours of Video Game Playing on

Average School Day.. ......................................................................................42

Figure 10.7: Child’s Weight Status Category by Number of Non-Diet Sodas Consumed in

a Week ............................................................................................................43

TABLE OF CONTENTS



Figure 10.8: Child’s Weight Status Category by Number of Diet Sodas Consumed in a

Week ................................................................................................................44

Figure 10.9: Child’s Weight Status Category by Number of Juice Drinks Consumed in a

Week ..............................................................................................................45

Figure 10.10: Infancy Feeding Habits .................................................................................47

Figure 10.11: Child’s Weight Status Category by Infancy Feeding Habits ........................48



EXECUTIVE SUMMARY

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

status, the Nevada Institute for Children’s Research and Policy (NICRP), in partnership with 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 children’s health.

In the fall of 2014, NICRP distributed questionnaires to all public elementary schools in the state, except

Clark County School District, who requested that a sample of their schools be surveyed. The survey had

an overall response rate of 30.6 percent, with a total of 7,480 surveys received from parents in all 17

school districts in Nevada. The data for this year and the past two were weighted so that the survey data

collected represent each district and all children in the state (32,163). Weighted data are presented

throughout this report to compare Clark County (73.6 percent), Washoe County (14.6 percent) and the

rural counties combined (11.8 percent) as well as the past two survey years. The following tables contain

some of the key findings of the survey. Please note that for each table, red arrows indicate what we think

is a negatie change, green indicates positive change, and yellow indicates no change.

Health Status: When compared to last year, behaviors in this category remain relatively steady with only

slight fluctuations. There was an increase in obesity, increase in inactivity, increase in video game

play/computer play, but a reduction in soda drinking and an increase in the percent of parents reporting

feeding their infant breast milk only at one and three months. It is important to remember that these

fluctuations are minor, so overall, the data remained fairly consistent in comparison to the last survey

year.

2013-2014 2014-2015 % Change *

Weight Status Underweight 15.1% 16.14% +6.9% Healthy 55.0% 52.4% -4.7% Overweight/Obese 29.9% 31.5% +5.4%

Physical Activity < 3 days per week of 30-minutes of physical activity 19.6% 20.0% +2.0%

Television Viewing on School Days 3 hrs or more of television watched per school day 20.6% 20.7% +0.5%

Computer/Video Game Play on School Days ≥ 3 hr of computer/video games played per school day 3.9% 5.2% +33.3%

Consumption of Non-Diet Soda Never drink non-diet soda 59.6% 60.8% +2.0% Drink non-diet soda once a day or more 6.8% 6.8% 0.0%

Consumption of Diet Soda Never drink diet soda 85.7% 87.5% +2.1%

Drink diet soda once a day or more 2.4% 2.0% -16.7% Infant Feeding Behaviors

Breastfed Only – One Month 46.1% 48.3% +4.8% Breastfed Only – Three Months 33.3% 34.9% +4.8% Breastfed Only – Six Months 23.1% 21.9% -5.2% Breastfed Only – Twelve Months - 13.9% - -

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

EXECUTIVE SUMMARY



Household Income: There were slight fluctuations in data from last year, but overall incomes remained

steady in all three categories.

2013-2014 2014-2015 % Change *

Household Income Less than $25,000 per year 33.4% 33.2% -0.6% Less than $45,000 per year 55.6% 55.0% -0.6% $45,000 or more per year 44.3% 45.0% +1.6%

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

Insurance Status: The percentage of uninsured children dramatically decreased from last year. Medicaid

coverage continues to increase at a greater rate than enrollment in private insurance which decreased this

past year.

2013-2014 2014-2015 % Change *

Insurance Status Uninsured 12.6% 7.6% -39.7% Private Insurance 50.0% 48.4% -3.2% Medicaid 25.9% 31.3% +20.8% Nevada Check-up 6.5% 6.7% +3.1%

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

Routine Care: As compared to last year, the percentage of children receiving a routine check-up

increased while having a primary care provider and visiting the dentist remained consistent.

2013-2014 2014-2015 % Change *

Routine Care Had a routine medical checkup in last 12 months 85.9% 87.0% +1.3% Have a primary care provider 86.4% 86.4% 0.0% Have been to the dentist in past 12 months 74.0% 74.8% +1.1%

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

Access to Health Care: Compared to last year, fewere respondents this year indicated that they had

barriers to accessing health care. For those that reported having barriers, there was a decrease in barriers

due to lack of insurance and lack of money. The percentage of respondents trying to access mental health

care remained fairly consistent over the past year, and there was a decrease in the percentage of

respondents having trouble obtaining these services.

2013-2014 2014-2015 % Change *

Barriers to Accessing Health Care**

None 72.1% 79.4% +7.6% Lack of Transportation 3.4% 3.4% 0.0% Lack of Insurance 10.1% 7.3% -27.7% Lack of Quality Medical Providers 5.2% 5.1% -1.9% Lack of Money/Financial Resources 13.8% 10.4% -24.6% Have tried to access mental health services 4.2% 4.4% +4.8%

Had trouble obtaining mental health services 35.9% 31.8% -11.4% 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.



INTRODUCTION

Academic achievement for children is vital to their success in life. Those that do well in school

have greater opportunities for post-secondary education, and later have better prospects for

employment. One of the major factors that can affect a child’s academic achievement is his or

her health status. Academic outcomes and health conditions are consistently linked in the

literature (Eide, Showalter, & Goldhaber, 2010; Taras & Potts-Datema, 2005). Children with

poor health status, especially those with common chronic health conditions such as obesity or

asthma have increased numbers of school absences, thus more academic deficiencies than those

students with a good health status (Basch, 2010). In addition, children that have health insurance

have fewer absences from school, as compared to children without health insurance (Yeung,

Gunton, Kalbacher, Seltzer, & Wesolowski, 2010). In a study examining school achievement,

when compared with children with low absenteeism, children with high absenteeism had lower

academic performance (Farrington, Roderick, Allensworth, Ngaoka, Keyes, Johnson &

Beechum, 2012). Therefore, to increase the likelihood for academic success in children, their

health concerns need to be addressed. Preventative care is crucial to a child’s ability to succeed

in school.

According to data from the KIDS COUNT Data Center at the Annie E. Casey Foundation

(2013), 13 percent of Nevada’s teens (ages 16-19) are not in school and are not working, and 42

percent are not graduating on time compared to 8 percent and 22 percent nationally. The

National Dropout Prevention center lists poor attendance and low achievement as two of the

significant risk factors for school dropout (Hammond, Linton, Smink, & Drew, 2007).

Additionally, studies examining school dropout rates indicate that early intervention is necessary

to prevent students from dropping out of school. Middle and high school students that drop out

likely stopped being engaged in school much earlier in their academic career. Therefore, early

prevention and intervention is crucial to improving graduation rates. Ensuring that children have

their basic needs met, including receiving adequate health care, can directly impact a child’s

academic achievement as well as increase their likelihood for high school graduation.

To gain information about the health status of children entering the school system and better

track student health status, in 2008 the Nevada Institute for Children’s Research and Policy

(NICRP) partnered with the state’s 17 school districts, the Southern Nevada Health District, and

the Nevada Division of Public and Behavioral Health (NDPBH) to conduct an annual health

survey examining the health status as well as health insurance status of Nevada’s children

entering kindergarten. The goal of the study is to longitudinally quantify the health status of

children as they enter school so that specific areas for improvement can be identified and

potentially increase academic success among Nevada’s students. This report reflects the results

of the seventh year of the Annual Kindergarten Health Survey.

METHODOLOGY

The original survey used in this study was created in 2008 in partnership with the Clark County

School District (CCSD) and the Southern Nevada Health District (SNHD). The survey was

intended to provide a general understanding of the overall health status of children when they

INTRODUCTION



enter school. The original short questionnaire was developed in both English and Spanish and

consisted of 22 questions. Small revisions to the survey have occurred each year; therefore, data

for all items presented in this report may not be available for all seven years. The current version

of the survey consists of 28 questions (13 demographic questions and 15 health related

questions) and, like the original survey, is available in both English and Spanish.

In the Fall of 2014, questionnaires were distributed to kindergarten teachers in all public

elementary schools in the state, with the exception of schools in the Clark County School

District. The Clark County School District requested that only a sample of their schools be

included in the survey to reduce burden on school staff. Therefore, surveys were sent to a

randomly selected sample of schools (n = 139) in the district. This sample size was determined

based on a 5 percent margin of error in survey results. In addition, schools were divided by Title

I status, and a representative random sample of both Title I eligible and non-Title I eligible

schools was selected. Schools qualify as Title I eligible when they serve large populations of

children from low income families (typically a minimum of 40%) and receive supplemental

federal funding from the Department of Education. Title I eligibility status was provided by the

Clark County School District. It was determined that 159 of the 215 elementary schools in the

district (74%) were Title I eligible schools. One hundred and three schools (74 percent of the

target 139 schools in the sample) were randomly selected from a list of all Title I eligible schools

using the statistical analysis program PASW Statistics 22.0. The remaining 36 schools (26

percent of the needed sample of 139) were randomly selected from a list of schools that were not

Title I eligible.

For all school districts in Nevada, surveys were distributed to parents during the first part of the

school year. Parents who chose to participate, completed the survey and then turned it in to

either the school office or their child’s teacher. The surveys were then returned to NICRP via

mail. The parent could also mail the survey to NICRP directly.

In efforts to increase the response rate from the previous year, this year extra measures were

taken to ensure that all schools had received their surveys in the mail. In August, after surveys

were sent to all school districts, each school was called to verify receipt of the survey materials.

Many schools verified receipt while others could not account for the surveys and it was difficult

who would know whether or not surveys were received. For schools that were sure they had not

received the surveys, they were asked if they wanted to participate and have surveys resent,

which was done upon request. In addition to the calls in August, one more set of phone calls

were made in mid-October to schools in which we had not received any surveys. Once on the

phone we attempted to verify if the surveys were distributed to parents and to determine if the

school had any questions or problems with the survey in which we could be of service. In some

cases, these phone calls reminded the school to distribute the surveys or just to send in collected

surveys in some had been received.

Once surveys were received by NICRP, each survey was assigned a unique identification number

by NICRP staff to aid in tracking of survey responses. All survey responses received as of

January 31, 2015 were analyzed using PASW Statistics software version 22.0 (SPSS IBM, New

York, U.S.A). A weight based on county was applied to each record to adjust for student

nonresponse. The weights are scaled so that the weighted count of students equals each county’s

INTRODUCTION



population of kindergarten students as of count day for each survey year listed in this report.

Therefore, the responses received from the 7,480 respondents represents a total of 32,163

kindergarten students in the State of Nevada. Weighted estimates are representative of all

kindergarten students in the state of Nevada, as well as for Clark County, Washoe County, and

the combination of all rural counties. This report only displays weighted results that are

representative of the regions and the state.

LIMITATIONS TO THE STUDY

As in all research studies, there are limitations to the data collected. First, all information

contained in this report was self-reported by each parent or guardian. The information provided

relies on the memory and honesty of the survey respondents. Additionally, several of the

responses were left blank on the surveys received. All of the surveys received were included in

the analyses, but it is important to note when reading percentages presented in the figures below

that not all respondents answered all questions. Therefore some figures may represent all cases

(indicating all responded to the question), while others may have a smaller number of total cases

because of respondents leaving that particular question blank. All percentages calculated for this

report are based on the total weighted number of people answering the question, rather than the

total number of people who completed a survey. Third, the school district survey data apply only

to children who attend kindergarten and therefore are not representative of all persons in that age

group. However, based on the number of 5 year olds that were projected to reside in the state of

Nevada in 2013 (making them 6 years old in 2014 and eligible for kindergarten which was

approximately 39,809 children) (Nevada State Demographer, 2013) and the number of children

enrolled on count day (39,739) (Nevada Department of Education, personal communication,

May 5, 2015), it appears that only a very small percentage of children do not attend kindergarten.



SURVEY RESULTS Presented in the figures below are the basic frequencies (counts and percentages) of responses

for all questions included in the survey. Cross tabulations were also calculated for selected

variables to provide 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 are presented with figures as appropriate. In addition, the 2014-

2015 data were compared across counties (Clark, Washoe, rural counties combined) for the

current data collection period, and with data from the previous two years. All data presented after

the response rates will be weighted data.

RESPONSE RATES Each school district involved in the study provided NICRP with the estimated number of

kindergarten students enrolled in their district for the 2014-2015 school year. Based on these

estimates, 24,458 surveys were sent out to participating schools. At the end of the data collection

period (January 2015), 7,480 surveys were returned to NICRP for a response rate of 30.6

percent. 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%, 2013-2014 = 29.1%) has declined. This year, however there was a 1.5

percent point increase in response rate. Significant attempts were made this year to increase the

response rate such as ensuring school districts had their surveys in advance of the start of the

school year, schools were notified when then surveys were sent out, and schools who had not

returned surveys by October were given a reminder call. However, this did not appear to

significantly affect the current response rate. With that said, the 30.6% response rate is still

sufficient to make generalization about our state. Response rates for each school district (Table

1.1) ranged from 20.0% in Esmeralda County to 74.2% in Elko County.

Table 1.1 Survey Response Rate by School District

School District # Surveys Sent Out # Surveys Returned Response Rate

Carson City 665 281 42.3

Churchill County 350 98 28.0

Clark County 15,522 3,480 22.4

Douglas County 400 186 46.5

Elko County 600 445 74.2

Esmeralda County 20 4 20.0

Eureka County 28 6 21.4

Humboldt County 330 135 40.9

Lander County 100 52 52.0

Lincoln County 69 25 36.2

Lyon County 800 230 28.8

Mineral County 60 20 33.3

Nye County 379 143 37.7

Pershing County 60 8 13.3

Storey County 30 13 43.3

Washoe County 4,960 2,314 46.7

White Pine County 85 40 47.1

All Districts 24,458 7,480 30.6

RESPONSE RATES



NICRP was able to calculate a response rate based on the number of surveys returned and the

number of kindergartners enrolled within each school district by obtaining the unaudited

enrollment numbers for each school district from the Department of Education. This information

would indicate how much of the actual kindergarten 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 higher

than the unaudited enrollment data and the response rate varied between 2% and 10%. However,

for Esmeralda County, the response rate differed by almost 40% with the unaudited enrollment

response rate being higher than the survey distribution response rate. This indicates that

Esmeralda County overestimated their enrollment. In Elko County, response rates differed by

about 20%, with the survey distribution response rate being higher than the unaudited enrollment

response rate.

Despite the differences, the overall response rate for the unaudited enrollment response rate and

the survey distribution response rate only varied by 0.6 percentage points. Some deviation

between 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 appears

to 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 635 665 44.3% 42.3%

Churchill County 265 350 37.0% 28.0%

Clark County 14,210 15,522 24.5% 22.4%

Douglas County 400 400 46.5% 46.5%

Elko County 818 600 54.4% 74.2%

Esmeralda County 7 20 57.1% 20.0%

Eureka County 25 28 24.0% 21.4%

Humboldt County 272 330 49.6% 40.9%

Lander County 101 100 51.5% 52.0%

Lincoln County 61 69 41.0% 36.2%

Lyon County 604 800 38.1% 28.8%

Mineral County 46 60 43.5% 33.3%

Nye County 369 379 38.8% 37.7%

Pershing County 47 60 17.0% 13.3%

Storey County 26 30 50.0% 43.3%

Washoe County 4,692 4,960 49.3% 46.7%

White Pine County 112 85 35.7% 47.1%

All Districts 22,690 24,458 33.0% 30.6%

RESPONSE RATES



Survey Participation by School District

Figure 1.1 illustrates the participation of Washoe, Clark, and Rural Counties. A total of 7,480

surveys were returned, with 46.5% of those surveys completed by parents in Clark County,

30.9% from Washoe County, and the remaining 22.5% from the rural counties. This year, Clark

County had a much lower response rate (60.2%) compared to previous years and Washoe County

had a much higher response rate (26.4%). It is unknown why Clark County’s rates decreased so

substantially, however, in Washoe County, their district made a concerted effort to distribute the

survey to all of their schools and encouraged participation.

Figure 1.2 illustrates county-specific participation for only rural counties, which combined,

represents 22.4 percent of the total respondents.

46.5%

30.9%

22.5%

Figure 1.1: Survey Participation by School District(2014-2015 n = 7,480 )

Clark County

Washoe County

Rural Counties

16.7%

5.8%

11.0%

26.4%

0.2% 0.4%

8.0%

3.1%1.5%

13.6%

1.2%

8.5%

0.5% 0.8%2.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Figure 1.2: Survey Response Rate Among All Rural Counties

(2014-2015 n =1,686 )



DEMOGRAPHICS

The survey was created to be one page in length, with one side presented in English and the

reverse side presented in Spanish. Of the 7,480 respondents that returned the surveys, 85.8

percent completed the English version and 14.2 percent completed the Spanish version.

Please note that all data provided from this point on are weighted to be representative of the

regions of the state and the state as a whole. Therefore, the responses received from the 7,480

respondents represents a total of 32,163 kindergarten students. Figure 2.1 below demonstrates

that after weights are applied, the distribution of the data mirrors that of the actual distribution of

kindergarten students by region and the state overall.

Parents were asked to respond to questions regarding their annual household income and their

child’s gender, race/ethnicity, and preschool setting prior to kindergarten. Data for each of these

questions are presented in Figures 2.1 through 2.3 below, with all percentages calculated using

the 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 nearly

equally between males (49.9 percent) and females (50.1 percent). These results are consistent

with survey results from the past two years.

Family Demographics

The average age of the child’s mother was 33.10 (SD = 6.94) and the average age of the father

was 35.93(SD = 7.67). The average number of adults living in a house was 2.12 (SD = 0.86) and

ranged from 0 to 22. The number of children living in a house averaged 2.53 (SD = 1.20) and

ranged from 0 to 12. Approximately 30 percent of parents indicated that they were a single

parent or guardian. The percentage of single parents in Clark County and Washoe County is

similar and higher than the percentage of single parents in the Rural Counties (25.6%) (see

Appendix A, Table 11.1).

73.6% 14.6%

11.8%

Figure 2.1: Weighted Survey Data by School District(2014-2015 n = 32,163 )

Clark County

Washoe County

Rural Counties

DEMOGRAPHICS



Annual Household Income

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 the

middle value of a distribution, and is the best measure of central tendency to reduce the impact of

outliers (very high or very low incomes) in the distribution. Compared to the median income

listed for Nevada, 55 percent of all respondents reported an annual income below $45,000

(Figure 2.2 below).

Compared to previous survey years:

The number of families with annual income levels below $25,000 has decreased by .2

percentage points since last year, although there was a decrease in families earning less

than $15,000 per year.

Over the past three years, there have been minor fluctuations in both directions in all

income categories.

The largest change among all the categories has been a 1.4 percentage point increase the

number of families earning over $95,000.

$0-

$14,999

$15,000

-

$24,999

$25,000

-

$34,999

$35,000

-

$44,999

$45,000

-

$54,000

$55,000

-

$64,999

$65,000

-

$74,999

$75,000

-

$84,999

$85,000

-

$94,999

$95,000

+

2012-2013 18.1 15.6 12.9 9.3 8.0 6.3 6.1 6.0 4.0 13.7

2013-2014 18.0 15.5 12.6 9.6 7.6 6.7 6.1 5.5 4.0 14.4

2014-2015 17.3 15.9 13.1 8.7 7.5 6.3 5.7 5.8 3.9 15.8

0.0

5.0

10.0

15.0

20.0

% o

f R

esp

ond

ents

Figure 2.2: Annual Household Income by School Year(2012-2013 n = 27,451; 2013-2014 n = 28,124; 2014-2015 n= 27,461 )

DEMOGRAPHICS



Race/Ethnicity This year, race and ethnicity data were compared to the most recent data available from the

Nevada Department of Education student demographic profiles. This provides a more accurate

comparison of race and ethnicity as it is restricted to school aged children rather than to all

residents of in the state of Nevada. Compared to the racial demographics of the students

attending public schools in Nevada, the reported race/ethnicity of the kindergartners in this

survey were fairly similar with differences only ranging from 0-6.9% percentage points (see

Figure 2.3). However, there were proportionally more children in the KHS survey whose parents

or guardians reported that the child had multiple races. It is important to note that the Nevada

Department of Education does not provide an option for “other” while the KHS does take that

into account.

These results are consistent with KHS data received in 2012-2013 and in 2013-2014. When

comparing results across counties for the 2014-2015 school year (refer to Table 11.1 in

Appendix A), there is a higher percentage of African American/Black and Asian/Pacific Islander

kindergartners in Clark County as compared to Washoe County, and even fewer in the Rural

Counties. In addition, there are more Native American/Alaska Native kindergartners in the Rural

Counties as compared to Washoe County, and even fewer in Clark County.

Note. * Nevada Department of Education 2013-2014 Demographic Profile

African

American

/Black

Asian/

Pacific

Islander

Caucasian Hispanic

Native

American

/ Alaska

Native

Other

Race

Multiple

Races

Survey Sample 6.3% 6.5% 38.3% 33.7% 1.1% 0.1% 14.1%

Nevada DOE* 9.9% 6.9% 36.0% 40.6% 1.1% 5.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Race/Ethnicity

Figure 2.3: Child's Race/Ethnicity(2014-2015 n = 31,310)

DEMOGRAPHICS



Preschool Setting

Respondents were asked to indicate the type of preschool setting, if any, their kindergartner

attended in the past twelve months (see Figure 2.4). These categories were adjusted from the

2012-2013 survey in order to capture more specific settings. Therefore, the 2013-2014 school

year might not have data for certain categories.

Compared to 2013-2014 data:

33.5 percent of respondents indicated that their kindergartner had stayed at home in the

prior year, which is a 2.4 percentage point decrease from last year.

Attendance at school district preschool sites has steadily increased over the past two

years.

When comparing the 2014-2015 data across counties (Table 11.1):

A higher percentage of children attended Head Start in Washoe County (8.5) and the

rural counties (10.2) as compared to Clark County (4.9).

A higher percentage of children attended school district run preschools in Clark County

(24.9) as compared to Washoe (20.9) and the Rural counties (23.4).

A higher percentage of children in Washoe County (35.8) did not attend preschool as

compared to rural counties (23.2) and Clark County (34.0).

Note. Blank boxes indicate data are not available. For these categories, percents will not total 100 because not all

categories for those years are available.

Head

Start

Other

Facility/

Care

Home-

Based

Care

University

Campus

Pre-

School

School

District

Pre-

School

None/

Stayed

Home

Multiple

Sites

Friends/

Family/

Neighbor

Care

2012-2013 5.8% 24.7% 6.6% 1.2% 19.2% 40.0% 2.4%

2013-2014 6.6% 21.9% 5.8% 1.1% 21.8% 35.9% 4.0% 2.8%

2014-2015 5.8% 22.6% 5.1% 0.9% 24.2% 33.5% 4.7% 3.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Figure 2.4: Child's Type of Preschool Setting During Last Twelve Months(2012-2013 n = 32,116; 2013-2014 n = 32,103; 2014-2015 n= 29,812 )

DEMOGRAPHICS



Average Hours of Preschool Attendance Since the 1950s there has been a drastic increase in the percentage of children who are spending

time in non-parental child care settings (McGroder, 1988). Sixty percent of children under five

spend an average of 29 hours per week in some form of non-parental child care setting (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

spent in non-parental care. Therefore, in addition to the preschool setting, a question was

included to determine how many hours children spent in the preschool setting.

Results from Table 2.1 indicate that almost half of parents/guardians have their child in someone

else’s care 20 hours or less per week (40.7 percent) and only 7.6 percent have them in someone

else’s 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 Rural

counties (56.1) as compared to Clark (40.1) and Washoe (36.3) counties.

A higher percentage of children were in care more than 20 hours a week in Washoe

County (28.2) and Clark County (28.1) compared to the Rural Counties (20.3).

Table 2.1 Average Preschool Hours of Attendance (n=27,034) 0 HRS 5-10 HRS 10-15 HRS 15-20 HRS 20-30 HRS 30-40 HRS 40+ HRS

31.8% 17.7% 14.4% 8.6% 8.4% 11.5% 7.6%



INSURANCE STATUS

Background

Nevada has consistently placed near the bottom of nationwide rankings with regard to the

percent of children covered by health insurance. According to the U.S. Census Bureau American

Community Survey (2013), approximately 7.1 percent of children under the age of 18 in the

United States are uninsured compared to 14.9 percent of children under the age of 18 in Nevada.

A correlation exists between children’s 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

are more likely to have poorer health outcomes as compared to insured children. For example,

parents of uninsured children are more likely to report that their child has an unmet health need

(DeRigne, Porterfield & Metz 2009). Nevada was ranked 46th when compared nationally across

four dimensions of health: healthcare access and affordability, prevention and treatment,

avoidable hospital use and cost, equity, and healthy lives (Radley, McCarthy, Lippa, Hayes, &

Schoen, 2014).

Status of Health Insurance of Kindergarten Students

In the current study, respondents were asked to indicate their child’s current health insurance

coverage.

Uninsured Private MedicaidNevada

Check UpOther

Multiple

Types

2012-2013 13.6% 47.6% 23.5% 6.3% 6.4% 2.6%

2013-2014 12.6% 50.0% 25.9% 6.5% 2.1% 2.9%

2014-2015 7.6% 48.4% 31.3% 6.7% 2.8% 3.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

% o

f R

esp

on

den

ts

Figure 3.1: Types of Children's Health Insurance Coverage

by School Year(2012-2013 n = 32,719; 2013-2014 n = 32.595; 2014-2015 n= 27,309 )

INSURANCE STATUS



Approximately 92.4 percent of respondents indicated that their child had some type of

health insurance and 7.6 percent of respondents stated that their child had no coverage. This is

the lowest rate of uninsured children since this survey’s inception in 2008-2009 (not presented

here because the data is unweighted) and a 40% decrease in the number of uninsured children

compared to last year.

Approximately 2.8 percent of respondents indicated that their child had some “other” type of

health insurance not listed on the survey questionnaire. Respondents indicated that these “other”

types of insurance 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 be reported or recoded into another category. It is possible that some of these

responses could have been coded as belonging to the private or public survey categories.

In addition, 3.1 percent of respondents selected “multiple types” of health insurance for their

kindergartner. The majority of these respondents specified that their child had both Medicaid and

a private form of health insurance, or Medicaid and Nevada Check Up.

Of the health insurance options:

Nearly half (48.4%) of the respondents indicated that their kindergartner had private

health insurance.

Approximately 38% of the respondents indicated that their kindergartner had public

health insurance (either Medicaid or the state’s children’s health insurance program,

Nevada Check Up).

The rates of children enrolled in private insurance are decreasing while enrollment in

public insurance (e.g., Medicaid) is increasing. Given that private insurance rates over the past

year decreased slightly (50.0% in 2013-2014), participation in public health insurance raised

approximately 5 percentage points since 2013-2014, and the number of children uninsured

decreased the same amount this year, many of these children likely obtained public health

insurance (see Figure 3.1). A recent study using data from the Kindergarten Health Survey

suggests, access to health care is reduced for those receiving public insurance compared to

private insurance (Haboush, Phebus, Hensley, Teramoto, & Tanata, 2013).While it is a goal to

increase health coverage for children, it is important to ensure that they have access to quality

healthcare.

Increasing Access to Insurance through the Nevada Health Link (Silver State Exchange)

Due to regulations of the Affordable Care Act, in October of 2013, Nevada began its health

exchange program, the Silver State Exchange, better known as Nevada Health Link. The 2014-

2015 survey was able to capture respondent’s participation in that program for their children.

Results are as follows:

19.2% of respondents (n=31,148) indicated that they or someone else applied for their

child.

11.6% of respondents (n=27,589) indicated that they had applied for insurance for

themselves.

o Of those that applied for themselves, 71% indicated that they were approved.

INSURANCE STATUS



Annual Household Income and Insurance Status

Not surprisingly, children from families with a lower household income are more likely to be

uninsured than those children whose family has a higher income (see Figure 3.2).

43.1 percent of children who are uninsured live in households with an annual income

of less than $25,000. This is consistent with previous years.

However, 32.2 percent of children who live in a household with an annual income of

less than $25,000 have insurance, which is not consistent with data from previous

years.

Given the reduced rates on uninsured children in Nevada, income may be less of a

barrier than in previous years.

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

100 due to rounding.

$0 -

$14,999

$15,000

-

$24,999

$25,000

-

$34,999

$35,000

-

$44,999

$45,000

-

$54,999

$55,000

-

$64,999

$65,000

-

$74,999

$75,000

-

$84,999

$85,000

-

$94,999

$95,000

+Total

Uninsured 23.1% 20.0% 19.8% 8.5% 11.6% 5.6% 3.1% 3.8% 1.4% 3.2% 100%

Insured 16.7% 15.5% 12.5% 8.8% 7.2% 6.4% 5.9% 6.0% 4.1% 16.9% 100%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Household Income

Figure 3.2: Annual Household Income by Child's Insurance

Status(2014-2015: Uninsured n = 2,033 ; Insured n = 25,273 ; Total n = 27,306 )

INSURANCE STATUS



Race/Ethnicity and Insurance Status

Figure 3.3, detailing the relationship between race/ethnicity and insurance status, shows that

nearly half of children who are uninsured are Hispanic (47.2 percent) and almost a third are

Caucasian (28.3 percent).

While data has been fairly consistent over the past 2 survey years (Appendix B), compared to the

2013-2014 school year:

The percentage of uninsured children decreased for all racial groups with the exception of

Caucasian children (25.3%) and children with multiple races (10.8%).

The percentage of uninsured Hispanic children decreased by 3.1 % , but are still more

likely to be uninsured as compared to other racial/ethnic groups.

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

Research indicates that in Nevada, and across the United States, Hispanic populations are much

more likely to be uninsured than Caucasian populations (Newport & Mendes, 2009).

Approximately 32 percent of Hispanics across the country are uninsured (Kaiser Family

Foundation, 2013). This rate is likely to increase in states with large proportions of Hispanic

immigrants like Nevada. Although many of these Hispanic children are eligible for public health

insurance, barriers to enrollment such as language and literacy challenges, and fears about

immigration enforcement for families with mixed immigration status continue to impede

parents/guardians from obtaining insurance coverage for their children (Kaiser Family

Foundation, 2013).

African

American/

Black

Asian/

Pacific

Islander

Caucasian Hispanic

Native

American/

Alaska

Native

Other

Race

Multiple

RacesTotal

Uninsured 4.8% 3.9% 28.3% 47.2% 0.6% 0.1% 15.0% 100%

Insured 6.3% 6.7% 39.2% 32.5% 1.1% 0.1% 14.1% 100%

Total % of

Respondents6.2% 6.5% 38.4% 33.6% 1.1% 0.1% 14.2% 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(2014-2015:Uninsured n = 28,665 ; Insured n = 2,361 ; Total n = 31,026)



ACCESS TO HEALTHCARE

Barriers to Accessing Healthcare

When asked about accessing health care for their child, 20.6 percent of respondents indicated

that they had experienced at least one barrier. The majority had difficulty due to either “lack

of money” or “lack of insurance” for health care services.

Of all respondents experiencing one or more barriers to accessing health care (approximately

6,370 respondents):

77.4% reported having health insurance (28.9% private, 34.5% Medicaid, 7.8%

Nevada Check Up, and 3.7% Other/Multiple);

60.3% had an annual household income of less than $35,000.

3.0%

10.3%

4.9%

14.6%

2.3%

3.4%

10.1%

5.2%

13.8%

2.1%

3.4%

7.3%

5.1%

10.4%

1.9%

0.0%

5.0%

10.0%

15.0%

Barriers

.

Figure 4.1: Types of Barriers When Accessing Health Care

for Child(2012-2013 n = 31,810; 2013-2014 n = 31,583; 2014-2015 n= 6,370 )

2012-2013 2013-2014 2014-2015

ACCESS TO HEALTHCARE



Knowledge Regarding Accessing Support Services

To obtain a better understanding of why parents/guardians might experience difficulty accessing

services, a question was added in the 2013-2014 survey to try to assess levels of knowledge

regarding accessing support services.

Overall, 26.8% of respondents (n=31,529) were somewhat aware of how to access support

services and 29.1% reported that they did not know how to access support services. Those in the

Rural counties (only 26.7 percent knew how to access services) were less sure of how to access

services than those in Washoe County (50.8 percent knew how to access services) and Clark

County (40.7 percent knew how to access services).

When exploring race/ethnicity and differences in knowledge, results indicate that those that

classified themselves as Asian/Pacific Islander or Hispanic had less knowledge about accessing

support services compared to the other groups.


African

American

Asian /

Pacific

Islander

Caucasian Hispanic

Native

American

/ Alaska

Native

Other

Race

Multiple

Races

Yes 52.0% 30.8% 53.0% 31.9% 58.4% 39.1% 49.5%

Somewhat / Not Really 22.8% 29.4% 26.7% 28.3% 21.6% 30.4% 26.1%

No 25.2% 39.8% 20.2% 39.8% 20.1% 30.4% 24.4%

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Figure 4.2: Access to Support Services by Child's Race/Ethnicity(2014-2015: African American n = 1,921 ; Asian / Pacific Islander n = 2,002 ; Caucasian n = 11,866 ;

Hispanic n = 10,220; Native American / Alaska Native n = 334; Other n = 23 ; Multiple Rac

Race/Ethnicity



ROUTINE CARE

Background

Access to routine medical care services is a major factor contributing to a child’s health status.

Routine care includes basic health care services such as immunizations, vision screenings, and

well child visits. Children without health insurance are more likely to miss out on routine care

than insured children. Hoilette, Clark, Gebremariam, and Davis (2009) found that 23.3% of

uninsured children in the United States reported that they did not have a regular source of care.

Having access to regular primary care services, or a medical home, is another key indicator of

children’s overall health status. Studies have shown that having access to usual care has been

associated with better health and reduced health disparities, and that children without a regular

source of care are nine times more likely to be hospitalized for a preventable problem (Shi, et al.,

1999; Starfield, Shuh, 2004). Primary care providers, (e.g. physicians, physician’s assistants,

nurses) offer a medical home where children can receive basic care services, such as annual

check-ups and immunizations. Children that regularly see a primary care provider who

coordinates and organizes their care tend to have a better health status than children without

access to a primary care provider (Starfield, Shi & Macinko, 2005).

Routine Care for Kindergarten Students

Current survey results indicate that 87 percent of kindergartners had at least one routine medical

check-up in the twelve months prior to the date of the survey. Similarly, 86.4 percent of parents

reported that their child had a primary care provider. Compared to last year, the percentage of

children who had a routine checkup slightly increased (1.1 points) while the percentage of

children who had a primary care provide remained the same.


13.0%

87.0%

13.6%

86.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

No Yes

Figure 5.1: Child's Routine Check-Ups and Presence of

Primary Care Provider(2014-2015: Check-Up n = 31,441 ; Primary Care Provider n = 31,450)

Has your child been seen by a medical provider for a routine check-up in the past twelve months?

Does your child have a primary care provider?

ROUTINE CARE



In the current sample, approximately 89.5 percent of children with health insurance have a

primary care provider, while only 49.3 percent of children without insurance have a primary care

provider. These results clearly indicate that a child’s insurance status is related to having a

primary care provider (see Figure 5.2).

50.7%

10.5%

49.3%

89.5%

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(2014-2015: Uninsured n = 2,400 ; Insured n = 28,832 ; Total n = 31,232)

PCP - No PCP - Yes

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, 98.1 percent had a primary care provider.

Of the children that had not had a routine check-up in the last year, 46.7 percent did not

have a primary care provider.

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

46.7%

8.2%

53.3%

98.1%

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)(2014-2015: No PCP n = 4,010 ; Has PCP n = 26,883 ; Total n = 30,893)

PCP - No PCP - Yes



CARE FOR ILLNESS OR INJURY

In recent years, a growing number of uninsured children with minor, non-life-threatening

conditions 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 high costs for medical care (Garcia et al., 2010). These families are often left with little

option 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 19.3 percent of respondents indicated they had visited an ER for a non-life

threatening illness or injury for their child once or twice in the past year. This number has risen

slightly over the past three years, however the number of those that have not used the ER has

remained fairly consistent, with a slight decrease in the past two years (see Figure 6.1).

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

VisitsTotal

2012-2013 80.6% 17.9% 1.4% 0.1% 0.1% 100.0%

2013-2014 80.0% 18.3% 1.5% 0.2% 0.1% 100.0%

2014-2015 79.0% 19.3% 1.5% 0.1% 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(2012-2013 n = 32,693; 2013-2014 n = 32,575; 2014-2015 n= 31,725)

CARE FOR ILLNESS OR INJURY



Insurance status does not appear to be an indicator of usage of an ER. Figure 6.2 shows the

percentage of ER visits by child’s insurance status. For both insured and uninsured groups, the

vast majority of children had not been to an ER for a non-emergency in the past 12 months.

However, those with insurance seem to use the ER more frequently than those without insurance

for non-life threatening care.

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

VisitsTotal

Uninsured 86.7% 12.0% 1.4% 0.0% 0.0% 100%

Insured 78.3% 20.0% 1.5% 0.1% 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(2014-2015: Uninsured n = 2,392 ; Insured n = 29,089 ; Total n = 31,481 )



MEDICAL CONDITIONS

Many of Nevada’s children have medical conditions. Treatment for these children can be

expensive and can require a team of medical care providers, led by a primary care physician,

devoted to the treatment and maintenance of their conditions. Thus, quality health insurance

coverage is vital for children with special health conditions, as it improves their chances of

having ongoing care and treatment.

According to this year’s survey results, 27.7 percent of parents indicated that their child had

a medical condition (see Figure 7.1).

6.9 percent of respondents reported that their child had asthma, which was the highest

reported medical condition after allergies.

Diedhiou, Probst, Harding, Martin, and Xirasagar (2010), found that in the United

States, approximately 9% of 14,916 children with special health care needs and

asthma lacked consistent health care coverage; children aged 0 to 5 years

represented 23.7% of that sample.

Approximately 4.7 percent of respondents indicated that their child had an “other”

health condition not listed on the survey. Such “other” conditions included eczema, food

allergies, and rare diseases or disorders.

Note. Blank cells indicate data is not available. Respondents can select multiple categories therefore the total percent

within each year might exceed 100%.

ADD/

ADHDAllergy Asthma Autism Cancer Diabetes

Glasses/

Contacts

Hearing

Impaired

Mental

Health

Physical

Disabilit

y

Other SeizuresNo

Medical

2012-2013 1.4% 8.1% 0.4% 0.0% 0.2% 3.5% 0.3% 0.3% 0.3% 6.6% 0.5% 81.8%

2013-2014 1.3% 15.1% 7.5% 0.6% 0.1% 0.1% 5.1% 0.3% 0.4% 0.4% 5.2% 0.6% 71.2%

2014-2015 1.3% 15.5% 6.9% 0.5% 0.1% 0.1% 4.7% 0.4% 0.4% 0.4% 4.7% 0.4% 72.3%

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(2012-2013 n = 30,599; 2013-2014 n = 32,969; 2014-2015 n= 29,765)

MEDICAL CONDITIONS



Developmental Screening

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 or

physical development. Early identification of developmental delay, coupled with the initiation of

intervention programs can contribute to greater academic and social success throughout a child’s

life (Brookings Institute 2014). Many children with developmental disabilities are not identified

until they have entered kindergarten or later, causing the child to miss out on crucial years of

intervention (CDC, 2014b). Therefore, a question was added to this year’s survey in which

respondents were asked whether or not their child received a developmental screening in the past

12 months.

Overall, 51.8 percent of respondents (n=30,068) reported that their child did not have a

developmental screening and 25.0% reported that they were unsure. When exploring differences

among the counties, more respondents in the Rural Counties (30.2 percent) reported that their

child had been screened as compared to Washoe County (24.6 percent) and Clark County (21.8

percent).

When exploring race/ethnicity differences in screening (Figure 7.2), results indicate that those

that classified their child as Native American/Alaskan Native had the highest rate of reported

screening, while those classified as Hispanic and Asian/Pacific Islander had the lowest screening

rates.

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

African

American

Asian / Pacific

IslanderCaucasian Hispanic

Native

American /

Alaska Native

Yes 28.1% 17.6% 27.5% 18.7% 20.2%

No 48.0% 59.0% 49.1% 55.9% 45.5%

Not Sure 23.9% 23.4% 23.5% 25.4% 34.2%

Total 100.0% 100.0% 100.0% 100.0% 100.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Pe

rce

nt

of

Res

po

nd

ents

Figure 7.2 Developmental Screening by Child's

Race/Ethnicity(2014-2015: African American n = 1,908 ; Asian/Pacific Islander n = 1,987 ; Caucasian n =

11,760 ; Hispanic n = 9,749 ; Native American/Alaska Native n = 336)



DENTAL CARE

Background

Routine dental care is also important to children’s health and daily functioning. Children without

access to regular dental care are more likely to experience dental problems, such as dental

cavities and tooth abscesses. Dental problems have been linked to poor performance in school,

difficulty concentrating, and problems completing school work. (Seirawan, Faust, Mulligan,

2012). Research also indicates that uninsured children are much more likely to have unmet

dental needs (e.g. teeth cleanings). One study found that 4 percent of privately insured children

and 5 percent of publicly insured children had an unmet dental need, whereas 22 percent of

uninsured children had an unmet dental need (Child Trends, 2015). Additionally, uninsured

children are 1.5 times more likely to not have received preventative care in the last year and 3

times more likely to have an unmet dental need than insured children (Liu et al., 2007).

Dental Care of Children Entering Kindergarten

To prevent oral health problems, it is generally recommended that children receive regular dental

check-ups every six months to a year as soon as they receive their first tooth, or when they are

one year old (American Academy of Pediatric Dentistry, 2014). In the current study, 25.2 percent

of survey respondents indicated that their kindergartner had NOT seen a dentist in the past

twelve months, which was a slight decrease from the 2012-2013 and 2013-2014 data (Figure

8.1).

25.8%

74.2%

26.0%

74.0%

25.2%

74.8%

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 (2012-2013 n = 32,772; 2013-2014 n = 31,224; 2014-2015 n= 29,289)

2012-2013 2013-2014 2014-2015



MENTAL HEALTH

Many of Nevada’s children have mental health conditions that require specialized treatment. It is

important that these children have regular access to mental health services. This is particularly

true for young children entering the elementary school system. Without access to mental health

care providers to manage and treat their conditions, children with mental health conditions are

more likely to experience learning difficulties and developmental delays (Baker, Neece Fenning,

Crni & Blacher, 2010).

The survey results indicate that 4.4 percent of respondents have tried to access mental health

services for their children, a percentage similar to the 2012-2013 and 2013-2014 data. Of the

respondents who have tried to access these services for their child:

Of those that attempted to access services, 31.8 percent reported having trouble

obtaining the services, a slight decrease from the previous survey year (35.9).

When examining this percentage across counties, it was found that there were

slight differences between counties, with those in Washoe County reporting

less trouble obtaining services (see Figure 9.1).

Reported barriers to obtaining services most frequently included problems

making appointments/waiting periods, lack of providers, or insurance not

covering the issue.

33.6%

22.0%

34.5%31.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Yes

Trouble Obtaining Mental Health Service

Figure 9.1: Trouble Obtaining Mental Health Services

by County

(2014-2015 Tried to obtain Mental Health Services

Clark n = 851 ; Washoe n = 205 ; Rural n = 171 ; Statewide n = 1,227 )

Clark County Washoe County Rural County Statewide



WEIGHT AND HEALTHY BEHAVIORS

Childhood obesity is a growing public health problem, as it has doubled in children and quadrupled

in adolescents since the 1980’s (Ogden, Carroll, Kit, Flegal, 2014). Research has indicated there is a

significant link between high Body Mass Index (BMI) values and type II diabetes (Ganz, Wintfeld,

Li, Alas, Langer, & Hammer, 2014).). Therefore, monitoring children’s weight has become an

important tool for analyzing potential health problems.

The current survey asked parents to write in their child’s height and weight information. NICRP

used this information to calculate a Body Mass Index (BMI) value for each child with valid height

and weight responses. BMI values were calculated using the standard formula employed by the CDC

and 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 the

calculation 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 of

this age range. Age is an important determinant as it is used to determine weight status category and

is strongly correlated with height. Second, if a child’s 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 from

the analysis. Finally, if a child’s weight was reported under 20lbs, the child was excluded from the

analysis. This resulted in 12,077 (37.5 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 on

CDC standards, which uses a child’s age, gender, and BMI percentile. Table 10.1, below, outlines

the 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 5th percentile

Healthy Weight BMI from the 5th percentile to less than the 85th percentile

Overweight BMI from the 85th percentile to less than the 95th percentile

Obese BMI equal to or greater than the 95th percentile Source: Centers for Disease Control and Prevention (2011a). About BMI for Children and Teens. Retrieved

from http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html#What is BMI

percentile




For the purpose of this study, NICRP used 10 different weight status formulas: one formula for girls

and one for boys in each of the following ages: 4.0, 4.5, 5.0, 5.5, and 6.0. Table 10.2 outlines the

calculations 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 <= BMI < 16.808 16.808 <= BMI < 18.028 BMI >= 18.028

4.5 0 < BMI < 13.614 13.614 <= BMI < 16.760 16.760 <= BMI < 18.084 BMI >= 18.084

5.0 0 < BMI < 13.527 13.527 <= BMI < 16.796 16.796 <= BMI < 18.240 BMI >= 18.240

5.5 0 < BMI < 13.465 13.465 <= BMI < 16.906 16.906 <= BMI < 18.486 BMI >= 18.486

6.0 0 < BMI < 13.428 13.428 <= BMI < 17.083 17.083 <= BMI < 18.808 BMI >= 18.808

Males

Age

Weight Status Category


4.0 0 < BMI < 14.043 14.043 <= BMI < 16.935 16.935 <= BMI < 17.842 BMI >= 17.842

4.5 0 < BMI < 13.932 13.932 <= BMI < 16.852 16.852 <= BMI < 17.829 BMI >= 17.829

5.0 0 < BMI < 13.845 13.845 <= BMI < 16.839 16.839 <= BMI < 17.927 BMI >= 17.927

5.5 0 < BMI < 13.781 13.781 <= BMI < 16.891 16.891 <= BMI < 18.118 BMI >= 18.118

6.0 0 < BMI < 13.739 13.739 <= BMI < 17.003 17.003 <= BMI < 18.389 BMI >= 18.389 Source: Centers for Disease Control and Prevention (2011b). Body Mass for Age Tables. Retrieved from

http://www.cdc.gov/growthcharts/html_charts/bmiagerev.htm

In the 2010-2011 report, specific validity criteria was established regarding age, height, and weight

to calculate the most accurate BMI.




Based on the calculated BMI for this year’s sample, more than half (52.4 percent) of the children

were categorized as being at a healthy weight, a rate consistent with the previous school year (see

Figure 10.1). However,

16.1% of children were underweight; Washoe County (19.0%) had slightly higher

percentages of underweight children as compared to Clark County (16.1%) and the Rural

Counties (13.4%).

9.8% of children were overweight, and approximately one fifth (21.7%) of the children

were considered obese. The Rural counties (23.7%) had slightly higher percentages of obese

children as compared to Clark County (21.6%) and Washoe County (20.3%).

Even though the percentage of overweight children have declined, the percentage of obese

children continues to climb indicating our state should continue to invest in efforts to

increase healthy behaviors.

15.7%

55.0%

11.1%

18.2%16.9%

49.4%

14.7%

19.0%

16.1%

52.4%

9.8%

21.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%


Figure 10.1: Child's Weight Status Category(2012-2013 n = 13,284; 2013-2014 n = 607; 2014-2015 n= 12,077 )

2012-2013 2013-2014 2014-2015




When comparing each child’s race/ethnicity with his or her BMI, there are some differences in

distributions across weight status categories for each race/ethnicity group. It is important to note that

the total number of respondents included in this analysis is even fewer than those in the above

statistics on valid BMI’s within the sample, because some respondents did not provide information

on race/ethnicity.

The distribution of race/ethnicity for children with valid BMIs varies slightly from the race/ethnicity

demographics of the survey sample as a whole, with the greatest discrepancy being the percentage of

Hispanic children with valid BMI data. Even though respondents who reported that their child was

Hispanic make up 33.7% of the total sample, only 20.9% of those with a valid BMI are Hispanic.

Figure 10.2 illustrates the race/ethnicity data for children with a valid BMI.

African

American/

Black

Asian/

Pacific

Islander

Caucasian Hispanic

Native

American/

Alaska

Native

Other

Race

Multiple

RacesTotal

% w/Valid BMI 5.7% 6.3% 51.0% 20.9% 0.6% 0.1% 15.3% 100%

% Total Sample 6.3% 6.5% 38.3% 33.7% 1.1% 0.1% 14.1% 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 (2014-2015: Valid BMI & Valid Race n = 11,876)




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

The highest percentages of obese children were Native American/Alaska Native children

(29.2 percent); however, this is based on a very small sample of Native American/Alaska

Native children.

Hispanic children (28.9%), children of multiple races (27.4%), and African

America/Black children (26.0%) all had obesity rates that were over 25%.

Caucasian children had the lowest rates of obesity (16.8%), and African American

children had much lower rates of children who were overweight (4.5%) compared to all

other racial/ethnic groups listed below.

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

category. Other race is not included due to the minimal response rate in that category (.01%).

African

American/

Black

Asian/

Pacific

Islander

Caucasian Hispanic

Native

American/

Alaska

Native

Multiple

Races

Underweight 29.9% 20.0% 14.0% 17.4% 5.6% 15.0%

Healthy Weight 39.6% 45.4% 60.0% 42.6% 50.0% 48.2%

Overweight 4.5% 13.5% 9.2% 11.1% 15.3% 9.5%

Obese 26.0% 21.0% 16.8% 28.9% 29.2% 27.4%

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

*Total % Valid BMI 5.7% 6.3% 51.0% 20.9% 0.6% 15.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Race/Ethnicity

Figure 10.3: Child's Weight Status Category by

Child's Race/Ethnicity(2014-2015 n = 11,844 )




Behaviors Related to Healthy Weight in Young Children

Explanations for obesity in young children are related to a number of factors including behavior

regiments such 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 soft

drinks have been found to be related to higher BMIs (Delva, Johnston & O’Malley, 2007;

Kumanyika, 2008). Therefore, the following questions were included on the Kindergarten Health

Survey in order to determine the frequencies of these behaviors among children entering

kindergarten.

Physical Activity Parents/guardians were asked to report the number of times per week their child is physically active

for at least thirty minutes. Over half of the respondents (51.4%) indicated that their child was

physically active 6-7 times a week for at least thirty minutes at a time. Figure 10.4 details the

relationship 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 throughout

the week (4-7 times per week). However, only a very small percentage of children (1.4%)

with a valid BMI were reported to engage in physical activity 0-1 times a week, and

14.0% reported activity 2-3 times per week.

These results are consistent with the findings from the 2013-2014 school year.

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

amount of physical activity.

0-1 Times Per

Week

2-3 Times Per

Week

4-5 Times Per

Week

6-7 Times Per

Week

Underweight 20.7% 17.6% 17.0% 15.6%

Healthy Weight 46.3% 46.0% 49.5% 55.0%

Overweight 5.5% 12.9% 11.1% 8.6%

Obese 27.4% 23.5% 22.4% 20.9%

Total 100% 100% 100% 100%

*Total % Valid BMI 1.0% 14.0% 27.0% 58.0%

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(2014-2015 n = 11,441 )




To gain a better understanding of the barriers that parents are facing in regards to providing physical

activities for their children, respondents that indicated that their child was physically active one time

or less per week, were asked to indicate barriers to them being more physically active. The most

frequently reported barrier was weather (46.9%), followed by lack of time and/or a busy work

schedule (28.2%), lack of a safe play space which included comments regarding air quality (9.0%),

medical conditions (12.5%), preference for electronic media (2.3%), and transportation (1.0%).

Please note the response categories are not mutually 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 but

less than 2 hours during a weekday. The 2011 National Survey of Children's Health reported data

regarding 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 hours of

television.

Table 10.3 Average Television Watched During a Weekday (n=28,713)

None 1 hour or less

Between 1hr

& 4 hrs

4 hours or

more Total %

Nationwide 6.3% 41.8% 40.3% 11.6% 100.0%

Nevada 4.7% 38.9% 41.9% 14.5% 100.0%

KHS Data 2.1% 42.5% 49.4% 5.9% 100.0%

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

When comparing the number 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.




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 Health

Informatics and Epidemiology), 37.9 percent of youths in Nevada used computers 3 or more hours

per day for something that was not related to school, which was slightly less than the most recent

national average of 41.3 percent (CDC, 2013). To determine similar activity in children entering

kindergarten, this same question on video game use was included on the survey starting in the 2011-

2012 school year.

2014-2015 results indicate that the majority of children either do not play video or computer games

(30%) or play one hour or less (54%) on an average school day. While these numbers are fairly

consistent across all counties, the percentage of children that do not play video games is less in Clark

County (28.7%) compared to both Washoe (32.3%) and the Rural (38.6%) counties.

When looking at the amount of hours that children play video games per day, the percent of children

in the obese category increases as the number of hours of video game play increases. Among those

kindergartners that reportedly play two or more hours of video games per day, there is a slightly

higher rate of obesity (23.6%) compared to those who reportedly do not play video games (18.9%).

NoneLess than 1

Hr a Day1 Hr a Day

2 Hrs a

Day

3 Hrs a

Day

4 Hrs a

Day

5+ Hrs a

Day

Underweight 12.7% 16.7% 15.5% 16.9% 19.6% 13.1% 15.6%

Healthy 65.3% 59.6% 55.6% 45.6% 44.3% 58.8% 40.6%

Overweight 7.7% 6.1% 11.5% 10.9% 9.4% 10.6% 3.1%

Obese 14.3% 17.7% 17.4% 26.7% 26.7% 17.4% 40.6%

*Total % Valid BMI 2.4% 14.9% 33.0% 32.3% 12.7% 3.6% 1.2%

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(2014-2015 n = 10,971 )




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

category.

Soda Consumption: Non-Diet Soda

According to the 2013 High School Youth Risk Behavior Survey, 16.2 percent of youth in Nevada

drank a can, bottle, or glass of non-diet soda/pop at least one time per day, 7 days prior to

administration of the survey, which was below the national average of 29.2 percent (Office of Public

Health Informatics and Epidemiology). To determine similar activity in children entering

kindergarten, this same question on soda consumption was included on the survey starting in the

2011-2012 school year.

Results indicate that:

The majority of children either did not drink any non-diet soda/pop (60.8%) or drank some a

few times per week (29.9%).

o These numbers are fairly consistent among Clark and Washoe County and are

slightly higher in the Rural Counties (64.1%).

6.8% of respondents reported that their child drank non-diet soda/pop once a day, and 2.5%

indicated that their child drank non-diet soda/pop more than once a day.

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

two counties, and highest in Clark County.

NoneLess than 1 Hour a

Day1 Hour a Day 2 + Hours a Day

Underweight 16.7% 14.5% 17.6% 17.4%

Healthy 55.3% 53.7% 48.2% 47.8%

Overweight 9.2% 9.4% 10.4% 11.2%

Obese 18.9% 22.4% 23.8% 23.6%

Total 100% 100% 100% 100%

*Total % Valid BMI 27.8% 30.9% 26.2% 15.1%

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(2014-2015 n = 11,142 )




Figure 10.7 illustrates child’s weight status category by number of non-diet sodas consumed in one

week’s time. Of the respondents with kindergartners having a valid BMI, most reported that their

child had less than one non-diet soda a day (94.3%). The highest rates of overweight and obesity are

seen in children who drank non-diet soda a once day.

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

Diet Soda

Similarly, the survey asked the parents/guardians to indicate the level of consumption of diet soda

products in the past seven days. Although this question was asked on the High School Youth Risk

Behavior Survey, this data was not available for comparison at the time of this report.


The majority of children in the current study did not drink any diet soda/pop (87.5%). This

percentage was highest in Rural Counties (88.6%) and lower in Clark County (87.8%) and

the lowest in Washoe County (85.7%).

10.1 % reported that their child drank diet soda/pop a few times a week, 2% reported daily

consumption, and 0.4% reported consumption more than once a day.

o In Washoe County, more children drank diet soda/pop a few times a week (11.5%),

followed by Clark (9.8%) and Rural Counties (9.5%). Washoe County also reported

None A Few Times One a DayMore than One

a Day

Underweight 14.8% 19.4% 20.0% 17.5%

Healthy 55.5% 47.4% 36.3% 55.6%

Overweight 9.6% 9.1% 16.3% 6.4%

Obese 20.1% 24.1% 27.5% 20.5%

Total 100% 100% 100% 100%

*Total % Valid BMI 67.3% 27.0% 4.2% 1.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Per

cent

of

Res

po

nd

ents

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

Non-Diet Sodas Consumed in a Week (2014-2015 n = 11,211)




slightly higher rates of diet soda/pop consumption once a day (2.4%) compared to

Clark County (2%) and the Rural Counties (1.6%).

When looking at children’s weight status category by number of diet sodas/pop drank in one week, it

is difficult to project a relationship given that so few of the respondents reported that their child

drank diet soda either once a day or more than once a day.


Juice Consumption Parents and childcare providers often perceive fruit juice as a healthy alternative to sodas and other

sugary beverages for children. Coupled by a wide variety of types of juices available, there has been

an increase in the consumption of fruit juices by children over the past 30 to 40 years. Low levels of

fiber and high sugar, even in 100% fruit juice, raises health issues for children (Wojcicki, Heyman,

2012). Research has also found that an excessive consumption of fruit juice among children may be

a contributing factor to obesity (Wojcicki, Heyman 2012). Because of the current debates over the

impact of consumption of juice on children’s health benefits, a question was added in the 2013-2014

survey year.

None A Few Times One a DayMore than One a

Day

Underweight 16.4% 15.1% 21.3% 0.0%

Healthy 53.5% 42.5% 39.1% 69.0%

Overweight 9.5% 13.5% 13.0% 0.0%

Obese 20.7% 28.9% 26.6% 31.0%

Total 100% 100% 100% 100%

*Total % Valid BMI 88.6% 9.6% 1.5% 0.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Per

cent

of

Res

po

nd

ents


Diet Sodas Consumed in a Week (2014-2015 n = 11,177)





The majority of children in the current study did drink juice a few times a week (43.8%),

once a day (26.3) or more than once a day (19.9%).

o Clark County reported a higher percentage of children who drank juice more than

once a day (20.2%) compared to the Rural Counties (18.3%) and Washoe County

(19.4%).

10.0 % reported that their child did not drink juice.

o Clark County reported that a higher percentage of children did not drink juice

(10.3%) as compared to Rural (9.5%) and Washoe (8.7%) counties.

When looking at children’s weight status category by number of juice drinks consumed in one week,

it appears that the more juice that is consumed the higher the obesity rates become (Figure 10.8).

Even though juice is thought to be a healthy drink, there is a clear trend that as juice consumption

increases, the percentage of children in the healthy weight category decreases and the percentage of

children in the obese category increases. However, children who are overweight do not demonstrate

a consistent pattern.


None A Few Times One a DayMore than One a

Day

Underweight 13.7% 15.9% 18.7% 15.1%

Healthy 62.7% 53.2% 48.7% 47.9%

Overweight 10.6% 9.1% 9.0% 12.0%

Obese 13.0% 21.8% 23.6% 25.0%

Total 100% 100% 100% 100%

*Total % Valid BMI 11.6% 43.5% 27.0% 17.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Per

cent

of

Res

po

nd

ents


Juice Drinks Consumed in a Week (2014-2015 n = 11,277)




Infant Feeding Behaviors Breastfeeding has been shown to have many health benefits for both the breastfeeding mother and

her child. Breastfeeding has been associated with reduced risk of cancer, diabetes, and postpartum

depression in mothers, and reduced risk of ear infections, gastrointestinal issues, allergies, SIDS,

obesity, and diabetes in children (United States Department of Health and Human Services, 2011).

Starting in 2007, the Centers for Disease Control and Prevention has issued a Breastfeeding Report

Card that provides both national and state level data. According to the 2014 report card, Nevada is

1.7 percentage points above the national average (79.2%) for babies who have ever been breastfed,

and Nevada is slightly below the national average for exclusive breastfeeding at 6 months (US =

18.8%; NV = 18.0%) but above the national average at 3 months (US = 40.7%; NV = 43.9%) (CDC,

2014a).

In order to obtain more detailed information about breastfeeding practices in Nevada, a new question

was added to the 2012-2013 survey to determine feeding practices of children entering kindergarten

when they were one, three, and six months old. As illustrated in Figure 10.10, 48.3% of respondents

indicated that their child was breastfed exclusively at one month old and this percentage declined at

both 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 infants

who are breastfed ever (81.9%), and at 6 months nonexclusively (60.6%) (CDC, 2013). According

to the 2014-2015 KHS survey, 41.8% of children entering kindergarten in Nevada were breastfed at

6 months nonexclusively, which is a slight decrease from last year (45.8%). This year, we extended

the question to include feeding practices at 12 months. Results indicated that 13.9% of respondents

breastfed exclusively at 12 months and 30.8% nonexclusively.

It is important to note that there are many reasons that a child may not receive breast milk

exclusively during the first six months (US Department of Health and Human Services, 2011). The

KHS expanded this year to capture information regarding barriers to breastfeeding. Of those who

reported barriers (32,163), the most frequently reported barrier was the inability to produce milk

(35.4%), followed by medical conditions (allergies, premature birth, etc.; 26.5%), issues latching

onto the nipple (14%), and work/school (15.4%). Other barriers (8.7%) included lack of support,

foster children, the baby was not gaining enough weight, and breast implants.




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 in

children (Gubbels, Thijs, Stafleu, Von Buuren, & Kremers, 2011). Figure 10.11 illustrates child

weight status categories by infant feeding behaviors. Children who received breast milk exclusively

at 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.

Breast OnlyBreast and

FormulaFormula Only

Other (e.g.

Food)Not Sure

1 Month 48.3% 22.2% 27.9% 0.4% 1.2%

3 Months 34.9% 24.5% 38.5% 1.0% 1.1%

6 Months 21.9% 19.9% 46.0% 10.9% 1.3%

12 Months 13.9% 16.9% 40.6% 27.3% 1.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%P

erce

nt

of

Res

po

nd

ents

Figure 10.10: Infancy Feeding Habits(2014-2015 1 month n = 20,341 ; 3 months n = 20,436; 6 months n = 16,380; 12 months n = 20,605 )




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.

Sleep Behaviors

Adequate sleep enables healthy brain growth and development, as well as emotional wellbeing in

children and adults alike (Sarchiapone, Mandelli, Carli, Iosue, Wasserman, 2014). Research has also

shown that inadequate sleep in adults and children has been linked to a number of chronic health

issues, including diabetes, cardio vascular disease, obesity and depression (US DHHS National

Heart, Lunch and Blood Institute, 2012; Taheri, 2006). The National Sleep Foundation (2011)

recommends that children five years of age get no less than 10 hours of sleep each night. For the

2014-2015 report, a new question was included to track the amount of sleep kindergartners are

getting per night.

Results indicate that on average, children in Nevada are getting the recommended amount of sleep

on both the weekdays and the weekends and this data is consistent among Clark, Washoe, and rural

counties.

1M 3M 6M 12M 1M 3M 6M 12M 1M 3M 6M 12M

Breast Only Breast & Formula Formula Only

Underweight 17.6% 16.0% 15.1% 17.0% 11.7% 17.1% 21.7% 18.1% 15.0% 14.3% 15.0% 18.3%

Healthy 56.0% 59.8% 62.1% 55.8% 53.8% 48.9% 48.4% 46.2% 50.5% 53.7% 52.9% 50.6%

Overweight 10.7% 9.0% 10.2% 10.0% 8.6% 12.7% 9.8% 11.2% 10.4% 8.6% 8.3% 8.8%

Obese 15.7% 15.2% 12.5% 17.2% 25.9% 21.3% 20.1% 24.6% 24.1% 23.4% 23.8% 22.3%

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

% Valid BMI 38.5% 27.9% 13.9% 20.5% 32.3% 18.7% 10.9% 22.1% 36.8% 28.0% 26.7% 57.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Per

cen

t o

f R

esp

on

den

tsFigure 10.11: Child Weight Status Category

by Infancy Feeding Habits (2014-2015 1 Month n = 8,358 ; 3 Months n = 8,557 ; 6 Months n = 6,575; 12 Months n = 5,234)




Table 10. 4 Average Sleep per Night for the State of Nevada

n Average Standard Deviation

Average Weekday Per Night 31,456 10.41 (.82)

Average Weekend Per Night 28,494 10.59 (.96)

Though napping is commonly associated with a productive daily routine for young children, recent

literature has stated that naps for children over 2 years old contribute to restlessness and poorer sleep

at night than children who do not nap during the day (Staton, Smith, Pattinson, & Thorpe, 2015;

Lam, Mahone, Mason, & Scharf, 2011; Spittler, 2007). Children require adequate night time sleep in

order to support healthy brain growth and development, so the amount of time per day children

spend napping on weekends and on weekdays (if at all) was also added to this year’s survey.

Therefore, the 2014-2015 survey also inquired about the average number of hours a child naps

during the day.

Results are as follows:

Naps During the Week

o 23.2% of respondents indicated that their child took a nap on weekdays

For 29% of the data, it could not be determined if the child did or did not take

a nap.

o The average length of the naps were 1.44 hours (SD=.63) and the range was between

.17 hours and 4.5 hours (n = 6,089).

o This data is consistent among Clark, Washoe, and rural counties.

Naps on the Weekend

o 21% of respondents indicated that their child took a nap on the weekend.

For 40% of the data, it could not be determined if the child did or did not take

a nap.

o The average length of the naps were 1.60 hours (SD=.67) and the range was between

.25 hours and 4.5 hours (n = 5,716).

o This data is also consistent among Clark, Washoe, and rural counties.



APPENDIX A:

SUMMARY OF 2014-2015 WEIGHTED SURVEY RESULTS BY COUNTY

Table 11.1 below outlines the percentages of responses for the 2014-2015 school year survey

results by Clark County, Washoe County, and the Rural Counties. Not all respondents answered

every question on the surveys that were returned. All percentages calculated are based on the

total weighted number of people answering the question, rather than the total number of people

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 county categories.

Table 11.1 Comparison of 2014-2015 Weighted Data by County

Survey Indicator State

(Percents)

Clark

County (Percents)

Washoe

County (Percents)

Rural

Counties (Percents)

Survey Participation -- 73.6 14.6 11.8

Demographic Information

Gender of Kindergartener

Male 49.9 49.9 49.5 50.4

Female 50.1 50.1 50.5 49.6

Race/Ethnicity of Kindergartener

African American/Black 6.3 7.9 2.6 0.5

Asian/Pacific Islander 6.5 7.7 4.6 1.1

Caucasian 38.3 33.8 42.4 61.2

Hispanic 33.7 35.0 36.9 21.4

Native American/ Alaska

Native 1.1 0.4 1.9 4.4

Other Race 0.1 0.1 0.0 0.2

Multiple Races 14.1 15.1 11.5 11.2

Annual Household Income of Survey Respondents

$0-$14,999 17.3 17.7 16.8 14.9

$15,000-$24,999 15.9 15.5 18.8 14.6

$25,000-$34,999 13.1 12.9 15.2 11.3

$35,000-$44,999 8.7 8.3 9.8 10.0

$45,000-$54,999 7.5 7.5 7.4 7.9

$55,000-$64,999 6.3 6.2 5.3 8.5

$65,000-$74,999 5.7 5.8 4.9 5.8

$75,000-$84,999 5.8 5.9 5.1 6.1

$85,000-$94,999 3.9 3.8 3.9 4.9

$95,000+ 15.8 16.4 12.9 15.9

APPENDIX A: WEIGHTED 2014-2015 SURVEY RESULTS BY COUNTY



Table 11.1 continued


(Percents)

Clark

County (Percents)

Washoe

County (Percents)

Rural

Counties (Percents)

Type of School Child Attended in the Past 12 Months

Head Start 5.8 4.9 8.5 10.2

Other Facility/Center 22.6 22.4 22.0 25.2

Home-Based 5.1 5.4 3.7 4.9

School District Preschool 24.2 24.9 20.9 23.4

University Campus

Preschool 0.9 0.7 0.5 4.2

None/Stayed at Home 33.5 34.0 35.8 23.2

Friends/Family Care 3.1 3.1 2.9 3.7

Multiple 4.7 4.5 5.7 5.2

Average Preschool Hours of Attendance

0 Hours 31.8 31.9 35.5 23.6

5-10 Hours 17.7 18.6 12.1 20.3

10-15 Hours 14.4 13.7 13.8 22.9

15-20 Hours 8.6 7.8 10.4 12.9

20-30 Hours 8.4 8.6 8.4 6.2

30-40 Hours 11.5 11.4 13.1 9.9

More than 40 Hours 7.6 8.1 6.7 4.2

Single Parent or Guardian 29.9 30.5 30.6 25.6

Average # of Children in

Household (Standard Deviation)

2.53

(1.20)

2.53

(1.21)

2.55

(1.20)

2.52

(1.10)

Average # of Adults in Household

(Standard Deviation)

2.12

(0.86)

2.14

(0.88)

2.12

(0.85)

2.01

(0.63)

Average Age of Mother/Guardian


33.10

(6.94)

33.29

(6.91)

32.62

(6.81)

32.55

(7.21)

Average Age of Father/Guardian


35.93

(7.67)

36.17

(7.65)

35.53

(7.47)

34.94

(7.97)

Health Insurance Status and Access to Health Care

Health Insurance Type

Uninsured 7.6 7.8 6.7 7.7

Private 48.4 48.5 44.3 53.1

Medicaid 31.3 30.9 35.4 28.2

Nevada Check-up 6.7 7.0 7.6 4.2

Other 2.8 2.9 2.3 3.0

Multiple Types 3.1 2.9 3.7 3.8

Kindergartner Does NOT Have a

Primary Care Provider 13.6 12.6 13.8 19.1






(Percents)

Clark

County (Percents)

Washoe

County (Percents)

Rural

Counties (Percents)

Types of Barriers Experienced When Trying to Access Healthcare

Lack of Transportation 3.4 3.7 2.0 3.0

Lack of Insurance 7.3 7.4 6.5 7.2

Lack of Quality Medical

Providers 5.1 4.5 4.3 10.1

Lack of Money/Financial

Resources 10.4 10.4 8.5 12.5

Other Barriers 1.9 1.6 1.8 3.5

Difficulties Accessing Mental

Health Services for Kindergartener 31.8 33.6 22.0 34.5

Know how to access support

services 44.0 40.7 50.8 26.7

Applied for insurance for self using

Nevada Health Link 11.6 11.5 11.6 11.7

Applied for insurance for child

using Nevada Health Link 19.2 18.8 21.6 18.8

Routine Care and Health of Kindergartner

Has Not Had Routine Check-Up 13.0 12.4 13.5 16.5

Has Not Visited a Dentist in the

Last Year 25.2 26.5 18.5 24.9

Amount of Times the

Kindergartener Has Gone to the

ER for a Non-Life-Threatening

Illness or Injury in the Past 12

Months

None (0) 79.0 80.1 77.5 74.6

1 to 2 19.3 18.5 20.2 23.2

3 to 5 1.5 1.4 2.0 1.8

6 to 9 0.1 0.0 0.2 0.3

10 or More 0.1 0.0 0.1 0.1






(Percent)

Clark

County (Percent)

Washoe

County (Percent)

Rural

Counties (Percent)

Types of Medical Conditions Seen in Kindergarteners

ADD/ADHD 1.3 1.1 1.3 2.1

Allergies 15.5 15.9 11.4 17.5

Asthma 6.9 7.1 5.5 7.7

Autism 0.5 0.5 0.6 0.7

Cancer 0.1 0.1 0.2 0.0

Diabetes 0.1 0.1 0.2 0.2

Glasses/Contacts 4.7 4.5 4.6 6.2

Hearing Aid/Impairment 0.4 0.4 0.2 0.2

Mental Health Condition 0.4 0.3 0.2 0.8

Physical Disability 0.4 0.3 0.5 0.5

Seizures 0.4 0.2 0.6 0.8

Other Condition 4.7 4.6 5.2 5.0

Received a Developmental

Screening in past 12 months 23.2 21.8 24.6 30.2

Weight and Healthy Behaviors

Underweight 16.1 16.1 19.0 13.4

Healthy Weight 52.4 52.6 50.7 52.8

Overweight 9.8 9.8 9.9 10.1

Obese 21.7 21.6 20.3 23.7

Amount of Times per Week that Child Has at Least 30 Minutes of Physical Activity

0-1 Times 2.4 2.5 1.8 1.4

2-3 Times 17.6 19.2 12.9 11.2

4-5 Times 28.6 29.5 27.4 21.6

6 or More Times 51.4 48.8 58.0 65.9

Hours of Television Watched on an Average School Day

None 2.1 2.1 1.7 3.0

Less than One 12.5 12.0 11.2 20.2

1 Hour 30.0 30.0 29.0 31.8

2 Hours 34.6 34.9 34.6 31.1

3 Hours 14.8 14.9 17.3 9.5

4 Hours 4.1 4.3 4.0 3.1

5 Hours or More 1.8 1.8 2.2 1.3






(Percent)

Clark

County (Percent)

Washoe

County (Percent)

Rural

Counties (Percent)

Hours of Video or Computer Games Played on an Average School Day

None 30.0 28.7 32.3 38.6

Less than One 27.5 27.4 24.9 33.6

1 Hour 26.5 27.8 24.6 17.9

2 Hours 10.8 10.9 11.7 7.4

3 Hours 3.4 3.4 4.5 1.6

4 Hours 1.1 1.1 1.4 0.6

5 Hours or More 0.7 0.8 0.6 0.3

Number of Times Per Week the Kindergartner Drinks Non-Diet Soda

None 60.8 61.0 58.1 64.1

A Few Times 29.9 29.4 32.9 29.4

Once a Day 6.8 7.1 6.3 5.1

More Than Once a Day 2.5 2.5 2.7 1.4

Number of Times Per Week the Kindergartner Drinks Diet Soda

None 87.5 87.8 85.7 88.6

A Few Times 10.1 9.8 11.5 9.5

Once a Day 2.0 2.0 2.4 1.6


Number of Times Per Week the Kindergartner Drinks Juice

None 10.0 10.3 8.7 9.5

A Few Times 43.8 43.3 45.1 45.4

Once a Day 26.3 26.1 26.8 26.8


Infancy Eating Habits at One Month

Breast Only 48.3 45.8 58.5 52.3

Breast and Formula 22.2 23.2 19.4 18.7

Formula Only 27.9 29.3 20.6 27.4

Other (e.g. food) 0.4 0.5 0.2 0.3

Not Sure 1.2 1.2 1.3 1.2

Infancy Eating Habits at Three Months

Breast Only 34.9 33.2 40.9 38.2


Formula Only 38.5 40.3 29.5 38.1

Other (e.g. food) 1.0 1.1 0.7 0.6

Not Sure 1.1 1.0 1.2 1.1






(Percent)

Clark

County (Percent)

Washoe

County (Percent)

Rural

Counties (Percent)

Infancy Eating Habits at Six Months

Breast Only 21.9 20.9 26.1 22.6


Formula Only 46.0 46.7 41.8 46.8

Other (e.g. food) 10.9 11.3 9.7 10.4

Not Sure 1.2 1.1 1.5 2.0

Infancy Eating Habits at Twelve Months

Breast Only 13.9 13.0 17.1 15.1


Formula Only 40.6 41.9 36.8 36.4

Other (e.g. food) 27.3 26.9 24.9 32.8

Not Sure 1.3 1.2 1.7 2.1

Average # Hours of Sleep Per

Night on Weekdays


10.41

(.83)

10.36

(.81)

10.65

(.86)

10.42

(.74)

Average # Hours of Sleep Per

Night on Weekends


10.59

(.96)

10.57

(.97)

10.67

(.95)

10.66

(.88)



APPENDIX B:

COMPARISON OF WEIGHTED SURVEY RESULTS BY YEAR Table 11.2 below outlines the percentages of responses from the most recent three school

year surveys (2012/2013 – 2014/2015). Please note that for each survey year, not all

respondents answered every question. All percentages calculated are based on the total

weighted number of people answering the question, rather than the total number of

people who completed a survey. In addition, the percentages for Table 11.2 represent

percentages by year; therefore for each response category, percentages will total 100%

within each year and not across all years.

Table 11.2: Comparison of 2012-2013 through 2014-2015 Weighted Data

2012-2013

(Year 5)

2013-

2014

(Year 6)

2014-2015

(Year 7)

Survey Indicator (Percent) (Percent) (Percent)

Survey Participation by School

District

Clark County 73.9 73.7 73.7

Washoe County 14.4 14.4 14.6

Rural Counties 11.7 11.9 11.8

Demographic Information Gender of Kindergartener Male 50.7 50.9 49.9

Female 49.3 49.1 50.1

Race/Ethnicity of Kindergartener

African American/Black 6.2 6.9 6.3

Asian/Pacific Islander 6.7 6.6 6.5

Caucasian 38.1 36.8 38.3

Hispanic 33.2 33.4 33.7

Native American/Alaska

Native 0.9 1.4 1.1

Other Race 0.8 0.8 0.1

Multiple Races 14.0 14.1 14.1

APPENDIX B: WEIGHTED SURVEY RESULTS BY SURVEY YEAR



Table 11.2 Continued

2012-2013

(Year 5)

2013-2014

(Year 6)

2014-2015

(Year 7)


Annual Household Income of

Survey Respondent $0-$14,999 18.1 18.0 17.3

$15,000-$24,999 15.6 15.4 15.9

$25,000-$34,999 12.9 12.6 13.1

$35,000-$44,999 9.3 9.6 8.7

$45,000-$54,000 8.0 7.6 7.5

$55,000-$64,999 6.3 6.7 6.3

$65,000-$74,999 6.1 6.1 5.7

$75,000-$84,999 6.0 5.5 5.8

$85,000-94,999 4.0 4.0 3.9

$95,000 + 13.7 14.4 15.8

Type of School Child Attended in

the Past 12 Months

Head Start 5.8 6.6 5.8

Other Facility/Care 24.7 21.9 22.6

Home-Based 6.6 5.8 5.1

University Campus Pre

School 1.2 1.1 0.9

School District Preschool 19.2 21.8 24.2

None/Stayed at Home 40 35.9 33.5

Friends/Family Care - 2.8 3.1

Multiple 2.4 4 4.7

Average Preschool Hours of

Attendance

0 Hours - 31.6 31.8

5-10 Hours - 17.7 17.7

10-15 Hours - 15.3 14.4

15-20 Hours - 8.9 8.6

20-30 Hours - 7.5 8.4

30-40 Hours - 11 11.5

More than 40 Hours - 8 7.6 Note: - Indicates no data available





2012-2013

(Year 5)

2013-2014

(Year 6)

2014-2015

(Year 7)


Single Parent or Guardian 29.5 31.2 29.9

Average # of Children in

Household (Standard Deviation) 2.54 (1.2)

2.55

(1.22) 2.53 (1.20)

Average # of Adults in Household

(Standard Deviation) 2.08 (0.81)

2.09

(0.79) 2.12 (0.86)

Average Age of Mother/Guardian


32.92

(6.75)

33.10

(6.94)

Average Age of Father/Guardian


35.56

(7.51)

35.93

(7.67)

Health Insurance Status and Access to Health Care

Health Insurance Type

Uninsured 13.6 12.6 7.6

Private 47.6 50.0 48.4

Medicaid 23.5 25.9 31.3

Nevada Check-Up 6.3 6.5 6.7

Other 6.4 2.1 2.8

Multiple Types 2.6 2.9 3.1

Kindergartner Does Not Have a

Primary Care Provider 16.6 13.6 13.6

Types of Barriers Experienced

When Trying to Access

Healthcare

Lack of Transportation 3.0 3.4 3.4

Lack of Insurance 10.3 10.1 7.3

Lack of Quality Medical

Providers 4.9 5.2 5.1

Lack of Money/Financial

Resources 14.6 13.8 10.4

Other Barriers 2.3 2.1 1.9

Respondent Has Experienced

Difficulties Attempting to Access

Mental Health Services for

Kindergartener

33.0 35.9 31.8

Knows how to access support

services - 43.1 44.0

Note: - Indicates no data available





2012-2013

(Year 5)

2013-2014

(Year 6)

2014-2015

(Year 7)


Annual Household Income of Uninsured Kindergarteners $0-$14,999 18.2 14.1 23.1

$15,000-$24,999 21.6 20 20.0

$25,000-$34,999 20.5 19 19.8

$35,000-$44,999 16.4 15.7 8.5

$45,000-$54,999 11.7 11.2 11.6

$55,000-$64,999 7.2 11.5 5.6

$65,000-$74,999 4.2 5.1 3.1

$75,000-$84,999 4.2 6.2 3.8

$85,000-94,999 3.0 1.6 1.4

$95,000 + 1.7 2.8 3.2

Race/Ethnicity of Uninsured Kindergarteners African American/Black 5.6 5.7 4.8

Asian/Pacific Islander 7.9 5.7 3.9

Caucasian 24.8 25.3 28.3

Hispanic 49.8 50.3 47.2

Native American/Alaska

Native 0.8

1.6 0.6

Other Race 0.4 0.5 0.1

Multiple Races 10.8 10.8 15.0

Routine Care and Health Status of

Kindergartener Kindergartener Has NOT Had

Routine Check-Up In Past Year 13.4 14.1 13.0

Kindergartener Has NOT Visited

Dentist in Past Year 25.8 26.0 25.2





2012-

2013

(Year 5)

2013-2014

(Year 6)

2014-2015

(Year 7)


Amount of Times the Kindergartener

Has Gone to the ER for a Non-Life-

Threatening Illness or Injury in the

Past 12 Months

None (0) 80.6 80.0 19.3

1 to 2 17.9 18.3 1.5

3 to 5 1.4 1.5 0.1

6 to 9 0.1 0.2 0.1

10 or More 0.1 0.1 Types of Medical Conditions Seen in Kindergarteners ADD/ADHD 1.4 1.3 1.3

Allergies - 15.1 15.5

Asthma 8.1 7.9 6.9

Autism 0.4 0.6 0.5

Cancer 0.0 0.1 0.1

Diabetes 0.2 0.1 0.1

Glasses/Contacts 3.5 5.1 4.7

Hearing Aid/Impairment 0.3 0.3 0.4

Mental Health Condition 0.3 0.4 0.4

Physical Disability 0.3 0.4 0.4

Seizures 0.5 0.6 0.4

Other Condition 6.6 5.2 4.7

Received a Developmental Screening

in past 12 months - 22.5 23.2

Weight and Healthy Behaviors Kindergartener's Weight Status

Underweight 15.7 15.1 16.1

Healthy Weight 55 55.0 52.4

Overweight 11.1 9.9 9.8

Obese 18.2 20.0 21.7 Note: - Indicates no data available





2012-2013

(Year 5)

2013-2014

(Year 6)

2014-2015

(Year 7)


Times A Week Kindergartner Does at Last 30min of Physical Activity

0-1 Times 2.8 2.5 2.4

2-3 Times 17.7 17.1 17.6

4-5 Times 27.7 27.2 28.6

6 or More Times 51.8 53.3 51.4

Hours of Television Watched on an Average School Day

None 1.8 2.0 2.1

Less than One 11.8 12.1 12.5

1 Hour 28.8 29.2 30.0

2 Hours 36.8 36.2 34.6

3 Hours 15.1 14.4 14.8

4 Hours 3.6 4.2 4.1

5 Hours or More 2.0 2.0 1.8

Hours of Video or Computer Games Played on an Average School Day

None 35.1 31.7 30.0

Less than One 29.3 29.0 27.5

1 Hour 24.1 25.2 26.5

2 Hours 8.6 10.3 10.8

3 Hours 1.8 2.8 3.4

4 Hours 0.7 0.7 1.1

5 Hours or More 0.4 0.4 0.7

Number of Times Per Week the Kindergartner Drinks Non-Diet Soda

None 55.6 59.6 60.8

A Few Times 33.8 30.7 29.9

Once a Day 6.9 6.8 6.8

More Than Once a Day 3.7 2.9 2.5





2012-2013

(Year 5)

2013-2014

(Year 6)

2014-2015

(Year 7)


Number of Times Per Week the Kindergartner Drinks Diet Soda

None 82.9 85.7 87.5

A Few Times 14.2 11.3 10.1

Once a Day 2.5 2.4 2.0

More Than Once a Day 0.4 0.5 0.4

Number of Times Per Week the Kindergartner Drinks Juice

None - 8.6 10.0

A Few Times - 40.1 43.8

Once a Day - 27.7 26.3

More Than Once a Day - 23.5 19.9

Infancy Eating Habits at One Month

Breast Only 45.5 46.1 48.3

Breast and Formula 21.8 22.6 22.2

Formula Only 30.6 29.6 27.9

Other (e.g. food) 0.5 0.4 0.4

Not Sure 1.5 1.3 1.2

Infancy Eating Habits at Three Months

Breast Only 32.4 33.3 34.9



Other (e.g. food) 0.7 0.7 1.0

Not Sure 1.3 1.0 1.1

Infancy Eating Habits at Six Months

Breast Only 22.0 23.1 21.9



Other (e.g. food) 7.4 6.4 10.9

Not Sure 1.5 1.3 1.2 Note: - Indicates no data available



APPENDIX C: SURVEY INSTRUMENT



APPENDIX D: REFERENCES American Academy of Pediatric Dentistry. (2014). Frequently asked question. Retrieved from

http://www.aapd.org/resources/frequently_asked_questions/#36

Annie E Casey Foundation. (2013). 2013 Data Book: State Trends of Child Well-Being. Retrieved from

http://datacenter.kidscount.org/files/2013kidscountdatabook.pdf

Baker, B. L., Neece, C. L., Fenning, R. M., Crnic, K. A., & Blacher, J. (2010). Mental Disorders in Five Year Old

Children With or Without Developmental Delay: Focus on ADHD. Journal of Clinical Child and

Adolescent Psychology : The Official Journal for the Society of Clinical Child and Adolescent Psychology,

American Psychological Association, Division 53, 39(4), 492–505. doi:10.1080/15374416.2010.486321

Basch, C.E. (2010). Healthier Students are Better Learners: A Missing Link in Efforts to Close the Achievement

Gap. Retrieved from http://www.equitycampaign.org/i/a/document/12557_EquityMattersVol6_Web

03082010. Pdf

Centers for Disease Control and Prevention. (2000). Clinical Growth Charts: Children 2 to 20 years. Retrieved from

http://www.cdc.gov/growthcharts/clinical_charts.htm

Centers for Disease Control and Prevention. (2011a). About BMI for Children and Teens. Retrieved from

http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html#What is BMI

percentile

Centers for Disease Control and Prevention. (2011b). Body Mass for Age Tables. Retrieved from

http://www.cdc.gov/growthcharts/html_charts/bmiagerev.htm

Centers for Disease Control and Prevention. (2013). Youth Risk Behavior Surveillance System: 2013 National

Overview. Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf

Centers for Disease Control and Prevention. (2014a). Breastfeeding Report Card – United States, 2014. Retrieved

from http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf

Centers for Disease Control and Prevention. (2014b). Developmental Monitory and Screening. Retrieved

from www.cdc.gov/ncbddd/childevelopment/screening.html

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