Health Status of Children Entering Kindergarten in Nevada Results of the

Health Status of Children Entering
Kindergarten in Nevada
Results of the
2014-2015
(Year 7)
Nevada
Kindergarten
Health Survey
June 2015
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
The Nevada Institute for Children's Research and Policy (NICRP) is a not-for-profit, nonpartisan 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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 2
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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 3
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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 4
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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 5
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
Healthy
Overweight/Obese
15.1%
55.0%
29.9%
16.14%
52.4%
31.5%
+6.9%
-4.7%
+5.4%
19.6%
20.0%
+2.0%
20.6%
20.7%
+0.5%
3.9%
5.2%
+33.3%
59.6%
6.8%
60.8%
6.8%
+2.0%
0.0%
85.7%
2.4%
87.5%
2.0%
+2.1%
-16.7%
46.1%
33.3%
23.1%
-
48.3%
34.9%
21.9%
13.9%
+4.8%
+4.8%
-5.2%
-
Physical Activity
< 3 days per week of 30-minutes of physical activity
Television Viewing on School Days
3 hrs or more of television watched per school day
Computer/Video Game Play on School Days
≥ 3 hr of computer/video games played per school day
Consumption of Non-Diet Soda
Never drink non-diet soda
Drink non-diet soda once a day or more
Consumption of Diet Soda
Never drink diet soda
Drink diet soda once a day or more
Infant Feeding Behaviors
Breastfed Only – One Month
Breastfed Only – Three Months
Breastfed Only – Six Months
Breastfed Only – Twelve Months
-
Note. *Green arrows = positive change, red arrows = negative change, and yellow arrows = no change (< +.5%).
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 6
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
Less than $45,000 per year
$45,000 or more per year
33.4%
55.6%
44.3%
33.2%
55.0%
45.0%
-0.6%
-0.6%
+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
Private Insurance
Medicaid
Nevada Check-up
12.6%
50.0%
25.9%
6.5%
7.6%
48.4%
31.3%
6.7%
-39.7%
-3.2%
+20.8%
+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
Have a primary care provider
Have been to the dentist in past 12 months
85.9%
86.4%
74.0%
87.0%
86.4%
74.8%
*
+1.3%
0.0%
+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
Lack of Transportation
Lack of Insurance
Lack of Quality Medical Providers
Lack of Money/Financial Resources
Have tried to access mental health services
Had trouble obtaining mental health services
72.1%
3.4%
10.1%
5.2%
13.8%
4.2%
35.9%
79.4%
3.4%
7.3%
5.1%
10.4%
4.4%
31.8%
+7.6%
0.0%
-27.7%
-1.9%
-24.6%
+4.8%
-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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 7
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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 8
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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 9
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 10
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 20142015 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
Carson City
665
281
Churchill County
350
98
Clark County
15,522
3,480
Douglas County
400
186
Elko County
600
445
Esmeralda County
20
4
Eureka County
28
6
Humboldt County
330
135
Lander County
100
52
Lincoln County
69
25
Lyon County
800
230
Mineral County
60
20
Nye County
379
143
Pershing County
60
8
Storey County
30
13
Washoe County
4,960
2,314
White Pine County
85
40
All Districts
24,458
7,480
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
Response Rate
42.3
28.0
22.4
46.5
74.2
20.0
21.4
40.9
52.0
36.2
28.8
33.3
37.7
13.3
43.3
46.7
47.1
30.6
April 2015
Page 11
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
Survey
Unaudited
# Surveys
Unaudited Enrollment
Distribution
School District
Enrollment
Sent Out
Response Rate
Response Rate
Carson City
665
42.3%
635
44.3%
Churchill County
350
28.0%
265
37.0%
Clark County
15,522
22.4%
14,210
24.5%
Douglas County
400
46.5%
400
46.5%
Elko County
600
74.2%
818
54.4%
Esmeralda County
20
20.0%
7
57.1%
Eureka County
28
21.4%
25
24.0%
Humboldt County
330
40.9%
272
49.6%
Lander County
100
52.0%
101
51.5%
Lincoln County
69
36.2%
61
41.0%
Lyon County
800
28.8%
604
38.1%
Mineral County
60
33.3%
46
43.5%
Nye County
379
37.7%
369
38.8%
Pershing County
60
13.3%
47
17.0%
Storey County
30
43.3%
26
50.0%
Washoe County
4,960
46.7%
4,692
49.3%
White Pine County
85
47.1%
112
35.7%
All Districts
24,458
30.6%
22,690
33.0%
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 12
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 1.1: Survey Participation by School District
(2014-2015 n = 7,480 )
30.9%
Clark County
Washoe County
22.5%
Rural Counties
46.5%
Figure 1.2 illustrates county-specific participation for only rural counties, which combined,
represents 22.4 percent of the total respondents.
Figure 1.2: Survey Response Rate Among All Rural Counties
(2014-2015 n =1,686 )
30.0%
26.4%
25.0%
20.0%
16.7%
13.6%
15.0%
11.0%
8.0%
10.0%
8.5%
5.8%
5.0%
0.0%
3.1%
0.2% 0.4%
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
1.5%
1.2%
2.4%
0.5% 0.8%
April 2015
Page 13
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.
Figure 2.1: Weighted Survey Data by School District
(2014-2015 n = 32,163 )
73.6%
14.6%
Clark County
Washoe County
11.8%
Rural Counties
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).
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 14
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.
Figure 2.2: Annual Household Income by School Year
(2012-2013 n = 27,451; 2013-2014 n = 28,124; 2014-2015 n= 27,461 )
20.0
% of Respondents
15.0
10.0
5.0
0.0
$0$14,999
2012-2013
2013-2014
2014-2015
18.1
18.0
17.3
$15,000 $25,000 $35,000 $45,000 $55,000 $65,000 $75,000 $85,000
$95,000
+
$24,999 $34,999 $44,999 $54,000 $64,999 $74,999 $84,999 $94,999
15.6
12.9
9.3
8.0
6.3
6.1
6.0
4.0
13.7
15.5
12.6
9.6
7.6
6.7
6.1
5.5
4.0
14.4
15.9
13.1
8.7
7.5
6.3
5.7
5.8
3.9
15.8
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 15
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.
Figure 2.3: Child's Race/Ethnicity
(2014-2015 n = 31,310)
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
African
American
/Black
Survey Sample
Nevada DOE*
6.3%
9.9%
Native
Asian/
American
Pacific Caucasian Hispanic
/ Alaska
Islander
Native
6.5%
38.3%
33.7%
1.1%
6.9%
36.0%
40.6%
1.1%
Race/Ethnicity
Other
Race
Multiple
Races
0.1%
14.1%
5.6%
Note. * Nevada Department of Education 2013-2014 Demographic Profile
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 16
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).
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 )
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2012-2013
2013-2014
2014-2015
Head
Start
Other
Facility/
Care
HomeBased
Care
5.8%
6.6%
5.8%
24.7%
21.9%
22.6%
6.6%
5.8%
5.1%
University
Campus
PreSchool
1.2%
1.1%
0.9%
School
District
PreSchool
19.2%
21.8%
24.2%
None/
Stayed
Home
Multiple
Sites
40.0%
35.9%
33.5%
2.4%
4.0%
4.7%
Friends/
Family/
Neighbor
Care
2.8%
3.1%
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 17
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
31.8%
5-10 HRS
17.7%
10-15 HRS
14.4%
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
15-20 HRS
8.6%
20-30 HRS
8.4%
30-40 HRS
11.5%
40+ HRS
7.6%
April 2015
Page 18
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.
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 )
80.0%
70.0%
% of Respondents
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2012-2013
2013-2014
2014-2015
Uninsured
Private
Medicaid
13.6%
12.6%
7.6%
47.6%
50.0%
48.4%
23.5%
25.9%
31.3%
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
Nevada
Check Up
6.3%
6.5%
6.7%
Other
6.4%
2.1%
2.8%
Multiple
Types
2.6%
2.9%
3.2%
April 2015
Page 19
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 20142015 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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 20
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.
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 )
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
$15,000
$24,999
Uninsured 23.1% 20.0%
Insured
16.7% 15.5%
$0 $14,999
$25,000
$34,999
19.8%
12.5%
$35,000
$44,999
8.5%
8.8%
$45,000
$54,999
11.6%
7.2%
$55,000
$64,999
5.6%
6.4%
$65,000
$74,999
3.1%
5.9%
$75,000
$84,999
3.8%
6.0%
$85,000
$95,000
Total
+
$94,999
1.4%
3.2% 100%
4.1% 16.9% 100%
Household Income
Note. Percentages are calculated out of the number within each insurance category. Percentages may not add up to
100 due to rounding.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 21
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.
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)
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Uninsured
Insured
Total % of
Respondents
African
American/
Black
Asian/
Pacific
Islander
Caucasian
Hispanic
4.8%
6.3%
3.9%
6.7%
28.3%
39.2%
47.2%
32.5%
Native
American/
Alaska
Native
0.6%
1.1%
6.2%
6.5%
38.4%
33.6%
1.1%
Other
Race
Multiple
Races
Total
0.1%
0.1%
15.0%
14.1%
100%
100%
0.1%
14.2%
100%
Race/Ethnicity
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).
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 22
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.
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 )
14.6%
13.8%
15.0%
10.4%
10.3%
10.1%
10.0%
7.3%
5.2%
5.1%
4.9%
5.0%
3.0%
3.4% 3.4%
2.3%
2.1% 1.9%
0.0%
2012-2013
Barriers
.
2013-2014
2014-2015
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 23
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.
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
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Yes
Somewhat / Not Really
No
Total
African
American
Asian /
Pacific
Islander
Caucasian
Hispanic
52.0%
22.8%
25.2%
100.0%
30.8%
29.4%
39.8%
100.0%
53.0%
26.7%
20.2%
100.0%
31.9%
28.3%
39.8%
100.0%
Native
American
/ Alaska
Native
58.4%
21.6%
20.1%
100.0%
Other
Race
Multiple
Races
39.1%
30.4%
30.4%
100.0%
49.5%
26.1%
24.4%
100.0%
Race/Ethnicity
Note. Percentages are calculated out of the number within each insurance category.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 24
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.
Figure 5.1: Child's Routine Check-Ups and Presence of
Primary Care Provider
90.0%
(2014-2015: Check-Up n = 31,441 ; Primary Care Provider n = 31,450)
87.0%
86.4%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
13.0%
13.6%
10.0%
0.0%
No
Yes
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?
Note. Percentages are calculated out of the number within each insurance category.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 25
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).
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)
100.0%
89.5%
90.0%
80.0%
70.0%
60.0%
50.0%
50.7%
49.3%
40.0%
30.0%
20.0%
10.5%
10.0%
0.0%
Uninsured
Insured
Insurance Status
PCP - No
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
PCP - Yes
April 2015
Page 26
ROUTINE CARE
Having a primary care provider is also related to whether or not a child has had a routine checkup 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.
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)
98.1%
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
53.3%
46.7%
40.0%
30.0%
20.0%
8.2%
10.0%
0.0%
Routine Check-Up - No
Routine Check-Up - Yes
Presence of PCP
PCP - No
PCP - Yes
Note. Percentages are calculated out of the number within each PCP category.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 27
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-lifethreatening 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).
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)
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2012-2013
2013-2014
2014-2015
No Visits
1-2 Visits
3-5 Visits
6-9 Visits
80.6%
80.0%
79.0%
17.9%
18.3%
19.3%
1.4%
1.5%
1.5%
0.1%
0.2%
0.1%
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
10 or More
Visits
0.1%
0.1%
0.1%
Total
100.0%
100.0%
100.0%
April 2015
Page 28
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.
Figure 6.2: Percentage of Emergency Room Visits for NonLife-Threatening Care by Child's Insurance Status
(2014-2015: Uninsured n = 2,392 ; Insured n = 29,089 ; Total n = 31,481 )
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Uninsured
Insured
No Visits
1-2 Visits
3-5 Visits
6-9 Visits
86.7%
78.3%
12.0%
20.0%
1.4%
1.5%
0.0%
0.1%
10 or More
Visits
0.0%
0.1%
Total
100%
100%
Number of Visits.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 29
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.
Figure 7.1: Types of Medical Conditions in Children
(2012-2013 n = 30,599; 2013-2014 n = 32,969; 2014-2015 n= 29,765)
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
2012-2013
1.4%
8.1%
0.4%
0.0%
0.2%
3.5%
0.3%
0.3%
Physical
Disabilit
y
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%
ADD/
ADHD
Allergy
Asthma
Autism
Cancer
Diabetes
Glasses/ Hearing Mental
Contacts Impaired Health
Other
Seizures
No
Medical
Note. Blank cells indicate data is not available. Respondents can select multiple categories therefore the total percent
within each year might exceed 100%.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 30
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.
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)
Percent of Respondents
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Yes
No
Not Sure
Total
African
American
Asian / Pacific
Islander
Caucasian
Hispanic
28.1%
48.0%
23.9%
100.0%
17.6%
59.0%
23.4%
100.0%
27.5%
49.1%
23.5%
100.0%
18.7%
55.9%
25.4%
100.0%
Native
American /
Alaska Native
20.2%
45.5%
34.2%
100.0%
Note. Percentages may not add up to 100 due to rounding.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 31
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).
Figure 8.1: Child's Dental Visit
(2012-2013 n = 32,772; 2013-2014 n = 31,224; 2014-2015 n= 29,289)
80.0%
74.2%
74.0%
74.8%
70.0%
60.0%
50.0%
40.0%
30.0%
25.8%
26.0%
25.2%
20.0%
10.0%
0.0%
No
2012-2013
Yes
2013-2014
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
2014-2015
April 2015
Page 32
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.
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 )
70.0%
60.0%
50.0%
40.0%
34.5%
33.6%
31.8%
30.0%
20.0%
22.0%
10.0%
0.0%
Yes
Trouble Obtaining Mental Health Service
Clark County
Washoe County
Rural County
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
Statewide
April 2015
Page 33
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
Underweight
Healthy Weight
Overweight
Obese
BMI Percentile Range
BMI less than the 5th percentile
BMI from the 5th percentile to less than the 85th percentile
BMI from the 85th percentile to less than the 95th percentile
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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 34
WEIGHT AND HEALTHY BEHAVIORS
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
4.0
4.5
5.0
5.5
6.0
Weight Status Category
Underweight
Healthy Weight
0 < BMI < 13.725
13.725 <= BMI < 16.808
0 < BMI < 13.614
13.614 <= BMI < 16.760
0 < BMI < 13.527
13.527 <= BMI < 16.796
0 < BMI < 13.465
13.465 <= BMI < 16.906
0 < BMI < 13.428
13.428 <= BMI < 17.083
Overweight
16.808 <= BMI < 18.028
16.760 <= BMI < 18.084
16.796 <= BMI < 18.240
16.906 <= BMI < 18.486
17.083 <= BMI < 18.808
Obese
BMI >= 18.028
BMI >= 18.084
BMI >= 18.240
BMI >= 18.486
BMI >= 18.808
Weight Status Category
Underweight
Healthy Weight
0 < BMI < 14.043
14.043 <= BMI < 16.935
0 < BMI < 13.932
13.932 <= BMI < 16.852
0 < BMI < 13.845
13.845 <= BMI < 16.839
0 < BMI < 13.781
13.781 <= BMI < 16.891
0 < BMI < 13.739
13.739 <= BMI < 17.003
Overweight
16.935 <= BMI < 17.842
16.852 <= BMI < 17.829
16.839 <= BMI < 17.927
16.891 <= BMI < 18.118
17.003 <= BMI < 18.389
Obese
BMI >= 17.842
BMI >= 17.829
BMI >= 17.927
BMI >= 18.118
BMI >= 18.389
Males
Age
4.0
4.5
5.0
5.5
6.0
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 35
WEIGHT AND HEALTHY BEHAVIORS
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.
Figure 10.1: Child's Weight Status Category
(2012-2013 n = 13,284; 2013-2014 n = 607; 2014-2015 n= 12,077 )
60.0%
55.0%
52.4%
50.0%
49.4%
40.0%
30.0%
20.0%
10.0%
21.7%
19.0%
16.9%
15.7%
14.7%
16.1%
11.1%
18.2%
9.8%
0.0%
Underweight
Healthy Weight
2012-2013
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
Overweight
2013-2014
Obese
2014-2015
April 2015
Page 36
WEIGHT AND HEALTHY BEHAVIORS
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.
Figure 10.2: Race/Ethnicity of Participants with a
Valid Body Mass Index
(2014-2015: Valid BMI & Valid Race n = 11,876)
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
African
Asian/
American/ Pacific
Black
Islander
% w/Valid BMI
% Total Sample
5.7%
6.3%
6.3%
6.5%
Native
American/
Caucasian Hispanic
Alaska
Native
51.0%
20.9%
0.6%
38.3%
33.7%
1.1%
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
Other
Race
Multiple
Races
Total
0.1%
0.1%
15.3%
14.1%
100%
100%
April 2015
Page 37
WEIGHT AND HEALTHY BEHAVIORS
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.
Figure 10.3: Child's Weight Status Category by
Child's Race/Ethnicity
(2014-2015 n = 11,844 )
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Underweight
Healthy Weight
Overweight
Obese
Total
*Total % Valid BMI
African
American/
Black
Asian/
Pacific
Islander
Caucasian
Hispanic
29.9%
39.6%
4.5%
26.0%
100%
5.7%
20.0%
45.4%
13.5%
21.0%
100%
6.3%
14.0%
60.0%
9.2%
16.8%
100%
51.0%
17.4%
42.6%
11.1%
28.9%
100%
20.9%
Native
American/
Alaska
Native
5.6%
50.0%
15.3%
29.2%
100%
0.6%
Multiple
Races
15.0%
48.2%
9.5%
27.4%
100%
15.1%
Race/Ethnicity
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%).
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 38
WEIGHT AND HEALTHY BEHAVIORS
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.
Figure 10.4: Child's Weight Status Category by Amount of
Physical Activity Per Week
(2014-2015 n = 11,441 )
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Underweight
Healthy Weight
Overweight
Obese
Total
*Total % Valid BMI
0-1 Times Per
Week
20.7%
46.3%
5.5%
27.4%
100%
1.0%
2-3 Times Per
Week
17.6%
46.0%
12.9%
23.5%
100%
14.0%
4-5 Times Per
Week
17.0%
49.5%
11.1%
22.4%
100%
27.0%
6-7 Times Per
Week
15.6%
55.0%
8.6%
20.9%
100%
58.0%
Amount of Physical Activity
Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each category for the
amount of physical activity.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 39
WEIGHT AND HEALTHY BEHAVIORS
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)
Between 1hr
4 hours or
Total %
& 4 hrs
more
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.
None
1 hour or less
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 40
WEIGHT AND HEALTHY BEHAVIORS
Figure 10.5: Child's Weight Status Category by Hours of
Television Watched on Average School Day
(2014-2015 n = 10,971 )
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
None
Underweight
Healthy
Overweight
Obese
*Total % Valid BMI
12.7%
65.3%
7.7%
14.3%
2.4%
Less than 1
1 Hr a Day
Hr a Day
16.7%
15.5%
59.6%
55.6%
6.1%
11.5%
17.7%
17.4%
14.9%
33.0%
2 Hrs a
Day
16.9%
45.6%
10.9%
26.7%
32.3%
3 Hrs a
Day
19.6%
44.3%
9.4%
26.7%
12.7%
4 Hrs a
Day
13.1%
58.8%
10.6%
17.4%
3.6%
5+ Hrs a
Day
15.6%
40.6%
3.1%
40.6%
1.2%
Hours of Television Watched
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 20112012 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%).
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 41
WEIGHT AND HEALTHY BEHAVIORS
Figure 10.6: Child's Weight Status Category by
Hours of Video Game Playing on Average School Day
(2014-2015 n = 11,142 )
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
None
Underweight
Healthy
Overweight
Obese
Total
*Total % Valid BMI
16.7%
55.3%
9.2%
18.9%
100%
27.8%
Less than 1 Hour a
Day
14.5%
53.7%
9.4%
22.4%
100%
30.9%
1 Hour a Day
2 + Hours a Day
17.6%
48.2%
10.4%
23.8%
100%
26.2%
17.4%
47.8%
11.2%
23.6%
100%
15.1%
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 42
WEIGHT AND HEALTHY BEHAVIORS
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.
Figure 10.7: Child's Weight Status Category by Number of
Non-Diet Sodas Consumed in a Week
(2014-2015 n = 11,211)
60.0%
Percent of Respondents
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Underweight
Healthy
Overweight
Obese
Total
*Total % Valid BMI
None
A Few Times
One a Day
14.8%
55.5%
9.6%
20.1%
100%
67.3%
19.4%
47.4%
9.1%
24.1%
100%
27.0%
20.0%
36.3%
16.3%
27.5%
100%
4.2%
More than One
a Day
17.5%
55.6%
6.4%
20.5%
100%
1.5%
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.
Results indicate that:
 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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 43
WEIGHT AND HEALTHY BEHAVIORS
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.
Figure 10.8: Child's Weight Status Category by Number of
Diet Sodas Consumed in a Week
(2014-2015 n = 11,177)
60.0%
Percent of Respondents
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Underweight
Healthy
Overweight
Obese
Total
*Total % Valid BMI
None
A Few Times
One a Day
16.4%
53.5%
9.5%
20.7%
100%
88.6%
15.1%
42.5%
13.5%
28.9%
100%
9.6%
21.3%
39.1%
13.0%
26.6%
100%
1.5%
More than One a
Day
0.0%
69.0%
0.0%
31.0%
100%
0.3%
Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicity category.
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 44
WEIGHT AND HEALTHY BEHAVIORS
Results indicate that:
 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.
Figure 10.9: Child's Weight Status Category by Number of
Juice Drinks Consumed in a Week
(2014-2015 n = 11,277)
60.0%
Percent of Respondents
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Underweight
Healthy
Overweight
Obese
Total
*Total % Valid BMI
None
A Few Times
One a Day
13.7%
62.7%
10.6%
13.0%
100%
11.6%
15.9%
53.2%
9.1%
21.8%
100%
43.5%
18.7%
48.7%
9.0%
23.6%
100%
27.0%
More than One a
Day
15.1%
47.9%
12.0%
25.0%
100%
17.9%
Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicity category.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 45
WEIGHT AND HEALTHY BEHAVIORS
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 20122013. 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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 46
WEIGHT AND HEALTHY BEHAVIORS
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 )
60.0%
Percent of Respondents
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Breast Only
1 Month
3 Months
6 Months
12 Months
48.3%
34.9%
21.9%
13.9%
Breast and
Formula
22.2%
24.5%
19.9%
16.9%
Formula Only
27.9%
38.5%
46.0%
40.6%
Other (e.g.
Food)
0.4%
1.0%
10.9%
27.3%
Not Sure
1.2%
1.1%
1.3%
1.3%
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 47
WEIGHT AND HEALTHY BEHAVIORS
Figure 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)
70.0%
Percent of Respondents
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Underweight
Healthy
Overweight
Obese
Total
% Valid BMI
1M
17.6%
56.0%
10.7%
15.7%
100%
38.5%
3M
6M
Breast Only
16.0% 15.1%
59.8% 62.1%
9.0% 10.2%
15.2% 12.5%
100% 100%
27.9% 13.9%
12M
17.0%
55.8%
10.0%
17.2%
100%
20.5%
1M
3M
6M
12M
Breast & Formula
11.7% 17.1% 21.7% 18.1%
53.8% 48.9% 48.4% 46.2%
8.6% 12.7% 9.8% 11.2%
25.9% 21.3% 20.1% 24.6%
100% 100% 100% 100%
32.3% 18.7% 10.9% 22.1%
1M
15.0%
50.5%
10.4%
24.1%
100%
36.8%
3M
6M
Formula Only
14.3% 15.0%
53.7% 52.9%
8.6% 8.3%
23.4% 23.8%
100% 100%
28.0% 26.7%
12M
18.3%
50.6%
8.8%
22.3%
100%
57.4%
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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 48
WEIGHT AND HEALTHY BEHAVIORS
Table 10. 4 Average Sleep per Night for the State of Nevada
n
Average
Average Weekday Per Night
31,456
10.41
Average Weekend Per Night
28,494
10.59
Standard Deviation
(.82)
(.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.
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 49
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
Survey Participation
State
(Percents)
--
Demographic Information
Gender of Kindergartener
Male
49.9
Female
50.1
Race/Ethnicity of Kindergartener
African American/Black
6.3
Asian/Pacific Islander
6.5
Caucasian
38.3
Hispanic
33.7
Native American/ Alaska
1.1
Native
Other Race
0.1
Multiple Races
14.1
Annual Household Income of Survey Respondents
$0-$14,999
17.3
$15,000-$24,999
15.9
$25,000-$34,999
13.1
$35,000-$44,999
8.7
$45,000-$54,999
7.5
$55,000-$64,999
6.3
$65,000-$74,999
5.7
$75,000-$84,999
5.8
$85,000-$94,999
3.9
$95,000+
15.8
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
Clark
County
Washoe
County
Rural
Counties
(Percents)
(Percents)
(Percents)
73.6
14.6
11.8
49.9
50.1
49.5
50.5
50.4
49.6
7.9
7.7
33.8
35.0
2.6
4.6
42.4
36.9
0.5
1.1
61.2
21.4
0.4
1.9
4.4
0.1
15.1
0.0
11.5
0.2
11.2
17.7
15.5
12.9
8.3
7.5
6.2
5.8
5.9
3.8
16.4
16.8
18.8
15.2
9.8
7.4
5.3
4.9
5.1
3.9
12.9
14.9
14.6
11.3
10.0
7.9
8.5
5.8
6.1
4.9
15.9
April 2015
Page 50
APPENDIX A: WEIGHTED 2014-2015 SURVEY RESULTS BY COUNTY
Table 11.1 continued
Survey Indicator
State
(Percents)
Clark
County
Washoe
County
Rural
Counties
(Percents)
(Percents)
(Percents)
8.5
22.0
3.7
20.9
10.2
25.2
4.9
23.4
0.5
4.2
35.8
2.9
5.7
23.2
3.7
5.2
35.5
12.1
13.8
10.4
8.4
13.1
6.7
30.6
2.55
(1.20)
2.12
(0.85)
32.62
(6.81)
35.53
(7.47)
23.6
20.3
22.9
12.9
6.2
9.9
4.2
25.6
2.52
(1.10)
2.01
(0.63)
32.55
(7.21)
34.94
(7.97)
6.7
44.3
35.4
7.6
2.3
3.7
7.7
53.1
28.2
4.2
3.0
3.8
13.8
19.1
Type of School Child Attended in the Past 12 Months
Head Start
5.8
4.9
Other Facility/Center
22.6
22.4
Home-Based
5.1
5.4
School District Preschool
24.2
24.9
University Campus
0.9
0.7
Preschool
None/Stayed at Home
33.5
34.0
Friends/Family Care
3.1
3.1
Multiple
4.7
4.5
Average Preschool Hours of Attendance
0 Hours
31.8
31.9
5-10 Hours
17.7
18.6
10-15 Hours
14.4
13.7
15-20 Hours
8.6
7.8
8.4
8.6
20-30 Hours
30-40 Hours
11.5
11.4
More than 40 Hours
7.6
8.1
Single Parent or Guardian
29.9
30.5
Average # of Children in
2.53
2.53
Household (Standard Deviation)
(1.20)
(1.21)
Average # of Adults in Household
2.12
2.14
(Standard Deviation)
(0.86)
(0.88)
Average Age of Mother/Guardian
33.10
33.29
(Standard Deviation)
(6.94)
(6.91)
Average Age of Father/Guardian
35.93
36.17
(Standard Deviation)
(7.67)
(7.65)
Health Insurance Status and Access to Health Care
Health Insurance Type
Uninsured
7.6
7.8
Private
48.4
48.5
Medicaid
31.3
30.9
Nevada Check-up
6.7
7.0
Other
2.8
2.9
Multiple Types
3.1
2.9
Kindergartner Does NOT Have a
13.6
12.6
Primary Care Provider
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 51
APPENDIX A: WEIGHTED 2014-2015 SURVEY RESULTS BY COUNTY
Table 11.1 continued
Survey Indicator
State
(Percents)
Clark
County
Washoe
County
Rural
Counties
(Percents)
(Percents)
(Percents)
Types of Barriers Experienced When Trying to Access Healthcare
Lack of Transportation
3.4
3.7
2.0
Lack of Insurance
7.3
7.4
6.5
Lack of Quality Medical
5.1
4.5
4.3
Providers
Lack of Money/Financial
10.4
10.4
8.5
Resources
Other Barriers
1.9
1.6
1.8
Difficulties Accessing Mental
31.8
33.6
22.0
Health Services for Kindergartener
Know how to access support
44.0
40.7
50.8
services
Applied for insurance for self using
11.6
11.5
11.6
Nevada Health Link
Applied for insurance for child
19.2
18.8
21.6
using Nevada Health Link
Routine Care and Health of Kindergartner
Has Not Had Routine Check-Up
13.0
12.4
13.5
Has Not Visited a Dentist in the
25.2
26.5
18.5
Last Year
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
1 to 2
19.3
18.5
20.2
3 to 5
1.5
1.4
2.0
6 to 9
0.1
0.0
0.2
10 or More
0.1
0.0
0.1
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
3.0
7.2
10.1
12.5
3.5
34.5
26.7
11.7
18.8
16.5
24.9
74.6
23.2
1.8
0.3
0.1
April 2015
Page 52
APPENDIX A: WEIGHTED 2014-2015 SURVEY RESULTS BY COUNTY
Table 11.1 continued
Survey Indicator
State
(Percent)
Clark
County
Washoe
County
Rural
Counties
(Percent)
(Percent)
(Percent)
1.3
11.4
5.5
0.6
0.2
0.2
4.6
0.2
0.2
0.5
0.6
5.2
2.1
17.5
7.7
0.7
0.0
0.2
6.2
0.2
0.8
0.5
0.8
5.0
24.6
30.2
Types of Medical Conditions Seen in Kindergarteners
ADD/ADHD
1.3
1.1
Allergies
15.5
15.9
Asthma
6.9
7.1
Autism
0.5
0.5
Cancer
0.1
0.1
Diabetes
0.1
0.1
Glasses/Contacts
4.7
4.5
Hearing Aid/Impairment
0.4
0.4
Mental Health Condition
0.4
0.3
Physical Disability
0.4
0.3
Seizures
0.4
0.2
Other Condition
4.7
4.6
Received a Developmental
Screening in past 12 months
Weight and Healthy Behaviors
23.2
21.8
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
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 53
APPENDIX A: WEIGHTED 2014-2015 SURVEY RESULTS BY COUNTY
Table 11.1 continued
Survey Indicator
State
(Percent)
Clark
County
Washoe
County
Rural
Counties
(Percent)
(Percent)
(Percent)
Hours of Video or Computer Games Played on an Average School Day
None
30.0
28.7
32.3
Less than One
27.5
27.4
24.9
1 Hour
26.5
27.8
24.6
2 Hours
10.8
10.9
11.7
3 Hours
3.4
3.4
4.5
4 Hours
1.1
1.1
1.4
5 Hours or More
0.7
0.8
0.6
Number of Times Per Week the Kindergartner Drinks Non-Diet Soda
None
60.8
61.0
58.1
A Few Times
29.9
29.4
32.9
Once a Day
6.8
7.1
6.3
More Than Once a Day
2.5
2.5
2.7
Number of Times Per Week the Kindergartner Drinks Diet Soda
None
87.5
87.8
85.7
A Few Times
10.1
9.8
11.5
Once a Day
2.0
2.0
2.4
More Than Once a Day
0.4
0.5
0.3
Number of Times Per Week the Kindergartner Drinks Juice
None
10.0
10.3
8.7
A Few Times
43.8
43.3
45.1
Once a Day
26.3
26.1
26.8
More Than Once a Day
19.9
20.2
19.4
Infancy Eating Habits at One Month
Breast Only
48.3
45.8
58.5
Breast and Formula
22.2
23.2
19.4
Formula Only
27.9
29.3
20.6
Other (e.g. food)
0.4
0.5
0.2
Not Sure
1.2
1.2
1.3
Infancy Eating Habits at Three Months
Breast Only
34.9
33.2
40.9
Breast and Formula
24.5
24.3
27.8
Formula Only
38.5
40.3
29.5
Other (e.g. food)
1.0
1.1
0.7
Not Sure
1.1
1.0
1.2
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
38.6
33.6
17.9
7.4
1.6
0.6
0.3
64.1
29.4
5.1
1.4
88.6
9.5
1.6
0.3
9.5
45.4
26.8
18.3
52.3
18.7
27.4
0.3
1.2
38.2
22.0
38.1
0.6
1.1
April 2015
Page 54
APPENDIX A: WEIGHTED 2014-2015 SURVEY RESULTS BY COUNTY
Table 11.1 continued
Survey Indicator
State
(Percent)
Clark
County
Washoe
County
Rural
Counties
(Percent)
(Percent)
(Percent)
26.1
20.9
41.8
9.7
1.5
22.6
18.2
46.8
10.4
2.0
17.1
19.5
36.8
24.9
1.7
15.1
13.2
36.4
32.8
2.1
10.65
(.86)
10.42
(.74)
10.67
(.95)
10.66
(.88)
Infancy Eating Habits at Six Months
Breast Only
21.9
20.9
Breast and Formula
19.9
20.0
Formula Only
46.0
46.7
Other (e.g. food)
10.9
11.3
Not Sure
1.2
1.1
Infancy Eating Habits at Twelve Months
Breast Only
13.9
13.0
Breast and Formula
16.9
17.0
Formula Only
40.6
41.9
Other (e.g. food)
27.3
26.9
Not Sure
1.3
1.2
Average # Hours of Sleep Per
Night on Weekdays
10.41
10.36
(Standard Deviation)
(.83)
(.81)
Average # Hours of Sleep Per
Night on Weekends
10.59
10.57
(Standard Deviation)
(.96)
(.97)
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 55
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
20132012-2013
2014
2014-2015
(Year 5)
(Year 6)
(Year 7)
Survey Indicator
(Percent)
(Percent) (Percent)
Survey Participation by School
District
Clark County
Washoe County
Rural Counties
Demographic Information
Gender of Kindergartener
Male
Female
Race/Ethnicity of Kindergartener
African American/Black
Asian/Pacific Islander
Caucasian
Hispanic
Native American/Alaska
Native
Other Race
Multiple Races
73.9
14.4
11.7
73.7
14.4
11.9
73.7
14.6
11.8
50.7
49.3
50.9
49.1
49.9
50.1
6.2
6.7
38.1
33.2
6.9
6.6
36.8
33.4
6.3
6.5
38.3
33.7
0.9
1.4
1.1
0.8
14.0
0.8
14.1
0.1
14.1
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 56
APPENDIX B: WEIGHTED SURVEY RESULTS BY SURVEY YEAR
Table 11.2 Continued
Survey Indicator
Annual Household Income of
Survey Respondent
$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 +
Type of School Child Attended in
the Past 12 Months
Head Start
Other Facility/Care
Home-Based
University Campus Pre
School
School District Preschool
None/Stayed at Home
Friends/Family Care
Multiple
Average Preschool Hours of
Attendance
0 Hours
5-10 Hours
10-15 Hours
15-20 Hours
20-30 Hours
30-40 Hours
More than 40 Hours
2012-2013
(Year 5)
(Percent)
2013-2014 2014-2015
(Year 6)
(Year 7)
(Percent) (Percent)
18.1
15.6
12.9
9.3
8.0
6.3
6.1
6.0
4.0
13.7
18.0
15.4
12.6
9.6
7.6
6.7
6.1
5.5
4.0
14.4
17.3
15.9
13.1
8.7
7.5
6.3
5.7
5.8
3.9
15.8
5.8
24.7
6.6
6.6
21.9
5.8
5.8
22.6
5.1
1.2
19.2
40
2.4
1.1
21.8
35.9
2.8
4
24.2
33.5
3.1
4.7
-
31.6
17.7
15.3
8.9
7.5
11
8
31.8
17.7
14.4
8.6
8.4
11.5
7.6
-
0.9
Note: - Indicates no data available
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 57
APPENDIX B: WEIGHTED SURVEY RESULTS BY SURVEY YEAR
Table 11.2 Continued
Survey Indicator
Single Parent or Guardian
Average # of Children in
Household (Standard Deviation)
Average # of Adults in Household
(Standard Deviation)
Average Age of Mother/Guardian
(Standard Deviation)
Average Age of Father/Guardian
(Standard Deviation)
2012-2013
(Year 5)
(Percent)
29.5
2.54 (1.2)
2.08 (0.81)
33.02 (6.69)
35.7 (7.3)
Health Insurance Status and Access to Health Care
Health Insurance Type
Uninsured
13.6
Private
47.6
Medicaid
23.5
Nevada Check-Up
6.3
Other
6.4
Multiple Types
2.6
Kindergartner Does Not Have a
16.6
Primary Care Provider
Types of Barriers Experienced
When Trying to Access
Healthcare
Lack of Transportation
3.0
Lack of Insurance
10.3
Lack of Quality Medical
4.9
Providers
Lack of Money/Financial
14.6
Resources
Other Barriers
2.3
Respondent Has Experienced
Difficulties Attempting to Access
Mental Health Services for
Kindergartener
Knows how to access support
services
2013-2014 2014-2015
(Year 6)
(Year 7)
(Percent) (Percent)
31.2
29.9
2.55
2.53 (1.20)
(1.22)
2.09
2.12 (0.86)
(0.79)
32.92
33.10
(6.75)
(6.94)
35.56
35.93
(7.51)
(7.67)
12.6
50.0
25.9
6.5
2.1
2.9
7.6
48.4
31.3
6.7
2.8
3.1
13.6
13.6
3.4
10.1
3.4
7.3
5.2
5.1
13.8
10.4
2.1
1.9
33.0
35.9
31.8
-
43.1
44.0
Note: - Indicates no data available
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 58
APPENDIX B: WEIGHTED SURVEY RESULTS BY SURVEY YEAR
Table 11.2 Continued
2012-2013
2013-2014 2014-2015
(Year 5)
(Year 6)
(Year 7)
Survey Indicator
(Percent)
(Percent) (Percent)
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
0.8
Native
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
13.4
14.1
13.0
Routine Check-Up In Past Year
Kindergartener Has NOT Visited
25.8
26.0
25.2
Dentist in Past Year
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 59
APPENDIX B: WEIGHTED SURVEY RESULTS BY SURVEY YEAR
Table 11.2 Continued
Survey Indicator
20122013-2014 2014-2015
2013
(Year 6)
(Year 7)
(Year 5)
(Percent) (Percent) (Percent)
Amount of Times the Kindergartener
Has Gone to the ER for a Non-LifeThreatening Illness or Injury in the
Past 12 Months
None (0)
80.6
1 to 2
17.9
3 to 5
1.4
6 to 9
0.1
10 or More
0.1
Types of Medical Conditions Seen in Kindergarteners
ADD/ADHD
1.4
Allergies
Asthma
8.1
Autism
0.4
Cancer
0.0
Diabetes
0.2
Glasses/Contacts
3.5
Hearing Aid/Impairment
0.3
Mental Health Condition
0.3
Physical Disability
0.3
Seizures
0.5
Other Condition
6.6
Received a Developmental Screening
in past 12 months
Weight and Healthy Behaviors
Kindergartener's Weight Status
Underweight
15.7
Healthy Weight
55
Overweight
11.1
Obese
18.2
80.0
18.3
1.5
0.2
0.1
19.3
1.5
0.1
0.1
1.3
15.1
7.9
0.6
0.1
0.1
5.1
0.3
0.4
0.4
0.6
5.2
1.3
15.5
6.9
0.5
0.1
0.1
4.7
0.4
0.4
0.4
0.4
4.7
22.5
23.2
15.1
55.0
9.9
20.0
16.1
52.4
9.8
21.7
Note: - Indicates no data available
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 60
APPENDIX B: WEIGHTED SURVEY RESULTS BY SURVEY YEAR
Table 11.2 Continued
Survey Indicator
2012-2013
(Year 5)
(Percent)
2013-2014 2014-2015
(Year 6)
(Year 7)
(Percent) (Percent)
Times A Week Kindergartner Does at Last 30min of Physical Activity
2.5
0-1 Times
2.8
17.1
2-3 Times
17.7
4-5 Times
27.7
27.2
53.3
6 or More Times
51.8
2.4
17.6
28.6
51.4
Hours of Television Watched on an Average School Day
None
1.8
Less than One
11.8
1 Hour
28.8
2 Hours
36.8
3 Hours
15.1
4 Hours
3.6
5 Hours or More
2.0
2.1
12.5
30.0
34.6
14.8
4.1
1.8
2.0
12.1
29.2
36.2
14.4
4.2
2.0
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
A Few Times
33.8
30.7
Once a Day
6.9
6.8
More Than Once a Day
3.7
2.9
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
60.8
29.9
6.8
2.5
April 2015
Page 61
APPENDIX B: WEIGHTED SURVEY RESULTS BY SURVEY YEAR
Table 11.2 Continued
Survey Indicator
2012-2013
(Year 5)
(Percent)
2013-2014 2014-2015
(Year 6)
(Year 7)
(Percent) (Percent)
Number of Times Per Week the Kindergartner Drinks Diet Soda
None
82.9
85.7
A Few Times
14.2
11.3
Once a Day
2.5
2.4
More Than Once a Day
0.4
0.5
Number of Times Per Week the Kindergartner Drinks Juice
None
8.6
A Few Times
40.1
Once a Day
27.7
More Than Once a Day
23.5
Infancy Eating Habits at One Month
Breast Only
Breast and Formula
Formula Only
Other (e.g. food)
Not Sure
Infancy Eating Habits at Three Months
Breast Only
Breast and Formula
Formula Only
Other (e.g. food)
Not Sure
Infancy Eating Habits at Six Months
Breast Only
Breast and Formula
Formula Only
Other (e.g. food)
Not Sure
87.5
10.1
2.0
0.4
10.0
43.8
26.3
19.9
45.5
21.8
30.6
0.5
1.5
46.1
22.6
29.6
0.4
1.3
48.3
22.2
27.9
0.4
1.2
32.4
24.7
40.9
0.7
1.3
33.3
23.6
41.3
0.7
1.0
34.9
24.5
38.5
1.0
1.1
22.0
22.3
46.8
7.4
1.5
23.1
22.7
46.5
6.4
1.3
21.9
19.9
46.0
10.9
1.2
Note: - Indicates no data available
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2015
Page 62
APPENDIX C: SURVEY INSTRUMENT
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2014
Page 63
APPENDIX C: SURVEY INSTRUMENT
Nevada Institute for Children’s Research and Policy, UNLV
Results of the 2013-2014 Nevada Kindergarten Health Survey
April 2014
Page 64
APPENDIX D: REFERENCES
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Results of the 2014-2015 Nevada Kindergarten Health Survey
April 2014
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APPENDIX D: REFERENCES
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