Health Status of Children Entering Kindergarten in Nevada
Results of the 2015-2016 (Year 8)
Nevada Kindergarten Health Survey
May 2016
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, non- partisan organization dedicated to advancing children's issues in Nevada.
As a research center within the UNLV School of Community Health Sciences, NICRP is dedicated to improving the lives of children through research, advocacy, and other specialized services.
NICRP's History: NICRP started in 1998 based on a vision of First Lady Sandy Miller. She wanted an organization that could bring credible research and rigorous policy analysis to problems that confront Nevada's children. But she didn't want to stop there; she wanted to transform that research into meaningful legislation that would make a real difference in the lives of our children.
NICRP's Mission: The Nevada Institute for Children's Research and Policy (NICRP) looks out for Nevada's children. Our mission is to conduct community-based research that will guide the development of programs and services for Nevada's children. For more information regarding NICRP research and services, please visit our website at: http://www.nic.unlv.edu
NICRP Staff Contributors:
Amanda Haboush-Deloye, Ph.D. Associate Director
Patricia Haddad, B.A. Research Assistant
Yaretsi Arroyo, B.S. Research Assistant
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 May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 2
TABLE OF CONTENTS
Executive Summary ...... 6
Introduction ...... 8 Methodology ...... 9 Limitations to the Study ...... 10
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 2015-2016 Survey Results by County ...... 51
Appendix B: Comparison of Survey Results by Survey Year ...... 57
Appendix C: Survey Instrument ...... 64
Appendix D: References ...... 66
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 ...... 41 Table 10.4: Average Sleep per Night for the State of Nevada ...... 50 Table 11.1: Comparison of 2015-2016 Weighted Data by County ...... 51 Table 11.2: Comparison of 2013-2014 through 2015-2016 Weighted Data ...... 57
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 ...... 40 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 May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 ...... 46 Figure 10.10: Infancy Feeding Habits ...... 48 Figure 10.11: Child’s Weight Status Category by Infancy Feeding Habits ...... 49
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 2015, 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 24.2 percent, with a total of 5,736 surveys received from parents in 15 school districts in Nevada. The data were weighted so that the survey data collected represent each district and all children in the state (32,151). Weighted data are presented throughout this report to compare Clark County (73.2 percent), Washoe County (15.4 percent) and the rural counties combined (11.4 percent). Comparison to previous years are also included. 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 negative 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 a slight increase in obesity, inactivity, and video game play/computer play, but also a slight reduction in soda drinking. There was also an increase in the percent of parents reporting feeding their infant breast milk only at one and three months, but a decrease at 12 months. 2014-2015 2015-2016 % Change * Weight Status Underweight 16.14% 15.5% -4.0% Healthy 52.4% 52.5% +0.2% Overweight/Obese 31.5% 32.0% +1.6% Physical Activity < 3 days per week of 30-minutes of physical activity 20.0% 21.6% +8.0% Television Viewing on School Days 3 hrs or more of television watched per school day 20.7% 16.2% -21.7% Computer/Video Game Play on School Days ≥ 3 hr of computer/video games played per school day 5.2% 5.4% +3.8% Consumption of Non-Diet Soda Never drink non-diet soda 60.8% 61.6% +1.3% Drink non-diet soda once a day or more 6.8% 5.9% -13.2% Consumption of Diet Soda Never drink diet soda 87.5% 86.7 -0.9% Drink diet soda once a day or more 2.0% 2.0% 0.0% Infant Feeding Behaviors Breastfed Only – One Month 48.3% 47.1% -2.5% Breastfed Only – Three Months 34.9% 33.6% -3.7%
Breastfed Only – Six Months 21.9% 21.5% -1.8% Breastfed Only – Twelve Months 13.9% 10.3% -25.9% Note. *Green arrows = positive change, red arrows = negative change, and yellow arrows = no change (< +.5%).
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 6
EXECUTIVE SUMMARY
Household Income: There are dramatic differences in this data from last year. Compared to last year, there is a substantial decrease in household income of less than $25,000 per year. 2014-2015 2015-2016 % Change * Household Income Less than $25,000 per year 33.2% 20.1% -39.5% Less than $45,000 per year 55.0% 40.3% -26.7% $45,000 or more per year 45.0% 59.8% +32.9% Note. *Green arrows = positive change, red arrows = negative change, and yellow arrows = no change (< +.5%).
Insurance Status: The percentage of uninsured children decreased from last year. Coverage under Nevada Check-up continues to increase at a greater rate than enrollment in private insurance. Coverage under private insurance slightly increased. 2014-2015 2015-2016 % Change * Insurance Status Uninsured 7.6% 6.4% -15.8% Private Insurance 48.4% 49.8% +2.9% Medicaid 31.3% 31.3% 0.0% Nevada Check-up 6.7% 7.8% +16.4% 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 and having a primary care provider slightly increased and visiting the dentist remained consistent. 2014-2015 2015-2016 % Change * Routine Care Had a routine medical checkup in last 12 months 87.0% 89.6% +2.98% Have a primary care provider 86.4% 87.6% +1.4% Have been to the dentist in past 12 months 74.8% 74.4% -0.5% Note. * Green arrows = positive change, red arrows = negative change, and yellow arrows = no change (< +.5%).
Access to Health Care: Compared to last year, slightly fewer respondents this year indicated that they had barriers to accessing health care. For those that reported having barriers, there were increases in barriers due to lack of insurance and lack of money, and a larger increase in barriers due to lack of quality medical providers. The percentage of respondents trying to access mental health care increased over the past year. 2013-2014 2014-2015 % Change * Barriers to Accessing Health Care** None 79.4% 78.1% -1.6% Lack of Transportation 3.4% 3.4% 0.0% Lack of Insurance 7.3% 7.4% +1.4% Lack of Quality Medical Providers 5.1% 6.5% +27.5% Lack of Money/Financial Resources 10.4% 11.8% +13.5% Have tried to access mental health services 4.4% 5.3% +20.5% Had trouble obtaining mental health services 31.8% 32.1% +0.9% Note: *Green arrows = positive change, red arrows = negative change, and yellow arrows = no change (< +.5%). **Since respondents could select more than one barrier, totals may add up to more than 100%.
For more detailed information on all survey items, please see Appendix B of the full report. Data for specific counties and/or schools may also be available upon request. Please contact NICRP at (702) 895-1040 for additional information.
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INTRODUCTION
Academic achievement for children is vital to their success in life. Those that do well in 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, while health insurance is only one piece of increasing access to health services, children with 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.
The most recent data from the KIDS COUNT Data Center indicate that 9 percent of Nevada’s teens (ages 16-19) are not in school and are not working, compared to 7 percent nationally. In addition, the percent of Nevada students graduating on time is 33 percent, compared to 18 percent nationally (KIDS COUNT Data Center, 2016). 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 careers. 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 eighth year of the Annual Kindergarten Health Survey.
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 8
INTRODUCTION
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 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 eight years. The current version of the survey consists of 31 questions (13 demographic questions and 18 questions related to health and early childhood environments) and, like the original survey, is available in both English and Spanish.
In the fall of 2015, 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. When conducting the randomized sample, a representative random sample of both Title I eligible and non-Title I eligible schools were 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 161 of the 215 elementary schools in the district (75%) were Title I eligible schools. One hundred and four schools (75 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 35 schools (25 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 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 previous years, this year extra measures were taken to ensure that all schools had received their surveys. In Clark County’s surveys were hand delivered by NICRP staff. This was done in part because approval to conduct the surveys was delayed in Clark County and was not obtained until late September. Delivering them by hand was done to ensure schools received the surveys and understood the process. For the other districts in the state, 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. It was difficult to determine 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, additional phone calls were made in mid-October to schools from which we had not received any surveys. During these phone calls we attempted to verify if the
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INTRODUCTION 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 schools to distribute the surveys or just to send in surveys that had been collected.
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 February 8, 2016 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 population of kindergarten students as of count day for each survey year listed in this report. Therefore, the responses received from the 5,736 respondents represents a total of 32,151 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 the 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 2014 (making them 6 years old in 2015 and eligible for kindergarten, which was approximately 39,219 children) (Nevada State Demographer, 2014) and the number of children enrolled on count day (34,495) (Nevada Department of Education, 2015), it appears approximately 12 percent of children do not attend kindergarten. Finally, given the significant delay in sending out the surveys in Clark County this year, the response rate was much lower compared to past years. It is anticipated that without this delay the response rate would have been similar to last year.
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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. Percentage calculations are presented with figures as appropriate. In addition, the 2015-2016 data were compared across counties (Clark, Washoe, rural counties combined) for the current data collection period, with data from the previous two years in the text, and three years in the Appendix B 11.2. 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 2015-2016 school year. Based on these estimates, 23,751 surveys were sent out to participating schools. At the end of the data collection period (February 2016), 5,736 surveys were returned to NICRP for a response rate of 24.2 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%, 2014-2015 = 30.6%) has declined. This year, there was a 6.4 percent point decrease 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 the 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 24.2% response rate is still sufficient to make generalizations about our state. Response rates for each school district (Table 1.1) ranged from 0% in Esmeralda and Pershing County to 55.3% in Mineral County.
Table 1.1 Survey Response Rate by School District School District # Surveys Sent Out # Surveys Returned Response Rate Carson City 609 237 38.9% Churchill County 200 91 45.5% Clark County 15,203 2,222 14.6% Douglas County 450 193 42.9% Elko County 725 299 41.2% Esmeralda County 9 0 0.0% Eureka County 30 11 36.7% Humboldt County 305 151 49.5% Lander County 100 33 33.0% Lincoln County 65 16 24.6% Lyon County 750 323 43.1% Mineral County 47 26 55.3% Nye County 480 166 34.6% Pershing County 45 0 0.0% Storey County 24 6 25.0% Washoe County 4,609 1,914 41.5% White Pine County 100 48 48.0% All Districts 23,751 5,736 24.2% Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 0% and 6%. However, for Lyon County the response rate differed by 12% with the unaudited enrollment response rate being higher than the survey distribution response rate. This indicates that Lyon County overestimated their enrollment. For the 2015-2016 school year Esmeralda and Pershing County had complications with surveys which led to no surveys being returned from either county.
Despite the differences, the overall response rate for the unaudited enrollment response rate and the survey distribution response rate only slightly differ. 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 distributed Response Rate Response Rate Carson City 591 609 40.1% 38.9% Churchill County 228 200 39.9% 45.5% Clark County* 14,125 15,203 15.7% 14.6% Douglas County 411 450 46.9% 42.9% Elko County 838 725 35.7% 41.2% Esmeralda County 11 9 0.0% 0.0% Eureka County 30 30 36.7% 36.7% Humboldt County 289 305 52.2% 49.5% Lander County 99 100 33.3% 33.0% Lincoln County 62 65 25.8% 24.6% Lyon County 579 750 55.8% 43.1% Mineral County 52 47 50.0% 55.3% Nye County 356 480 46.6% 34.6% Pershing County 47 45 0.0% 0.0% Storey County 22 24 27.3% 25.0% Washoe County 4,956 4,609 38.6% 41.5% White Pine County 96 100 50.0% 48.0% All Districts 22,792 23,751 25.2% 24.2% *This is 60% of the total enrollment of 23,542 due to the sampling procedures used in Clark County.
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 12
RESPONSE RATES
Survey Participation by School District
Figure 1.1 illustrates the participation of Washoe, Clark, and all rural counties combined. A total of 5,736 surveys were returned with 38.7% of those surveys completed by parents in Clark County, 33.4% from Washoe County, and the remaining 27.9% from the rural counties. This year, Clark County had a much lower response rate compared to last year (46.5%) and all rural counties had an increased response rate (22.5%). It is unknown why Clark County’s rates decreased so substantially.
Figure 1.1: Survey Participation by School District (2015-2016 n = 5,736 ) 33.4%
Clark County 27.9% Washoe County Rural Counties 38.7%
Figure 1.2 illustrates county-specific participation for only rural counties which, combined, represents 27.9 percent of the total respondents.
Figure 1.2: Survey Response Rate Among All Rural Counties (2015-2016 n = 5,736 ) 30.0%
25.0% 20.2% 20.0% 18.7% 14.8% 15.0% 12.1% 9.4% 10.4% 10.0% 5.7% 5.0% 3.0% 2.1% 0.7% 1.0% 1.6% 0% 0% 0.4% 0.0%
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 5,736 respondents that returned the surveys, 84.6 percent completed the English version and 15.4 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 5,736 respondents represents a total of 32,151 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 (2015-2016 n = 32,151 )
73.2% 15.4%
Clark County Washoe County 11.4% 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 (49.7 percent) and females (50.3 percent). These results are consistent with survey results from the past two years.
Family Demographics The average age of the child’s mother was 33.20 (SD = 6.923) and the average age of the father was 35.81 (SD = 8.010). The average number of adults living in a house was 2.10 (SD = 0.795) and ranged from 0 to 8. The number of children living in a house averaged 2.53 (SD = 1.197) and ranged from 0 to 12. Approximately 29.1 percent of parents indicated that they were a single parent or guardian. The percentage of single parents in Clark County and Washoe County are the same, but higher than the percentage of single parents in the rural counties (27.6%) (see Appendix A, Table 11.1).
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DEMOGRAPHICS
Annual Household Income According to the U.S. Census Bureau, Small Area Income and Poverty Estimates (2015), the 2014 estimated median household income in Nevada was $51,487. 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, 54.1 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. There was also 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 2.9 percentage point increase the number of families earning $85,000-95,000.
Figure 2.2: Annual Household Income by School Year ( 2013-2014 n = 28,124; 2014-2015 n = 27,461; 2015-2016 n = 32,151 )
20.0
15.0
10.0 % of Respondents of %
5.0
0.0 $15,000 $25,000 $35,000 $45,000 $55,000 $65,000 $75,000 $85,000 $0- $95,000 ------$14,999 + $24,999 $34,999 $44,999 $54,000 $64,999 $74,999 $84,999 $94,999 2013-2014 18.0 15.5 12.6 9.6 7.6 6.7 6.1 5.5 4.0 14.4 2014-2015 17.3 15.9 13.1 8.7 7.5 6.3 5.7 5.8 3.9 15.8 2015-2016 15.4 15.5 13.4 9.8 7.5 6.3 6.2 5.2 5.1 15.7
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 demographic profiles for kindergarten students. This provides a more accurate comparison of race and ethnicity as it is restricted to kindergarten students rather than to all residents of in the state of Nevada. This is the first year that data has been obtained for students in kindergarten as previously it was for students in all grades in the state. 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 0-8.8% 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 and proportionally less African American children represented than reported by the Nevada DOE. 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 2013-2014 and in 2014-2015. When comparing results across counties for the 2015-2016 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 (2015-2016 n = 32,151) 50.0%
40.0%
30.0%
20.0%
10.0%
0.0% Native African Asian/ American Other Multiple American Pacific Caucasian Hispanic / Alaska Race Races /Black Islander Native 2015-2016 5.3% 6.0% 37.8% 34.3% 1.1% 0.8% 14.8% Nevada DOE* 10.6% 5.5% 33.1% 42.8% 0.9% 7.2% Race/Ethnicity
Note. * Nevada Department of Education (2015). 2015-2016 School Year student Counts as of 10.1.2015. Retrieved from http://www.doe.nv.gov/DataCenter/Enrollment/. Please note that the Nevada DOE does not include other race as a category.
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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.
Compared to 2014-2015 data: 31.7 percent of respondents indicated that their kindergartner had stayed at home in the prior year, which is a 1.8 percentage point decrease from last year. Attendance at school district preschool sites has steadily increased over the past two years.
When comparing the 2015-2016 data across counties (Table 11.1): A higher percentage of children attended Head Start in rural counties (8.2) and Washoe County (7.6) as compared to Clark County (5.5). A higher percentage of children attended school district run preschools in rural counties (34.1) as compared to Clark County (25.0) and Washoe (20.5). A higher percentage of children in Clark County (32.8) and Washoe County (32.0) did not attend preschool as compared to rural counties (23.9).
Figure 2.4: Child's Type of Preschool Setting During Last Twelve Months (2013-2014 n = 32,103; 2014-2015 n = 29,812; 2015-2016 n = 32,151 )
50.0% 40.0% 30.0% 20.0% 10.0% 0.0% University School Friends/ Other Home- None/ Campus District Multiple Family/ Head Start Facility/ Based Stayed Pre- Pre- Sites Neighbor Care Care Home School School Care 2013-2014 6.6% 21.9% 5.8% 1.1% 21.8% 35.9% 4.0% 2.8% 2014-2015 5.8% 22.6% 5.1% 0.9% 24.2% 33.5% 4.7% 3.1% 2015-2016 6.1% 23.3% 4.5% 0.9% 25.4% 31.7% 5.2% 3.0%
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. Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 17
DEMOGRAPHICS
Results from Table 2.1 indicate that almost more than three-quarters of parents/guardians have their child in someone else’s care 20 hours or less per week (77.9 percent) and only 3.3 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 (82.3) as compared to Clark (78.2) and Washoe (73.0) counties. A higher percentage of children were in care more than 20 hours a week in Washoe County (27.0) and Clark County 21(.8) compared to the rural counties (17.7).
Table 2.1 Average Preschool Hours of Attendance (n =32,151) 0 HRS 5-10 HRS 11-15 HRS 16-20 HRS 21-30 HRS 31-40 HRS 41+ HRS 35.0% 21.8% 13.9% 7.1% 7.1% 11.7% 3.3%
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 (2015a), approximately 6.0 percent of children under the age of 18 in the United States are uninsured compared to 9.6 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: Survey Responses Concerning Types of Health Insurance Covering Children by School Year (2013-2014 n = 32.595; 2014-2015; n= 27,309; 2015-2016 n = 32,151 ) 80.0%
70.0%
60.0%
50.0%
40.0%
30.0% % % Respondents of
20.0%
10.0%
0.0% Nevada Multiple Uninsured Private Medicaid Other Check Up Types 2013-2014 12.6% 50.0% 25.9% 6.5% 2.1% 2.9% 2014-2015 7.6% 48.4% 31.3% 6.7% 2.8% 3.2% 2015-2016 6.4% 49.8% 31.3% 7.8% 1.5% 3.3%
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 19
INSURANCE STATUS
Approximately 93.6 percent of respondents indicated that their child had some type of health insurance and 6.4 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 15.8% decrease in the number of uninsured children compared to last year.
Approximately 1.5 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, 3.3 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 (49.8%) of the respondents indicated that their kindergartner had private health insurance. Approximately 39.1% 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).
Over the past two years the uninsured rate in Nevada has significantly decreased. With this decline, there has been an increase in the number of children covered by public insurance, Medicaid or Nevada Check-Up. It is important to ensure the children covered by public insurance have equal access to quality care as insurance coverage does not always indicate access to care (Story et al., 2014). Large disparities in access of care still exist based on type of health insurance (Bisgaier & Rhodes, 2011; Crossman et al., 2014). Children with public insurance are still found to have less access to care compared to children with private insurance, particularly outpatient specialty care, because providers may be less likely to accept patient that have public insurance (Bisgaier & Rhodes, 2011).
A 2016 study conducted by the Nevada Institute for Children’s Research and Policy (NICRP) examined the perceived quality of care of parents for children in Nevada who had either public (250) or private (250) insurance. Preliminary results indicate that the preceptions of quality of care (healthcare services, personal doctor, and health plan) between thoses with private (8.30 out of 10) and public (9.02 out of 10) insurance are similar with publically insured individuals rating quality slightly higher, but overall ratings of satisfaction with healthcare services were positive. In addition, there were little differences when the data were examined by race, income, or by geographic region (rural compared to urban). Parents with both types of insurance also listed barriers to accessing quality care such as lack of specialist in Nevada, lack of providers (especially those that take Medicaid), and long wait times at the physicians office (Nevada Institute for Children’s Research and Policy, 2016). So while overall experiences are rates positively, there are still challenges to overcome in Nevada in order to increase access to quality care for all children.
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 20
INSURANCE STATUS
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 2015- 2016 survey was able to capture respondents’ participation in that program for their children. Results are as follows: 19.1% of the 30, 982 respondents indicated that they or someone else applied for their child. o 42.8% indicated that their child was approved. 13.5% of the 28,984 respondents indicated that they had applied for insurance for themselves. o Of those that applied for themselves, 31.8% indicated that they were approved.
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). 44.9 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, 29.9 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 2014-2015. 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 (2015-2016: Uninsured n = 2,043; Insured n = 29,861; Total n = 31,904 ) 30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0% $15,000 $25,000 $35,000 $45,000 $55,000 $65,000 $75,000 $85,000 $0 - $95,000 ------Total $14,999 + $24,999 $34,999 $44,999 $54,999 $64,999 $74,999 $84,999 $94,999 Uninsured 19.5% 25.4% 16.8% 10.2% 10.2% 5.7% 3.1% 2.2% 2.8% 4.0% 100.0% Insured 15.0% 14.9% 13.1% 9.9% 7.3% 6.3% 6.4% 5.4% 5.3% 16.6% 100.0% 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 May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 21
INSURANCE STATUS
Race/Ethnicity and Insurance Status Figure 3.3, detailing the relationship between race/ethnicity and insurance status, shows that more than half of children who are uninsured are Hispanic (52.8 percent) and almost a third are Caucasian (25.0 percent).
While data has been fairly consistent over the past 2 survey years (Appendix B), compared to the 2014-2015 school year: The percentage of uninsured children decreased for all racial groups with the exception of Asian/Pacific Islander children (6.9%). The percentage of uninsured Hispanic children decreased by 5.6%, 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 (2015-2016: Uninsured n = 2,020; Insured n = 29,498; Total n = 31,518 )
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% Native African Asian/ American/ Other Multiple American/ Pacific Caucasian Hispanic Total Alaska Race Races Black Islander Native Uninsured 2.9% 6.9% 25.0% 52.8% 1.4% 1.2% 9.8% 100.0% Insured 5.5% 5.8% 38.9% 32.8% 1.1% 0.7% 15.2% 100.0% Total % of Respondents 5.3% 5.9% 38.0% 34.1% 1.1% 0.8% 14.8% 100.0% 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 May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 22
ACCESS TO HEALTHCARE
Barriers to Accessing Healthcare When asked about accessing health care for their child, 21.9 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 (2013-2014 n = 31,583; 2014-2015 n= 30,855; 2015-2016 n =30,985)
15.0% 13.8% 11.8% 10.1% 10.4% 10.0% 7.3% 7.4% 6.4% 5.2% 5.1% 5.0% 3.4% 3.4% 3.4% 2.1% 1.9% 1.2%
0.0%
Barriers . 2013-2014 2014-2015 2015-2016
Of all respondents experiencing one or more barriers to accessing health care: 80.8% reported having health insurance (32.7% Private, 34.8% Medicaid, 7.6% Nevada Check Up, and 5.6% Other/Multiple); 57.2% had an annual household income of less than $35,000.
Barriers to accessing care were also examined in the 2016 study conducted by the Nevada Institute for Children’s Research and Policy (NICRP) mentioned previously. Preliminary results indicate that both parents who had public and private insurance experienced barriers accessing care. Of those who were privately insured and reported barriers (50.4%), many indicated that insurance cost, payouts, restrictions, and long wait times were barriers. Of those who were publicly insured and reported barriers (30.8%), the most common complaints were long wait times and refusal of services based on their insurance provider (Nevada Institute for Children’s Research and Policy, 2016).
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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, 30.4% reported that they did not know how to access support services (n =31,473) and 27.3% of respondents were somewhat aware of how to access support services. Respondents in Clark County (38.6 percent knew how to access services) were less sure of how to access services than those in Washoe County (51.6 percent knew how to access services) and rural counties (53.9 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 reported having less knowledge about accessing support services compared to the other groups.
Figure 4.2: Access to Support Services by Child's Race/Ethnicity (2015-2016: African American n = 676; Asian / Pacific Islander n = 665; Caucasian n = 6,236; Hispanic n = 3,010; Native American /Alaska Native n = 187; Other n = 147; Multiple Race n = 2,232
90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Native African Asian / Americ Caucasi Hispani Other Multipl Americ Pacific an / an c Race e Races an Islander Alaska Native Yes 41.5% 35.3% 52.6% 28.4% 55.8% 63.1% 48.7% Somewhat / Not Really 25.1% 21.7% 28.6% 28.5% 21.2% 19.3% 25.5% No 33.4% 43.0% 18.8% 43.1% 23.0% 17.6% 25.8% Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 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 May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 89.6 percent of kindergartners had at least one routine medical check-up in the twelve months prior to the date of the survey. Similarly, 87.6 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 (2 points) while the percentage of children who had a primary care provider remained the same. Figure 5.1: Child's Routine Check-Ups and Presence of Primary Care Provider (2015-2016: Check-Up n = 31,417; Primary Care Provider n = 30,982) 89.6% 87.6% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.4% 12.4% 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 May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 25
ROUTINE CARE
In the current sample, approximately 90.6 percent of children with health insurance have a primary care provider while only 45.7 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 (2015-2016: Uninsured n = 2,043; Insured n = 29,861; Total n = 31,904)
100.0% 90.6% 90.0% 80.0% 70.0% 60.0% 54.3% 50.0% 45.7% 40.0% 30.0% 20.0% 10.0% 9.4% 0.0% Uninsured Insured Insurance Status
PCP - No PCP - Yes
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 26
ROUTINE CARE
Having a primary care provider is also related to whether or not a child has had a routine check- up in the past 12 months (see Figure 5.3). Of the children that had a routine check-up, 91.8 percent had a primary care provider. Of the children that had not had a routine check-up in the last year, 46.5 percent did not have a primary care provider.
Figure 5.3: Child's Routine Check-Ups by Presence of Primary Care Provider (PCP) (2015-2016: No PCP n = 3,852; Has PCP n = 27,130; Total n = 30,982)
100.0% 91.8% 90.0% 80.0% 70.0%
60.0% 53.5% 50.0% 46.5% 40.0% 30.0% 20.0% 10.0% 8.2% 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 May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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-life- threatening conditions because that is the only place that they can get the care they need.
Approximately 21.2 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 (2013-2014 n = 32,575; 2014-2015 n = 31,725; 2015-2016 n = 32,151) 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 10 or More No Visits 1-2 Visits 3-5 Visits 6-9 Visits Total Visits 2013-2014 80.0% 18.3% 1.5% 0.2% 0.1% 100.0% 2014-2015 79.0% 19.3% 1.5% 0.1% 0.1% 100.0% 2015-2016 77.0% 21.2% 1.6% 0.1% 0.1% 100.0%
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 Non- Life-Threatening Care by Child's Insurance Status (2015-2016: Uninsured n = 2,043; Insured n = 29,861; Total n = 31,904 )
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% 10 or More No Visits 1-2 Visits 3-5 Visits 6-9 Visits Total Visits Uninsured 83.8% 15.7% 0.5% 0.0% 0.0% 100.0% Insured 76.5% 21.6% 1.7% 0.1% 0.1% 100.0% Number of Visits.
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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, 30.1 percent of parents indicated that their child had a medical condition (see Figure 7.1). 7.7 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 heart conditions, blood disorders, eczema, and other rare diseases and conditions.
Figure 7.1: Types of Medical Conditions in Children (2013-2014 n = 32,969; 2014-2015 n = 29,765; 2015-2016 n = 32,151)
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0% ADD/ Glasses/ Hearing Mental Physical No Allergy Asthma Autism Cancer Diabetes Other Seizures ADHD Contacts Impaired Health Disability Medical 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% 2015-2016 1.2% 16.5% 7.7% 1.0% 0.2% 0.1% 5.9% 0.4% 0.3% 0.5% 4.7% 0.8% 69.9%
Note. Respondents can select multiple categories therefore the total percent within each year might exceed 100%.
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 (Sawhill & Karpilow, 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.
Of all respondents who answered this question (n=31,175), 44.1 percent reported that their child did not have a developmental screening and 27.5% reported that they were unsure. When exploring differences among the counties, more respondents in the rural counties (36.3 percent) reported that their child had been screened as compared to Washoe County (35.8 percent) and Clark County (25.5 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 Asian/Pacific Islander reported the lowest screening rates.
Figure 7.2 Developmental Screening by Child's Race/Ethnicity (2015-2016: African American n = 443; Asian/Pacific Islander n = 342; Caucasian n = 3,489; Hispanic n = 2,980; Native American/Alaska Native n = 140; Other Race n = 244; Multiple Races n = 4,596) 60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% Native Asian / African American / Multiple Pacific Caucasian Hispanic Other Race American Alaska Races Islander Native Yes 27.2% 18.4% 29.6% 28.8% 41.8% 18.4% 28.8% No 51.1% 56.6% 43.4% 41.9% 31.3% 45.1% 44.0% Not Sure 21.8% 25.0% 27.0% 29.2% 26.9% 36.5% 27.2% Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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, 23.6 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 (2013-2014 n = 31,224; 2014-2015 n= 29,289; 2015-2016 n = 32,151)
76.4% 80.0% 74.0% 74.8% 70.0% 60.0% 50.0% 40.0% 30.0% 26.0% 25.2% 23.6% 20.0% 10.0% 0.0% No Yes
2013-2014 2014-2015 2015-2016
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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, Crnic & Blacher, 2010).
The survey results indicate that 5.3 percent of respondents have tried to access mental health services for their children, which was a slight increase from the 2013-2014 and 2014-2015 data. Of the respondents who have tried to access these services for their child: Of those that attempted to access services, 19.5 percent reported having trouble obtaining the services, a decrease from the previous survey year (32.1). 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 difficulties with insurance, conflicts with work schedules, and difficulties setting appointments. Distance to providers was also cited as a barrier.
Figure 9.1: Trouble Obtaining Mental Health Services by County (2015-2016 Tried to obtain Mental Health Services Clark n = 710; Washoe n = 192; Rural n = 144; Statewide n = 1,046 ) 90.0%
80.0% 80.3% 76.6% 67.9% 70.0% 63.8% 60.0%
50.0%
40.0% 36.2% 32.1% 30.0% 23.4% 20.0% 19.7%
10.0%
0.0% Yes No Trouble Obtaining Mental Health Service Clark County Washoe County Rural County Statewide
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey 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 12,308 (38.3 percent of the entire sample) with a valid BMI value.
Once BMI was calculated, each child in the sample was assigned a weight status category based on CDC standards, which uses a child’s age, gender, and BMI percentile. Table 10.1, below, outlines the BMI percentile ranges for each weight status category.
Table 10.1: Weight Status Categories by BMI Percentile Ranges
Weight Status Category BMI Percentile Range Underweight BMI less than the 5th percentile Healthy Weight BMI from the 5th percentile to less than the 85th percentile Overweight BMI from the 85th percentile to less than the 95th percentile Obese BMI equal to or greater than the 95th percentile Source: Centers for Disease Control and Prevention (2011a). About BMI for Children and Teens. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html#What is BMI percentile
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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 Weight Status Category Age Underweight Healthy Weight Overweight Obese 4.0 0 < BMI < 13.725 13.725 <= BMI < 16.808 16.808 <= BMI < 18.028 BMI >= 18.028 4.5 0 < BMI < 13.614 13.614 <= BMI < 16.760 16.760 <= BMI < 18.084 BMI >= 18.084 5.0 0 < BMI < 13.527 13.527 <= BMI < 16.796 16.796 <= BMI < 18.240 BMI >= 18.240 5.5 0 < BMI < 13.465 13.465 <= BMI < 16.906 16.906 <= BMI < 18.486 BMI >= 18.486 6.0 0 < BMI < 13.428 13.428 <= BMI < 17.083 17.083 <= BMI < 18.808 BMI >= 18.808
Males Weight Status Category Age Underweight Healthy Weight Overweight Obese 4.0 0 < BMI < 14.043 14.043 <= BMI < 16.935 16.935 <= BMI < 17.842 BMI >= 17.842 4.5 0 < BMI < 13.932 13.932 <= BMI < 16.852 16.852 <= BMI < 17.829 BMI >= 17.829 5.0 0 < BMI < 13.845 13.845 <= BMI < 16.839 16.839 <= BMI < 17.927 BMI >= 17.927 5.5 0 < BMI < 13.781 13.781 <= BMI < 16.891 16.891 <= BMI < 18.118 BMI >= 18.118 6.0 0 < BMI < 13.739 13.739 <= BMI < 17.003 17.003 <= BMI < 18.389 BMI >= 18.389 Source: Centers for Disease Control and Prevention (2011b). Body Mass for Age Tables. Retrieved from http://www.cdc.gov/growthcharts/html_charts/bmiagerev.htm
In the 2010-2011 report, specific validity criteria was established regarding age, height, and weight to calculate the most accurate BMI.
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WEIGHT AND HEALTHY BEHAVIORS
Based on the calculated BMI for this year’s sample, more than half (52.5%) of the children were categorized as being at a healthy weight, a rate consistent with the previous school year (see Figure 10.1). However, 15.5% of children were underweight; Washoe County (18.1%) had slightly higher percentages of underweight children as compared to the rural counties (16.1%) and Clark County (14.9%). 10.6% of children were overweight, and approximately one-fifth (21.4%) of the children were considered obese. o Clark County had the highest percentage of obese children (23.0%) as compared to rural counties (18.1) and Washoe County (16.4). Even though the percentage of obese children has declined, the percentage of overweight 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 ( 2013-2014 n = 607; 2014-2015 n = 12,077; 2015-2016 n = 12,308 ) 60.0%
50.0% 52.4%52.5% 49.4% 40.0%
30.0%
20.0% 21.7% 19.0% 21.4% 16.9% 15.5% 16.1% 14.7% 10.0% 10.6% 9.8%
0.0% Underweight Healthy Weight Overweight Obese 2013-2014 2014-2015 2015-2016
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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 34.3% of the total sample, only 19.9% 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 (2015-2016: Valid BMI & Valid Race n = 12,331; Total n = 32,151)
60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Native African Asian/ American/ Other Multiple American/ Pacific Caucasian Hispanic Total Alaska Race Races Black Islander Native % w/Valid 4.7% 6.0% 50.6% 19.9% 0.8% 0.6% 17.5% 100% BMI % Total 5.3% 6.0% 37.8% 34.3% 1.1% 0.8% 14.8% 100% Sample
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WEIGHT AND HEALTHY BEHAVIORS
As seen in Figure 10.3, the differences in BMI across racial/ethnic groups indicate that: The highest percentages of obese children were Native American/Alaska Native children (39.6 percent); however, this is based on a very small sample of Native American/Alaska Native children. African America/Black children (37.7%), Hispanic children (31.4%), Asian/Pacific Islander children (26.8%), and children categorized as Other (29.6%) all had obesity rates that were over 25%. Caucasian children had the lowest rates of obesity (13.9%).
Figure 10.3: Child's Weight Status Category by Child's Race/Ethnicity (2015-2016 n = 12,200 )
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% Native African Asian/ American/ Multiple American/ Pacific Caucasian Hispanic Other Race Alaska Races Black Islander Native Underweight 17.0% 23.2% 15.1% 12.0% 7.3% 36.6% 17.9% Healthy Weight 37.5% 40.4% 61.2% 43.6% 46.9% 33.8% 46.3% Overweight 7.8% 9.6% 9.8% 13.0% 6.3% 0.0% 10.9% Obese 37.7% 26.8% 13.9% 31.4% 39.6% 29.6% 24.9% Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% *Total % Valid BMI 4.7% 5.9% 50.7% 19.9% 0.8% 0.6% 0.6%
Race/Ethnicity
Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicity category.
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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 (48.6%) 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 (2.4%) with a valid BMI were reported to engage in physical activity 0-1 times a week, and 19.2% reported activity 2-3 times per week. These results are consistent with the findings from the 2013-2014 school year.
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WEIGHT AND HEALTHY BEHAVIORS
Figure 10.4: Child's Weight Status Category by Amount of Physical Activity Per Week (2015-2016 n = 12,309) 60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% 0-1 Times Per 2-3 Times Per 4-5 Times Per 6-7 Times Per Week Week Week Week Underweight 9.8% 15.6% 15.1% 15.9% Healthy Weight 35.9% 46.2% 50.5% 55.5% Overweight 26.8% 10.8% 12.8% 9.0% Obese 27.5% 27.3% 21.6% 19.6% Total 100.0% 100% 100% 100% *Total % Valid BMI 1.2% 14.5% 27.9% 56.4% 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.
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 (29.7%), followed by lack of time and/or a busy work schedule (23.9%), lack of a safe play space (11.0%), medical conditions (16.1%), and preference for electronic media (5.23%). 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.
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WEIGHT AND HEALTHY BEHAVIORS
Table 10.3 Average Television Watched During a Weekday (n=28,713) Between 1hr 4 hours or None 1 hour or less 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 2.5% 48.6% 44.7% 4.1% 100.0% Note. Nationwide/Nevada data source: NSCH, 2011/2012. Percentages may not add up to 100 due to rounding.
When comparing the number of hours a child watches television per day with his or her BMI, it appears that as TV viewing time increases, it is less likely that he/she will be of a healthy weight.
Figure 10.5: Child's Weight Status Category by Hours of Television Watched on Average School Day (2015-2016 n = 11,766) 70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% Less than 1 Hr a 2 Hrs a 3 Hrs a 4 Hrs a 5+ Hrs a None 1 Hr a Day Day Day Day Day Day Underweight 18.1% 15.8% 17.7% 14.0% 14.5% 11.0% 15.9% Healthy 66.7% 57.5% 52.3% 51.4% 43.5% 58.2% 52.4% Overweight 4.6% 7.8% 11.2% 10.5% 11.2% 8.8% 15.9% Obese 10.6% 18.8% 18.8% 24.1% 30.8% 22.0% 15.9% *Total % Valid BMI 2.4% 19.2% 33.8% 30.3% 10.8% 1.5% 2.0%
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 2015 High School Youth Risk Behavior Survey (Lensch, Baxa, Zhang, Gay, Larson, Clements-Nolle, Yang, 2015), 38.3 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
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 41
WEIGHT AND HEALTHY BEHAVIORS entering kindergarten, this same question on video game use was included on the survey starting in the 2011-2012 school year.
2015-2016 results indicate that the majority of children either do not play video or computer games (28.5%) or play one hour or less (53.4%) 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 (29.9%) compared to those who reportedly do not play video games (22.0%).
Figure 10.6: Child's Weight Status Category by Hours of Video Game Playing on Average School Day (2015-2016 n = 12,023) 60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% Less than 1 Hour a None 1 Hour a Day 2 + Hours a Day Day Underweight 14.0% 13.3% 18.2% 18.4% Healthy 50.2% 59.3% 53.9% 41.0% Overweight 13.8% 11.0% 6.5% 10.7% Obese 22.0% 16.3% 21.3% 29.9% Total 100% 100% 100% 100% *Total % Valid BMI 27.6% 30.5% 25.6% 16.3%
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 2015 High School Youth Risk Behavior Survey, 14.9 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
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 42
WEIGHT AND HEALTHY BEHAVIORS administration of the survey, which was below the national average of 29.2 percent (Lensch, Baxa, Zhang, Gay, Larson, Clements-Nolle, Yang, 2015). 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 (61.6%) or drank some a few times per week (29.7%). o These numbers are lowest in Clark (60.2), slightly higher in Washoe County (63.9%), and highest in the rural counties (67.2%). 5.9% of respondents reported that their child drank non-diet soda/pop once a day, and 2.8% 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 Clark and Washoe.
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 (94.2%). The highest rates of overweight and obesity are seen in children who drank non-diet soda once a day.
Figure 10.7: Child's Weight Status Category by Number of Non-Diet Sodas Consumed in a Week (2015-2016 n = 12,195) 60.0%
50.0%
40.0%
30.0%
20.0%
Percent of Respondents 10.0%
0.0% A Few More than None One a Day Times One a Day Underweight 16.3% 13.3% 14.3% 18.2% Healthy 53.9% 50.8% 45.6% 36.8% Overweight 10.1% 11.3% 16.2% 6.3% Obese 19.7% 24.5% 23.9% 38.7% Total 100% 100% 100% 100% *Total % Valid BMI 68.9% 25.3% 3.7% 2.1%
Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicity category.
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WEIGHT AND HEALTHY BEHAVIORS
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 (86.7%). This percentage was highest in rural counties (88.7%) and lower Washoe County (86.3%) and the lowest in Clark County (86.5%). 11.0 % reported that their child drank diet soda/pop a few times a week, 2% reported daily consumption, and 0.3% reported consumption more than once a day. o In Clark County, more children drank diet soda/pop a few times a week (11.2%), followed by Washoe (10.9%) and rural counties (9.5%). Washoe County reported slightly higher rates of diet soda/pop consumption once a day (2.5%) compared to Clark County (2.0%) 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 (2015-2016 n = 12,052) 60.0%
50.0%
40.0%
30.0%
20.0%
10.0% Percent of Respondents 0.0% More than One a None A Few Times One a Day Day Underweight 15.7% 12.2% 21.1% 28.9% Healthy 53.8% 43.4% 39.2% 34.2% Overweight 10.8% 10.1% 0.0% 7.9% Obese 19.7% 34.3% 39.8% 28.9% Total 100% 100% 100% 100% *Total % Valid BMI 88.8% 9.4% 1.4% 0.3%
Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicity category.
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WEIGHT AND HEALTHY BEHAVIORS
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.
Results indicate that: The majority of children in the current study did drink juice a few times a week (44.1%), once a day (28.2%), or more than once a day (17.2%). o Clark County reported a higher percentage of children who drank juice more than once a day (17.8%) compared to the rural counties (16.3%) and Washoe County (15.1%). 10.5% reported that their child did not drink juice. o Washoe County reported that a higher percentage of children did not drink juice (11.1%) as compared to Clark (10.7%) and rural (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.
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WEIGHT AND HEALTHY BEHAVIORS
Figure 10.9: Child's Weight Status Category by Number of Juice Drinks Consumed in a Week (2015-2016 n = 12,193) 60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% More than One a None A Few Times One a Day Day Underweight 15.6% 15.1% 15.7% 16.1% Healthy 61.0% 52.3% 52.8% 44.8% Overweight 8.8% 10.0% 11.5% 12.3% Obese 14.7% 22.6% 19.9% 26.7% Total 100% 100% 100% 100% *Total % Valid BMI 13.0% 42.4% 29.0% 15.6%
Note. * indicates percentages are calculated out of the total number of Valid BMI responses in each race/ethnicity category.
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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, 47.1% 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 past years. 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 2015-2016 KHS survey, 41.5% of children entering kindergarten in Nevada were breastfed at 6 months nonexclusively, which is similar to last year (41.8%). In 2014-2015, we extended the question to include feeding practices at 12 months. Results indicated that 10.3% of respondents breastfed exclusively at 12 months and 21.7% 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 in 2014-2015 to capture information regarding barriers to breastfeeding. In 2015- 2016, of those who reported barriers (n=5,579), the most frequently reported barriers were the inability to produce milk (30.8%) and medical conditions (allergies, premature birth, etc.) (30.7%), followed by work/school time constraints (11.9%), and issues latching onto the nipple (13.0%). Other barriers (13.4%) included lack of support/knowledge about breastfeeding, pain, and adopted or fostered children.
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WEIGHT AND HEALTHY BEHAVIORS
Figure 10.10: Infancy Feeding Habits (2015-2016 1 month n = 28,955; 3 months n = 28,136; 6 months n = 21,659; 12 months n = 21,872)
50.0%
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0% Breast and Breast Only Formula Only Other (e.g. Food) Not Sure Formula 1 Month 47.1% 26.9% 23.9% 0.5% 1.6% 3 Months 33.6% 26.3% 37.8% 0.7% 1.6% 6 Months 21.5% 20.0% 47.6% 8.6% 2.3% 12 Months 10.3% 11.4% 36.3% 39.8% 2.3%
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 May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 48
WEIGHT AND HEALTHY BEHAVIORS
Figure 10.11: Child Weight Status Category by Infancy Feeding Habits (2015-2016 1 Month n = 11,552; 3 Months n = 11,290; 6 Months n = 8,594; 12 Months n = 8,463) 70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% 1M 3M 6M 12M 1M 3M 6M 12M 1M 3M 6M 12M Breast Only Breast & Formula Formula Only Underweight 16.2% 18.0% 17.5% 19.1% 14.3% 13.9% 19.7% 29.5% 16.1% 15.0% 14.6% 14.2% Healthy 57.4% 58.1% 61.2% 58.7% 49.4% 49.6% 48.4% 43.1% 46.6% 50.2% 51.1% 50.3% Overweight 9.8% 9.3% 7.1% 6.8% 12.5% 12.8% 13.3% 11.0% 11.7% 11.2% 10.1% 11.2% Obese 16.6% 14.6% 14.2% 15.4% 23.8% 23.8% 18.5% 16.4% 25.6% 23.7% 24.2% 24.3% Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% % Valid BMI 50.2% 31.2% 23.6% 11.1% 25.5% 25.4% 20.4% 10.6% 22.4% 35.1% 44.7% 35.2%
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, Lung and Blood Institute, 2012; Taheri, 2006). The National Sleep Foundation (2016) recommends that children five years of age need 11-13 hours of sleep each night and children 6-11 years need between 9-11 hours of sleep per 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 (Table 10.4)and this data is consistent among Clark, Washoe, and rural counties (see Table 11.1).
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 49
WEIGHT AND HEALTHY BEHAVIORS
Table 10. 4 Average Sleep per Night for the State of Nevada n Average Standard Deviation Average Weekday Per Night 31,383 10.44 (.80) Average Weekend Per Night 30,423 10.54 (.95)
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 18.1% of respondents indicated that their child took a nap on weekdays. o The average length of the naps were 1.60 hours (SD=.75) and the range was between .21 hours and 5 hours (n = 4,752). o This data is consistent among Clark, Washoe, and rural counties.
Naps on the Weekend o 21.1% of respondents indicated that their child took a nap on the weekend. o The average length of the naps were 1.65 hours (SD=.72) and the range was between 0 hours and 6 hours (n = 5,059). o This data is also consistent among Clark, Washoe, and rural counties.
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 50
APPENDIX A: SUMMARY OF 2015-2016 WEIGHTED SURVEY RESULTS BY COUNTY
Table 11.1 below outlines the percentages of responses for the 2015-2016 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 2015-2016 Weighted Data by County Clark Washoe Rural Survey Indicator State (Percents) County County Counties (Percents) (Percents) (Percents) Survey Participation -- 73.2 15.4 11.4
Demographic Information Gender of Kindergartner Male 49.7 49.7 50.2 49.3 Female 50.3 50.3 49.8 50.7 Race/Ethnicity of Kindergartner African American/Black 5.3 6.9 1.3 0.5 Asian/Pacific Islander 6.0 6.9 4.7 1.3 Caucasian 37.8 31.7 48.8 62.5 Hispanic 34.3 37.6 28.8 20.3 Native American/ Alaska 1.1 0.6 1.6 3.8 Native Other Race 0.8 1.0 0.3 0.2 Multiple Races 14.8 15.4 14.4 11.4 Annual Household Income of Survey Respondents $0-$14,999 15.4 15.9 12.9 15.1 $15,000-$24,999 15.5 15.6 17.0 13.1 $25,000-$34,999 13.4 13.8 12.0 12.4 $35,000-$44,999 9.8 10.0 9.6 9.3 $45,000-$54,999 7.5 7.3 7.3 8.7 $55,000-$64,999 6.3 6.3 5.4 7.5 $65,000-$74,999 6.2 6.0 6.6 6.6 $75,000-$84,999 5.2 5.0 4.7 7.1 $85,000-$94,999 5.1 5.3 4.1 4.9 $95,000+ 15.7 14.8 20.3 15.2
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 51
APPENDIX A. SUMMARY OF 2015-2016 SURVEY RESULTS BY COUNTY
Table 11.1 continued Clark Washoe Rural Survey Indicator State (Percents) County County Counties (Percents) (Percents) (Percents) Type of School Child Attended in the Past 12 Months Head Start 6.1 5.5 7.6 8.2 Other Facility/Center 23.3 22.9 25.9 22.4 Home-Based 4.5 4.7 4.5 3.1 School District Pre-School 25.4 25.0 20.5 34.1 UniversityCampusPreSchool 0.9 0.7 1.1 1.6 None/Stayed at Home 31.7 32.8 32.0 23.9 Friends/Family Care 3.0 3.2 2.8 1.8 Mulitple 5.2 5.2 5.5 5.0 Average Preschool Hours of Attendance 0 Hours 35.0 36.3 35.5 26.0 5-10 Hours 21.8 23.3 15.4 20.5 11-15 Hours 13.9 12.7 12.0 24.7 16-20 Hours 7.1 5.9 10.1 11.1 21-30 Hours 7.1 7.1 7.9 6.7 31-40 Hours 11.7 11.7 13.8 8.6 More than 40 Hours 3.3 3.0 5.4 2.4 Single Parent or Guardian 29.1 29.3 29.3 27.6 Average # of Children in Household 2.53 2.53 2.48 2.56 (Standard Deviation) (1.20) (1.21) (1.15) (1.19) Average # of Adults in Household 2.10 2.12 2.07 1.95 (Standard Deviation) (0.80) (0.83) (0.76) (0.59) Average Age of Mother/Guardian 33.20 33.32 33.14 32.51 (Standard Deviation) (6.92) (6.87) (6.77) (7.41) Average Age of Father/Guardian 35.81 35.98 35.62 34.93 (Standard Deviation) (8.01) (8.07) (7.57) (8.14)
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 52
APPENDIX A. SUMMARY OF 2015-2016 SURVEY RESULTS BY COUNTY
Table 11.1 continued Clark Washoe Rural Survey Indicator State (Percents) County County Counties (Percents) (Percents) (Percents) Health Insurance Status and Access to Health Care Health Insurance Type Uninsured 6.4 6.4 5.6 7.5 Private 49.8 48.6 51.7 54.5 Medicaid 31.3 31.7 30.8 29.1 Nevada Check-up 7.8 8.6 6.9 3.5 Other 1.5 1.5 1.4 1.5 Multiple Types 3.3 3.2 3.5 3.8 Kindergartner Does NOT Have a Primary 12.4 11.8 11.3 17.7 Care Provider Types of Barriers Experienced When Trying to Access Healthcare Lack of Transportation 3.4 3.9 1.9 2.0 Lack of Insurance 7.4 7.6 6.1 7.8 Lack of Quality Medical Providers 6.5 6.2 5.2 10.0 Lack of Money/Financial 11.8 12.3 8.1 13.1 Resources Other Barriers 1.2 1.3 0.7 1.1 Difficulties Accessing Mental Health 32.1 36.2 19.7 23.4 Services for Kindergartner Know how to access support services 42.4 38.6 51.6 53.9 Applied for insurance for self using Nevada 13.5 12.9 14.7 16.0 Health Link Applied for insurance for child using Nevada 19.1 18.6 20.1 20.6 Health Link Routine Care and Health of Kindergartner Has Not Had Routine Check-Up 10.4 10.0 9.7 14.0 Has Not Visited a Dentist in the Last Year 23.6 25.6 14.9 22.9
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 53
APPENDIX A. SUMMARY OF 2015-2016 SURVEY RESULTS BY COUNTY
Table 11.1 continued Clark Washoe Rural Survey Indicator State (Percent) County County Counties (Percent) (Percent) (Percent) Amount of Times the Kindergartner Has Gone to the ER for a Non-Life-
Threatening Illness or Injury in the Past 12 Months None (0) 77.0 77.1 78.1 74.6 1 to 2 21.2 21.0 20.3 23.3 3 to 5 1.6 1.6 1.6 1.9 6 to 9 0.1 0.2 0.0 0.1 10 or More 0.1 0.1 0.0 0.1 Types of Medical Conditions Seen in Kindergartners ADD/ADHD 1.2 1.0 1.8 1.7 Allergies 16.5 17.0 13.6 17.1 Asthma 7.7 8.4 5.5 6.1 Autism 1.0 1.0 0.8 1.2 Cancer 0.2 0.2 0.1 0.1 Diabetes 0.1 0.1 0.1 0.0 Glasses/Contacts 5.9 6.0 4.9 6.2 Hearing Aid/Impairment 0.4 0.4 0.3 0.5 Mental Health Condition 0.3 0.2 0.4 0.8 Physical Disability 0.5 0.5 0.3 0.3 Seizures 0.8 0.9 0.6 0.6 Other Condition 4.7 4.7 5.1 4.2 Received a Developmental 28.4 25.5 35.8 36.3 Screening in past 12 months Weight and Healthy Behaviors Underweight 15.5 14.9 18.1 16.1 Healthy Weight 52.5 51.9 54.2 53.8 Overweight 10.6 10.1 11.4 12.0 Obese 21.4 23.0 16.4 18.1 Amount of Times per Week that Child Has at Least 30 Minutes of Physical Activity 0-1 Times 2.4 2.9 1.2 0.9 2-3 Times 19.2 21.9 13.4 9.8 4-5 Times 29.8 31.2 24.5 27.7 6 or More Times 48.6 44.0 60.9 61.6
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 54
APPENDIX A. SUMMARY OF 2015-2016 SURVEY RESULTS BY COUNTY
Table 11.1 continued Clark Washoe Rural Survey Indicator State (Percent) County County Counties (Percent) (Percent) (Percent) Hours of Television Watched on an Average School Day None 2.5 2.4 3.1 2.8 Less than One 14.9 14.6 13.3 19.2 1 Hour 33.7 33.2 33.4 37.2 2 Hours 32.6 33.0 34.3 28.2 3 Hours 12.1 12.6 11.7 9.6 4 Hours 2.4 2.4 2.6 2.1 5 Hours or More 1.7 1.8 1.6 0.8 Hours of Video or Computer Games Played on an Average School Day None 28.5 26.4 31.4 38.5 Less than One 26.8 25.9 28.8 29.8 1 Hour 26.6 28.1 24.3 20.3 2 Hours 12.6 13.7 10.6 8.2 3 Hours 3.7 4.1 2.9 2.3 4 Hours 1.1 1.2 1.1 0.4 5 Hours or More 0.6 0.6 0.8 0.5 Number of Times Per Week the Kindergartner Drinks Non-Diet Soda None 61.6 60.2 63.9 67.2 A Few Times 29.7 30.5 27.5 27.2 Once a Day 5.9 6.1 6.4 4.2 More Than Once a Day 2.8 3.1 2.2 1.5 Number of Times Per Week the Kindergartner Drinks Diet Soda None 86.7 86.5 86.3 88.7 A Few Times 11.0 11.2 10.9 9.5 Once a Day 2.0 2.0 2.5 1.6 More Than Once a Day 0.3 0.3 0.3 0.1 Number of Times Per Week the Kindergartner Drinks Juice None 10.5 10.7 11.1 8.7 A Few Times 44.1 43.5 45.4 45.8 Once a Day 28.2 28.0 28.3 29.1 More Than Once a Day 17.2 17.8 15.1 16.3
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 55
APPENDIX A. SUMMARY OF 2015-2016 SURVEY RESULTS BY COUNTY
Table 11.1 continued Clark Washoe Rural Survey Indicator State (Percent) County County Counties (Percent) (Percent) (Percent) Infancy Eating Habits at One Month Breast Only 47.1 43.3 58.1 57.0 Breast and Formula 26.9 28.9 22.3 20.3 Formula Only 23.9 25.7 17.6 20.8 Other (e.g. food) 0.5 0.4 0.6 0.5 Not Sure 1.6 1.7 1.5 1.5 Infancy Eating Habits at Three Months Breast Only 33.6 30.7 41.3 41.1 Breast and Formula 26.3 27.2 25.9 21.5 Formula Only 37.8 39.7 30.7 34.9 Other (e.g. food) 0.7 0.7 0.7 0.6 Not Sure 1.6 1.6 1.4 1.7 Infancy Eating Habits at Six Months Breast Only 21.5 19.9 24.8 27.6 Breast and Formula 20.0 20.1 20.6 18.7 Formula Only 47.6 49.1 44.3 42.4 Other (e.g. food) 8.6 8.5 8.4 9.0 Not Sure 2.3 2.4 2.0 2.3 Infancy Eating Habits at Twelve Months Breast Only 10.3 9.5 12.0 13.1 Breast and Formula 11.4 11.3 13.4 9.1 Formula Only 36.3 37.6 33.6 31.8 Other (e.g. food) 39.8 39.3 38.7 43.9 Not Sure 2.3 2.3 2.4 2.1 Average # Hours of Sleep Per Night on Weekdays (Standard Deviation) 10.44(.80) 10.40(.80) 10.67 (.82) 10.42(.74) Average # Hours of Sleep Per Night on Weekends (Standard Deviation) 10.54(.95) 10.50(.96) 10.65(.93) 10.70(.86)
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 56
APPENDIX B: COMPARISON OF SURVEY RESULTS BY YEAR Table 11.2 below outlines the percentages of responses from the most recent three school year surveys (2013/2014 – 2015/2016). 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 2013-2014 through 2015-2016 Weighted Data 2012-2013 2013-2014 2014-2015 2015-2016 (Year 5) (Year 6) (Year 7) (Year 8) Survey Indicator (Percent) (Percent) (Percent) (Percent) Survey Participation by School
District Clark County 73.9 73.7 73.7 73.2 Washoe County 14.4 14.4 14.6 15.4 Rural Counties 11.7 11.9 11.8 11.4 Demographic Information Gender of Kindergartner Male 50.7 50.9 49.9 49.7 Female 49.3 49.1 50.1 50.3 Race/Ethnicity of Kindergartner African American/Black 6.2 6.9 6.3 5.3 Asian/Pacific Islander 6.7 6.6 6.5 6.0 Caucasian 38.1 36.8 38.3 37.8 Hispanic 33.2 33.4 33.7 34.3 Native American/Alaska Native 0.9 1.4 1.1 1.1 Other Race 0.8 0.8 0.1 0.8 Multiple Races 14.0 14.1 14.1 14.8
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 57
APPENDIX B. COMPARISON OF SURVEY RESULTS BY YEAR
Table 11.2 Continued 2012-2013 2013-2014 2014-2015 2015-2016
(Year 5) (Year 6) (Year 7) (Year 8) Survey Indicator (Percent) (Percent) (Percent) (Percent) Annual Household Income of
Survey Respondent $0-$14,999 18.1 18.0 17.3 15.4 $15,000-$24,999 15.6 15.4 15.9 15.5 $25,000-$34,999 12.9 12.6 13.1 13.4 $35,000-$44,999 9.3 9.6 8.7 9.8 $45,000-$54,000 8.0 7.6 7.5 7.5 $55,000-$64,999 6.3 6.7 6.3 6.3 $65,000-$74,999 6.1 6.1 5.7 6.2 $75,000-$84,999 6.0 5.5 5.8 5.2 $85,000-94,999 4.0 4.0 3.9 5.1 $95,000 + 13.7 14.4 15.8 15.7 Type of School Child Attended in the Past 12 Months Head Start 5.8 6.6 5.8 6.1 Other Facility/Care 24.7 21.9 22.6 23.3 Home-Based 6.6 5.8 5.1 4.5 University Campus Pre School 1.2 1.1 0.9 25.4 School District Pre-School 19.2 21.8 24.2 0.9 None/Stayed at Home 40 35.9 33.5 31.7 Friends/Family Care - 2.8 3.1 3.0 Multiple 2.4 4.0 4.7 5.2 Average Preschool Hours of
Attendance 0 Hours - 31.6 31.8 35.0 5-10 Hours - 17.7 17.7 21.8 11-15 Hours - 15.3 14.4 13.9 16-20 Hours - 8.9 8.6 7.1 21-30 Hours - 7.5 8.4 7.1 31-40 Hours - 11.0 11.5 11.7 More than 40 Hours - 8.0 7.6 3.3
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 58
APPENDIX B. COMPARISON OF SURVEY RESULTS BY YEAR
Table 11.2 Continued 2012-2013 2013-2014 2014-2015 2015-2016
(Year 5) (Year 6) (Year 7) (Year 8) Survey Indicator (Percent) (Percent) (Percent) (Percent) Single Parent or Guardian 29.5 31.2 29.9 29.1 Average # of Children in Household 2.53 2.54 (1.2) 2.55 (1.22) 2.53 (1.19) (Standard Deviation) (1.20) Average # of Adults in Household 2.12 2.08 (0.81) 2.09 (0.79) 2.10 (0.79) (Standard Deviation) (0.86) Average Age of Mother/Guardian 33.10 33.20 33.02 (6.69) 32.92 (6.75) (Standard Deviation) (6.94) (6.92) Average Age of Father/Guardian 35.93 35.81 35.7 (7.3) 35.56 (7.51) (Standard Deviation) (7.67) (8.01) Health Insurance Status and Access to Health Care Health Insurance Type Uninsured 13.6 12.6 7.6 6.4 Private 47.6 50.0 48.4 49.8 Medicaid 23.5 25.9 31.3 31.3 Nevada Check-Up 6.3 6.5 6.7 7.8 Other 6.4 2.1 2.8 1.5 Multiple Types 2.6 2.9 3.1 3.3 Kindergartner Does Not Have a 16.6 13.6 13.6 12.4 Primary Care Provider Types of Barriers Experienced When
Trying to Access Healthcare Lack of Transportation 3.0 3.4 3.4 3.4 Lack of Insurance 10.3 10.1 7.3 7.4 Lack of Quality Medical Providers 4.9 5.2 5.1 6.5 Lack of Money/Financial Resources 14.6 13.8 10.4 11.8 Other Barriers 2.3 2.1 1.9 1.2 Respondent Has Experienced Difficulties Attempting to Access 33.0 35.9 31.8 32.1 Mental Health Services for Kindergartner Knows how to access support services - 43.1 44.0 42.4
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 59
APPENDIX B. COMPARISON OF SURVEY RESULTS BY YEAR
Table 11.2 Continued 2012-2013 2013-2014 2014-2015 2015-2016
(Year 5) (Year 6) (Year 7) (Year 8) Survey Indicator (Percent) (Percent) (Percent) (Percent) Annual Household Income of Uninsured Kindergartners $0-$14,999 18.2 14.1 23.1 15.4 $15,000-$24,999 21.6 20.0 20.0 15.5 $25,000-$34,999 20.5 19.0 19.8 13.4 $35,000-$44,999 16.4 15.7 8.5 9.9 $45,000-$54,999 11.7 11.2 11.6 7.5 $55,000-$64,999 7.2 11.5 5.6 6.3 $65,000-$74,999 4.2 5.1 3.1 6.2 $75,000-$84,999 4.2 6.2 3.8 5.2 $85,000-94,999 3.0 1.6 1.4 5.1 $95,000 + 1.7 2.8 3.2 15.7 Race/Ethnicity of Uninsured Kindergartners African American/Black 5.6 5.7 4.8 5.3 Asian/Pacific Islander 7.9 5.7 3.9 5.9 Caucasian 24.8 25.3 28.3 37.8 Hispanic 49.8 50.3 47.2 34.3 Native American/Alaska Native 0.8 1.6 0.6 1.1 Other Race 0.4 0.5 0.1 0.8 Multiple Races 10.8 10.8 15.0 14.8 Routine Care and Health Status of Kindergartner Kindergartner Has NOT Had 13.4 14.1 13.0 Routine Check-Up In Past Year 10.4 Kindergartner Has NOT Visited 25.8 26.0 25.2 23.6 Dentist in Past Year Amount of Times the Kindergartner Has Gone to the ER for a Non-Life-
Threatening Illness or Injury in the Past 12 Months None (0) 80.6 80.0 79.0 77.0 1 to 2 17.9 18.3 19.3 21.2 3 to 5 1.4 1.5 1.5 1.6 6 to 9 0.1 0.2 0.1 0.1 10 or More 0.1 0.1 0.1 0.1
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 60
APPENDIX B. COMPARISON OF SURVEY RESULTS BY YEAR
Table 11.2 Continued 2012-2013 2013-2014 2014-2015 2015-2016
(Year 5) (Year 6) (Year 7) (Year 8) Survey Indicator (Percent) (Percent) (Percent) (Percent) Types of Medical Conditions Seen in Kindergartners ADD/ADHD 1.4 1.3 1.3 1.2 Allergies - 15.1 15.5 16.5 Asthma 8.1 7.9 6.9 7.7 Autism 0.4 0.6 0.5 1.0 Cancer 0.0 0.1 0.1 0.2 Diabetes 0.2 0.1 0.1 0.1 Glasses/Contacts 3.5 5.1 4.7 5.9 Hearing Aid/Impairment 0.3 0.3 0.4 0.4 Mental Health Condition 0.3 0.4 0.4 0.3 Physical Disability 0.3 0.4 0.4 0.5 Seizures 0.5 0.6 0.4 0.8 Other Condition 6.6 5.2 4.7 4.7 Received a Developmental Screening in - 22.5 23.2 past 12 months 28.4 Weight and Healthy Behaviors Kindergartner's Weight Status Underweight 15.7 15.1 16.1 15.5 Healthy Weight 55.0 55.0 52.4 52.5 Overweight 11.1 9.9 9.8 10.6 Obese 18.2 20.0 21.7 21.4 Times A Week Kindergartner Does at Last 30min of Physical Activity 0-1 Times 2.8 2.5 2.4 2.4 2-3 Times 17.7 17.1 17.6 19.2 4-5 Times 27.7 27.2 28.6 29.8 6 or More Times 51.8 53.3 51.4 48.6 Hours of Television Watched on an Average School Day None 1.8 2.0 2.1 2.5 Less than One 11.8 12.1 12.5 14.9 1 Hour 28.8 29.2 30.0 33.7 2 Hours 36.8 36.2 34.6 32.6 3 Hours 15.1 14.4 14.8 12.1 4 Hours 3.6 4.2 4.1 2.4 5 Hours or More 2.0 2.0 1.8 1.7
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 61
APPENDIX B. COMPARISON OF SURVEY RESULTS BY YEAR
Table 11.2 Continued 2012-2013 2013-2014 2014-2015 2015-2016
(Year 5) (Year 6) (Year 7) (Year 8) Survey Indicator (Percent) (Percent) (Percent) (Percent) Hours of Video or Computer Games Played on an Average School Day None 35.1 31.7 30.0 28.5 Less than One 29.3 29.0 27.5 26.8 1 Hour 24.1 25.2 26.5 26.6 2 Hours 8.6 10.3 10.8 12.6 3 Hours 1.8 2.8 3.4 3.7 4 Hours 0.7 0.7 1.1 1.1 5 Hours or More 0.4 0.4 0.7 0.6 Number of Times Per Week the Kindergartner Drinks Non-Diet Soda None 55.6 59.6 60.8 61.6 A Few Times 33.8 30.7 29.9 29.7 Once a Day 6.9 6.8 6.8 5.9 More Than Once a Day 3.7 2.9 2.5 2.8 Number of Times Per Week the Kindergartner Drinks Diet Soda None 82.9 85.7 87.5 86.7 A Few Times 14.2 11.3 10.1 11.0 Once a Day 2.5 2.4 2.0 2.0 More Than Once a Day 0.4 0.5 0.4 0.3 Number of Times Per Week the Kindergartner Drinks Juice None - 8.6 10.0 10.5 A Few Times - 40.1 43.8 44.1 Once a Day - 27.7 26.3 28.2 More Than Once a Day - 23.5 19.9 17.2 Infancy Eating Habits at One Month Breast Only 45.5 46.1 48.3 47.1 Breast and Formula 21.8 22.6 22.2 26.9 Formula Only 30.6 29.6 27.9 23.9 Other (e.g. food) 0.5 0.4 0.4 0.5 Not Sure 1.5 1.3 1.2 1.6 Infancy Eating Habits at Three Months Breast Only 32.4 33.3 34.9 33.6 Breast and Formula 24.7 23.6 24.5 26.3 Formula Only 40.9 41.3 38.5 37.8 Other (e.g. food) 0.7 0.7 1.0 0.7 Not Sure 1.3 1.0 1.1 1.6
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 62
APPENDIX B. COMPARISON OF SURVEY RESULTS BY YEAR
Table 11.2 Continued 2012-2013 2013-2014 2014-2015 2015-2016
(Year 5) (Year 6) (Year 7) (Year 8) Survey Indicator (Percent) (Percent) (Percent) (Percent) Infancy Eating Habits at Six Months Breast Only 22.0 23.1 21.9 21.5 Breast and Formula 22.3 22.7 19.9 20.0 Formula Only 46.8 46.5 46.0 47.6 Other (e.g. food) 7.4 6.4 10.9 8.6 Not Sure 1.5 1.3 1.2 2.3 Average # Hours of Sleep Per Night on Weekdays (Standard - - 10.41 10.44 Deviation) (.81) (.80) Average # Hours of Sleep Per Night on Weekends (Standard - - 10.59 10.54 Deviation) (.96) (.95)
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 63
APPENDIX C: SURVEY INSTRUMENT
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 64
APPENDIX C. SURVEY INSTRUMENT
Nevada Institute for Children’s Research and Policy, UNLV May 2016 Results of the 2015-2016 Nevada Kindergarten Health Survey Page 65
APPENDIX D: REFERENCES
American Academy of Pediatric Dentistry. (2014). Frequently asked question. Retrieved from http://www.aapd.org/resources/frequently_asked_questions/#36
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Basch, C.E. (2010). Healthier Students are Better Learners: A Missing Link in Efforts to Close the Achievement Gap. Retrieved from http://www.equitycampaign.org/i/a/document/12557_EquityMattersVol6_Web 03082010. Pdf
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