Upload
tranlien
View
214
Download
1
Embed Size (px)
Citation preview
Jim Gibbons, Governor State of Nevada
Oct 2009
Richard Whitley, MS, Administrator Health Division
Michael J Willden, Director Department of Health and Human Services
Tracey Green, MD, State Health Officer Health Division
2008‐2009 THIRDGRADE ORAL HEALTH SURVEY
Nevada
Department of Health and Human Services Nevada State Health Division
Oral Health Program
i
TABLE OF CONTENTS
INTRODUCTION ............................................................................................................................................. 1
KEY FINDINGS ................................................................................................................................................ 2
Figure 1 – STATEWIDE ORAL HEALTH OUTCOMES ................................................................................... 2
Figure 2 – ORAL HEALTH OUTCOMES VERSUS HEALTH PEOPLE 2010 TARGETS ...................................... 3
Figure 3 – TREATMENT URGENCY ............................................................................................................. 4
Figure 4 – UNTREATED DECAY BY SEALANT STATUS ................................................................................ 5
TOPICS ........................................................................................................................................................... 6
Figure 5 – STATEWIDE ORAL HEALTH OUTCOMES BY SCHOOL YEAR ....................................................... 6
Figure 6 – ORAL HEALTH OUTCOMES BY SEX ........................................................................................... 7
Figure 7 – ORAL HEALTH OUTCOMES BY RACE/ETHNICITY ...................................................................... 8
Figure 8 – ORAL HEALTH OUTCOMES BY REGION .................................................................................... 9
Figure 9 – ORAL HEALTH OUTCOMES BY ELIGIBILITY FOR FREE OR REDUCED LUNCHES ....................... 10
Figure 10 – TIME SINCE LAST DENTAL VISIT ............................................................................................ 11
Figure 11 – REASON FOR LAST DENTAL VISIT ......................................................................................... 12
Figure 12 – ORAL HEALTH OUTCOMES BY TIME SINCE LAST DENTAL VISIT ........................................... 13
Figure 13 – TIME SINCE LAST DENTAL VISIT IN CLARK COUNTY ............................................................. 14
Figure 14 – TIME SINCE LAST DENTAL VISIT IN WASHOE COUNTY ......................................................... 15
Figure 15 – TIME SINCE LAST DENTAL VISIT IN ALL OTHER COUNTIES ................................................... 16
Figure 16 – DENTAL INSURANCE STATUS ............................................................................................... 17
Figure 17 – ORAL HEALTH OUTCOMES BY DENTAL INSURANCE STATUS ............................................... 18
Figure 18 – ORAL HEALTH OUTCOMES BY MEDICAL AND DENTAL INSURANCE STATUS ....................... 19
Figure 19 – DENTAL INSURANCE STATUS IN CLARK COUNTY ................................................................. 20
Figure 20 – DENTAL INSURANCE STATUS IN WASHOE COUNTY ............................................................. 21
Figure 21 – DENTAL INSURANCE STATUS IN ALL OTHER COUNTIES ....................................................... 22
Figure 22 – INABILITY TO SEEK DENTAL CARE WHEN NEEDED ............................................................... 23
Figure 23 – REASON FOR THE INABILITY TO SEEK DENTAL CARE WHEN NEEDED .................................. 24
SURVEY METHOD ........................................................................................................................................ 25
SAMPLING ................................................................................................................................................... 26
1
INTRODUCTION
During the 2008‐2009 academic year, the Oral Health Program conducted a survey of third‐grade students in Nevada, the third of its kind. The primary purpose of the survey was to obtain population parameter estimates for three oral health indicators: caries experience, untreated decay, and dental sealants. As a secondary benefit, the screenings directly impacted the students by educating them about healthy oral hygiene habits and informing their parents or guardians of the need for dental care.
The statewide measures generated from the survey were then used to determine Nevada's status relative to the national targets specified in Healthy People 2010. In addition to the estimates, 95% confidence intervals are given, which illustrate the range of values that surveys conducted during the same time period and using the same methodology would have likely produced.
The results, as presented on the following pages, demonstrate that Nevada needs to make considerable progress before meeting any of the three oral health targets. Only through a combination of public health policy, improvements in access to dental services, and concerted oral health interventions can Nevada make strides toward achieving these important aims.
The first section of this report provides an overview of the key findings of the survey, the overall oral health outcome estimates for the state. The subsequent section examines these estimates more closely by breaking them down by various demographic characteristics and according to the affordability and accessibility of dental care. Finally, the last two sections detail the surveying and sampling methods used to conduct the screenings.
KEY FIN
64.9% of tteeth. The
28.1% of tmeasure s
37.5% of tconfidenc
Figure
NDINGS
third‐grade ste confidence
third‐grade stspans from 24
third‐grade stce interval of
1 – STATEWID
tudents in Neinterval of th
tudents in Ne4.3% to 31.8%
tudents in Nethis measure
DE ORAL HEA
CARIE
evada have exhis measure sp
UNTR
evada have un%.
DENT
evada have dee spans from 3
ALTH OUTCOM
2
#1 ES EXPERIENC
xperienced depans from 60
#2 REATED DECA
ntreated den
#3 TAL SEALANT
ental sealants33.1% to 41.8
MES
CE
ental decay in0.8% to 69.1%
AY
tal decay. The
TS
s on at least o8%.
n their prima%.
e confidence
one permane
ry or perman
interval of th
ent molar. The
ent
his
e
Now in ththis surve
• 2pe
• 2pe
• 2te
The resultconsidera
• A
• A
• A
Figure 2
he second decey generated
1‐1b: “Reducermanent tee
1‐2b: “Reducermanent tee
1‐8a: “Increaeeth.” Here, c
ts, as presentable progress
t 64.9%, Neva
t 28.1%, Neva
t 37.5%, Neva
2 – ORAL HEA
cade of Healtcomparative
e the proporteth.” Children
e the proporteth.” Again, c
se the propochildren were
ted graphicallbefore meet
ada will have
ada will have
ada will have
ALTH OUTCO
HEALTH
hy People, thmeasures are
tion of children were define
tion of childrechildren were
rtion of childe defined as t
ly and here being any of the
to reduce th
to reduce th
to increase t
MES VERSUS
3
#4 HY PEOPLE 20
e 2010 objece as follows:
en with dentaed as those 6‐
en with untre defined as in
ren who havehose 8 years
elow, demone three target
e prevalence
e rate of untr
the proportio
S HEALTH PEO
010
ctives from th
al caries expe‐8 years old. T
eated dental dn 21‐1b. The t
e received deold. The targ
strate that Nts.
of caries exp
reated decay
n having den
OPLE 2010 TA
e oral health
erience in theThe target wa
decay in primtarget was se
ntal sealants et was set at
evada needs
perience by 23
by 8 points.
tal sealants b
ARGETS
module for w
ir primary anas set at 42%.
mary and t at 21%.
on their mol50%.
to make
3 points.
by 13 points.
which
d .
ar
Dependindental carthird‐grad5.5% weremeasures
Figure 3
ng on the comre was also evde students ine in need of us span from 6
3 – TREATME
mbination of ovaluated for en Nevada exhurgent dental8.2% to 75.5%
ENT URGENCY
TREATM
oral health oueach third‐graibited no obv care due to %, 19.4% to 2
Y
4
#5 MENT URGEN
utcomes obseade student. vious dental ppain or infect25.8%, and 4.0
NCY
erved at the tiThe survey inproblem, 22.6tion. The conf0% to 6.9%, r
ime of screenndicates that 6% needed defidences interrespectively.
ning, the needwhile 71.9% ental care, anrvals of these
d for of nd e
Dental seademonstrNevada, uuntreatedThe confid
Figure 4
alants are a prate the impauntreated decd decay versudence interva
4 – UNTREAT
UNT
proven meansct that sealancay was crosss 37.9% withals of these m
TED DECAY BY
TREATED DEC
s of preventinnts are havings‐tabulated byout, an increa
measures span
Y SEALANT ST
5
#6 CAY BY SEALA
ng cavities in g on cavity frey sealant statase in the fren from 8.1% t
TATUS
ANT STATUS
the pits and fequency amotus. 11.6% of quency of deto 15.1% and
fissures of teeong third‐gradthose with seental decay of33.4% to 42.
eth. To de students inealants had f over three t4%, respectiv
n
imes. vely.
TOPICS
The 2008‐third‐gradmeasure f
Figure 5
‐2009 academde students infor untreated
5 – STATEWID
mic year markn Nevada. A sd decay and th
DE ORAL HEA
ACA
ks the third tistatistically sighose taken du
ALTH OUTCOM
6
TOPIC: ADEMIC YEAR
me the Oral Hgnificant diffeuring previou
MES BY SCHO
R
Health Prograerence can beus academic y
OOL YEAR
am has condue seen betweyears.
ucted a surveyen the curren
y of nt
Looking afigures anmales ver27.1% of mof female
Figure 6
t the oral heand confidencersus 63.2% of males versus s have denta
6 – ORAL HEA
alth outcomee intervals sugfemales have28.9% of feml sealant on a
ALTH OUTCO
s by sex reveggest that sexe experiencedmales have unat least one p
MES BY SEX
7
TOPIC: SEX
aled that whix does not apd dental decantreated dentermanent mo
ile slight diffeppear to have ay in their primtal decay, andolar.
erences were a major impamary or permd 37.9% of ma
observed, thact. 66.9% of manent teeth,ales versus 37
e
, 7.1%
Analyzingto the sizewide, meathe narrowcorrespon
At 82.1%,HawaiiansAmericancomparatAsians an
Similarly, Islanders,Natives, 1Asians an
The higheNative Hawas obserbetween W
1 All racial
Figure 7
g the oral heae of the sampaning that thewest confidending proport
the highest rs/Pacific Islans, Native Ametive combinatd Hispanics.
Asians had th 34.9%, and H15.2%. Again, d Hispanics.
est rates of deawaiians/Pacirved among BWhites and B
categories exc
7 – ORAL HEA
lth outcomesples for some eir measures nce intervals tions in the N
rate of caries nders, 74.5%, ericans/Alasktions, a statist
he highest ratHispanics, 32.a statistically
ental sealantsfic Islanders, Blacks/AfricanBlacks/African
clude those of H
ALTH OUTCO
s according toof the racial are likely to bwere Whites
Nevada popula
experience wand Hispanicka Natives, antically signific
te of untreate.6%. The lowey significantly
s were observ49.9%. At 43n Americans, n Americans.
Hispanic herita
MES BY RACE
8
TOPIC: RACE
o race and ethcategories1, mbe unreliables and Hispanication and, co
was observedcs, 71.8%. Thend Multi‐raciacant differenc
ed decay at 3est rate was oy difference w
ved among Na.5%, Whites h26.7%. A stat
age. The ethnic
E/ETHNICITY
hnicity showemany of the ce. The racial acs, which onensequently, t
among Asiane rates amongals were nearce was observ
8.7% followeobserved amowas detected
ative Americahad the next tistically signi
c category of H
ed much variaconfidence innd ethnic cate might expecthe survey sam
ns followed bg Whites, Blaly the same. Oved between
ed by Native Hong Native Ambetween Wh
ans/Alaska nahighest rate. ificant differe
Hispanics includ
ability, thoughtervals were tegories exhibct given their mple.
y Native ck/African Of all possibleWhites and b
Hawaiians/Pamericans/Alaites and both
atives, 50.5%,The lowest rence was obse
des them inste
h due very biting
e both
cific ska h
, and ate erved
ead.
The sampgeneratedstate: Clar
The prevaWashoe C
The preva23.4% for
The propo55.8% in Wobserved
Figure 8
pling method d for the threrk County, W
alence of carieCounty and al
alence of untrr Washoe Cou
ortion of thirdWashoe Counbetween Cla
8 – ORAL HEA
of the surveyee regions thaashoe County
es experiencel other count
reated decay unty and all ot
d‐grade studenty and 43.1%rk County an
ALTH OUTCO
y was designeat are commoy, and all othe
e was highestties, respectiv
was also somther counties
ents having d% in all other d Washoe Co
MES BY REGI
9
TOPIC: REGION
ed such that ponly used in Ner counties.
t in Clark Couvely.
mewhat highes.
ental sealantcounties. A stounty.
ION
parameter estNevada to loo
nty, 67.5%, v
er in Clark Cou
s was 32.9% tatistically sig
timates couldk at different
ersus 57.8% a
unty, 29.5%, v
in Clark Coungnificant diffe
d also be t parts of the
and 57.7% fo
versus 24.7%
nty in contrasterence was
r
% and
t to
Eligibility status. Fohealth oulunches eeligible wlower amsocio‐ecopredictor
Figure 9
for the Natioor the 2008‐20tcome measuxhibited a hisere more likeong those elinomic statusof oral health
9 – ORAL HEA
NA
nal School Lu009 survey, stures. A higherstory of cariesely to have ungible for the , as approximh.
ALTH OUTCO
ATIONAL SCH
unch Programtatistically sigr proportion os, 71.4%, comntreated decaprogram, 31.
mated by eligi
MES BY ELIG
10
TOPIC: HOOL LUNCH
m is often usedgnificant diffeof third‐gradempared to thoay, 34.6% vers5%, in compability for free
IBILITY FOR F
PROGRAM
d as an indicaerences were e students eliose not eligiblsus 20.0%. Dearison to thos or reduced l
FREE OR REDU
ator of overalobserved acrigible for freele, 57.9%. Furental sealant se ineligible, 4unches, appe
UCED LUNCH
l socio‐econoross all three e or reduced rthermore, thrates were a45.6%. Overaears to be a m
HES
omic oral
hose lso ll,
major
Regular dtreated. Wnoted thanever visi
Figure
ental examinWhile 69.2% oat it had beented a dentist
10 – TIME SIN
ations hold tof parents repn over a year s.
NCE LAST DEN
DE
he potential tported that thsince their ch
NTAL VISIT
11
TOPIC: ENTAL VISIT
to detect oraheir child hadild’s last visit
l health probd visited a den, and 8.5% in
lems early onntist in the padicated that t
n and have thast year, 22.3their child ha
em % ad
Furtherm70.4%, todentist; 9treatmentreason, anobserved
It should bone reasoa dentist pconsent fo
Figure
ore, the reasook their child.6% that somt of a conditiond 8.2% that between tho
be noted thaton. There is alpresented heorm and resp
11 – REASON
on for each st in on their o
mething was won that the dtheir child haose who took
t the values dlso a minute dere and previoponses were n
N FOR LAST D
tudent’s last own; whereaswrong, botherentist had disad never visitetheir child in
do not sum todifference beously becausenot always co
ENTAL VISIT
12
dental visit ws, 4.8% indicatring, or hurtinscovered at aed a dentist. on their own
o 100% due toetween the pre this was gatonsistent.
was examinedted that theirng; 6.0% that n earlier appA statisticallyn and all othe
o some resporoportions of thered in two
d. The vast mar child was cathey took theointment; 4.2y significant der groups.
ondents indicastudents hav
o separate pla
ajority of parelled in by theeir child in fo2% some otheifference was
ating more thving never visaces on the
ents, e r er s
han sited
The surverepresentthe oral h
At 71.7%,year ago. never visione, in thamong thscreened.
The prevaversus 19dentist ov
The propodentist in 4.1% amobetween
Figure
ey also alloweted by three dealth outcom
the prevalenAmong thoseted a dentist e wide confidose parents h.
alence of untr.1% and 44.4ver a year ago
ortion of thirdthe past yea
ong those havall three grou
12 – ORAL HE
ed the three odifferent groumes.
nce of caries ee having visite43.8%. The ladence intervahaving never
reated decay % among thoo, respectively
d‐grade studer in contrast tving never visups.
EALTH OUTCO
oral health ouups. Time sinc
experience wed a dentist iast figure seeal of the meastaken their c
was highest ose having visy.
ents having dto 19.0% amoited a dentist
OMES BY TIM
13
utcomes to bece last dental
as highest amn the past yeems counterinsure for this ghild to a dent
among thosesited a dentist
ental sealantong those havt. A statistical
ME SINCE LAST
e analyzed by visit appears
mong those har, it was 66.0ntuitive, yet agroup and, twtal visit not co
e having nevet in the past y
s was 49.7% ving visited a lly significant
T DENTAL VIS
y time since las to be a signi
aving visited 0% and amona potential exwo, in a possibonsenting to
r visited a deyear and thos
among thosedentist over difference w
SIT
ast dental visiificant predict
a dentist oveng those haviplanation mable selection bhaving their c
ntist, 45.8%, se having visit
e having visitea year ago an
was observed
it, as tor of
er a ng ay lay, bias child
ted a
ed a nd
While 67.23.1% nothad never
Figu
6% of parentted that it har visited a den
re 13 – TIME
s in Clark Coud been over antist.
SINCE LAST D
unty reporteda year since t
DENTAL VISIT
14
d that their chheir child’s la
T IN CLARK CO
hild had visiteast visit, and 9
OUNTY
ed a dentist in9.3% indicate
n the past yead that their c
ar, child
While 75.18.2% nothad never
Figu
5% of parentted that it har visited a den
re 14 – TIME
s in Washoe d been over antist.
SINCE LAST D
County repora year since t
DENTAL VISIT
15
rted that theiheir child’s la
T IN WASHOE
r child had viast visit, and 6
E COUNTY
sited a dentis6.3% indicate
st in the past d that their c
year, child
While 71.year, 22.3child had
Figu
7% of parent3% noted thatnever visited
re 15 – TIME
s in all other t it had been a dentist.
SINCE LAST D
counties repoover a year s
DENTAL VISIT
16
orted that theince their chi
T IN ALL OTHE
eir child had vild’s last visit,
ER COUNTIES
visited a dent and 6.0% ind
S
tist in the pasdicated that t
st their
InsuranceWhile 68.
Figure
e coverage is a9% of studen
16 – DENTAL
a crucial detents were cove
INSURANCE
DENTA
erminant of aered by denta
STATUS
17
TOPIC: AL INSURANC
ccess to and l insurance, 3
CE
affordability 31.1% were n
of medical anot.
nd dental servvices.
Looking astatisticalsignificantwith the l
The prevacompared
The prevathose wit
The propoinsurancebetween t
Figure
t the oral healy significant t predictor ofatter.
alence of caried to those wit
alence of untrh, 22.1%. A st
ortion of thirde versus 22.0%the two.
17 – ORAL HE
alth outcomedifferences ff the oral hea
es experiencethout, 62.1%.
reated decay tatistically sig
d‐grade stude% among thos
EALTH OUTCO
s by dental inor two of thelth outcomes
e was slightly.
was higher agnificant diffe
ents having dse without. A
OMES BY DEN
18
nsurance state three. Dentas—like time s
higher amon
mong those werence was ob
ental sealantA statistically s
NTAL INSURA
us revealed dal insurance since last visit
ng those with
without dentbserved betw
s was 45.9% significant dif
ANCE STATUS
differences acstatus appeart—and is likely
dental insura
al insurance, ween the two.
among thosefference was
S
cross all threes to be a y to be corre
ance, 66.4%,
39.0%, versu
e with dental observed
e and
lated
us
In additioand dentaimprovemboth dent
The prevalowest amthis resultprevious agiven the of caries econtributi
At 42.1%,among thobserved both med
Likewise, both medobserved
Figure
n, the oral heal insurance cments to two tal and medic
alence of cariemong those wt seems againanomaly—buwide confideexperience, aing to such co
the prevalenose with bothbetween tho
dical and dent
those with nodical and dentbetween tho
18 – ORAL HE
ealth outcomcoverage. Indof the three ocal coverage.
es experiencewith only medn odd. There mut in this case,ence interval, nd, two, in a ounterintuitiv
nce of untreath medical andose with no intal insurance.
o insurance htal insurance ose with no in
EALTH OUTCO
es were furthependently, houtcomes. A
e was highestical insurancemay be a num, additional ethat those wdefinitional ive results.
ted decay wad dental insurnsurance and
had the loweshad the highensurance and
OMES BY ME
19
her analyzed bhaving eithersynergistic ef
t among those, 58.2. As wamber of explaxplanations m
with only dentssue around
as highest amrance, 22.0%both those w
st rate of denest rate, 45.9those with b
DICAL AND D
by the possib dental or meffect was obse
e with only das the case wnations—incmay lay, one, tal insurance what constitu
ong those wit. A statisticallwith only med
tal sealants, 19%. A statisticoth medical a
DENTAL INSU
ble combinatioedical coveragerved among
ental insuranith time sinceluding those in the theoreactually haveutes caries ex
th no insuranly significant dical insuranc
19.8%; wherecally significanand dental ins
RANCE STAT
ons of medicage resulted ing those who h
nce, 73.6%, ane last dental vnoted for theetical possibile the lowest rxperience tha
nce and lowesdifference wae and those w
eas, those witnt difference surance.
US
al n had
nd visit, e ity, ate t is
st as with
th was
While 68.
Figu
9% of studen
re 19 – DENT
nts were cove
TAL INSURAN
ered by denta
CE STATUS IN
20
l insurance in
N CLARK COU
n Clark County
UNTY
y, 31.1% weree not.
While 69.
Figu
6% of studen
re 20 – DENT
nts were cove
TAL INSURAN
ered by denta
CE STATUS IN
21
l insurance in
N WASHOE CO
n Washoe Cou
OUNTY
unty, 30.4% wwere not.
While 61.
Figu
7% of studen
re 21 – DENT
nts were cove
TAL INSURAN
ered by denta
CE STATUS IN
22
l insurance in
N ALL OTHER
n all other cou
COUNTIES
unties, 38.3%% were not.
Due to issit is needecare whenthis issue
Figure 2
sues of accessed. For the 20n their child nover the time
22 – INABILIT
sibility, availa008‐2009 survneeded it dure period.
TY TO SEEK D
ACCESS T
ability, and affvey, 33.5% ofing the past 1
ENTAL CARE
23
TOPIC: TO DENTAL C
fordability, def parents indi12 months. 66
WHEN NEED
CARE
ental care is ncated that th6.5% of paren
DED
not necessariey were unabnts indicated
ly available wble to seek dethat did not
when ental have
Furthermaffordabil45.4% of tthe time,
Due to mu
Figure 2
ore, the reasolity was mostthe time, respfollowed by ‘
ultiple respon
23 – REASON
on for the ina often the isspectively. An ‘not a serious
nses, the valu
N FOR THE INA
ability to seeksue, with ‘cou‘other’ reasos enough prob
ues do not sum
ABILITY TO SE
24
k dental care uld not afford on was indicatblem’ 6.7% of
m to 100%.
EEK DENTAL
when neededit’ and ‘no inted, without ff the time.
CARE WHEN
d was examinnsurance’ citefurther expla
NEEDED
ned. Overall, ed 49.6% and nation, 9.2% of
25
SURVEY METHOD
As with previous surveys, active consent was required of a student’s parent or guardian before he or she could be screened. The consent form was combined with a questionnaire that gathered basic demographic information and asked questions concerning socio‐economic status and the accessibility, availability, and affordability of dental services. Only children of consenting parents or guardians were screened.
Individual surveys were conducted by visual oral health screening in accordance with the diagnostic criteria outlined in the Association of State and Territorial Dental Directors’: Basic Screening Surveys: An Approach to Monitoring Community Oral Health. For each survey, the screener wore a fresh pair of gloves and used a disposable mouth mirror and a flashlight. Cotton swabs were also used as needed.
The screeners for the survey were either members of the Oral Health Program team or dental hygiene students from the Dental Hygiene Program at Truckee Meadows Community College. Team staff provided additional training to the students regarding the survey and calibrated them to the evaluation criteria to ensure consistent returns. Overall, 4 of the 42 schools were screened by the hygiene students.
At each school, a list of students identified as in need of dental treatment was submitted to the school nurse for follow‐up with the child’s parent or guardian, and all students were educated about the importance of dental hygiene and taught healthy oral hygiene habits.
26
SAMPLING
Third‐grade students were the focus demographic of the 2008‐2009 oral health survey, and schools were the primary sampling unit.
During the 2007‐2008 school year, there were 363 schools with third‐grade students in Nevada for a total of 34,234 third‐grade students. Of these schools, 45 had less than 20 students enrolled in third‐grade, so they were excluded from the sampling frame. As a result, there were no qualifying schools left in either Esmeralda or Eureka counties, thus neither had the possibility of being represented. The remaining 318 schools—for a total of 33,947 third‐grade students—were then stratified by the three regions frequently used in Nevada: Clark County, Washoe County, and all other counties.
Stratum‐specific sample sizes were calculated for each oral health measure using the third‐grade student population of each region, parameter estimates for each of the three oral health indicators from the previous 2005‐2006 third‐grade oral health survey, and an error of 7%. The largest of the three was then chosen. These sample sizes were then adjusted according to the fraction of the region’s third‐grade student population to be sampled and to account for a survey design effect. As a final adjustment, the sample sizes were increased in anticipation of a response rate of 46%.
Next, to determine the number of schools to survey in each region, it was assumed that 60 students would be available for screening at each school, which meant that 42 schools were needed: 15 in Clark County, 13 in Washoe County, and 14 in all other counties. To determine which schools would be selected, they were ordered by the percentage of students eligible for the National School Lunch Program, and a school was randomly chosen as the starting point. Schools were then successively selected on an interval basis as determined by the number of schools to be surveyed in each region. Due to the refusal of two principals to participate in the survey, two substitute schools had to be chosen for Washoe County.
Department of Health and Human Services Nevada State Health Division
Oral Health Program
4150 Technology Way Suite 101 Carson City NV 89706
(775) 684‐4285 http://health.nv.gov/cc_oralhealth.htm