Public Health Nutrition

Nutrition and health

Health behaviours and health-care utilization in Canadian schoolchildren

Sara FL Kirka1 c1, Stefan Kuhlea2, Arto Ohinmaaa2 and Paul J Veugelersa2

a1 School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada, B3H 3E2

a2 School of Public Health, University of Alberta, Edmonton, Alberta, Canada


Objective Poor nutritional habits and physical inactivity are two health behaviours believed to be linked with increasing rates of overweight and obesity in children. The objective of the present study was to determine whether children who reported healthier behaviours, specifically in relation to nutrition and physical activity, also had lower health-care utilization.

Design Population-based cross-sectional study, linking survey data from the 2003 Children's Lifestyle and School Performance Study (CLASS) with Nova Scotia administrative health data. Health-care utilization was defined as both (i) the total physician costs and (ii) the number of physician visits, for each child from 2001 to 2006. Exposures were two indices of healthy eating, the Diet Quality Index and the Healthy Eating Index, and self-reported physical activity and screen time behaviours.

Setting Elementary schools in the Canadian province of Nova Scotia.

Subjects Grade 5 students and their parents; of the 5200 students who participated in CLASS and completed surveys, 4380 (84 %) could be linked with information in the administrative data sets.

Results The study found a relationship between both indices of healthy eating and a borderline significant trend towards lower health-care utilization in this population sample of children. No statistically significant relationships were seen for physical activity or screen time.

Conclusions Both measures of diet quality produced similar results. The study suggests that healthy eating habits established in childhood may be associated with lower health-care utilization, although further research over a longer time frame is needed to demonstrate statistical significance.

(Received September 18 2011)

(Revised January 23 2012)

(Accepted February 22 2012)

(Online publication May 21 2012)


  • Diet quality;
  • Physical activity;
  • Health-care utilization;
  • Children;
  • Administrative data


c1 Corresponding author: Email