Pre-COVID-19 pandemic health-related behaviours in children (2018-2020) and association with being tested for SARS-CoV-2 and testing positive for SARS-CoV-2 (2020-2021): a retrospective cohort study using survey data linked with routine health data in Wales, UK

Research output: Journal contributionsJournal articlesResearchpeer-review


  • Emily Marchant
  • Emily Lowthian
  • Tom Crick
  • Lucy J. Griffiths
  • Richard Fry
  • Kevin Dadaczynski
  • Orkan Okan
  • Michaela James
  • Laura Cowley
  • Fatemeh Torabi
  • Jonathan Kennedy
  • Ashley Akbari
  • Ronan Lyons
  • Sinead Brophy

Objectives Examine if pre-COVID-19 pandemic (prior March 2020) health-related behaviours during primary school are associated with (1) being tested for SARS-CoV-2 and (2) testing positive between 1 March 2020 and 31 August 2021. Design Retrospective cohort study using an online cohort survey (January 2018 to February 2020) linked with routine PCR SARS-CoV-2 test results. Setting Children attending primary schools in Wales (2018-2020), UK, who were part of the Health and Attainment of Pupils in a Primary Education Network (HAPPEN)_school network. Participants Complete linked records of eligible participants were obtained for n=7062 individuals. 39.1% (n=2764) were tested (age 10.6±0.9; 48.9% girls) and 8.1% (n=569) tested positive for SARS-CoV-2 (age 10.6±1.0; 54.5% girls). Main outcome measures Logistic regression of health-related behaviours and demographics were used to determine the ORs of factors associated with (1) being tested for SARS-CoV-2 and (2) testing positive for SARS-CoV-2. Results Consuming sugary snacks (1-2 days/week OR=1.24, 95% CI 1.04 to 1.49; 5-6 days/week OR=1.31, 95% CI 1.07 to 1.61; reference 0 days), can swim 25 m (OR=1.21, 95% CI 1.06 to 1.39) and age (OR=1.25, 95% CI 1.16 to 1.35) were associated with an increased likelihood of being tested for SARS-CoV-2. Eating breakfast (OR=1.52, 95% CI 1.01 to 2.27), weekly physical activity ≥60 min (1-2 days OR=1.69, 95% CI 1.04 to 2.74; 3-4 days OR=1.76, 95% CI 1.10 to 2.82; reference 0 days), out-of-school club participation (OR=1.06, 95% CI 1.02 to 1.10), can ride a bike (OR=1.39, 95% CI 1.00 to 1.93), age (OR=1.16, 95% CI 1.05 to 1.28) and girls (OR=1.21, 95% CI 1.00 to 1.46) were associated with an increased likelihood of testing positive for SARS-CoV-2. Living in least deprived areas (quintile 4 OR=0.64, 95% CI 0.46 to 0.90; quintile 5 OR=0.64, 95% CI 0.46 to 0.89) compared with the most deprived (quintile 1) was associated with a decreased likelihood. Conclusions Associations may be related to parental health literacy and monitoring behaviours. Physically active behaviours may include coparticipation with others and exposure to SARS-CoV-2. A risk-versus-benefit approach must be considered in relation to promoting these health behaviours, given the importance of health-related behaviours such as childhood physical activity for development.

Original languageEnglish
Article numbere061344
JournalBMJ Open
Issue number9
Number of pages11
Publication statusPublished - 07.09.2022

Bibliographical note

Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.

The Economic and Social Research Council (ESRC) funded the
development of the HAPPEN network (grant number: ES/J500197/1) which this
research was conducted through. The National Centre for Population Health and
Wellbeing Research (NCPHWR) funded by Health and Care Research Wales provided
infrastructural support for this work. This work was supported by the Con-COV
team funded by the Medical Research Council (grant number: MR/V028367/1).
This work was supported by Health Data Research UK, which receives its funding
from HDR UK (HDR-9006) funded by the UK Medical Research Council, Engineering
and Physical Sciences Research Council, Economic and Social Research Council,
Department of Health and Social Care (England), Chief Scientist Office of the
Scottish Government Health and Social Care Directorates, Health and Social Care
Research and Development Division (Welsh Government), Public Health Agency
(Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work
was a collaboration with the ADR Wales programme of work. ADR Wales is part of
the Economic and Social Research Council (part of UK Research and Innovation)
funded ADR UK (grant number: ES/S007393/1). This work was supported by the
Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales and
by the COVID- 19 Longitudinal Health and Wellbeing National Core Study funded by
the Medical Research Council (MC_PC_20030).

    Research areas

  • Community child health, COVID-19, Epidemiology, Public health, PUBLIC HEALTH
  • Health sciences