Fuel poverty and child mental health: exploring underlying mechanisms and experiences in order to reduce inequalities

随着英国经历几十年来最严重的生活成本危机（ONS, 2022），估计到明年1月，超过50%的家庭（1500万）将陷入燃料贫困（Bradshaw & Keung, 2022）。燃料贫困（FP）的定义在全球范围内各不相同（Thomson & Snell, 2016），即使在英国，各国也不同意（Hinson & Bolton 2022）。在英国，如果一个家庭的能效等级为D级或更低，并且扣除住房和燃料成本后的可支配收入低于贫困线（低于家庭收入中位数的60%），则正式属于FP （BEIS, 2021）。它是社会最弱势群体的交叉点，包括因生育障碍而面临最大健康风险的儿童（PHE, 2017; Liddell & Morris, 2010; Marmot et al 2011）。研究表明计划生育与成人心理健康不良之间存在联系（Liddell & Morris, 2010; Marmot at el）。2011年)，但对儿童来说，重点是身体健康，有证据表明哮喘等呼吸系统问题的可能性增加（Mohan， 2021年）。新兴文献将FP与儿童心理健康不良（CMH）联系起来（Oliveras et al., 2021），但机制尚不清楚，需要更多的研究来了解英国儿童的经历。本研究旨在了解是什么因素解释了FP和CMH之间的关系，以及可以做些什么来减少或阻止它们的影响。研究结果将为政策制定者、研究人员和从业人员提供有关使用干预措施、在何处针对这些干预措施以及谁将从中受益的证据。研究Questions1。计划生育如何影响儿童的MH轨迹？什么因素解释（调解或缓和）计划生育和CMH结果之间的关系？儿童及其家庭的计划生育生活经验是什么？这与CMH有什么关系？三项相互关联的研究将产生证据，为政策和实践提供信息，以减少计划生育对综合卫生保健结果的影响。它将与布拉德福德健康研究所合作进行，使用来自布拉德福德出生（BiB）研究的主要（研究3）和次要（研究2）数据。BiB是2007年建立的一项大型队列研究，追踪在布拉德福德市出生的婴儿从童年到成年的发展情况（Wright et al., 2013）。它在2007年至2011年期间招募了12453名孕妇，收集了有关遗传、营养、环境和社会因素的信息，自招募以来，家庭子集为大量的BiB数据扫描做出了贡献。研究1A将进行系统综述，以建立描述FP影响CMH机制的理论框架。在Baxter等人（2010）的指导下，将在研究2中开发和测试一个逻辑模型。了解计划生育与CMH之间关系的中介和调节因素为政策和实践变化提供了理论指导。研究2：关于FP的早期生活经历如何影响CMH结局的出现和发展轨迹，我们知之甚少。通过重复测量分析，本研究将探讨妊娠/分娩和幼儿期（4/5岁）暴露于FP如何促进儿童早期和中期CMH症状的发展。进一步的分析将使用结构方程模型来测试基于文献搜索和逻辑模型的假设中介变量。总的来说，这些分析将产生关于采取何种干预措施、在何处采取这些措施以及谁将从中受益的证据。研究3将对BiB队列中燃料不足的儿童及其父母进行访谈。借鉴Butler和Sheriff（2017）的方法论方法，解释现象学分析（Smith et al., 2009）将用于理解儿童及其家庭如何与计划生育相关并理解计划生育的经验。研究结果将与研究1和研究2一起进行审查，产生一个变化理论模型，为患有或有生育障碍风险的儿童和家庭的未来政策和实践提供信息。

As the UK experiences the worst cost of living crisis in decades (ONS, 2022) estimates suggest that by January over 50% of households (15 million) will be fuel poor (Bradshaw & Keung, 2022). Definitions of fuel poverty (FP) vary globally (Thomson & Snell, 2016), even within the UK, nations disagree (Hinson & Bolton 2022). In England, officially a household is in FP if it has an energy efficiency rating of band D or below and a disposable income under the poverty line (60% below median household income) after housing and fuel costs (BEIS, 2021). It is intersections of society's most vulnerable, including children who are at the greatest risk of ill health due to FP (PHE, 2017; Liddell & Morris, 2010; Marmot et al 2011).Research suggests links between FP and poor adult mental health (Liddell & Morris, 2010; Marmot at el. 2011) but for children the focus has been on physical health with evidence suggesting an increased likelihood of respiratory problems such as asthma (Mohan, 2021). Emergent literature has linked FP to poor child mental health (CMH) (Oliveras et al., 2021) however mechanisms remain unclear with more research needed to understand UK children's experiences.This research aims to understand what factors explain the relationship between FP and CMH and what can be done to reduce or stop their impact. Findings will provide evidence for policy makers, researchers and practitioners on interventions to use, where to target them and who would benefit from them.Research Questions1. How does FP impact MH trajectories of children?2. What factors explain (mediate or moderate) the relationship between FP and CMH outcomes?3. What is the lived experience of FP for children and their families and how does this relate to CMH?Three linked studies will generate evidence to inform policy and practices to reduce the impact of FP on CMH outcomes. It will be conducted in collaboration with the Bradford Institute for Health Research, using primary (Study 3) and secondary (Study 2) data from the Born in Bradford (BiB) Study. BiB is a large cohort study established in 2007, tracking the development of babies born in the city of Bradford from childhood into adulthood (Wright et al., 2013). It recruited 12,453 pregnant women between 2007 and 2011 capturing information on genetic, nutritional, environmental and social factors with subsets of families contributing to numerous BiB data sweeps since recruitment.Study 1A systematic review will be produced to establish a theoretical framework describing the mechanisms through which FP impacts CMH. Guided by Baxter et al. (2010), a logic model will be developed and tested in Study 2. Understanding factors that mediate and moderate the relationship between FP and CMH provides a rationale guided by theory for policy and practice change.Study 2Little is known about how early life experiences of FP impact the emergence and trajectory of CMH outcomes. Using repeated measures analysis, this study will explore how exposure to FP at pregnancy/birth and early childhood (4/5 years) contribute to the development of CMH symptoms in early and middle childhood. A further analysis will be conducted using structural equation modelling to test hypothesised mediating variables based on literature searches and the logic model. Collectively these analyses will generate evidence on types of interventions to use, where to target them and who would benefit from them.Study 3Interviews will be conducted with fuel poor children from the BiB cohort and their parents. Drawing on Butler and Sheriff's (2017) methodological approach interpretative phenomenological analysis (Smith et al., 2009) will be used to understand how children and their families relate to and make sense of experiences of FP. Findings will be interrogated alongside studies 1&2 producing a theory of change model to inform future policy and practice for children and families living with or at risk of FP.