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

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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.