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

由于英国经历了几十年来最严重的生活成本危机（国家统计局，2022年），估计到1月，超过50%的家庭（1500万）将成为燃料贫乏的家庭（Bradshaw & Keung，2022年）。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 &博尔顿，2022）。在英格兰，如果一个家庭的能源效率等级为D级或以下，并且在扣除住房和燃料成本后，其可支配收入低于贫困线（低于家庭收入中位数的60%），则该家庭正式处于FP状态（BEIS，2021）。它是社会最脆弱群体的交叉点，包括因FP而处于健康不良风险最高的儿童（PHE，2017; Liddell & Morris，2010; Marmot et al 2011）。2011年），但对于儿童，重点是身体健康，有证据表明呼吸系统问题（如哮喘）的可能性增加（Mohan，2021年）。紧急文献将FP与儿童心理健康状况差（CMH）联系起来（Oliveras等人，2021）然而，机制仍然不清楚，需要更多的研究来了解英国儿童的经验。这项研究的目的是了解什么因素解释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。调查结果将为决策者、研究人员和从业人员提供证据，说明应采取哪些干预措施，以及哪些人将从中受益。FP如何影响儿童的MH轨迹？2.哪些因素可以解释FP和CMH结果之间的关系（中介或中度）？3. FP对儿童及其家庭的生活体验是什么？这与CMH有什么关系？三项相关研究将提供证据，为政策和实践提供信息，以减少计划生育对CMH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年建立的大型队列研究，跟踪布拉德福德市出生的婴儿从童年到成年的发育（Wright et al.，2013年）。它在2007年和2011年之间招募了12，453名孕妇，捕获有关遗传，营养，环境和社会因素的信息，其中家庭子集有助于自招募以来的大量BiB数据扫描。在巴克斯特等人（2010）的指导下，将在研究2中开发和测试逻辑模型。了解因素，调解和温和的FP和CMH之间的关系提供了一个理论指导的政策和实践的changes.Study 2Little是鲜为人知的FP的早期生活经历如何影响CMH的结果的出现和轨迹。使用重复测量分析，本研究将探讨妊娠/出生和幼儿期（4/5岁）暴露于FP如何有助于儿童早期和中期CMH症状的发展。将使用结构方程模型进行进一步分析，以检验基于文献检索和逻辑模型的假设中介变量。总体而言，这些分析将产生的证据类型的干预措施使用，在哪里针对他们，谁会从中受益。研究3访谈将进行燃料贫困的儿童从围兜队列和他们的父母。借鉴Butler和Sheriff（2017）的方法论方法，解释现象学分析（Smith et al.，2009年）将被用来了解儿童及其家庭如何与计划生育的经验和意义。调查结果将与研究1和2一起进行询问，以产生一个变化模型的理论，为未来的政策和实践提供信息，为患有FP或有FP风险的儿童和家庭提供信息。

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.