Understanding influences and decisions of households with children with asthma regarding temperature and humidity in the home in winter a qualitative study

Objectives: This study aimed to understand the influences and decisions of households with children with asthma regarding keeping warm and well at home in winter. Setting: Community settings in Rotherham and Doncaster, South Yorkshire, UK. Participants: Individuals from 35 families and 25 health, education and social care staff underwent interview. 5 group interviews were held, 1 with parents (n=20) and 4 with staff (n=25). Outcome: measures This qualitative study incorporated in-depth, semistructured individual and group interviews, framework analysis and social marketing segmentation techniques. Results: The research identifies a range of psychological and contextual influences on parents that may inadvertently place a child with asthma at risk of cold, damp and worsening health in a home. Parents have to balance a range of factors to manage fluctuating temperatures, damp conditions and mould. Participants were constantly assessing their family's needs against the resources available to them. Influences, barriers and needs interacted in ways that meant they made ‘trade-offs’ that drove their behaviour regarding the temperature and humidity of the home, including partial self-disconnection from their energy supply. Evidence was also seen of parents lacking knowledge and understanding while working their way through conflicting and confusing information or advice from a range of professionals including health, social care and housing. Pressure on parents was increased when they had to provide help and support for extended family and friends. Conclusions: The findings illustrate how and why a child with asthma may be at risk of a cold home. A ‘trade-off model’ has been developed as an output of the research to explain the competing demands on families. Messages emerge about the importance of tailored advice and information to families vulnerable to cold-related harm

The association of cold weather and all-cause and cause-specific mortality in the island of Ireland between 1984 and 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This article has been made available through the Brunel Open Access Publishing Fund.Background This study aimed to assess the relationship between cold temperature and daily mortality in the Republic of Ireland (ROI) and Northern Ireland (NI), and to explore any differences in the population responses between the two jurisdictions. Methods A time-stratified case-crossover approach was used to examine this relationship in two adult national populations, between 1984 and 2007. Daily mortality risk was examined in association with exposure to daily maximum temperatures on the same day and up to 6 weeks preceding death, during the winter (December-February) and cold period (October-March), using distributed lag models. Model stratification by age and gender assessed for modification of the cold weather-mortality relationship. Results In the ROI, the impact of cold weather in winter persisted up to 35 days, with a cumulative mortality increase for all-causes of 6.4% (95%CI=4.8%-7.9%) in relation to every 1oC drop in daily maximum temperature, similar increases for cardiovascular disease (CVD) and stroke, and twice as much for respiratory causes. In NI, these associations were less pronounced for CVD causes, and overall extended up to 28 days. Effects of cold weather on mortality increased with age in both jurisdictions, and some suggestive gender differences were observed. Conclusions The study findings indicated strong cold weather-mortality associations in the island of Ireland; these effects were less persistent, and for CVD mortality, smaller in NI than in the ROI. Together with suggestive differences in associations by age and gender between the two Irish jurisdictions, the findings suggest potential contribution of underlying societal differences, and require further exploration. The evidence provided here will hope to contribute to the current efforts to modify fuel policy and reduce winter mortality in Ireland

The Impact of Domestic Energy Efficiency Retrofit Schemes on Householder Attitudes and Behaviours

Retrofitting existing housing stock to improve energy efficiency is often required to meet climate mitigation, public health and fuel poverty targets. Increasing uptake and effectiveness of retrofit schemes requires understanding of their impacts on householder attitudes and behaviours. This paper reports results of a survey of 500 Kirklees householders in the UK, where the Kirklees Warm Zone scheme took place. This was a local government led city-scale domestic retrofit programme that installed energy efficiency measures at no charge in over 50,000 houses. The results highlight key design features of the scheme, socio-economic and attitudinal factors that affected take-up of energy efficiency measures and impacts on behaviour and energy use after adoption. The results emphasise the role that positive feedback plays in reinforcing pro-environmental attitudes and behaviours of participants and in addressing concerns of non-participants. Our findings have implications for the design and operation of future domestic energy efficiency retrofit schemes

Socioeconomic position across life and body composition in early old age: findings from a British birth cohort study.

Background Previous studies have reported associations between lower lifetime socioeconomic position (SEP) and higher body mass index in adulthood, but few have examined associations with direct measures of fat and lean mass which are likely to have independent roles in health and physical functioning. Methods We examined associations of SEP across life with dual-energy X-ray absorptiometry measures of fat and lean mass at 60–64 years using data from a total of 1558 men and women participating in the Medical Research Council (MRC) National Survey of Health and Development. We also examined whether associations of childhood SEP with fat and lean mass were explained by preadulthood weight gain (birth weight, 0–7 and 7–20 years) and adult SEP. Results Lower SEP across life was associated with higher fat mass and higher android to gynoid fat mass ratio. For example, the mean difference in fat mass index comparing the lowest with the highest paternal occupational class at 4 years (slope index of inequality) was 1.04 kg/m1.2 in men (95% CI 0.09 to 1.99) and 2.61 in women (1.34 to 3.89), equivalent to a 8.6% and 16.1% difference, respectively. After adjustment for fat mass, lower SEP across life was associated with lower lean mass in women, while only contemporaneous household income was associated in men. Associations between childhood SEP and outcomes were partly explained by preadulthood weight gain and adult SEP. Conclusions This study identified lifetime socioeconomic patterning of fat and lean mass in early old age. This is likely to have important implications and may partly explain socioeconomic inequalities in health and physical functioning

Advancing an energy justice perspective of fuel poverty: Household vulnerability and domestic retrofit policy in the United Kingdom

The concept of energy justice has brought philosophies of ethics and principles of social justice to bear on a range of contemporary energy issues. More inter-disciplinary and applied endeavours are now needed to take this field forward. One such application is to the issue of fuel poverty and the challenge of retrofitting inefficient housing stock. An energy justice perspective sees fuel poverty as a fundamentally socio-political injustice, not just one of uneven distribution. Starting from this premise, we highlight the multiple injustices faced by two groups who are regarded by policymakers as being particularly vulnerable to fuel poverty: disabled people and low-income families. In the UK, these groups are nominally prioritised within fuel poverty policy, but their complex situations are not always fully appreciated. Building on the theoretical foundations of energy justice, we present an inter-disciplinary dialogue that connects this approach with wider vulnerability research and domestic energy efficiency policy. Specifically, we discuss ‘within group’ heterogeneity (recognition justice), stakeholder engagement in policy and governance (procedural justice) and the overlap of multiple structural inequalities (distributional justice). In each section we illustrate the added value of combining justice and vulnerability conceptualisations by linking them to domestic energy efficiency schemes

The short-term health and psychosocial impacts of domestic energy efficiency investments in low-income areas: a controlled before and after study

Background Research suggests that living in fuel poverty and cold homes contributes to poor physical and mental health, and that interventions targeted at those living in poor quality housing may lead to health improvements. However, little is known about the socio-economic intermediaries and processes that contribute to better health. This study examined the relationship between energy efficiency investments to homes in low-income areas and mental and physical health of residents, as well as a number of psychosocial outcomes likely to be part of the complex relationship between energy efficiency measures and health outcomes. Methods A quasi-experimental field study with a controlled pretest-posttest design was conducted (intervention n = 364; control n = 418) to investigate the short-term health and psychosocial impacts of a domestic energy efficiency programme that took place across Wales between 2013 and 2015. Survey data were collected in the winters before and after installation of energy efficiency measures, including external wall insulation. The study used a multilevel modelling repeated measures approach to analyse the data. Results The energy efficiency programme was not associated with improvements in physical and mental health (using the SF-12v2 physical and mental health composite scales) or reductions in self-reported respiratory and asthma symptoms. However, the programme was associated with improved subjective wellbeing (B = 0.38, 95% CI 0.12 to 0.65), as well as improvements in a number of psychosocial outcomes, including increased thermal satisfaction (OR = 3.83, 95% CI 2.40 to 5.90), reduced reports of putting up with feeling cold to save heating costs (OR = 0.49, CI = 0.25 to 0.94), fewer financial difficulties (B = −0.15, 95% CI -0.25 to -0.05), and reduced social isolation (OR = 0.32, 95% CI 0.13 to 0.77). Conclusion The study showed that investing in energy efficiency in low-income communities does not lead to self-reported health improvements in the short term. However, investments increased subjective wellbeing and were linked to a number of psychosocial intermediaries that are conducive to better health. It is likely that better living conditions contribute to improvements in health outcomes in the longer term. Better understanding of the impacts on recipients of energy efficiency schemes, could improve targeting of future fuel poverty policies

The health impacts of energy performance investments in low-income areas: a mixed-methods approach

The study found improvements in subjective well-being and a number of psychosocial outcomes, but there was no evidence of changes in physical health

Modelling the association between weight status and social deprivation in English school children: Can physical activity and fitness affect the relationship?

Background: The association between being overweight/obese and deprivation is a serious concern in English schoolchildren. Aim: To model this association incorporating known confounders and to discover whether physical fitness and physical activity may reduce or eliminate this association. Subjects and methods: Cross-sectional data were collected between 2007–2009, from 8053 10–16 year old children from the East-of-England Healthy Heart Study. Weight status was assessed using waist circumference (cm) and body mass (kg). Deprivation was measured using the Index of Multiple Deprivation (IMD). Confounding variables used in the proportional, allometric models were hip circumference, stature, age and sex. Children’s fitness levels were assessed using predicted VO2 max (20-metre shuttle-run test) and physical activity was estimated using the Physical Activity Questionnaire for Adolescents or Children. Results: A strong association was found between both waist circumference and body mass and the IMD. These associations persisted after controlling for all confounding variables. When the children’s physical activity and fitness levels were added to the models, the association was either greatly reduced or, in the case of body mass, absent. Conclusions: To reduce deprivation inequalities in children’s weight-status, health practitioners should focus on increasing physical fitness via physical activity in areas of greater deprivation