https://orcid.org/0000-0002-1130-2333
Figures
Abstract
Background
The fossil fuel industry’s practices and products create wide‑ranging harms to human health, with disproportionate impacts on communities already affected by structural disadvantage. Young people, particularly adolescents, are among those most affected by these harms, yet they are often excluded from health and climate decision-making. At the same time, youth-led initiatives to counter the fossil fuel industry’s practices and products are increasing globally. Despite this momentum, little is known about what interventions involving adolescents exist, how they work, and under what circumstances they may reduce health inequities driven by the fossil fuel industry. This study protocol aims to address this gap by conducting a realist review to explore how interventions involving adolescents can counter industry practices and products. It takes a structural racism lens to examine how inequities shape both exposure to harm and opportunities for participation. The review seeks to identify relevant interventions, understand the mechanisms through which they produce change, and examine the contexts that enable or hinder their effectiveness.
Methods
The study follows established realist review standards and draws on diverse sources of evidence, including published research and grey literature. Adolescents and a multidisciplinary expert steering group have contributed to shaping the review questions and will continue to be involved throughout the process. The review will generate explanations about how interventions work by developing context–mechanism–outcome configurations. These explanations will be refined through iterative synthesis and engagement with advisory groups.
Discussion
The review is expected to produce a set of theories illustrating how adolescents’ participation can influence action against the fossil fuel industry to help reduce health inequities. The findings will inform public health practitioners, policymakers, organisations working with adolescents, and researchers seeking to design, adapt, or scale interventions that amplify adolescents’ role in addressing the fossil fuel industry’s health harms.
Citation: Deivanayagam TA, Szawlowski S-M, Abdul-Qayum S, Camargo A, Fonso A, Isba R, et al. (2026) Interventions involving young people for health equity targeting the fossil fuel industry’s practices and products: A realist review protocol. PLoS One 21(8): e0356102. https://doi.org/10.1371/journal.pone.0356102
Editor: Tingzhen Ming, Wuhan University of Technology, CHINA
Received: February 25, 2026; Accepted: July 28, 2026; Published: August 13, 2026
Copyright: © 2026 Deivanayagam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All data are in the manuscript and/or supporting information files. As this manuscript is a review protocol, no datasets have been generated or analysed yet. All relevant data will be made available as supplementary material as part of the subsequent publication of the realist review.
Funding: TAD declares being funded by the National Institute for Health Research (NIHR) Doctoral Fellowship (NIHR303268) focusing on fossil fuels, climate change, racism, and health inequalities. MvS’s position is supported by the National Institute for Health and Care Research (grant number NIHR156820 Addressing the Commercial Determinants of Health in Sub-Saharan Africa) and by the Centre for Pesticide Suicide Prevention which is funded by the Good Ventures Foundation at the recommendation of Open Philanthropy. MvS has funding through the SPECTRUM consortium which is funded by the UK Prevention Research Partnership (UKPRP), a consortium of UK funders [UKRI Research Councils: Medical Research Council (MRC), Engineering and Physical Sciences Research Council (EPSRC), Economic and Social Research Council (ESRC) and Natural Environment Research Council (NERC); Charities: British Heart Foundation, Cancer Research UK, Wellcome and The Health Foundation; Government: Scottish Government Chief Scientist Office, Health and Care Research Wales, National Institute of Health Research (NIHR) and Public Health Agency (NI)]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Fossil fuels like oil and gas, and the world’s continued reliance on them, are a major threat to human health – from extraction to processing, to combustion, and disposal. An estimated 2.5 million deaths annually are due to outdoor air pollution from burning fossil fuels [1]. Fossil fuels contribute to respiratory illnesses, cancers, cardiovascular diseases, and congenital diseases [2]. However, these harms are not distributed equally. Communities already facing structural disadvantage – particularly those on low incomes and racially minoritised people – experience disproportionate exposure to fossil fuel-related pollution and health risks [3]. From extraction sites often located near minoritised communities to the burden of air pollution, these inequities often fall on those least responsible for fossil fuel use, creating a cycle of harm that persists from cradle to grave [1]. The fossil fuel industry is also the driving force behind climate change, with 67% of greenhouse gases attributable to fossil fuel combustion. Climate change increases food insecurity, infectious diseases spread, heat-related illness, and deaths from climate-related disasters such as flooding, among other negative health consequences [1].
There is a growing body of literature examining how the practices and products of commercial actors impact health [4]. Despite strong scientific consensus on these harms and the availability of cleaner, more equitable energy alternatives, fossil fuel extraction projects continue to expand [5]. This is enabled by industry practices that block, delay and dilute policy similar to those adopted by the tobacco and other health-harming industries (HHIs) [6–9]. Practices include spreading doubt by undermining the independent evidence base and funding favourable research, as well as spreading misinformation and lobbying against regulations [10]. This results in national and international policies that align more with the business interests of the fossil fuel industry than with those of people and communities affected by its health impacts [11]. The health community is increasingly starting to recognise the fossil fuel industry as a commercial determinant of health (CDoH) [12]. These are defined as the strategies and approaches used by the private sector to promote products and choices that are detrimental to health [13]. Understanding the fossil fuel industry through a CDoH lens is critical because these industry practices are the primary drivers of continued fossil fuel dependence. Countering these practices is essential to achieving a global phase-out of the industry’s products (coal, oil, and gas).
The health community’s resistance to fossil fuels has never been stronger. In 2022, 192 health organisations worldwide, including the World Health Organization (WHO), have demanded a phase-out of fossil fuels by calling for an international fossil fuel non-proliferation treaty [14]. A 2023 open letter from organisations representing 46.3 million health workers worldwide also helped secure commitment to transition away from fossil fuels [15].
Children, defined as anyone under the age of 18 years, disproportionately suffer the health harms of fossil fuel use but are frequently excluded from climate decision-making [16,17]. The population we are interested in for this review are adolescents (aged 10–19 years old). The worsening threat of climate change affects all aspects of adolescents’ wellbeing [18]. Many feel disillusioned by inadequate action, [19] prompting resistance led by adolescents against fossil fuel projects, through tactics such as litigation, school strikes, and campaigns [20]. The UK Government [21] and United Nations (UN) policies [22] advocate for adolescents’ participation in both health and climate decision-making. The UK is also a signatory to the UN Convention on the Rights of the Child, a global treaty requiring children to participate in policymaking that affects them.
Health inequities persist, especially for racially minoritised children, who face greater harms from climate change [16] and more frequent exclusion from research and policy spaces [23,24]. Minoritised refers to individuals or populations (even numerical majorities) whose power is eroded by societal structures targeting their identity [25]. These inequities stem from structural racism – systems embedded in laws, institutions, and societal narratives that organise advantage and disadvantage [26]. Other intersecting factors such as class, gender, and disability can compound health inequities rising from climate change [3]. Structural racism also operates at the level of whose knowledge is recognised as legitimate; it influences the norms, resources, and cognitive habits that determine how knowledge is produced and valued [27]. Ensuring racialised adolescents’ meaningful involvement in policy and decision making is therefore essential not only because they are most affected, but also as an act of epistemic justice. Their lived experience offers insights necessary for equitable public health responses and for challenging the fossil fuel industry’s role in driving health inequities [18].
This protocol is for a realist review of interventions (programmes, campaigns or other initiatives) involving adolescents that counter the fossil fuel industry’s practices and products, with the outcome of addressing health inequity. Current health literature is skewed towards monitoring the health impacts of climate change, rather than evaluating the effectiveness and equity of interventions addressing them [28]. This review aims to identify existing interventions, explore their mechanisms of change, and inform public health responses that integrate young voices. A realist approach is well-suited for this task as it examines how interventions produce outcomes rather than simply asking “does it work”. By uncovering generative mechanisms and contextual factors, realist review can guide adaptation and scaling of interventions across settings [29]. Findings will inform a wider study to create an advocacy strategy addressing the fossil fuel industry’s role in driving climate-related health inequalities through a structural racism lens [30].
Methods
What is a realist review?
A realist review is a type of literature review that seeks to explain how, why, and for whom interventions work [31]. It aims to provide a causal understanding rather than simply assessing effectiveness by employing the Context–Mechanism–Outcome (CMO) framework (See Table 1) [33]. In other words, outcomes occur when mechanisms are triggered within particular contexts.
Grounded in the realist paradigm, this approach emphasises generative causation, i.e., understanding how programmes and policies produce outcomes through human decisions [34]. Analysis is theory-driven and iterative, aiming to develop and refine programme theories using evidence from diverse sources. These theories will articulate and critique the assumptions underlying intervention design and guide adaptation across settings [35].
Our review will follow Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards [36] and realist methodology, comprising five stages: (1) defining the review’s scope, (2) building initial programme theory, (3) systematic evidence search, (4) selection and appraisal and (5) extraction and synthesis [37].
Who we are
The research team consists of a core group of two people (TAD and SS). TAD is the project lead and PhD student. SS is a PhD student and will be the second independent screener and data extractor. The project lead is supervised by DD, AP, and RI. A youth advisory board (YAB) made up of six adolescents who identify as racially minoritised aged 14–17 years from across England were invited to participate. A multidisciplinary expert steering group (ESG) has representation from parents, community-based organisations, experts by experience, researchers and public health professionals. These partners helped in shaping the initial review questions and reviewing the protocol. Moving forward, they will continue to help refine key criteria, interpret the findings, and distil the programme theories. Some of them join as authors on this protocol. Shared agreements on ways of working for the YAB and ESG were written at the start of the review and can be found in S1 File. The core group and supervisors will continue to meet monthly during the research process to review progress, develop procedures and troubleshoot. TAD will maintain correspondence with the YAB and ESG.
Step 1. Define the review scope
According to RAMESES standards, the first step of a realist review is to clarify the scope and definitions of key concepts [32]. A preliminary search across PubMed, GeoBase and Scopus helped develop a sense of the size of the evidence base and inform the scope and definitions. The root terms were ‘climate change’, ‘young people’, ‘fossil fuel’, and ‘advocacy/intervention’, with no restrictions on date or methods. From this, we refined definitions and identified gaps in interventions involving minoritised adolescents addressing fossil fuel-related health inequities.
We define adolescents as 10–19-year-olds, according to the UN definition [38]. The fossil fuel industry in this review is defined as the corporate entities engaged in the extraction, transport, refinement, and sale of oil, coal, and gas, and their derivative products. This includes their owners (private or state), trade bodies, and those entities acting on their behalf while in receipt of their funding, such as think tanks, public relations, and legal firms [39]. Interventions of interest include advocacy initiatives, litigation, activism, campaigns, policymaking, or strategies that involve adolescents. We acknowledge that levels of involvement or participation will vary across interventions. Studies will not be excluded based on low levels of participation alone. Instead, we will include interventions where adolescents’ involvement corresponds to Rung five and above (consulted and informed) on Hart’s ladder of children’s participation [40]. The ladder then will be used analytically to classify and interpret degrees of involvement, and ultimately power-sharing during data extraction and synthesis, rather than a strict exclusion criterion.
Governments can introduce policies to reduce harm, but the fossil fuel industry repeatedly blocks, weakens, and delays such policies through what is known as corporate political activity (CPA). These are “practices to secure preferential treatment and/or prevent, shape, circumvent or undermine public policies in ways that further corporate interests” [41]. In this review, we will include interventions that counter industry CPA both directly and indirectly. This means including, for example, campaigns advocating for clean air, renewable energy initiatives, or education programmes that raise awareness of the industry’s harms and build collective power. While these do not directly target fossil fuel companies or their products, they are helping to counter the narratives and sociopolitical norms “framed” by the industry that serve to normalise their products and play down the harms. Therefore, any interventions that have an element that counters the fossil fuel industry’s CPA will be included.
Addressing health inequities – which stem from wider political and social inequities – requires building social and policy movements capable of challenging the structural drivers of harm. Interventions that counter industry CPA form part of a wider movement ecosystem, in which community actors, youth groups, civil society organisations, and social movements collectively work to resist the industry’s practices and influence. Movement ecosystems provide the infrastructure, relationships, and strategic capacities needed for policy and systems change, as highlighted in the social movement literature [42,43]. Recognising these interventions as elements of a broader movement landscape reinforces the importance of applying a CPA lens in this review, as it allows us to capture how collective action, organising, and movement-driven pressure contribute to challenging the health inequities produced by the fossil fuel industry.
This review uses a structural racism lens, [44] acknowledging racial discrimination in policymaking, that racially minoritised people experience higher exposure to health harms, [45] and their exclusion from research, decision-making and environmental movements [3]. This lens necessitates most affected people’s participation in research questions, methods, and outputs (see ‘Who we are’) [46]. Interventions that are participatory, anti-racist, or rooted in social movements will be prioritised in the search. Studies referencing health inequities linked to racism will rank higher in relevance during appraisal. However, we acknowledge that many primary studies measure disparities without explicitly naming racism [47]. Data extraction and synthesis will note these limitations. Devakumar and colleagues’ conceptual model on racism and health will be referred to during data synthesis [48]. This model is well-suited to the review because it attributes health inequities to macro-level power hierarchies embedded across society. Applying this model allows us to frame the health harms of fossil fuels as an intergenerational health crisis, driven by commercial extractivism and structural racism [3].
The realist review questions emerging from the preliminary search and discussion between the researchers, ESG, YAB, and supervisory team were:
- What interventions (programmes, campaigns, or other initiatives) exist involving adolescents to address health inequities driven by the fossil fuel industry’s practices and products? (mechanism and outcomes)
- What are the mechanisms of change of these interventions? (mechanism)
- What are the circumstances that influence (e.g., enable or impede) these interventions’ functioning? (context)
Step 2. Build initial programme theories
Draft initial programme theories (IPTs) were generated from early searches and can be found in S2 File. Draft theories were refined through consensus building workshops with the YAB and ESG. Participants discussed intervention examples, and critiqued and ranked IPTs based on lived experience and prior work. The IPTs will guide evidence searching and synthesis.
To structure theory development, alongside Devakumar’s model [48], we will also refer to the MPOWER+ framework, adapted from tobacco control policy [49]. MPOWER+ has seven domains: monitor, protect, offer support, warn, enforce bans, raise taxes, and restrict undue commercial influence. The framework offers a systematic approach for public health action against fossil fuel-related harms, explicitly taking a CDoH lens. The original MPOWER included coordinated, evidence-based policies that significantly reduced smoking rates globally [50]. A key lesson from tobacco control was the adoption of Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC) [51]. This called for the protection of public health policies from the vested interests of the tobacco industry, supported by regulations that restrict industry influence. Where implemented, it helped to reduce the tobacco industry’s access to policymaking spaces and increase transparency. This Article is widely recognised as essential to making progress in addressing the health harms from tobacco. Drawing on lessons from tobacco control, where understanding industry practices was central to effective action, MPOWER+ may provide a benchmark for examining interventions seeking to counter these influences [52].
Step 3. Evidence searches – identification of data
The search strategy was developed by TAD and reviewed by the ESG and supervisory team (See S3 File). Review papers, qualitative and quantitative studies, evaluations, reports, and strategy documents will be identified. No date, geographic, or language restrictions will apply. Non-English documents will be translated using Google Translate.
Data sources will include:
- Databases: PubMed, Global Health, Scopus, Web of Science, and GEOBASE.
- Citation searching from primary studies and reviews.
- Purposive hand searching of websites and organisational reports such as UNICEF, WHO, and Fridays for Future. Only reports that provide evidence to inform the development of CMOs will be included.
- Input will be sought from the supervisory team and ESG to identify additional relevant publications, guidelines, and policies.
Further searches may be needed as the review progresses to support or refute the initial or emerging programme theories. All retrieved records will be imported into EndNote [53] for organisation and de-duplication, before transferring to Rayyan [54] to facilitate title and abstract screening.
Step 4. Selection and appraisal
Screening will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance [55]. Inclusion and exclusion criteria are summarised in Table 2 and may need refinement as the review progresses [35]. Given the emerging nature of the literature, we will apply these criteria broadly and err on the side of inclusion rather than exclusion at this stage if the reviewers feel the document will aide theory-building. Two reviewers (TAD and SS) will independently screen papers first by title and abstract. For grey literature, the executive summary will be read in full.
Two reviewers will undertake quality appraisal. In line with the realist approach, quality appraisal will be completed according to three criteria: relevance, richness, and rigour [56]. Criteria for ranking relevance developed with the ESG and supervisory team are shown in Table 3. If a study has high or moderate relevance, the full text will be appraised for richness and rigour.
Richness is whether the studies describe theories or concepts or describe the set of efforts needed to enact change [36]. Criteria from the existing literature [57] will be adapted to assess richness. Rigour refers to trustworthiness and credibility of the document [36], i.e., does the evidence support the conclusions made from it? The realist approach rejects the traditional ‘hierarchy of evidence’ whereby randomised controlled trials (RCTs) sit atop and opinion pieces underneath: valuable causal insights could be missed if seemingly poor-quality studies are ignored. We will therefore consider evidence of ‘lesser quality’ if they are relevant for identifying and developing programme theories for our study. Rigour will be assessed using RAMESES standards [36].
In this review, any studies and grey literature that describe the context of adolescents being involved in implementation plans and strategies challenging the fossil fuel industry, explore mechanisms and outcomes, and are in alignment with the inclusion criteria and search terms will be appraised. We will use a flow diagram for realist reviews [58] to show the process of selecting studies (S4 File). Any design limitations will be documented in an appraisal form adapting an existing template (S5 File) [59].
Step 5. Extraction and synthesis
Two reviewers (TAD and SS) will re-read the full texts and complete the data extraction, which will be discussed with the rest of the team in our regular meetings. Data extraction and synthesis for realist review is guided and RAMESES standards [36] Information will be extracted into a bespoke data extraction form (S6 File) capturing:
- Context (geographic setting, study type, target population, sampling)
- Intervention (activities, content, delivery mode, duration, staff)
- Outcomes (definitions, measures, time frame, findings)
- Notes on structural racism and equity considerations
Synthesis refers to the explanatory pursuit that will lead to an understanding of how, for whom and under what circumstances interventions involving adolescents in challenging the health inequalities generated by the fossil fuel industry work. Since realist reviews begin with theories and end with more refined theories, this step intends to translate data analysis into a refined ‘realist theory’. Methodological recommendations from the literature will be used and qualitative evidence will be synthesised by applying a realist approach to thematic analysis [60]. We will use retroductive reasoning [61] to refine CMO configurations and develop the final ‘realist theory’. Visual summaries of CMO configurations will be produced and validated through workshops with the YAB and ESG. These insights will inform future research related to interventions involving adolescents – a population disproportionately impacted by the harms of the fossil fuel industry. The outputs will be of value to funders, practitioners, policymakers, and researchers interested in creating evidence-informed solutions to counter the health harms driven by the industry [62].
The protocol is registered with PROSPERO: ID number 1267252. The completed PRISMA protocol checklist can be found in S7 File) [55]. No ethical approval is required as no primary data will be collected or analysed for the realist review. However, ethical approval has been obtained from the University College London Research Ethics Committee for the wider project that this review is part of (ID number: 1253).
Study status
Study start date: October 2024
Expected end date: April 2027
At the time of writing, the study status is as follows:
- Define the review scope: started.
- Build initial programme theories: started.
- Evidence searches: started.
- Selection and appraisal: not started.
- Data extraction and synthesis: not started.
Data collection (evidence searches, selection and appraisal) is aimed to be completed by April 2026. Results for the realist review are expected in July 2026. Dissemination will be completed by April 2027.
Discussion
A key strength of the study is that a comprehensive search strategy has been created to identify the most relevant literature. This includes systematic searches of academic databases, grey literature, and complementary techniques such as citation searching and snowballing. Youth advisors and an interdisciplinary panel of experts – spanning policy, advocacy, and research – have contributed to the development of this study, ensuring diverse perspectives are embedded throughout. However, engaging multiple stakeholder groups may present challenges in achieving consensus, particularly when shaping, refining, and prioritising programme theories that reflect complex social and political determinants.
Findings from the review will be published in a peer-review journal and shared via a report to the funder (NIHR), blogs, conference presentations, and social media (TikTok, Instagram, and LinkedIn posts). Existing contacts via the UK Faculty of Public Health and NHS are further avenues for dissemination. We will work with the UCL Communications team to produce a press release. Outputs aim to inform funding, policy, research, and collaboration with adolescents to address the health harms of fossil fuels. We intend for the review to provide an evidence base for shaping an inclusive response against the main driver of climate change.
Acknowledgments
We thank the FICCAH Study Youth Advisory Board for their contributions: Fatimah Asif. Marzana Begum, Hayley Bennet, Lila Mazen, Zainab Noor-Farooqi, and Tasnuva Zinan. We also thank Antonia Costas from Save the Children, and all members of the Expert Steering Group for their contributions.
References
- 1. Romanello M, Walawender M, Hsu S-C, Moskeland A, Palmeiro-Silva Y, Scamman D, et al. The 2025 report of the Lancet Countdown on health and climate change: climate change action offers a lifeline. Lancet. 2025;406(10521):2804–57. pmid:41175887
- 2.
Narayan S, Kuhl J, Miller J. Cradle to Grave: The Health Toll of Fossil Fuels and the Imperative for a Just Transition. 2nd edition. Global Climate and Health Alliance: 2025.
- 3. Deivanayagam TA, English S, Hickel J, Bonifacio J, Guinto RR, Hill KX, et al. Envisioning environmental equity: climate change, health, and racial justice. Lancet. 2023;402(10395):64–78. pmid:37263280
- 4. Gilmore AB, Fabbri A, Baum F, Bertscher A, Bondy K, Chang H-J, et al. Defining and conceptualising the commercial determinants of health. Lancet. 2023;401(10383):1194–213. pmid:36966782
- 5. Romanello M, Di Napoli C, Drummond P, Green C, Kennard H, Lampard P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet. 2022;400(10363):1619–54. pmid:36306815
- 6.
World Health Organization. Tobacco industry: decades of deception and duplicity. Geneva, Switzerland: World Health Organization. 2019.
- 7. Gilmore AB, van den Akker A. Protecting future generations from commercially driven health harms: lessons from tobacco control. Lancet. 2024;404(10449):221–3. pmid:38824940
- 8. 8.H. Workshop: The commercial determinants of health strategies and tactics: cases from 3 health harming industries. European Journal of Public Health. 2023;33(Supplement_2).
- 9. Boytchev H, Widmann N, Wörpel S. How much does the fossil fuel industry fund medical research?. BMJ. 2024;387:q2589. pmid:39603696
- 10.
Oreskes N, Conway EM. Merchants of doubt: How a handful of scientists obscured the truth on issues from tobacco smoke to global warming. Bloomsbury Publishing USA. 2011.
- 11. Osbourne R. Join the fight against fossil fuels. BMJ. 2022;379:o2414. pmid:36223905
- 12.
Faculty of Public Health. Fossil fuels, the fossil fuel industry and public health: the case for ending extraction and exploration to protect public health. 2024.
- 13. Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Glob Health. 2016;4(12):e895–6. pmid:27855860
- 14.
The Fossil Fuel Non-Proliferation Treaty Initiative. Health professionals around the world call for Fossil Fuel Non-Proliferation Treaty to protect lives of current and future generations. https://fossilfueltreaty.org/health-letter 2022. Accessed 2025 December 5.
- 15.
Sengupta S. Clash over ‘fossil fuels’ pits UAE against public health experts. 2023.
- 16. Gutschow B, Gray B, Ragavan MI, Sheffield PE, Philipsborn RP, Jee SH. The intersection of pediatrics, climate change, and structural racism: Ensuring health equity through climate justice. Curr Probl Pediatr Adolesc Health Care. 2021;51(6):101028. pmid:34238692
- 17. Rousell D, Cutter-Mackenzie-Knowles A. A systematic review of climate change education: giving children and young people a ‘voice’ and a ‘hand’ in redressing climate change. Children’s Geographies. 2019;18(2):191–208.
- 18. McGushin A, Gasparri G, Graef V. Adolescent wellbeing and climate crisis: adolescents are responding, what about health professionals?. BMJ. 2022;379:e071690.
- 19. Hickman C, Marks E, Pihkala P, Clayton S, Lewandowski RE, Mayall EE, et al. Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. Lancet Planet Health. 2021;5(12):e863–73. pmid:34895496
- 20. Gasparri G, Omrani OE, Hinton R. Children, adolescents, and youth pioneering a human rights-based approach to climate change. Health Hum Rights. 2021;23(2):95–108.
- 21.
Public Health England. Improving young people’s health and wellbeing: a framework for public health. 2015.
- 22.
UNICEF. Healthy Environments for Healthy Children: Global Programme Framework. 2021.
- 23. Powell RA, Njoku C, Elangovan R, Sathyamoorthy G, Ocloo J, Thayil S, et al. Tackling racism in UK health research. BMJ. 2022;376:e065574. pmid:35042720
- 24.
NIHR. Race equity in health research: Good for the public and the workforce. 2022.
- 25. Selvarajah S, Deivanayagam TA, Lasco G. Categorisation and minoritisation. BMJ Global Health. 2020;5(12):e004508.
- 26. Banaji MR, Fiske ST, Massey DS. Systemic racism: individuals and interactions, institutions and society. Cogn Res Princ Implic. 2021;6(1):82. pmid:34931287
- 27.
Medina J. The epistemology of resistance: Gender and racial oppression, epistemic injustice, and the social imagination. Oxford University Press. 2013.
- 28. Helldén D, Andersson C, Nilsson M, Ebi KL, Friberg P, Alfvén T. Climate change and child health: a scoping review and an expanded conceptual framework. Lancet Planet Health. 2021;5(3):e164–75. pmid:33713617
- 29.
Public Health England. A brief introduction to realist evaluation. 2021.
- 30.
NIHR. The FICCAH Study: Addressing the Fossil Fuel Industry’s Role in Driving Climate Change and Health Inequalities: A Multi-Method Youth Participatory Project Using a Structural Racism Lens. https://www.fundingawards.nihr.ac.uk/award/NIHR303268
- 31. Jagosh J. Realist Synthesis for Public Health: Building an Ontologically Deep Understanding of How Programs Work, For Whom, and In Which Contexts. Annu Rev Public Health. 2019;40:361–72. pmid:30633712
- 32.
Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review--a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;10 Suppl 1:21–34. https://doi.org/10.1258/1355819054308530 pmid:16053581
- 33.
Pawson R, Tilley N. Realistic evaluation. 1997;.
- 34.
Bhaskar R. A realist theory of science. Routledge. 2013.
- 35.
Pawson R, Greenhalgh T, Harvey G. Realist synthesis: an introduction. ESRC Research Methods Programme, University of Manchester. 2004.
- 36. Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: realist syntheses. BMC Med. 2013;11:21. pmid:23360677
- 37. Rycroft-Malone J, McCormack B, Hutchinson AM, DeCorby K, Bucknall TK, Kent B, et al. Realist synthesis: illustrating the method for implementation research. Implement Sci. 2012;7:33. pmid:22515663
- 38.
UNICEF. Adolescents. https://data.unicef.org/topic/adolescents/overview/. 2025. Accessed 2025 December 10.
- 39.
van Schalkwyk MC, Maani N, Petticrew M. The fossil fuel industry: fueling doubt and navigating contradiction. In: Maani N, Petticrew M, Galea S, editors. The commercial determinants of health. Oxford University Press. 2023. p. 0.
- 40.
Hart R. Children’s participation: From tokenism to citizenship. Florence: UNICEF. 1992.
- 41. Ulucanlar S, Lauber K, Fabbri A. Corporate political activity: taxonomies and model of corporate influence on public policy. Int J Health Policy Manag. 2023;12(7292).
- 42. Issa R, Baker C, Spooner R, Abrams R, Gopfert A, Evans M, et al. Mapping the movement for climate change and health in England: a descriptive review and theory of change analysis. Perspect Public Health. 2021;141(6):328–37. pmid:34816775
- 43. Raphael D. Reducing social and health inequalities requires building social and political movements. Humanity & Society. 2009;33(1–2):145–65.
- 44. Gee GC, Ford CL. Structural racism and health inequities: old issues, new directions. Du Bois Review. 2011;8(1):115–32.
- 45. Smith GS, Anjum E, Francis C, Deanes L, Acey C. Climate change, environmental disasters, and health inequities: the underlying role of structural inequalities. Curr Environ Health Rep. 2022;9(1):80–9. pmid:35338470
- 46. Garnett BR, Smith LC, Kervick CT, Ballysingh TA, Moore M, Gonell E. The emancipatory potential of transformative mixed methods designs: informing youth participatory action research and restorative practices within a district-wide school transformation project. International Journal of Research & Method in Education. 2019;42(3):305–16.
- 47. Priest N, Doery K, Lim CK, Lawrence JA, Zoumboulis G, King G, et al. Racism and health and wellbeing among children and youth-An updated systematic review and meta-analysis. Soc Sci Med. 2024;361:117324. pmid:39369498
- 48. Devakumar D, Selvarajah S, Abubakar I, Kim S-S, McKee M, Sabharwal NS, et al. Racism, xenophobia, discrimination, and the determination of health. Lancet. 2022;400(10368):2097–108. pmid:36502848
- 49. Keller T, Braithwaite I, Brook A, Beagley J, Narayan S, Deivanayagam TA. Adapting the MPOWER policy framework for fossil fuels and public health: reflections on content and process. Perspect Public Health. 2025;145(6):302–5. pmid:40580004
- 50. Lyle G, Hendrie D. Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020. Global Health. 2024;20(1):40. pmid:38715053
- 51.
World Health Organization. WHO Framework Convention on Tobacco Control. 2003.
- 52.
Maani N, Petticrew M, Galea S. The commercial determinants of health. Oxford University Press. 2023.
- 53.
EndNote Team. EndNote. Philadelphia, PA: Clarivate. 2013.
- 54. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. pmid:27919275
- 55. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. pmid:25554246
- 56. Dada S, Dalkin S, Gilmore B, Hunter R, Mukumbang FC. Applying and reporting relevance, richness and rigour in realist evidence appraisals: Advancing key concepts in realist reviews. Res Synth Methods. 2023;14(3):504–14. pmid:36872619
- 57. Kantilal K, Hardeman W, Whiteside H, Karapanagiotou E, Small M, Bhattacharya D. Realist review protocol for understanding the real-world barriers and enablers to practitioners implementing self-management support to people living with and beyond cancer. BMJ Open. 2020;10(9):e037636. pmid:32883731
- 58. Wong G, Pawson R, Owen L. Policy guidance on threats to legislative interventions in public health: a realist synthesis. BMC Public Health. 2011;11:222. pmid:21477347
- 59.
Jagosh J. Introduction to realist methodology - evaluation and synthesis. 2024.
- 60. Wiltshire G, Ronkainen N. A realist approach to thematic analysis: making sense of qualitative data through experiential, inferential and dispositional themes. Journal of Critical Realism. 2021;20(2):159–80.
- 61. Mukumbang FC. Retroductive Theorizing: A Contribution of Critical Realism to Mixed Methods Research. Journal of Mixed Methods Research. 2021;17(1):93–114.
- 62. Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061. pmid:34593508