Madrid immigrants' perceptions of urban food environments and their dietary behaviours.

Large cities are home to several groups of immigrants who undergo important changes in their environmental conditions and lifestyles that significantly modify their risk of chronic diseases. Quantitative evidence indicates that both their health and diet worsen over time; much less is known about the qualitative mechanisms that cause these changes. The aim of this article is to understand how immigrants in the city of Madrid perceive the relation between the urban food environment and dietary behaviour. Based on a Social Ecological Framework, we conducted a secondary qualitative analysis derived from data from 41 immigrant residents, collected in eight focus groups (FGs), conducted in two neighbourhoods in the city of Madrid. We identified the following main categories: 1) Transnational identity and dietary behaviour in the neighbourhood; 2) Transitions in dietary behaviour; and 3) Societal/structural factors determining dietary behaviour in the neighbourhood. The participants in the FGs mentioned that they try to maintain traditional dietary customs and perceive that the taste of their typical dishes is better than those of Spanish dishes. Contradictorily, some participants considered their traditional dietary patterns to be less healthy than Mediterranean ones (consuming olive oil, vegetables, fish). Some participants acknowledged having adapted to the latter voluntarily or through dietary negotiations with their children. Immigrant families with two working parents have difficulties cooking homemade food and resort to less healthy options, such as eating fast food or ready-made meals. Due to their low purchasing power, they buy both ethnic products and other products, as well as considering the prices and offers in supermarkets. Our study highlights several structural mechanisms connecting the physical and social urban food environment with dietary behaviours among immigrant residents of a large city.

Disproportionate infection, hospitalisation and death from COVID-19 in ethnic minority groups and Indigenous Peoples: an application of the Priority Public Health Conditions analytical framework.

The COVID-19 pandemic has resulted in disproportionate consequences for ethnic minority groups and Indigenous Peoples. We present an application of the Priority Public Health Conditions (PPHC) framework from the World Health Organisation (WHO), to explicitly address COVID-19 and other respiratory viruses of pandemic potential. This application is supported by evidence that ethnic minority groups were more likely to be infected, implying differential exposure (PPHC level two), be more vulnerable to severe disease once infected (PPHC level three) and have poorer health outcomes following infection (PPHC level four). These inequities are driven by various interconnected dimensions of racism, that compounds with socioeconomic context and position (PPHC level one). We show that, for respiratory viruses, it is important to stratify levels of the PPHC framework by infection status and by societal, community, and individual factors to develop optimal interventions to reduce inequity from COVID-19 and future infectious diseases outbreaks.

Menarche and reproductive health in Spanish Roma women from a reproductive justice perspective: a qualitative study.

OBJECTIVES: This study aimed to explore the perceptions of Roma women about their experience of menarche and reproductive health considering the principles of reproductive justice. DESIGN: Qualitative study based on semi-structured interviews with Roma women ages 18 through 67 in different neighborhoods in the southeast of Spain. Using a thematic analysis, we analyzed experiences related to menarche and menstruation and their significance for reproductive health, the preparation for the phase of menarche and intergenerational support. RESULTS: The Roma women interviewed shared their approach to the experiences of menarche and menstruation as children in their family environments with a focus on access to information provided by other women in the family and community for reproductive health management. In their discourses we observed that the onset of menstruation supposes a rupture in the public and private spaces of girls and women. CONCLUSIONS: The results of this study suggest that women and girls do not gain access to information that contributes to their reproductive wellbeing through their experience of menarche. Access to resources and skills to manage biological changes in adolescents could contribute to reducing the impact of cultural myths, false ideas and taboos that prevent advocacy and empowerment on issues of reproductive justice.

This study shows that the public spaces surrounding Roma women do not provide the tools and resources to promote and maintain their wellbeing and reproductive health after the onset of this important time. Sexual and reproductive health is not addressed during the time of childhood nor adolescence. Roma women lack a framework with an established discourse on reproductive justice, along with the necessary institutional resources. Preparation for and follow-up of the onset of menstruation among Roma women could be a key for their health. These results coincide with qualitative studies carried out in women from different cultural origins, in which menarche and menstruation are experienced as a transcendental fact. In other contexts, similar to Roma women, this stage in women's health lacks resources and information and an adequate approach from the perspective of reproductive health, which conditions the menstrual, sexual and reproductive health of women across their lifespan. Roma women experience menarche as a significant change in the life of a woman. They describe having lived the process as an abandonment of childhood and the beginning of an adult life, one that is implicitly linked to maternity and couple relationships. The results show that they defend the continuity of childhood among the new generation. Roma women express that they experienced menarche as an event that was traumatic, embarrassing and confusing. Menarche and menstruation are attended to in private and among the family, and masculine figures do not participate. The mother is the only transmitter of information and support during the process.

Examining Cybersexism in Online Gaming Communities: A Scoping Review.

Cybersexism in the context of online gaming communities, as epitomized by the Gamergate incident back in 2014, has been an issue for a while for gamer women, yet it has not received proper attention. In this scoping review, we have aimed to assess its main characteristics, its consequences for gamer women, its triggers and predictors, and related prevention and mitigation policies provided by the existing research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines were applied to the design of the scoping review. Empirical studies were accessed via database searches. The following databases were prospected: Scopus, ProQuest, Web of Science, PsycINFO, PubMed, and ACM from March to May 2021. A total of 33 studies were included in the final analysis after database searching, filtering, and snowballing. Most of the selected studies (66%, n = 22) were focused on the manifestations of cybersexism in gaming communities, with gender-driven trash-talking being the main one. The main drivers and triggers behind cybersexist behaviors were also the research topic in 66% (n = 22) of the studies and the consequences and coping strategies were studied in 52% (n = 17) of the articles. Furthermore, 12% (n = 4) of the studies assessed policies and actions to prevent cybersexism. Cybersexism and its manifestations are a reality that conditions gamer women, provoking avoidance and ultimately withdrawal from gaming and, therefore, creating inequality, impairing full digital citizenship, and widening the digital gender gap.

Pobreza energética y salud en población gitana y en población general de España / Energy poverty and self-rated health among Roma population and general population in Spain

Objetivo: Cuantificar la pobreza energética en población gitana y población general de España, en 2016, y observar la asociación de este fenómeno con la salud autopercibida, ajustando por los principales determinantes socioeconómicos. Método: La pobreza energética fue definida como la incapacidad económica para mantener el calor dentro del hogar, la presencia de humedad en la vivienda y tener retrasos en el pago de facturas de suministros, con datos de dos encuestas europeas para España en 2016: la Encuesta sobre Ingresos y Condiciones de Vida (EU-SILC) y la Segunda Encuesta sobre Minorías y Discriminación (EU-MIDIS II). Se calcularon modelos de regresión logística jerárquica con la salud autopercibida como variable resultado, ajustando progresivamente por variables demográficas (género y edad), ambientales (temperatura del hogar, humedad y retrasos en las facturas) y socioeconómicas (nivel educativo, estado civil y situación ocupacional). Resultados: El 45% de la población gitana mostró niveles moderados o altos de pobreza energética. La odds ratio (OR) de mala salud autopercibida era mayor en la población gitana (OR: 3,11; intervalo de confianza del 95% [IC95%]: 2,59-3,74). No poder mantener una temperatura adecuada en el interior del hogar incrementó considerablemente el riesgo de mala salud (OR: 2,10; IC95%: 1,90-2,32). Tras ajustar por variables demográficas, ambientales y socioeconómicas, no observamos asociación entre población de adscripción y salud autopercibida. Conclusiones: Considerando los principales determinantes sociales, indicadores de pobreza energética incluidos, ser una persona gitana no se asocia con declarar mala salud. Este resultado señala la relevancia de abordar los factores socioeconómicos, la pobreza energética entre ellos, para reducir las desigualdades en salud.(AU)

Objective: To quantify energy poverty in Roma population and in general population in Spain, in 2016, as well as to observe the association of this phenomenon with self-rated health, adjusted according to the main socio-economic determinants. Method: Energy poverty has been defined as the financial inability to keep a home warm, the presence of dampness in the dwelling and falling into arrears in utility bills, using data from two European surveys from Spain in 2016: the Survey on Income and Living Conditions (EU-SILC) and the Second Survey on Minorities and Discrimination (EU-MIDIS II). Hierarchical logistic regression models were estimated with self-rated health as the outcome variable, progressively adjusted according to demographic (gender and age), environmental (household temperature, humidity and arrears in utility bills) and socio-economic (level of education, marital status and employment status) variables. Results: Our results show that 45% of the Roma population had moderate or high levels of energy poverty. The odds ratio (OR) of poor self-rated health was higher in the Roma population (OR: 3.11; 95% confidence interval [95% CI]: 2.59–3.74). The inability to maintain an adequate indoor temperature significantly increased the risk of poor health (OR: 2.10; 95% CI: 1.90–2.32). After adjusting according to demographic, environmental and socio-economic variables, no association was observed between the population of ascription and self-rated health. Conclusions: Taking into account the main social determinants, including energy poverty indicators, being Roma is not associated with reporting poor health. This result points to the importance of tackling socio-economic factors, including energy poverty, to reduce health inequalities.(AU)

[Energy poverty and self-rated health among Roma population and general population in Spain]. / Pobreza energética y salud en población gitana y en población general de España.

OBJECTIVE: To quantify energy poverty in Roma population and in general population in Spain, in 2016, as well as to observe the association of this phenomenon with self-rated health, adjusted according to the main socio-economic determinants. METHOD: Energy poverty has been defined as the financial inability to keep a home warm, the presence of dampness in the dwelling and falling into arrears in utility bills, using data from two European surveys from Spain in 2016: the Survey on Income and Living Conditions (EU-SILC) and the Second Survey on Minorities and Discrimination (EU-MIDIS II). Hierarchical logistic regression models were estimated with self-rated health as the outcome variable, progressively adjusted according to demographic (gender and age), environmental (household temperature, humidity and arrears in utility bills) and socio-economic (level of education, marital status and employment status) variables. RESULTS: Our results show that 45% of the Roma population had moderate or high levels of energy poverty. The odds ratio (OR) of poor self-rated health was higher in the Roma population (OR: 3.11; 95% confidence interval [95% CI]: 2.59-3.74). The inability to maintain an adequate indoor temperature significantly increased the risk of poor health (OR: 2.10; 95% CI: 1.90-2.32). After adjusting according to demographic, environmental and socio-economic variables, no association was observed between the population of ascription and self-rated health. CONCLUSIONS: Taking into account the main social determinants, including energy poverty indicators, being Roma is not associated with reporting poor health. This result points to the importance of tackling socio-economic factors, including energy poverty, to reduce health inequalities.

"It is what we have been told to do": Masculinities and femininities crossing with sexual orientation and feminist activism in Spain.

Masculinities and femininities are often characterized by social inequalities and mainly studied from the perspectives of adult, heterosexual and non-activist people. This study explores the discourses on masculinities and femininities of young cisgender men and women, involved or not in feminist activism and of different sexual orientations (heterosexual, bisexual and homosexual) in Spain. Between 2019 and 2020, we conducted a qualitative study with 20 semi-structured interviews and 8 discussion groups in which 73 people participated. A socially dominant gender discourse was identified, which establishes a dichotomous understanding of masculinity in constant confrontation with femininity, as well as of heterosexuality against homosexuality, in a heteronormative context. Young people discursively position themselves differently from said discourse according to their sexual orientation and involvement in feminist activism. We encounter discursive positions that reproduce the socially dominant gender discourse, especially detected among non-activist heterosexuals. We also observe others that try to transgress it, mainly among activists of all sexual orientations and non-activist homosexuals and bisexuals. This study empirically adds to the knowledge of the configuration of inequalities in gender relations and how interactions with sexuality take place. The results also provide guidance for future gender-transformative interventions to promote gender equality and social justice.

Ethnic discrimination and mental health in the Sámi population in Sweden: The SámiHET study.

AIMS: To assess the association between experiences of discrimination and mental health among the Sámi population in Sweden. METHODS: Cross-sectional study among the self-identified Sámi population living in Sweden in 2021, registered in the electoral roll of the Sámi Parliament, the reindeer mark register and the 'Labour statistics based on administrative sources'. The analysis was based on a final sample of 3658 respondents aged between 18 and 84 years. Adjusted prevalence ratios aPRs for psychological distress (Kessler scale), self-reported anxiety and depression were estimated for four different forms of discrimination (direct experience of discrimination, offended because of ethnicity, historical trauma, and combined discrimination). RESULTS: Higher aPRs of psychological distress, anxiety and depression were observed in women experiencing direct discrimination because of their ethnicity, having been offended because of their ethnicity, and those with a family history of discrimination. Among men, higher aPRs for psychological distress were observed in those experiencing the four different forms of discrimination, but not for anxiety. Depression was only detected in the case of having been offended. Adding experiences of discrimination was associated with a higher prevalence of negative outcomes for all the indicators in women and for psychological distress in men. CONCLUSIONS: The observed association between experiences of discrimination and mental health problems would support a gender approach when considering ethnic discrimination in public health policies concerning the Sámi in Sweden.

Intimate partner violence complaints during COVID-19 lockdown in Spain: a cross-sectional and a case-control study.

BACKGROUND: During the COVID-19 lockdown, a large proportion of the women exposed to intimate partner violence had to live with their abusers full-time. This study analyzes the new official complaints that were filed during the lockdown in Spain. METHODS: Data from the Comprehensive Monitoring System for Cases of Gender Violence from the Ministry of the Interior, Spain. Using logistic regression models, the complaints registered during the lockdown were compared to those registered in the previous year. Subsequently, we analysed association between the seriousness of the incident reported and the period in which the complaint was filed. RESULTS: Official complaints decreased by 19% during the lockdown. The probability of complaints during lockdown mainly increased when victims had a relationship with the abusers [odds ratio (OR) = 1.33] and when they lacked social support (OR = 1.22). The probability that the complaints were associated with previous jealousy (OR = 0.87), previous harassment behaviours (OR = 0.88) or the victim's fear for minors' safety (OR = 0.87) decreased. In addition, during lockdown increased the probability that the complaints filed were due to incidents of severe physical violence (OR = 1.17); severe psychological violence against women with minors in their charge (OR = 1.22); and severe violence due to threats (OR = 1.53) when the woman had previously suffered harassment. CONCLUSIONS: The decrease in new complaints during the studied period and the increase in their severity evidence difficulties in seeking help due to the lockdown. In situations of confinement, it is necessary to design measures that protect women with a lack of social support, and at those who live with the aggressor.

Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys.

AIMS: This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. METHODS: We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n=11,401), Roma neighbours (n=5857) and the general population (n=101,579) stratified by gender, and adjusted by age, country and educational level. RESULTS: There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. CONCLUSIONS: These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.

Positive Masculinities and Gender-Based Violence Educational Interventions Among Young People: A Systematic Review.

BACKGROUND: Hegemonic masculinity has been recognized as contributing to the perpetration of different forms of gender-based violence (GBV). Abandoning hegemonic masculinities and promoting positive masculinities are both strategies used by interventions that foreground a "gender-transformative approach." Preventing GBV among young people could be strengthened by engaging young men. In this article, we aim to systematically review the primary characteristics, methodological quality, and results of published evaluation studies of educational interventions that aim to prevent different forms of GBV through addressing hegemonic masculinities among young people. MAIN BODY: We conducted a systematic review of available literature (2008-2019) using Medline (PubMed), Scopus, Web of Science, PsycInfo, the CINAHL Complete Database, and ERIC as well as Google scholar. The Template for Intervention Description and Replication was used for data extraction, and the quality of the selected studies was analyzed using the Mixed Method Appraisal Tool. More than half of the studies were conducted in Africa (n = 10/15) and many were randomized controlled trials (n = 8/15). Most of the studies with quantitative and qualitative methodologies (n = 12/15) reported a decrease in physical GBV and/or sexual violence perpetration/victimization (n = 6/15). Longitudinal studies reported consistent results over time. CONCLUSIONS: Our results highlight the importance of using a gender-transformative approach in educational interventions to engage young people in critical thinking about hegemonic masculinity and to prevent GBV.

Atender la urgencia o la desigualdad / Addressing urgency or inequality

No disponible

Herramienta multidimensional para la medición de la calidad de la participación en salud / A multidimensional tool to measure quality of social participation in health

Las estrategias, los programas y las acciones en salud han sido históricamente el resultado de prácticas institucionales con un componente participativo limitado. La acción institucional ha venido determinada sobre todo por el criterio de actores políticos y, en el mejor de los casos, por el criterio de profesionales de la salud. Nuevas formas de gobernanza para la equidad en salud abogan por la inclusión de la comunidad en el diseño de estrategias, programas y actividades en salud. Por ello, una preocupación creciente en el campo de la participación en salud es la medición de la calidad participativa de los nuevos diseños de prácticas institucionales. Este artículo tiene como objetivo desarrollar una propuesta operativa para diseñar, medir o describir el alcance en términos participativos de los procesos de planificación en salud. La propuesta elabora seis dimensiones para la medición y la evaluación del proceso participativo: inclusividad, flujo de información, calidad deliberativa, toma de decisiones, compromiso institucional y empoderamiento comunitario. (AU)

Health strategies, programs and activities have historically been the result of institutional practices with a limited participatory component. Traditionally, institutional action is mainly determined by the criteria of the political actors and, in the best of cases, by the criteria of healthcare professionals. New forms of governance for health equity advocate for the inclusion of the community in the design of strategies, programmes and activities in health. For this reason, a growing concern in the field of participation in health is the measurement of the participatory quality of new designs of institutional practices. This article aims to develop an operational proposal to design, measure or describe the scope in participatory terms of the health planning processes. The proposal elaborates six dimensions for the measurement and assessment of participatory process: inclusivity, information flow, deliberative quality, decision making, institutional commitment and community empowerment. (AU)

"If You Do Not Fit in With the Stereotype, They Eat You Alive": Discourses of Masculinities and Their Reflections in Young Spanish Men's Health.

Hegemonic masculinity has been especially linked, among other aspects, to unhealthy behaviors and heterosexuality. This study aimed to explore the discourses of masculinities with young Spanish men with different sexual orientations (heterosexuals, bisexuals, and homosexuals), comparing them with the social representations that are put into practice on Instagram. Three qualitative approaches were triangulated to seek a richer comprehension and interpretational level: discussion groups, semi-structured interviews, and an online non-participant observation on Instagram with a total of 26 young men aged between 18 and 24. Results indicate that hegemonic masculinity discourse is still significant when understanding and experiencing young men's masculinities, promoting behaviors that put their health at risk and generating psychological discomfort, especially among non-heterosexual men. Our findings provide knowledge of the social framework that legitimizes and reproduces male domination in younger generations both online and offline and how this is reflected in men's health.

[A multidimensional tool to measure quality of social participation in health]. / Herramienta multidimensional para la medición de la calidad de la participación en salud.

Health strategies, programs and activities have historically been the result of institutional practices with a limited participatory component. Traditionally, institutional action is mainly determined by the criteria of the political actors and, in the best of cases, by the criteria of healthcare professionals. New forms of governance for health equity advocate for the inclusion of the community in the design of strategies, programmes and activities in health. For this reason, a growing concern in the field of participation in health is the measurement of the participatory quality of new designs of institutional practices. This article aims to develop an operational proposal to design, measure or describe the scope in participatory terms of the health planning processes. The proposal elaborates six dimensions for the measurement and assessment of participatory process: inclusivity, information flow, deliberative quality, decision making, institutional commitment and community empowerment.

Coping with intimate partner violence and the COVID-19 lockdown: The perspectives of service professionals in Spain.

Socioeconomic crisis and humanitarian disasters can cause increased stress for women who experience inter-partner violence (IPV). This study analyzed the impact of the COVID-19 lockdown on this important issue, their related health and social services and working conditions from the perspectives of professionals in different sectors. Forty-three semi-structured interviews were carried out with 47 professionals (44 women and 3 men) from 40 different entities (September 2020-April 2021). This content analysis suggests that the pandemic and its associated prevention measures have had a negative impact on women exposed to IPV and their children, which affected their social wellbeing. Professionals described burnout, difficult and slow administrative processes, and problems with coordination and access to information. These negative impacts were mitigated, in part, by the work of professionals, but this suggests that a series of key strategies are needed to improve the response capacity of the service sector to IPV in situations of crisis. These improvements are related to the availability of human and material resources; an efficient coordination network between the professionals from different sectors; existence of informal support networks in the community; protocols/procedures and prior training for better implementation; and greater flexibility and accessibility of basic services that benefit women who experience IPV.

Intimate Partner Violence against Women during the COVID-19 Lockdown in Spain.

AIMS: To analyze the temporal and geographical distribution of different indicators for the evolution of intimate partner violence against women (IPV) before, during and after the COVID-19 induced lockdown between March and June 2020 in Spain. METHODS: Descriptive ecological study based on numbers of 016-calls, policy reports, women killed, and protection orders (PO) issued due to IPV across Spain as a whole and by province (2015-2020). We calculated quarterly rates for each indicator. A cluster analysis was performed using 016-call rates and protection orders by province in the second quarters of 2019 and 2020. ANOVAs were calculated for clustering by province, unemployment rates by province, and the current IPV prevalence. RESULTS: During the second quarter of 2020, the highest 016-call rate was recorded (12.19 per 10,000 women aged 15 or over). Policy report rates (16.62), POs (2.81), and fatalities (0.19 per 1,000,000 women aged 15 or over) decreased in the second quarter of 2020. In the third quarter, 016-calls decreased, and policy reports and POs increased. Four clusters were identified, and significant differences in unemployment rates between clusters were observed (F = 3.05, p < 0.05). CONCLUSIONS: The COVID-19 lockdown fostered a change in IPV-affected women's help-seeking behavior. Differences between the volume of contacts made via 016-call and the policy reports generated provide evidence for the existence of barriers to IPV-service access during the lockdown and the period of remote working. More efforts are needed to reorganize services to cope with IPV in non-presential situations. The provinces with the highest 016-call and PO rates were also those with the highest rates of unemployment, a worrying result given the current socioeconomic crisis.

Acceptability of Violence Against Women Among the Roma Population in Spain.

Acceptability of violence against women (VAW) is a key dimension in addressing this social problem, given its influence on both the violent conduct of aggressors and the decisions of affected women. This study analyzes, for the first time, the magnitude of acceptability of VAW and associated factors in the Roma population in Spain. The Roma population is the largest ethnocultural minority in Europe. Data were analyzed from the Spanish National Health Survey of the Roma Population of 2014, a survey of 1,167 people identified as members of the Roma community. The results indicate that 70.9% of those surveyed completely reject VAW, with lower probability of acceptability among women than men (odds ratio [OR]: 0.66; 95% confidence interval [CI]: [0.51, 0.86]). There is also a decrease in probability as income increases, in people who identify themselves as evangelical (OR: 0.5; 95% CI: [0.36, 0.71]) and among those who report being acquainted with a battered woman (OR: 0.68; 95% CI: [0.48, 0.97]), similarly in women and men. It has to be highlighted that the observed associations between socioeconomic conditions and acceptability of VAW should be considered when designing strategies for raising awareness about the consequences of VAW for the Roma population.

Health indicators of the National Roma Integration Strategy in Spain in the years 2006 and 2014.

BACKGROUND: In 2011, the European Commission adopted the European framework for the National Roma Integration Strategies (NRISs) 2020, which focussed on four areas: education, employment, health and housing. In 2012 Spain approved its Strategy 2012-20, one of the central aims of which is to reduce social inequalities in health that affect the Roma population. Our objective was to analyze changes in health inequalities between the Roma population and the general population in Spain in the years 2006 and 2014. METHODS: The Spanish National Health Surveys (NHSs) 2006 (n = 29 478) and 2012 (n = 20 884) and the NHS of the Spanish Roma Population 2006 (n = 933) and 2014 (n = 1155) were compared. This study considered the variables included in NRIS 2012-20: self-perceived health, tobacco use in men, traffic accidents in men and women, obesity in women and gynaecological visits. RESULTS: Despite the adoption of the NRIS 2012-20, there were no observed improvements in health between 2006 and 2014 in the Roma population. Nor was there a reduction in inequalities in health concerning the general population in Spain. Also, there was no reduction in the health inequalities by gender for the two populations. CONCLUSIONS: Health is determined in part by social factors including education, employment, housing and also by anti-Roma discourses and discrimination. Improving the health of the Roma population requires a multi-sectoral approach with a gender perspective.

Inequalities in the use of gynecological visits and preventive services for breast and cervical cancer in Roma women in Spain.

OBJECTIVES: The Roma population in Spain makes up about two percent of the population and has worse health indicators than the general population. We analyzed both populations in 2006 and 2014 to discover whether there are differences in terms of gynecological visits and preventive services for breast and cervical cancer in Spain. METHODS: Cross-sectional study is based on the Spanish National Health Survey (SNHS) of 2006 and 2012 and the National Health Survey of the Roma Population (NHSRP) of 2006 and 2014. RESULTS: Roma women used gynecological visits less than the general population in 2006 (ORa 0.5 [0.4; 0.6] and in 2014 (ORa 0.2 [0.2; 0.3)]. In addition, use of the mammogram was lower in Roma women (ORa 0.7 [0.6; 0.8]), especially in the ages of the screening tests, and they had lower probability of receiving cervical examinations in 2006 (ORa 0.5 [0.4; 0.6]) and in 2014 (ORa 0.7 [0.6; 0.9]). CONCLUSIONS: This study shows that the inequality gap in gynecological visits and preventive services for breast and cervical cancer in Roma women has persisted during the years studied (2006 and 2014), despite Spanish prevention policies.