Pornography, sexual orientation and ambivalent sexism in young adults in Spain.

BACKGROUND: On line platforms offer access to an almost unlimited variety of pornographic material that shows high levels of sexism. Despite this fact, there are still few studies that assess the effect of pornography on sexism in young adults The aim of this study is to analyze the association of pornography consumption and sexual orientation with benevolent sexism (BS) and hostile sexism (HS) in young men and women. METHODS: We surveyed 2,346 people aged 18-35 years old. Multiple regression models were carried out for BS and HS. The independent variables: current pornography consumption and sexual orientation. Covariates: socio-demographic variables -age, sex, level of education and place of birth-. RESULTS: A) HS: Men who consumed pornography had higher median values of HS than those who did not [ß(95%CI):2.39(0.67;4.10)]. Homosexual/ bisexual men displayed lower values of HS than heterosexual men [ß(95%CI):-2.98(-4.52;-1.45)]. The increase in HS levels associated with pornography consumption was notably greater in homosexual and bisexual women relative to heterosexual women, where that pattern was not observed [ß(95%CI for interaction): 2.27(0.11; 4.43)]. B) BS: Mean values of BS were observed to be lower for both women [ß(95%CI):-2.16(-2.99;-1.32)] and men [ß(95%CI):-4.30(-5.75;-2.86)] who consumed pornography compared to those who did not. Homosexual/bisexual men recorded mean values of BS lower than heterosexual men [ß(95%CI):-3.10(-4.21;-1.99)]. CONCLUSIONS: Pornography consumption is related to sexism and differs according to sex and sexual orientation. As sexism is the substratum of inequality between men and women, it is urgent to launch affective-sexual education programs for young people that take into account the determinants of sexism.

Is sexual attraction and place of origin a moderator of sex in pornography consumption? Cross-sectional study on a representative sample of young adults.

BACKGROUND: Pornography consumption is higher in men, but we do not know if this association can be modified by different variables, such as sexual attraction and place of origin. Given the impact pornography has on minors, there are limited studies that analyze the use of pornography in representative samples of the adult population. The aim was analyze the prevalence and factors associated with using pornography in young adult men and women, living in Spain, with different sexual attractions and different places of birth. METHODS: Cross-sectional study with an online survey conducted with 2515 men and women aged between 18 and 35 years of age. The prevalence of pornography consumption is described and analyzed in the total sample and stratified by sex, according to socio-demographic and sexual attraction variables. The association between covariates and pornography consumption at some point in life was estimated with prevalence ratios (PR) obtained with the Poisson models of robust variance. DEPENDENT VARIABLE: voluntarily using pornography at some point in life. Socio-demographic variables were included in the analysis: age, sex, level of education, place of birth. Sexual attraction was also analyzed. RESULTS: In Spain, 94.7% of men between 18 and 34 years and 74.6% of women have voluntarily used pornography at some point in their life. The mean age to start using it is earlier in men [Mean:14.2; Standard Deviation (SD):2.3]. Bisexual/homosexual attraction (reference: heterosexual) increases the probability of using pornography in women [(PR (95%CI): 1.30 (1.22; 1.38)]. Yet this is not observed in men. In both sexes, the probability of using pornography increases with age [(PR (95%CI): 1.01(1.00; 1.01)] and coming from abroad (reference: native), being the effect of country of birth significantly higher in women [(PR (95%CI): 1.17 (1.09; 1.26)] than in men [(PR (95%CI): 1.04 (1.01; 1.07). CONCLUSIONS: Public health programmes aimed at improving affective-sexual health should consider the high use of pornography among young adults in Spain, as well as those variables that increase its use.

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.

Do we have friendly services to meet the needs of young women exposed to intimate partner violence in the Madrid region?

INTRODUCTION: Women experiencing intimate partner violence (IPV) do not tend to go very frequently to formal support services. The objective of this study is to identify barriers related to the accessibility, acceptability, equity, appropriateness and effectiveness of IPV services from the perspective of the professionals working in the IPV public services. METHODS: A qualitative study was carried out in the Madrid region based on 13 semi-structured interviews of young women who had survived IPV as well as 17 interviews with professionals. A thematic content analysis was performed, guided by the dimensions proposed by the World Health Organization (WHO) for friendly services for young people. RESULTS: From the perspective of the young women and professionals, barriers were identified for all the dimensions of the WHO's friendly services for young people: accessibility: lack of information and support from the social setting, scarce dissemination of the services, economic cost, non-adapted schedules, inadequate locations or lack of services in settings close to young people; acceptability: lack of protocols to guarantee confidentiality, lack of speed in the provision of services or their referral, unwelcoming environments or unsympathetic professional malpractice; equity: discriminatory professional attitudes towards groups with different social status and lack of protocols to ensure the care of these groups; appropriateness: unmet needs and lack of multidisciplinary teams; and effectiveness: shortage of time, resources, competent professionals, protocols and coordination. CONCLUSIONS: Strategies are needed to make the necessary changes to promote friendly services for the care of young people exposed to IPV. Additionally, it must be emphasized that resources are needed to raise awareness and disseminate IPV services, as well as to train professionals in this area. PATIENT OR PUBLIC CONTRIBUTION: This paper is based on professionals' perspectives of public IPV-related services of different areas such as Psychology, Social Work, Nursing, Psychiatry, Social Education and young women exposed to IPV. They either work in the public administration at the local, regional or state level or in NGOs in Spain.

Prevalence of sexual harassment among young Spaniards before, during, and after the COVID-19 lockdown period in Spain.

BACKGROUND: Sexual harassment is a type of coercion, including social pressure, intimidation, physical force, and verbal acts, in addition to other forms such as cyber-harassment, recognized as a major important public health problem. METHODS: This cross-sectional study, based on a survey administered online to men and women aged 18 to 35 years and living in Spain throughout 15th and 28th October 2020, aims to analyze the prevalence and factors associated with sexual harassment among young people in Spain within the last 12 months, particularly according to the COVID-19 lockdown period. It has been conducted by bivariate analysis and robust Poisson regression models. The final sample includes 2.515 participants. RESULTS: The results indicate that women were almost twice as likely as men to experience sexual harassment (49% vs 22.2%). Also, among heterosexual men and women, the estimated prevalence was lower concerning that observed among bisexuals, gays, and lesbians (31.5% vs 53, 39.2, and 34.6% respectively). The prevalence percentage in the 18-24 age group was twice high as that observed in the 30-35 age group. Finally, during the lockdown period, the harassment through electronic channels increased (32.6% vs 16.5 and 17.8% before and after this period, respectively) and decreased on public roads (22.9% vs 63.4 and 54.4% pre-lockdown and post-lockdown periods, respectively). CONCLUSION: These findings highlight that sexual harassment presents a high prevalence among young people, especially cyber-harassment, and workplace harassment and it is important to be aware that young women are more likely to suffer harassment and even more if they do not have a partner or have LGB orientation. During the lockdown sexual harassment has moved from public spaces to the social network.

Evaluation of the lights4violence program: reduction in machismo and acceptance of violence among adolescents in Europe.

BACKGROUND: Machismo and acceptance of violence (AV) against women are part of the social construction of hegemonic masculinity and are related to the risk of dating violence. This study aims to analyze the effectiveness of the Lights4Violence program in reducing machismo and AV in secondary school students from different European cities. METHODS: Quasi-experimental longitudinal study using a convenience sample of 1,146 high school students from different European cities (12-17 years old) including 575 intervention group students (59.1% girls) and 571 control group students (62.7% girls). We performed linear regression models to identify the effect of the intervention, modelling the difference in means in machismo and AV (dependent variables) between wave-2 and wave-1. RESULTS: An interaction was identified between the group variable and the empathy variable. In wave-2, girls with high empathy at baseline in the intervention group obtained lower mean AV scores (ß: -0.131; p = 0.004). However, the boys in the intervention group (reference: control group) with low empathy at baseline registered a significant increase in the mean values of machismo (ß: 0.247; p < 0.001). CONCLUSION: The importance of empathy is shown in the effectiveness of interventions to reduce machismo and AV in adolescents. While the Lights4Violence program focuses on promoting healthy relationships, there were some controversial results. It is possible that some children, especially those with less empathy, may have felt "challenged" during the intervention and/or assessment. This suggests the need for the development of interventions that also consider psychological processes and integrate the promotion of positive expressions of masculinity.

Effect of the Lights4Violence intervention on the sexism of adolescents in European countries.

BACKGROUND: Sexism results in a number of attitudes and behaviors that contribute to gender inequalities in social structure and interpersonal relationships. The objective of this study was to evaluate the effectiveness of Lights4Violence, an intervention program based on promoting health assets to reduce sexist attitudes in young European people. METHODS: We carried out a quasi-experimental study in a non-probabilistic population of 1146 students, aged 12-17 years. The dependent variables were the difference in the wave 1 and wave 2 values in the subscales of the Ambivalent Sexism Inventory: benevolent sexism (BS) and hostile sexism (HS). The effect of the intervention was evaluated through linear regression analyses stratified by sex. The models were adjusted by baseline subscales scores, socio-demographic and psychological variables. RESULTS: In girls, we observed a decrease in BS in the intervention group compared to the control group (ß = - 0.101; p = 0.006). In the wave2,, BS decreased more in the intervention group compared to the control group in girls with mothers with a low level of education (ß = - 0.338; p = 0.001), with a high level of social support (ß = - 0.251; p < 0.001), with greater capacity for conflict resolution (ß = - 0.201; p < 0.001) and lower levels of aggressiveness (ß = - 0.232, p < 0.001). In boys, the mean levels of HS and BH decreased in wave 2 in both the control and intervention groups. The changes observed after the wave 2 were the same in the control group and in the intervention group. No significant differences were identified between both groups. CONCLUSIONS: The implementation of the Lights4Violence was associated with a significant reduction in BS in girls, which highlights the potential of interventions aimed at supporting the personal competencies and social support. It is necessary to reinforce the inclusion of educational contents that promote reflection among boys about the role of gender and the meaning of the attributes of masculinity. TRIAL REGISTRATION: Clinicaltrials.gov : NCT03411564 . Unique Protocol ID: 776905. Date registered: 26-01-2018.

Sexism and its associated factors among adolescents in Europe: Lights4Violence baseline results.

Despite the efforts of recent decades to reduce gender inequality, sexism is still prevalent among adolescents. The objective of this study was to identify the main socioeconomic characteristics, personal experiences, resources, and competencies associated with sexism in a sample of adolescents from different European countries. Baseline data from the Lights4Violence project included 1555 students ages 12-17 from secondary schools in six European countries (Spain, Italy, Romania, United Kingdom, Portugal, and Poland). Linear regression models were carried out, stratified by sex for benevolent (BS) and hostile (HS) dimensions of the Ambivalent Sexism Inventory. The average age of the sample was 14.3 years (SD = 1.5), 59.3% were girls. Boys scored higher on the measure of sexism (mean BS = 29.7; HS = 29.1) than girls (BS = 27.5, HS = 23.0; p < .001). Girls whose mothers had a university degree reported lower BS (ß = -0.113; p = .023) (reference: lower education). Girls who had experienced dating violence reported higher HS (ß = .080; p = .010) than those who had never been in an intimate relationship. For both sexes, high aggressiveness was associated with high levels of HS, and high aggressiveness was related to high levels of BS in boys. High assertiveness was associated with high levels of BS in both sexes and with high levels of HS in boys. A high level of problem-solving ability was associated with lower HS in both sexes. The study reinforces the need to invest in school programs aimed at preventing dating violence and promoting positive youth development.

Impact of an excise tax on the consumption of sugar-sweetened beverages in young people living in poorer neighbourhoods of Catalonia, Spain: a difference in differences study.

BACKGROUND: Sugar-sweetened beverage consumption is contributing to the obesity epidemic. On 28 March 2017, Catalonia enacted a law levying an excise tax on sugar-sweetened beverages for public health reasons. The purpose of this study is to assess the impact of the tax on the consumption of sugar-sweetened beverages in Catalonia (Spain). METHODS: Before-and-after study to assess changes in the prevalence of consumption of sugar-sweetened beverages among 1929 persons aged 12 to 40 years residing in low-income neighbourhoods of Barcelona (intervention) and Madrid (control). Beverage consumption frequency was ascertained via a validated questionnaire administered during the month prior to the tax's introduction (May 2017) and again at 1 year after it had come into force. The effect of the tax was obtained using Poisson regression models with robust variance weighted using propensity scores. RESULTS: While the prevalence of regular consumers of taxed beverages fell by 39% in Barcelona as compared to Madrid, the prevalence of consumers of untaxed beverages remained stable. The main reason cited by more than two-thirds of those surveyed for reducing their consumption of sugar-sweetened beverages was the increase in price, followed by a heightened awareness of their health effects. CONCLUSIONS: The introduction of the Catalonian excise tax on sugar-sweetened beverages was followed by a reduction in the prevalence of regular consumers of taxed beverages.

A qualitative study on primary health care responses to intimate partner violence during the economic crisis in Spain.

Background: The objective of this study was to explore how health professionals perceived the effect of the economic crisis and associated austerity measures on the detection of and cares for intimate partner violence (IPV) in primary care in Spain. Methods: Qualitative study designed using semi-structured interviews carried out with 145 health professionals in 16 primary health care centres in different regions of Spain. An inductive thematic analysis was made of the transcriptions. Results: Three main themes were identified: 'Women endure more violence during times of economic crisis', 'Fewer resources, fewer professionals and less time to respond to IPV' and 'Professionals' motivation as a requirement to respond to IPV'. Professionals perceived that economic precariousness triggered violence against women and made women more hesitant to put an end to violent relationships. They also reported that the austerity measures applied to primary health care negatively affected their ability to detect and adequately care for cases of IPV due to a heavy workload, reduced human resources, difficulties in training and the loss of resources to which women could be referred. To counteract these obstacles, health professionals' motivation played a vital role in the response to IPV. Conclusions: Institutional efforts to organize awareness programmes and training in order to improve and promote early diagnosis, care and rehabilitation of these women cannot stop during times of crisis and primary health care centres should facilitate health professionals' access to these programmes.

Priorities and strategies for improving Roma women's access to primary health care services in cases on intimate partner violence: a concept mapping study.

BACKGROUND: With an explicit focus on Roma women in Spain (Kale/Spanish Gypsies), this study aims to integrate key informants' opinions about the main actions needed to improve primary health care services' and professionals' responses to Roma women in an Intimate Partner Violence (IPV) situation. METHODS: Concept mapping study. A total of 50 (brainstorming phase), 36 (sorting and rating phase) and 16 (interpretation phase) participants from Roma civil society groups, primary health care professionals and other related stakeholders (social services, academic experts and other IPV NGOs representatives) from different cities in Spain were involved in the different study phases. RESULTS: Among the 55 action proposals generated, ten priority actions were identified through consensus as most important for improving primary health care's response to Romani women in an IPV situation, and these included primary, secondary and tertiary prevention activities. CONCLUSION: Results indicated that efforts to address this challenge should take an integrated approach that reinforces the primary health care response to IPV in general, while also promoting more specific actions to address barriers to access that affect all Roma women and those who experience IPV in particular.

Factors associated with a positive attitude towards receiving cancer information: a population-based study in Spain.

BACKGROUND: It is necessary to raise a positive attitude towards cancer information to improve disease prevention and control. OBJECTIVE: To identify social factors, health characteristics and cancer-related perceptions and knowledge associated with a positive attitude towards cancer information. DESIGN: We ran multivariate logistic regression models to analyse population-based data from OncoBarómetro-2010, a Spanish representative survey on perceptions and knowledge, related to cancer, conducted among 7938 people aged 18 years or more. MEASUREMENT: Attitudes towards cancer information. A positive attitude includes feeling motivated to keep informed, to have screening tests or to change lifestyle. A negative attitude includes feeling indifference, concern, frustration or fear. RESULTS: 38.3% of the studied population reported having received information related to cancer (within the last 6 months). Among those, 31.5% expressed a negative attitude towards cancer information. People more likely to have a positive attitude towards cancer information (reference category: negative attitude) were people aged 35-74 (ref: aged 18-34) (P < 0.001) and cancer survivors (ref: those who had not had cancer) (OR: 3.05; 95% CI: 1.73-5.38). The likelihood of a positive attitude increased with the level of education (P < 0.001). The variables negatively associated with a positive attitude towards cancer information were poor self-rated health status (ref: fair) (OR: 0.63; 95% CI: 0.42-0.95) and high self-perceived risk of developing cancer (ref: low) (OR: 0.75; 95% CI: 0.60-0.92). CONCLUSIONS: These findings have potential to inform programmes designed to promote cancer prevention behaviours. Policies should target population groups with low socio-economic groups, those with poor self-rated health and individuals with high self-perceived risk of cancer. Further, in order to increase knowledge of cancer symptoms, we need to focus on individuals with unhealthy lifestyles.

Health Care Austerity Measures in Times of Crisis: The Perspectives of Primary Health Care Physicians in Madrid, Spain.

The current financial crisis has seen severe austerity measures imposed on the Spanish health care system, including reduced public spending, copayments, salary reductions, and reduced services for undocumented migrants. However, the impacts have not been well-documented. We present findings from a qualitative study that explores the perceptions of primary health care physicians in Madrid, Spain. This article discusses the effects of austerity measures implemented in the public health care system and their potential impacts on access and utilization of primary health care services. This is the first study, to our knowledge, exploring the health care experiences during the financial crisis of general practitioners in Madrid, Spain. The majority of participating physicians disapproved of austerity measures implemented in Spain. The findings of this study suggest that undocumented migrants should regain access to health care services; copayments should be minimized and removed for patients with low incomes; and health care professionals should receive additional help to avoid burnout. Failure to implement these measures could result in the quality of health care further deteriorating and could potentially have long-term negative consequences on population health.

Intimate partner violence among women in Spain: the impact of regional-level male unemployment and income inequality.

BACKGROUND: Intimate partner violence (IPV) against women is a complex worldwide public health problem. There is scarce research on the independent effect on IPV exerted by structural factors such as labour and economic policies, economic inequalities and gender inequality. OBJECTIVE: To analyse the association, in Spain, between contextual variables of regional unemployment and income inequality and individual women's likelihood of IPV, independently of the women's characteristics. METHOD: We conducted multilevel logistic regression to analyse cross-sectional data from the 2011 Spanish Macrosurvey of Gender-based Violence which included 7898 adult women. The first level of analyses was the individual women' characteristics and the second level was the region of residence. RESULTS: Of the survey participants, 12.2% reported lifetime IPV. The region of residence accounted for 3.5% of the total variability in IPV prevalence. We determined a direct association between regional male long-term unemployment and IPV likelihood (P = 0.007) and between the Gini Index for the regional income inequality and IPV likelihood (P < 0.001). Women residing in a region with higher gender-based income discrimination are at a lower likelihood of IPV than those residing in a region with low gender-based income discrimination (odds ratio = 0.64, 95% confidence intervals: 0.55-0.75). CONCLUSIONS: Growing regional unemployment rates and income inequalities increase women's likelihood of IPV. In times of economic downturn, like the current one in Spain, this association may translate into an increase in women's vulnerability to IPV.

Factors associated with the utilization of primary care emergency centers in a Spanish region with high population dispersion: a mixed-methods study.

BACKGROUND: Adequate access to primary care emergency centers is particularly important in rural areas isolated from urban centers. However, variability in utilization of emergency services located in primary care centers among inhabitants of nearby geographical areas is understudied. The objectives of this study are twofold: 1) to analyze the association between the availability of municipal emergency care centers and utilization of primary care emergency centers (PCEC), in a Spanish region with high population dispersion; and 2) to determine healthcare providers' perceptions regarding PCEC utilization. METHODS: A mixed-methods study was conducted. Quantitative phase: multilevel logistic regression modeling using merged data from the 2003 Regional Health Survey of Castile and Leon and the 2001 census data (Spain). Qualitative phase:14 in-depth- interviews of rural-based PCEC providers. RESULTS: Having PCEC as the only emergency center in the municipality was directly associated with its utilization (p < 0.001). Healthcare providers perceived that distance to hospital increased PCEC utilization, and distance to PCEC decrease its use. PCEC users were considered to be predominantly workers and students with scheduling conflicts with rural primary care opening hours. CONCLUSIONS: The location of emergency care centers is associated with PCEC utilization. Increasing access to primary care by extending hours may be an important step toward optimal PCEC utilization. Further research would determine whether lower PCEC use by certain groups is associated with disparities in access to care.

[Sexual violence and young people: "it is not something you are born with, but with what you learn"]. / Violencia sexual y jóvenes: «no es algo con lo que naces, sino con lo que aprendes¼.

OBJECTIVE: To analyse the perceptions and experiences of young people in Spain about sexual violence (SV), its possible causes, victims and perpetrators.. METHOD: Qualitative study based on semi-structured interviews with 22 young people between 18 and 24 years old. A qualitative content analysis was carried out. RESULTS: In the juvenile narratives, the lack of definition and accuracy about what SV is stands out, except for mentioning rape, lack of consent and use of force in sexual relations. The girls, self-perceived as the main victims, also break with these narratives by providing a broader vision and gender inequalities related. In general, the most prevailed idea is that VS is perpetrated by men against women in heterosexual relationships inside and outside the couple. Regarding explanations, references coexist to both contextual factors (linked to gender inequalities and the social construction of sexual relationships) and behavioural factors (which includes the viewing of pornography). Tentatively proposals for improvement related to sexual and affective education emerge. CONCLUSIONS: In the perceptions of the young people, ambiguity seems to coexist with explicit references to the different ways in which it manifests itself and the influence of gender inequalities. Sex and life experience appear to influence these narratives. It is necessary to promote a more critical perspective on the social construction of SV and intimate relationships in the young population.

"Thanks to my activists Friends": a qualitative study of perspectives of young adults and professionals on the factors related to seeking support among victims of sexual violence in Spain.

BACKGROUND: Sexual violence (SV) is a public health problem with high prevalence among the young population. The use of formal resources for SV care (e.g. institutional services) is low in this age group. This study applies a framework of health assets to identify the factors that positively influence the search for support for SV among young people, the functions of that support and the level of proximity as articulated by both young people and professionals. METHODS: A qualitative study was conducted through 38 semi-structured interviews with young people and professionals from SV resource centers and/or care services for the young population in Spain. A thematic theoretical analysis was conducted, embedded in inductive insights emerging from the data, following a particular adaptation of the constant comparative method, under the grounded theory approach. This analysis was carried out by coding the interview transcripts with the support of Atlas.ti. RESULTS: Young women identified assets, categorized as feminist, that they believe they are essential in the search for formal support services for SV. However, unlike young men, they considered the police and judicial system to be barriers and not assets. There were also differences between the young people and professionals in identifying assets. Young people also considered their partner and traditional media as health assets, in contrast to professionals who did not identify these as such valuable resources in the help-seeking process. Informal assets, such as family, friends and the internet are considered close resources. In contrast, specialized care services for gender-based violence/SV and the judicial and police systems were perceived as more distant resources among the young interviewees. CONCLUSIONS: This study shows similarities and discrepancies among young women and men and SV response professionals in identifying assets for seeking SV support among youth. The study shows an inverse relationship between perceptions of proximity and the level of formality of the asset. This study also contributes to map the relationships and information exchanges between assets. It is advisable to inform professionals about the assets that professionals do not acknowledge, and about actions that allow young people to access formal resources.

Accessibility of intimate partner violence-related services for young women in Spain. Qualitative study on professionals' perspectives.

INTRODUCTION: Intimate partner violence (IPV) is common among young people, but the use of IPV resources among young adult women and teenagers is limited. This study aims to analyze professionals' perceptions about the main barriers and facilitators encountered by young women (16-29 years old) exposed to intimate partner violence (IPV) when accessing formal services in Spain. METHODS: Qualitative study based on 17 in depth interviews carried out in 2019 with professionals who manage resources for IPV care in Madrid (Spain) from different sectors (social services, health care, security forces, women or youth issues offices, associations). A qualitative content analysis was conducted. RESULTS: The professionals interviewed perceive the following barriers: 1) Time it takes for young women to recognize IPV because the social construction of sexual-affective relationships is permeated by gender inequality; 2) The process of leaving a situation of abuse; 3) Barriers inherent to IPV services. The key aspects to improve access to these resources are related to care services, professional practice, and the young women themselves. CONCLUSIONS: There are both psychosocial barriers, derived from the process of leaving a situation of violence, as well as structural barriers for young women to access and properly use the recognized services specifically aimed at them or comprehensive IPV care. Services need to be tailored to the needs of young women so they can be truly effective in order to escape IPV.

Rurality and avoidable hospitalization in a Spanish region with high population dispersion.

BACKGROUND: This study analyses the association between rurality and local rate of avoidable hospitalizations in a Spanish region with high population dispersion. METHODS: Ecological study using a municipality in the region of Castile and Leon (Spain) as the spatial unit of analysis. The variables used to operationalize rurality included the following: distance to hospital, population density, mean socio-economic level and percentage of the population aged >65 years. We calculated relative risk (RR) and 95% confidence intervals (CI) using the conditional autoregressive spatial model proposed by Besag, York and Mollié, with explanatory variables. RESULTS: The number of avoidable hospitalizations was 9923 or 4.5% of all admissions. The age- and gender-adjusted avoidable hospitalization rate was 4.06 per 1000 persons. Spatial analysis showed that two variables, distance from municipality of residence to reference hospital and percentage of population aged >65 years were inversely associated with risk for avoidable hospitalization [RR=0.996 (95% CI 0.993-0.999) and RR=0.989 (95% CI 0.982-0.996), respectively]. CONCLUSIONS: It is important to determine whether these lower avoidable hospitalization rates reflect an adequate level of accessibility and quality of primary care health services for rural populations or, in the contrary, they reveal access barriers to hospital care.