A retrospective, comparative analysis of A&E attendance paserns in Irish Traveller versus non-Traveller general practice patients.

BACKGROUND: Very little is known about Gypsy, Roma, and Traveller health, or access to and utilisation of health care. They are not coded in NHS data systems and there are multiple barriers including illiteracy, digital exclusion, and discrimination. AIM: To gain rare insight into Irish Traveller patients' emergency healthcare utilisation and outcomes. METHOD: A retrospective general practice review of A&E attendances was performed from January to December 2017, comparing Travellers with the rest of the practice patient population. A search was done for all A&E attendance letters and related admissions. Blind review of the diagnosis and management were assessed by two reviewers for appropriateness of attendance at A&E. The frequency and recurrence of A&E attendances, referral pathway toA&E, location of A&E, and age distribution were compared. RESULTS: Traveller patients attending A&E were younger. There were fewer repeat attendances in the travelling community but proportionally more in the Traveller under-20-year-old cohort. Only 38% of A&E attendances in Travellers (56% non-Travellers) were deemed appropriate (χ2 7.16, P = 0.007). Only 20% of Travellers (36% non-Travellers) attending A&E were admitted to hospital (χ2 6.33, P = 0.01). Further, 93% of A&E attendances in Irish Travellers (75% non-Travellers) did not follow initial contact with either a GP or NHS 111 (χ2 9.86, P<0.002). Finally, 51% of Irish Travellers (6% non-Travellers) attended A&E departments distant to their registered GP practice (χ2 89.5, P<0.001). CONCLUSION: This work throws light on health service utilisation patterns by Irish Travellers. A&E attendances may have been more suited to a non-emergency setting and there may have been missed opportunities for contact with primary care or NHS 111, which may have an impact on continuity, onward referral, and quality of care.

Association of socioeconomic disadvantage and ethnicity with perinatal neonatal, and infant mortality in Slovakia.

BACKGROUND: Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic. METHODS: The associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017-2022 were explored, using linear regression models. RESULTS: The higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020-2022). CONCLUSIONS: Life in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies.

Mental health and access to care among the Roma population in Europe: A scoping review.

The Roma are Europe's largest ethnic minority group, and often face discrimination and social exclusion. Social strife and lack of access to healthcare are associated with increased symptoms of psychopathology. We aimed to review evidence on mental health outcomes and on access to mental healthcare among the Roma population in Europe. We systematically searched five databases (PsycINFO, Global Health, Social Policy and Practice, Web of Science and PubMed) and conducted a grey literature search in August 2020. We identified 133 studies, 26 of which were included for final analysis. We present the results using a narrative synthesis. The available literature indicates a relatively high prevalence of anxiety, depression and substance abuse among Roma, and females seem to be more affected than males. Roma children exhibit more externalizing and internalizing disorders when compared with non-Roma children. Mental health and perceived well-being among the Roma population are strongly linked to social determinants of health such as housing or economic income. Access to mental healthcare is limited for Roma people because of several barriers pertaining to language, lack of information regarding available services, and the insurance and economic status of Roma people. Roma people report mainly negative experiences with mental health services, including a lack of understanding from healthcare providers, and instances of racism and discrimination. There is a need for more research on mental health and access to healthcare in Roma people. Future studies should be participatory in order to provide guidelines for mental healthcare that addresses the needs of the Roma population.

[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.

Disabled and Romani passengers face similar levels of discrimination but different levels of open hostility in the sharing economy.

This multimethod project investigates discrimination against members of two populous minority groups in the European Union: the Roma (numbering 6 million) and the disabled (numbering 100 million) on a leading Hungarian carpooling platform. In a field experiment, 1005 ride requests were sent to drivers, with passenger group membership (control, disabled, Roma) manipulated between participants. Widespread discrimination against both groups was apparent in significantly lower approval rates for disabled (56%) and Roma passengers (52%) relative to control (70%). Mechanisms driving anti-disabled and anti-Roma discrimination were probed using an experimental manipulation, natural language processing analysis of driver-passenger interactions, and an online survey (N = 398). Individuating information in the form of reviews did not mitigate unequal treatment, thus providing evidence against statistical (stereotype-based) discrimination. Militating against taste-based (attitudinal) discrimination, respondents reported negative attitudes toward Roma passengers but positive attitudes toward disabled passengers. Moreover, despite equivalent approval rates, disabled passengers were more likely to receive a response from drivers and received more polite responses than Roma passengers did. Overall, the observed patterns are most readily explained by intergroup emotions: Contempt toward Roma passengers likely engenders both passive and active harm, whereas pity toward disabled passengers likely engenders passive harm and active facilitation.

Can routine data be used to estimate the mental health service use of children and young people living on Gypsy and Traveller sites in Wales? A feasibility study.

INTRODUCTION: Gypsies and Travellers have poorer physical and mental health than the general population, but little is known about mental health service use by Gypsy and Traveller children and young people. Finding this group in routine electronic health data is challenging, due to limited recording of ethnicity. We assessed the feasibility of using geographical markers combined with linked routine datasets to estimate the mental health service use of children and young people living on Traveller sites. METHODS: Welsh Government supplied a list of Traveller site postcodes included in Caravan Counts between 2012 and 2020. Using spatial filtering with data from the Adolescent Mental Health Data Platform (ADP) at Swansea University's SAIL Databank, we created a cohort of Traveller site residents aged 11-25 years old, 2010-2019. ADP algorithms were used to describe health service use, and to estimate incidence and prevalence of common mental disorders (CMD) and self-harm. RESULTS: Our study found a subgroup of young Gypsies and Travellers (n = 802). We found no significant differences between our cohort and the general population for rates of CMD or self-harm. The rate of non-attendance for psychiatric outpatient follow-up appointments was significantly higher in our cohort. Rates were higher (but not statistically significant) among Gypsies and Travellers for measures suggesting less well-managed care, including emergency department attendance and prescribed CMD medication without follow-up. The small size of the cohort resulted in imprecise estimates with wide confidence intervals, compared with those for the general population. CONCLUSIONS: Gypsies and Travellers are under-represented in routine health datasets, even using geographical markers, which find only those resident in authorised traveller sites. Routine data is increasingly relied upon for needs assessment and service planning, which has policy and practice implications for this underserved group. To address health inequalities effort is required to ensure that health datasets accurately capture ethnicity.

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.

A Qualitative Evaluation of a Community-Based Intervention on Health-Related Behaviors in Disadvantaged Women.

Purpose: Grounded in social ecological model and self-determination theory, the aim of this study was to qualitatively evaluate the first and second year follow-ups of a community-based healthy lifestyle programme on health-related behaviors, and outcomes in disadvantaged adult women. Methods: Eleven disadvantaged adult women (M = 37.72; SD = 8.34) (seven of them from the Roma population) participated in this community-based participatory action research. Discussion groups, semi-structured interviews, and field notes were used to assess the effects of the intervention programme on health-related behaviors and health outcomes through thematic analysis. Results: Women perceived improvements in PA-related variables, healthy eating, and other health-related outcomes throughout two years. Most women mentioned these behavior changes in the first year, while others perceived them in the second year. Conclusions: These findings highlight the importance of developing contextual and culturally tailored interventions that address the specific problems and needs that emerge from ethnic groups. Given that some of these behavior changes were only mentioned by most of these women in the second year, long-term interventions seem to be ideally required in this population.

Irish Roma: a literature review.

It is estimated that the Roma are the largest ethnic minority population in Europe (HSE in Roma Intercultural Guide, 2020). There is a dearth of information in the Irish medical literature on the Roma in Ireland. The aim of this paper is to provide an overview of the Roma in Ireland, to identify Roma-specific culture, family structure, paediatric illness, and health equality within the context of the Irish population. To do this, a review was completed of the English language literature on Roma available from 2010 to 2021 using web of science databases. Relevant clinicians and organisations were contacted to compile data on the Irish Roma to inform appropriate action in Roma child health. Up until 2021, the national census in Ireland did not include Roma as a category in ethnicity (HSE in Roma Intercultural Guide, 2020). As such, it is difficult to get an accurate number of the population in Ireland. Pavee Point Traveller and Roma Centre in 2009 estimated a population of approximately 5000 (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). The majority of the Roma in Ireland are Romanian (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). There is limited understanding of their culture in Ireland (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). Often overlooked, small indigenous groups or nomadic races have unmet medical needs (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). Across Europe, they have a lower life expectancy and higher burden of illness due to lower socioeconomic status, discrimination, and poor access to health services (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). Cultural competence is necessary to provide effective healthcare.

The Roma population's fear of donating their own organs for transplantation.

BACKGROUND: The refusal rate for donating organs among the Roma people is much higher than that of any other social group. OBJECTIVE: To analyze the attitude towards the donation of one's own organs among the Roma population living in Spain. METHOD: . TYPE OF STUDY: Spanish national observational sociological study stratified by gender and age. STUDY POPULATION: Roma population aged ≥15 years living in Spain. SAMPLE SIZE: 1,253 respondents. Assessment instrument: Validated questionnaire on attitude towards organ donation for transplantation "PCID - DTO Ríos". Field work: Random selection based on stratification. Anonymous and self-administered completion. The collaboration of people of Roma ethnicity was required. STATISTICS: Student's t test, χ2, Fisher's exact test and a logistic regression analysis. RESULTS: The degree of completion was 18.2% (n = 228). Of those who completed the questionnaire, 42.1% (n = 96) were in favor of donation, 30.3% (n = 69) were undecided and the remaining 27.6% (n = 63) were against it. Of the 1,025 (81.8%) who declined to complete the questionnaire, 1,004 (98%) indicated that it was for fear of speaking about and filling in a questionnaire that raises the issue of death and organ donation after death. If those who did not complete the questionnaire due to fear of death and donating organs after death are considered not in favor, the results would be as follows: 7.8% (n = 96) in favor of donating their organs compared to 92.2% (n = 1166) not in favor (against or undecided). CONCLUSIONS: A majority of the Roma population prefer not speak of death nor organ donation after death. These findings show that current campaigns to promote organ donation are not effective in this population group.

Screening attendance disparities among Hungarian-speaking Roma and non-Roma women in central and eastern European countries.

The Roma populations in Central and Eastern Europe are two to three times more likely to have unmet health needs compared to non-Roma residents. The aim of the present study was to investigate the disparity in screening attendance between Hungarian-speaking Roma (R) and non-Roma (nR) women in Hungary (HU-R:322; nR:294), Romania (RO-R:258; nR:183), and Slovakia (SK-R:146; nR:163), while also identifying the factors that influence attendance at any kind of screening tests in both populations. In order to examine these factors, a multiple binary logistic regression was conducted. The findings revealed significant associations between attendance at any kind of screening tests and certain factors among different groups. Among Hungarian Roma women, it was found that having a chronic disease and smoking were linked to attendance at any kind of screening tests (p = 0.009). Specifically, having a chronic disease increased the odds of attendance (OR = 1.71 [1.01, 2.90]), while smoking decreased the odds (OR = 0.57[0.365, 0.91]). In Romania, the study found that not having health insurance decreased the odds of attendance among Roma women (OR = 0.50 [0.27, 0.91]), whereas having a chronic disease increased the odds (OR = 2.87 [1.44, 5.72]) (p = 0.006). Among non-Roma women in Romania, physical inactivity was associated with a decreased likelihood of attendance at any kind of screening tests (OR = 0.48 [0.25, 0.95]). Among Slovakian Roma women, not having health insurance (OR = 0.09[0.02, 0.36]) and smoking (OR = 0.25[0.11, 0.61]) were found to decrease the odds of attendance (p < 0.001). On the other hand, non-Roma women in Slovakia with chronic diseases were more likely to attend at any kind of screening tests (OR = 2.52[1.12, 5.66]). Our research emphasizes the impact of lacking health insurance on screening attendance, particularly among the Roma population. It also highlights the significance of health-related behaviours such as smoking and physical inactivity in relation to missed screening tests, which in turn contribute to the development of non-communicable diseases. Therefore, promoting targeted screening programs for the Roma community is crucial to ensure their access to screening tests, especially in cases of chronic illnesses.

Diet quality as assessed by Healthy Eating Index-2015 among Hungarian Roma living in settlements of Northeast Hungary.

Inequalities in diet quality are increasingly reported, but such studies among Roma are scarce and challenging. Here we attempt to examine diet quality and adherence to food based dietary guidelines among Hungarian Roma (HR) ethnic minority living in segregated settlements while comparing a sample of Hungarian adults from the general population (HG). Data were obtained from a complex comparative health survey conducted in Northeast Hungary in 2018, including sociodemographic and physical examination data. Dietary data were collected using two non-consecutive 24-h dietary recalls. We assessed diet quality based on using a 13-component Healthy Eating Index-2015 (HEI-2015, range 0-100). Differences in median intakes of food and nutrients and HEI-2015 scores were evaluated by Mann-Whitney test or Kruskal-Wallis test. Quantile regression was used to adjust HEI-2015 scores for socioeconomic factors including age, sex, educational status, and perceived financial status. This analysis included 393 and 415 subjects, aged between 18 to 70 years, of HR and HG populations, respectively. Results showed overall low median HEI-2015 scores for both HR and HG, with significantly lower total score among HR participants (41.6, interquartile range (IQR): 39.5-42.8) compared to HG (47.2, IQR: 45.7-51.1). Scores for individual components, such as intake of fruits, greens and beans, whole grains, seafood, and plant proteins were particularly suboptimal among both groups, but significantly lower among the HR population. Scores for refined grains, sodium, saturated fats and added sugar reflected high intakes of these components but did not differ between study groups. Our findings revealed an unfavorable diet quality among the HR compared to HG and a potentially increased risk for diet-related NCDs. Future health intervention programs are warranted to address dietary disparities of segregated minorities in Hungary while considering ethnic and cultural differences.

Desirable but not feasible: Measures and interventions to promote early childhood health and development in marginalized Roma communities in Slovakia.

Roma are the largest and most disadvantaged ethnic minority in Europe often facing generational poverty, and limited access to education, employment, housing, and various types of services. Despite many international and national initiatives, children from marginalized Roma communities face multiple risks and are being disadvantaged as early as from conception onward. We, therefore, aimed to identify measures and/or interventions targeting equity in early childhood health and development in marginalized Roma communities which implementation is considered to be urgent but not feasible. We used a group concept mapping approach-a participatory mixed research method-and involved 40 experts and professionals from research, policy and practice. From 90 measures and interventions proposed to achieve early childhood equity for children from marginalized Roma communities, 23 measures were identified as urgent but not feasible. These concerned particularly measures and interventions targeting living conditions (including access to income, access to housing, and basic infrastructure for families) and public resources for instrumental support (covering mainly topics related to financial and institutional frameworks). Our results reflect the most pressing issues in the area of equality, inclusion and participation of Roma and expose barriers to implementation which are likely to arise from public and political discourses perpetrating a negative image of Roma, constructing them as less deserving. Measures to overcome persistent prejudices against Roma need to be implemented along with the measures targeting equity in early childhood health and development.

Experiences and outcomes of Gypsy, Roma and Traveller women in pregnancy: a scoping review protocol.

INTRODUCTION: Gypsy, Roma and Traveller communities are subjected to a specific form of racism fuelled by deep-seated prejudice and stereotypes. These groups have historically been the victims of school segregation, forced assimilation policies, hate speech and hate crimes.Persecution and displacement have resulted in high rates of unemployment, reduced access to education and poorer health in general, which places these groups at significantly increased risk of poverty. In pregnancy, they are at increased risk of adverse obstetric outcomes. There is a gap in the literature surrounding the experiences and outcomes of pregnant women within this group. A scoping review was chosen as the appropriate methodology to identify what is known about the experiences and outcomes of pregnant women in these communities. METHODS AND ANALYSIS: The Levac et al guideline on conducting a scoping review will be followed. This six-step approach includes identification of the research question, identification of relevant studies, selection of studies, charting of data, summary of results and consultation with experiential experts. A comprehensive search of the following electronic databases from 1980 to 2021 will be conducted: CINAHL, Embase, MEDLINE, Scopus and Web of Science. Relevant grey literature and reference lists will also be searched. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool will be used. ETHICS AND DISSEMINATION: Ethical approval was not required for this protocol as all literature within this scoping review are publicly available. To facilitate dissemination of findings, the research team will present the findings to key stakeholders working with Gypsy, Roma and Traveller communities.

A Community-Based Participatory Action Research with Women from Disadvantaged Populations: Strengths and Weaknesses of a Multiple Health Behaviour Change Intervention.

Disadvantaged populations usually adopt risk behaviours, resulting in obesity and mental health-related disorders. Grounded in the socioecological model and self-determination theory, the aims were firstly to describe and implement a two-year multiple health behaviour change intervention, and secondly, to assess the strengths and weaknesses of the intervention. In total, 11 women from a disadvantaged population participated in this programme, which encompassed 117 sessions. Qualitative techniques were used to collect data and a thematic analysis was conducted. The variety of activities and the group-based intervention were the main strengths, and the decrease in attendance and the programme's tight schedule were the main weaknesses. This is the first intervention in a disadvantaged population mainly comprised of Roma women. The design described in detail and its assessment provide relevant knowledge to improve their health status and decrease inequalities. The practical implications for future research are useful for replicating interventions in similar contexts.

How to make healthy early childhood development more likely in marginalized Roma communities: a concept mapping approach.

BACKGROUND: This study aims to assess which measures could improve the healthy early childhood development of children from marginalized Roma communities and to identify priority measures. METHODS: Concept mapping approach was used, using mixed methods. In total 54 professionals, including social workers, educators, health care providers, municipality representatives, and project managers participated in our study. RESULTS: Four distinct clusters of measures targeting living conditions, public resources, healthcare and community interventions, and 27 individual priority measures of highest urgency and feasibility were identified. The cluster 'Targeting living conditions', was rated as the most urgent but least feasible, whereas the cluster 'Targeting health care', was considered least urgent but most feasible. Among the 27 priority measures, 'Planning parenthood' and 'Scaling up existing projects' had the highest priority. CONCLUSION: Our results reflect the public and political discourse and indicate significant barriers to implementation. Reducing inequalities in early childhood needs to be addressed through coordinated efforts.

Promoting justice through community-based research: International case studies.

Community-based participatory research (CBPR) approaches to promoting justice focus on working from the ground up and giving a voice to marginalized communities regarding their concerns, potential solutions, and how to address social justice issues that matter to them. The pursuit of justice is often related to efforts to attain personal as well as collective well-being. In this paper, we illustrate three exemplars of community psychologists' efforts to promote justice. Within each case study, we discuss the social and community context and examine how the researchers built partnerships and solidarity, developed ways of doing, and approached challenges and solutions. First, we present an example to promote economic justice through an entrepreneurship initiative developed in collaboration with young Black youth with disabilities in the United States. The second case illustrates an effort to promote reproductive justice in collaboration with Roma women and girls in Spain. The third exemplar depicts the use of life stories as a method to raise the voices of displaced, marginalized indigenous women in Peru. Based on these three case studies, we present a synthesis model of social justice. We also discuss implications for future studies emphasizing the importance of engaging community participants in research meaningful ways, developing sustainable partnerships, and decolonizing research.

Low prevalence of spectacle use in the Hungarian Roma population indicates unmet health needs.

The Roma population is the largest transnational ethnic minority group in Europe, often facing socioeconomic inequalities and various health problems. In the present study, we investigated visual acuity and its influencing factors along with spectacle use of the Roma population in comparison with the general population in Hungary. A cross-sectional survey was carried out including 832 participants aged 20-64 years. We recorded the uncorrected visual acuity along with anthropometric, demographic, socioeconomic and health-related data of each individual. Although the average uncorrected visual acuity was somewhat higher, the use of a visual aid was significantly less frequent in the Roma population, especially in the group with a visual acuity below 0.5 in both eyes (14.3% vs. 77.1%, p < 0.001). Age, abdominal obesity and disturbances of carbohydrate metabolism had a negative impact on visual acuity in both populations; however, the latter was a much stronger risk factor in the Roma population (OR 5.789, 95% CI 2.239-14.964, p < 0.001) than in the general population (OR 2.075, 95% CI 1.097-3.926, p = 0.025). Our results show serious unmet health needs within the Roma population, which calls for public health programs to improve poor primary care indicators on regular eye examination and much more rigorous diabetes control.

[Training for Roma health advocacy: a case study of Torreblanca, Seville]. / Capacitación de población gitana en abogacía para la salud: un estudio de caso en Torreblanca, Sevilla.

OBJECTIVE: The objective of this study is to build advocacy capacity among a group of gipsy Roma neighbours living in contexts of risk of social exclusion. METHODS: A Community Based Participatory Action Research design was used, in which 4 members of the community participated in the process of collecting evidence by photo-voice, analysing it using the ReACT method and disseminating the results. RESULTS: A total of 96 pieces of evidence were collected and analysed for qualitative data analysis. These were categorised according to (a) the type of unhealthy conditions and (b) the area of the neighbourhood where they were located. The subsequent thematic grouping made it possible to identify the causes: (a) the abandonment of public services; (b) discrimination; and (c) the lack of Roma presence in community spaces. The consequences identified were (a) mental and physical health problems and (b) the normalisation of undignified living conditions. The plan was designed to advocate for the presence of Roma in community spaces. CONCLUSIONS: Our study highlighted the relevance of the photo-voice to transcend the biomedical perspective and develop advocacy actions based on the knowledge created by the community. Future research should look more deeply into the impact of health advocacy on reducing inequalities and consider the importance of involving researchers, public health professionals and the community in addressing it.

Body structural and cellular aging of women with low socioeconomic status in Hungary: A pilot study.

OBJECTIVES: The health status of an individual is determined not only by their genetic background but also by their physical environment, social environment and access and use of the health care system. The Roma are one of the largest ethnic minority groups in Hungary. The majority of the Roma population live in poor conditions in segregated settlements in Hungary, with most experiencing higher exposure to environmental health hazards. The main aim of this study was to examine the biological health and aging status of Roma women living in low socioeconomic conditions in Hungary. METHODS: Low SES Roma (n: 20) and high SES non-Roma women (n: 30) aged between 35 and 65 years were enrolled to the present analysis. Body mass components were estimated by body impedance analysis, bone structure was estimated by quantitative ultrasound technique. Cellular aging was assessed by X chromosome loss estimation. Data on health status, lifestyle and socioeconomic factors were collected by questionnaires. RESULTS: The results revealed that low SES women are prone to be more obese, have a higher amount of abdominal body fat, and have worse bone structure than the national reference values. A positive relationship was found between aging and the rate of X chromosome loss was detected only in women with low SES. Waist to hip ratio, existence of cardiovascular diseases and the number of gravidities were predictors of the rate of X chromosome loss in women. CONCLUSIONS: The results suggested that age-adjusted rate of X chromosome loss could be related to the socioeconomic status.