¿Cómo medir el estatus migratorio de la población infantil y juvenil? Estudios sobre salud y desigualdades en salud en Europa / How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe

OBJETIVO: Analizar cómo se mide el estatus migratorio en la población infantil y juvenil en la literatura científica sobre salud y desigualdades sociales en salud en Europa. MÉTODO: Se realizó una búsqueda sistemática de publicaciones entre 2007 y 2017 en PubMed y Social Sciences Citation Index, en español, inglés y francés. Se incluyeron artículos realizados en Europa en los que se analizaran la salud o las desigualdades sociales en salud de la población menor de 18 años según su origen migratorio. Se realizó una descripción de las variables usadas para la medición del estatus migratorio. RESULTADOS: Se incluyeron 50 artículos. Veinte estudios analizaban alguna variable de salud perinatal, once de salud mental, nueve de salud dental y diez de otras variables. Las principales variables para definir el estatus migratorio fueron el país de nacimiento (32 estudios), tanto del niño o la niña como de la madre o de alguno de los progenitores, y en ocasiones de forma complementaria. Menos frecuente fue la utilización de la nacionalidad (15 estudios) del niño o la niña, o de los progenitores, especialmente la materna. El estatus migratorio se denomina de muy diferentes maneras, no siempre equiparables, y en ocasiones no se explicita claramente la variable utilizada. CONCLUSIONES: Existe una gran diversidad de formas de medir el estatus migratorio en la población infantil y juvenil. Son necesarios una mejor definición y un consenso para mejorar la comparabilidad temporal y geográfica del conocimiento en esta área, que ayude al diseño de políticas públicas encaminadas a reducir las desigualdades sociales en salud desde la infancia

OBJECTIVE: To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe. METHOD: A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described. RESULTS: 50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained. CONCLUSIONS: There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood

[How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe]. / ¿Cómo medir el estatus migratorio de la población infantil y juvenil? Estudios sobre salud y desigualdades en salud en Europa.

OBJECTIVE: To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe. METHOD: A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described. RESULTS: 50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained. CONCLUSIONS: There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood.

Roma populations and health inequalities: a new perspective.

PURPOSE: The purpose of this paper is to explore the emergence of "Roma health and wellbeing" as a focus of attention in European research and in policy and the possible detrimental consequences of action founded on a generic representation of "Roma health." DESIGN/METHODOLOGY/APPROACH: Based on discussions with and research conducted by scholars who work directly with Roma communities across European regions from a wide range of academic disciplines it suggests how future research might inform: a more nuanced understanding of the causes of poor health and wellbeing among diverse Roma populations and; actions that may have greater potential to improve the health and wellbeing among these populations. FINDINGS: In summary, the authors promote three types of research: first critical analyses that unpick the implications of current and past representations of "Roma" and "Roma health." Second, applied participatory research that meaningfully involves people from specific self-defined Roma populations to identify important issues for their health and wellbeing. Third, learning about processes that might impact on the health and wellbeing of Roma populations from research with other populations in similarly excluded situations. ORIGINALITY/VALUE: The authors provide a multidisciplinary perspective to inform research that does not perpetuate further alienation and prejudice, but promotes urgent action to redress the social and health injustices experienced by diverse Roma populations across Europe.

Help-Seeking Behavior Among Moroccan, Romanian, and Ecuadorian Women Experiencing Intimate Partner Violence in Spain.

This study aims to identify different types of response to intimate partner violence (IPV) and help-related seeking behavior among Spain's most numerous immigrant groups-Moroccans, Romanians, and Ecuadorians. Women reporting physical, sexual and/or psychological violence by a current or former intimate partner (n = 194) were selected from a cross-sectional study based on 1,607 surveys (2011). There are 84% of surveyed battered women who reported seeking help through informal and/or formal channels. The most frequently reported informal help-seeking behavior was talking with the abusive partner (from 63% to 83%). Moroccans identified social services (29.6%) and health care (25.9%) professionals as their most frequently used formal resources when seeking help. Approximately 32% of Ecuadorians and Romanians declared having reported their partners to the police. Among all of the women, seeking help through formal channels was more probable in cases where the severity of IPV was high (adjusted odds ratio = 5.69, 95% confidence interval [2.29, 14.12]). It is needed to increase professionals' opportunities to intervene in cases of IPV before they become severe.

Educación para la salud en la escuela primaria: opinión del profesorado de la ciudad de Alicante / Health education in primary school: Alicante city (Spain) teachers' opinions

Objetivo: Explorar la opinión del profesorado de educación primaria de la ciudad de Alicante sobre las actividades de salud realizadas en la escuela. Método: Estudio exploratorio mediante análisis de contenido cualitativo. Se formaron tres grupos de discusión (8-9 participantes) con profesorado de educación primaria (14 mujeres y 11 hombres) procedentes de 14 escuelas públicas y 7 concertadas de la ciudad de Alicante. La información se obtuvo preguntando a los/las participantes sobre las actividades de salud realizadas en el aula o en el centro escolar. Resultados: El profesorado diferenció las actividades que forman parte de las programaciones escolares de educación para la salud de las que proceden de programas de otras instituciones públicas o privadas. Consideró que los programas externos son impuestos, no tienen continuidad y responden a modas pasajeras. Aunque mostró una actitud más favorable y comprometida con las actividades y programaciones escolares, identificó la educación para la salud como una tarea secundaria. En su opinión, incrementar su formación en salud, implicar a los padres y las madres, profesionales sanitarios y la administración educativa fomentaría la educación para la salud en la escuela. Conclusiones: El profesorado muestra una opinión más favorable y un mayor compromiso hacia las actividades de salud que complementan y facilitan su tarea educativa. Su programación docente y opinión deben tenerse en cuenta para maximizar la eficiencia de las actividades de promoción y educación para la salud promovidas por instituciones, compañías y fundaciones externas a la escuela (AU)

Objective: This study explores the opinions of primary school teachers about health activities carried out in schools in Alicante city (Spain). Methods: An exploratory study was conducted through qualitative content analysis. Three focus groups were conducted with 25 primary school teachers (14 women and 11 men) working in 14 public and 7 private schools in the city of Alicante. Participants were asked about the health activities carried on in their schools. Results: Teachers distinguished between health education activities promoted by the school and those included in external programmes promoted by public and private institutions. External programmes were considered as impositions, lacking continuity and chosen according to passing fads. Although teachers demonstrated a more positive attitude towards activities arising from their own initiative, they identified health education as a secondary task. Teachers considered that improving their own health education training and promoting the involvement of parents, health professionals and public institutions were the most appropriate ways to promote health education in the school. Conclusion Teachers showed a more positive opinion and greater commitment towards health activities that complement and facilitate their teaching tasks. Their didactic programme and opinion should be taken into account to maximise the efficiency of the health promotion and education activities promoted by external organizations (AU)

[Health education in primary school: Alicante city (Spain) teachers' opinions]. / Educación para la salud en la escuela primaria: opinión del profesorado de la ciudad de Alicante.

OBJECTIVE: This study explores the opinions of primary school teachers about health activities carried out in schools in Alicante city (Spain). METHODS: An exploratory study was conducted through qualitative content analysis. Three focus groups were conducted with 25 primary school teachers (14 women and 11 men) working in 14 public and 7 private schools in the city of Alicante. Participants were asked about the health activities carried on in their schools. RESULTS: Teachers distinguished between health education activities promoted by the school and those included in external programmes promoted by public and private institutions. External programmes were considered as impositions, lacking continuity and chosen according to passing fads. Although teachers demonstrated a more positive attitude towards activities arising from their own initiative, they identified health education as a secondary task. Teachers considered that improving their own health education training and promoting the involvement of parents, health professionals and public institutions were the most appropriate ways to promote health education in the school. CONCLUSION: Teachers showed a more positive opinion and greater commitment towards health activities that complement and facilitate their teaching tasks. Their didactic programme and opinion should be taken into account to maximise the efficiency of the health promotion and education activities promoted by external organisations.

Toolkit on social participation: methods and techniques for ensuring the social participation of Roma populations and other social groups in the design, implementation, monitoring and evaluation of policies and programmes to improve their health

The toolkit on social participation was developed to help various stakeholders to promote social participation in the design, implementation, monitoring and evaluation of strategies, programmes and/or activities to improve the health of the population. This document is intended for use by policy-makers, project coordinators, professionals and nongovernmental organizations involved in promoting social participation of the general population, including Roma and other social groups (with the understanding that social participation processes must explicitly include Roma, but not exclusively). The toolkit comprises a detailed list of methods and techniques (tools) for promoting social participation throughout the policy process, providing examples and case studies mainly based on experiences of promoting social participation of Roma populations in Europe.

Barriers and facilitators to effective coverage of Intimate Partner Violence services for immigrant women in Spain.

OBJECTIVE: To explore service providers' perceptions in order to identify barriers and facilitators to effective coverage of Intimate Partner Violence (IPV) services for immigrant women in Spain, according to the different categories proposed in Tanahashi's model of effective coverage. METHODS: A qualitative study based on 29 in-depth personal interviews and four group interviews with a total of 43 professionals working in public services (social and health-care services, women's refuges, the police force, the judiciary) and NGOs in Barcelona, Madrid, Valencia and Alicante (Spain) in 2011. FINDINGS: Current IPV services in Spain partially fail in their coverage of abused immigrant women due to barriers of (i) availability, such as the inexistence of culturally appropriate services; (ii) accessibility, as having a residence permit is a prerequisite for women's access to different services and rights; (iii) acceptability, such as women's lack of confidence in the effectiveness of services; and (iv) effectiveness, for example, lack of specific training among professionals on the issues of IPV and immigration. However, interviewees also identified facilitators, such as the enabling environment promoted by the Spanish Law on Gender-Based Violence (1/2004), and the impetus it has provided for the development of other specific legislative tools to address IPV in immigrant populations in Spain (availability, accessibility and effectiveness). CONCLUSION: Whilst not dismissing cultural barriers, aspects related to service structure are identified by providers as the main barriers and facilitators to immigrant women use of IPV services. Despite noteworthy achievements, improvements are still required in terms of mainstreaming assistance tailored to immigrant women's needs in IPV policies and services.

Participación y representatividad de la población inmigrante en la Encuesta Nacional de Salud de España 2011-2012 / Participation and representation of the immigrant population in the Spanish National Health Survey 2011-2012

Objetivo: Las encuestas de salud constituyen la principal fuente para el conocimiento del estado de salud de la población inmigrante en España. Este artículo pretende analizar la representatividad de esta población en la Encuesta Nacional de Salud de España (ENSE) 2011-2012. Métodos: Se analizaron las publicaciones metodológicas y los microdatos de la ENSE 2011-2012, y los datos del Padrón Municipal de Habitantes. Se analizaron las diferencias en la tasa de participación y sus causas entre la población nacional y extranjera, así como la representación de 11 países de nacimiento en la encuesta respecto a la de la población general, con y sin utilizar los ponderadores de la encuesta. Resultados: Los hogares con alguna persona extranjera presentaron una menor tasa de participación, tanto por mayores errores en el marco muestral como por una mayor falta de respuesta. En todos los países de nacimiento la muestra era menor de lo que correspondería según la población empadronada, en especial entre la población china. Al utilizar la ponderación en los 11 casos, la estimación del tamaño de la población se acercó más al tamaño estimado con el Padrón, aunque globalmente se mantuvo la infrarrepresentación y no se eliminó el sesgo intranacional. Conclusiones: La menor participación de la población inmigrante y su carácter diferencial por país de origen sugieren la existencia de un potencial sesgo de la ENSE que debe tenerse en cuenta en los estudios que analicen la salud de esta población. Es necesario estudiar en mayor profundidad esta menor participación para tomar las medidas adecuadas que aumenten la representatividad de las encuestas de salud (AU)

Objective: Population health surveys have been the main data source for analysis of immigrants' health status in Spain. The aim of this study was to analyze the representation of this population in the Spanish National Health Survey (SNHS) 2011-2012. Methods: We analyzed methodological publications and data from the SNHS 2011-2012 and the population registry. Differences in the participation rate between the national and foreign populations and the causes for these differences were analyzed, as well as the representation of 11 countries of birth in the survey with respect to the general population, with and without weighting. Results: Households with any foreign person had a lower participation rate, either due to a higher error in the sampling frame or to a higher non-response rate. In each country of birth, the sample was smaller than would be expected according to the population registry, especially among the Chinese population. When we applied the sample weights to the 11 countries of birth, the estimated population volume was closer to the estimated volume of the population registry for all the countries considered, although globally both the underrepresentation and the intranational bias remained. Conclusions: The lower participation of the immigrant population and differences in participation depending on the country of origin suggest the existence of a potential bias in the SNHS, which should be taken into account in studies analyzing the health of this population. The lower participation rate should be studied in greater depth in order to take appropriate measures to increase the representativeness of health surveys (AU)

[Participation and representation of the immigrant population in the Spanish National Health Survey 2011-2012]. / Participación y representatividad de la población inmigrante en la Encuesta Nacional de Salud de España 2011-2012.

OBJECTIVE: Population health surveys have been the main data source for analysis of immigrants' health status in Spain. The aim of this study was to analyze the representation of this population in the Spanish National Health Survey (SNHS) 2011-2012. METHODS: We analyzed methodological publications and data from the SNHS 2011-2012 and the population registry. Differences in the participation rate between the national and foreign populations and the causes for these differences were analyzed, as well as the representation of 11 countries of birth in the survey with respect to the general population, with and without weighting. RESULTS: Households with any foreign person had a lower participation rate, either due to a higher error in the sampling frame or to a higher non-response rate. In each country of birth, the sample was smaller than would be expected according to the population registry, especially among the Chinese population. When we applied the sample weights to the 11 countries of birth, the estimated population volume was closer to the estimated volume of the population registry for all the countries considered, although globally both the underrepresentation and the intranational bias remained. CONCLUSIONS: The lower participation of the immigrant population and differences in participation depending on the country of origin suggest the existence of a potential bias in the SNHS, which should be taken into account in studies analyzing the health of this population. The lower participation rate should be studied in greater depth in order to take appropriate measures to increase the representativeness of health surveys.

Social and immigration factors in intimate partner violence among Ecuadorians, Moroccans and Romanians living in Spain.

BACKGROUND: Intimate partner violence (IPV) against women occurs in all countries, all cultures and at every level of society; however, some populations may be at greater risk than others. The aim of this study was to explore IPV prevalence among Ecuadorian, Moroccan and Romanian immigrant women living in Spain and its possible association with their personal, family, social support and immigration status characteristics. METHODS: Cross-sectional study of 1607 adult immigrant women residing in Barcelona, Madrid and Valencia (2011). Prevalence rates and adjusted odds ratios (AORs) were calculated, with current IPV being the outcome. Different women's personal (demographic), family, social support and immigration status characteristics were considered as explicative and control variables. All analyses were separated by women's country of origin. RESULTS: Current IPV prevalence was 15.57% in Ecuadorians, 10.91% in Moroccans and 8.58% in Romanians. Some common IPV factors were found, such as being separated and/or divorced. In Romanians, IPV was also associated with lack of social support [AOR 5.96 (1.39-25.62)] and low religious involvement [AOR 2.17 (1.06-4.43)]. The likelihood of current IPV was lower among women without children or other dependents in this subgroup [AOR 0.29 (0.093-0.92)]. CONCLUSION: The IPV prevalence rates obtained for Moroccan, Romanian and Ecuadorian women residing in Spain were similar. Whereas the likelihood of IPV appeared to be relatively evenly distributed among Moroccan and Ecuadorian women, it was higher among Romanian women in socially vulnerable situations related to family responsibilities and the lack of support networks. The importance of intervention in the process of separation and divorce was common to all women.

Preventing and addressing intimate partner violence against migrant and ethnic minority women: the role of the health sector

Violence against women is an extreme manifestation of gender inequality in society and a seriousviolation of fundamental human rights. Intimate partner violence (IPV) is the most common typeof such violence and takes place within couples. IPV can lead to death, physical injury, functionalimpairment, mental health problems, negative health behaviour, chronic conditions and reproductivehealth problems. Institutional discrimination, lack of access to or knowledge of services, and culturaldifferences can prevent women who are not only experiencing IPV but also migrants or members ofethnic minorities from seeking help. This policy brief aims to provide input into the role of the healthsector in preventing and addressing IPV among migrant women and those of ethnic minorities. Itdescribes the scope of the problem, presenting key evidence, and makes recommendations for healthpolicy and health systems, health facilities and health service providers.

Preventing and addressing intimate partner violence against migrant and ethnic minority women: the role of the health sector: policy brief

Violence against women is an extreme manifestation of gender inequality in society and a serious violation of fundamental human rights. Intimate partner violence (IPV) is the most common type of such violence and takes place within couples. IPV can lead to death, physical injury, functional impairment, mental health problems, negative health behaviour, chronic conditions and reproductive health problems. Institutional discrimination, lack of access to or knowledge of services, and cultural differences can prevent women who are not only experiencing IPV but also migrants or members of ethnic minorities from seeking help. This policy brief aims to provide input into the role of the health sector in preventing and addressing IPV among migrant women and those of ethnic minorities. It describes the scope of the problem, presenting key evidence, and makes recommendations for health policy and health systems, health facilities and health service providers.