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The objective of this study is to identify challenges and facilitators for detecting and addressing cases of intimate partner violence (IPV) against Roma women, from the perspectives of health personnel and representatives of Roma organizations, and to compare both perspectives. A total of 28 semi-structured interviews were carried out between November 2014 and February 2015 in different Spanish cities. A thematic analysis was carried out, guided by Aday and Andersen's model regarding barriers to access to health services. Both groups signaled the following as principal challenges: (a) consideration of IPV as a private problem among the Roma population, (b) little use of primary care providers for prevention, (c) distrust of Roma women toward primary care professionals as resources for seeking help, (d) the inexistence of Roma professionals in health services, (e) health professionals' lack of cultural sensitivity related to Roma people, and (f) the focus of health protocols for action against IPV on filing a police report. Potential facilitating factors included Roma women's trust in nurses, social workers, and pediatricians and ethnic heterogeneity. There is need to promote action to address the identified challenges through a health equity approach that includes greater training and awareness raising among health professionals about Roma culture and the specific needs of Roma women. [ABSTRACT FROM AUTHOR]

Background: Spain's financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period.Methods: An ecological longitudinal study was carried out in Spain's 17 regions. Two study periods were defined: pre-crisis period (2005-2007) and crisis period (2008-2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design.Results: Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008.Discussion: The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates.Conclusions: The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005. [ABSTRACT FROM AUTHOR]

Objectives To analyse the association between self-perceived discrimination and social determinants (social class, gender, country of origin) in Spain, and further to describe contextual factors which contribute to self-perceived discrimination. Methods Cross-sectional design using data from the Spanish National Health Survey (2006). The dependent variable was self-perceived discrimination, and independent and stratifying variables were sociodemographic characteristics (e.g. sex, social class, country of origin, educational level). Logistic regression was used. Results The prevalence of self-perceived discrimination was 4.2% for men and 6.3% for women. The likelihood of self-perceived discrimination was higher in people who originated from low-income countries: men, odds ratio (OR) 5.59 [95% confidence interval (CI) 4.55-6.87]; women, OR 4.06 (95% CI 3.42-4.83). Women were more likely to report self-perceived discrimination by their partner at home than men [OR 8.35 (95% CI 4.70-14.84)]. The likelihood of self-perceived discrimination when seeking work was higher among people who originated from low-income countries than their Spanish counterparts: men, OR 13.65 (95% CI 9.62-19.35); women, OR 10.64 (95% CI 8.31-13.62). In comparison with Spaniards, male white-collar workers who originated from low-income countries [OR 11.93 (95% CI 8.26-17.23)] and female blue-collar workers who originated from low-income countries (OR 1.6 (95% CI 1.08-2.39)] reported higher levels of self-perceived discrimination. Conclusions Self-perceived discrimination is distributed unevenly in Spain and interacts with social inequalities. This particularly affects women and immigrants. [ABSTRACT FROM AUTHOR]

Background: Myths of sexual aggression have a negative influence in aggressive behavior against women, in the institutional approaches to sexual violence and in how women cope with it. The objective of this study is to describe acceptance of myths of sexual aggression in young women and men residing in Spain., Method: Cross-sectional study carried out online with 2,515 women (50.2%) and men (49.8%) ages 18-35 in Spain in 2020. Information on myths was collected using the Acceptance of Modern Myths About Sexual Aggression Scale (AMMSA). We described the myths most prevalent among women and men. The variables associated with myths were identified using multiple regression. The regression models were adjusted by sociodemographic and sexual orientation variables., Results: The average AMMSA values were higher among men [mean: 3.11; standard deviation (sd):1.23] than among women (mean 2.49 sd:1.11). In both sexes, the myths with greater acceptance showed the presence of patriarchal gender roles in sexual contacts. Men were more likely than women to accept myths that question allegations and severity of violence. Having a higher level of educational studies (β -0.350 sd: 0.046) was associated with lower average AMMSA values. Being born in Latin America (β 0.047 sd: 0.063) was associated with higher average AMMSA values. Among heterosexual men, AMMSA values were greater than among gay and bisexual men. Among women, there was no difference in average AMMSA values based on sexual orientation., Conclusions: Myths persist during youth that question and trivialize sexual violence against women. It is necessary to implement strategies that reduce these myths, particularly in heterosexual men, in those of foreign-born origin and among those with low levels of education., (© 2024. The Author(s).)

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., Competing Interests: The authors have declares that no competing interest exist., (Copyright: © 2024 Otero-García et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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 [β(95%CI):2.39(0.67;4.10)]. Homosexual/ bisexual men displayed lower values of HS than heterosexual men [β(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 [β(95%CI for interaction): 2.27(0.11; 4.43)]. B) BS: Mean values of BS were observed to be lower for both women [β(95%CI):-2.16(-2.99;-1.32)] and men [β(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 [β(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., (© 2024. The Author(s).)

Objective: To analyze the discourses of young people and professionals on violence against women and to explore possible strategies for its prevention in Spain., Method: Qualitative study based on semi-structured interviews with 16 young people (18-24 years old) and 23 professionals working in violence against women prevention. A discourse analysis was carried out to identify the main interpretative repertoires., Results: The four interpretative repertoires of this study reflect how young people perceive physical violence in the domestic sphere as the most visible type of violence against women. In their discourses, both young men and women describe the bidirectional nature of intimate partner violence. The allusion to the responsibility of social agents in the perpetuation of violence against women emerges. Finally, young people and professionals emphasize the key role of boys in the prevention of violence against women., Conclusions: Physical violence continues to be the main type of violence perceived by the young population, but most girls were able to identify other more subtle and normalized forms of violence. Social agents have a strong influence on the imaginary of violence against women in the young population. Finally, future strategies against violence against women must involve young men in community-based strategies that work to promote positive and egalitarian attitudes and relationships., (Copyright © 2023 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

There is an increasing awareness of the magnitude of different forms of sexual violence (SV), especially in relation to youth. The COVID-19 pandemic has also had a negative impact on different forms of violence against women. In this study, we aim to analyse SV in the COVID-19 lockdown among young people and SV-related services from the perspective of professionals and young people from different sectors in Spain with responsibilities in attending SV and other forms of violence against women-related. A qualitative content analysis was performed on semi-structured interviews with 23 women and men aged 18 to 24 and 15 professionals working with youth and/or in violence against women or sexual violence related services. The sample was from northern, eastern and central regions of Spain. According to the professionals' experience, the COVID-19 lockdown lessened their ability to work on violence prevention. Both informants perceived that sexual violence had decreased in public spaces whereas it increased in digital ones and noticed the silence surrounding violent situations had deepened. However, they differed regarding its impact on sexual violence within intimate partners, mainly due to the lack of awareness of this problem among young men. In regard to violence against women and sexual violence, our results highlight the need to develop protocols for action and improve resource accessibility in crisis contexts., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Castellanos-Torres et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: This study seeks to deepen current knowledge of the phenomenon of gender-based violence (GVB) among young people in Spain, identifying the main challenges in terms of prevention from the perspective of key stakeholders in the field., Methods: 23 semi-structured qualitative interviews were performed with professionals whose work involves youth and comes from different areas: social work, policy making, youth education, feminist and LGBTQ activism and anti-violence masculinities engagement (13 women and 10 men)., Results: Among the main challenges identified by stakeholders in relation to GBV preventive strategies in young populations there is a need to focus on transformative programmes within educational settings. The findings indicate that specific programs and interventions in this area may not be yielding the expected effectiveness. This outcome could be attributed less to a lack of resources and more to a failure to address the core issues and challenges adequately. Thus, the results underline that intervention programmes should emphasise equitable gender norms and gender relations and incorporate content on anti-violence masculinities. Finally, a pivotal aspect seen by professionals to facilitate GBV prevention is the design and development of interventions based on participatory and active approaches, close to young people's everyday situations. The results also draw attention to the need to analyse the impact of new forms of violence in greater depth, especially those that occur through information and communication technologies., Conclusion: Among other implications for policy and practice, the study points to the need to articulate interventions designed to work simultaneously at different levels of influence acting on people., (© 2023. The Author(s).)

The objective of the prospective cohort study (the DESKcohort project) is to describe and monitor health, health behaviors, and their related factors among 12 and 19-year-old adolescents schooled at centers of Compulsory Secondary Education or post-compulsory secondary education in Central Catalonia, considering social determinants of health. The DESKcohort survey is administered biannually between the months of October and June, and the project has been running for three years. We have interviewed 7319 and 9265 adolescents in the academic years 2019/20 and 2021/22, respectively. They responded a questionnaire created by a committee of experts, that included the following variables: sociodemographic factors, physical and mental health, food, physical activity, leisure and mobility, substance use, interpersonal relationships, sexuality, screen use and digital entertainment, and gambling. The results are presented to educational centers, county councils, municipalities, and health and third sector entities to plan, implement, and evaluate prevention and health promotion actions that address the identified needs., (Copyright © 2023 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

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., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association.)

Masculinities and femininities are often characterized by social inequalities and mainly studied from the perspectives of adult, heterosexual and non-activist people. This study explores the discourses on masculinities and femininities of young cisgender men and women, involved or not in feminist activism and of different sexual orientations (heterosexual, bisexual and homosexual) in Spain. Between 2019 and 2020, we conducted a qualitative study with 20 semi-structured interviews and 8 discussion groups in which 73 people participated. A socially dominant gender discourse was identified, which establishes a dichotomous understanding of masculinity in constant confrontation with femininity, as well as of heterosexuality against homosexuality, in a heteronormative context. Young people discursively position themselves differently from said discourse according to their sexual orientation and involvement in feminist activism. We encounter discursive positions that reproduce the socially dominant gender discourse, especially detected among non-activist heterosexuals. We also observe others that try to transgress it, mainly among activists of all sexual orientations and non-activist homosexuals and bisexuals. This study empirically adds to the knowledge of the configuration of inequalities in gender relations and how interactions with sexuality take place. The results also provide guidance for future gender-transformative interventions to promote gender equality and social justice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cerdán-Torregrosa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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., (© 2022. The Author(s).)

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., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Objective: To compare the main academic characteristics and contents of the different master's programs in public health currently offered in Spain., Method: A systematic search has been carried out in the Register of Universities, Centers and Degrees of the Ministry of Education, Culture and Sports. The main academic characteristics and the contents (mandatory and optional) of the programs of 11 official master's degrees with the renewed accreditation in 2018 were analyzed based on the data published on the universities' web pages., Results: Most programs are 60 ECTS (European Credit Transfer and Accumulation System), face-to-face, taught in Spanish, include in their curriculum the completion of a master's thesis but not professional practices. Only contents related to statistics and basic epidemiology, and the training activity of master's thesis, are offers by all programs., Conclusions: The majority of public health master's programs in Spain shows a certain homogeneity regarding their academic characteristics, but a great heterogeneity in relation to their contents. There is also a great heterogeneity in the credits granted to the different subjects, especially optional subjects. It would be advisable to standardize a common core, especially in the mandatory contents., (Copyright © 2020 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To identify the barriers and facilitators of managing intimate partner violence (IPV) cases, from the perspective of primary health care (PHC) social workers., Method: Qualitative study through interviews with 14 social workers working in PHC centres in Spain. A thematic analysis approach was applied to identify barriers and facilitators according to the Tanahashi model., Results: The barriers identified by social workers in providing effective coverage to women suffering from IPV included insufficient practical training, a lack of knowledge from women on social workers' roles, a lack of teamwork, and excess IPV case referrals from other professionals to social workers. The identified facilitators were the existence of electronic protocols and good practices including therapeutic support groups and holistic intervention approaches., Conclusions: An excess of referrals to social workers of identified IPV cases following consultation by other members of the PHC team, alongside the lack of interdisciplinary teamwork, does not enable a comprehensive and holistic approach to this problem. Compulsory, practical, and interdisciplinary training in IPV for all PHC professionals and students must be a priority for health agencies and universities in order to facilitate a comprehensive and quality approach for all women suffering from IPV., (© 2021 John Wiley & Sons Ltd.)

Objectives: To analyse the prevalence of sexual violence (SV) and associated factors in Spanish young adults in the last year and before, during and after the COVID-19 lockdown., Design: Cross-sectional study based on the online 'SV in Young People Survey' (2020)., Setting: Non-institutionalised population residing in Spain., Participants: 2515 men and women aged 18-35 years old. The participants were obtained from a probability based, online closed panel of adults aged 16 or older that is representative of the non-institutionalised population. The sample designed includes quotas by sex, age, region and country of origin., Outcomes Measures and Analyses: SV victimisation by sociodemographics, sexual attraction and couple-related characteristics during the past year and before, during and after the COVID-19 lockdown (March-June 2020). Prevalence ratios were calculated using robust Poisson regression models., Results: In Spain, 8.5% of young people experienced SV during the past year. The greatest prevalence was observed in women with bisexual attraction (17.5%) and in men with homosexual attraction (14.2%). During the COVID-19 lockdown, the prevalence of SV victimisation was lower (1.9%), but unwanted intercourses increased, affecting 64.4% of those exposed to SV during the period. People with homosexual or bisexual attraction were more likely to experience SV in all of the studied periods (PRbefore: 2.01; p<0.001; PRduring: 2.63 p=0.002; PRafter: 2.67; p<0.001). Women were more likely than men to experience SV prior to the lockdown, while no cohabitation increased the likelihood to experience SV after this period CONCLUSIONS: SV victimisation in Spanish youth is high. During COVID-19, there were changes in the magnitude of factors associated with SV. It seems that SV events decreased in people who did not live with their partners, but unwanted intercourses increased. The development of prevention strategies to address SV in youth should take into account social inequalities by sex, sexual orientation and origin., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Dating Violence (DV) is a public health problem that is on the rise. In this paper, we aim to analyse different factors associated with DV victimization among female and male adolescents in Spain, considering socioeconomic circumstances, sexual orientation and the presence of different attitudes and experiences related to violence., Methods: Cross-sectional data from a convenience sample of 640 ever-partnered adolescents aged 13 to 17 at schools in the cities of Alicante (n = 359, 50.1% girls) and Terrassa (n = 281, 51.9%) in the context of an educational intervention to promote healthy relationships. We calculated the prevalence of different forms of DV (physical, sexual and control and fear) and carried out multivariate regression models by sex., Results: 5.5% of girls and 8.7% of boys declared having suffered lifetime physical and/or sexual violence, while 22% of girls and 20.5% of boys reported control and/or fear victimization. The likelihood of DV was higher among migrants and those with foreign-born parents (aPR girls = 2.1 CI95%: 1.1-3.9; aPR boys = 1.9: CI95%: 1.0-3.6); prior experiences of abuse (aPR girls = 1.6; CI95%: 1.0-2.6; aPR boys = 1.7; CI95%: 1.1-2.6); and those who showed higher levels of machismo (aPR girls = 1.0; CI95%: 1.0-1.1; aPR boys = 1.0; CI95%: 1.0-1.1). In girls, DV increased among those who reported lesbian/bisexual orientation and poor relationship with teachers., Conclusions: DV is socially patterned and increases among LGB adolescents (especially in the case of girls), migrants, and those with foreign-born parents, and adolescents who reported prior experiences of violence in childhood. Future DV prevention programs should consider social inequalities in the likelihood of DV and by reinforcing adolescents' abilities to recognize social support sources and reject machismo and violence., Competing Interests: The authors have declared that no competing interests exist.

Intimate partner violence (IPV) is a global public health concern that has serious effects on the well-being of women and their children. Being a mother and an immigrant are critical factors that prevent women from seeking to end an abusive relationship. Evidence suggests that immigrant women see their children's well-being and future as paramount while managing an abusive relationship. However, less is known about how women negotiate their children's needs and interests when deciding whether to stay with or leave an abusive partner. Drawing on interviews with IPV service providers in Spain, this study aims to explore providers' understandings of the position of the child in mothers' reflections regarding whether to end an abusive relationship and of the implications of such positioning for mothers' decision-making. The findings indicate that children hold two main positions in this process. In one, children are positioned as a trigger for mothers to stay with abusers. This occurs when women are economically dependent on their partner, when they think that their children need a father figure, or when the abuser plays a role in women's migratory status within Spain. Second, children are positioned as a trigger for mothers to leave abusers when mothers see children as victims of violence or children in need of a mother figure. Framed by positioning theory, we discuss how we can understand the consequences of such positioning for immigrant women who are survivors of IPV and for service provision in this context. The implications of the findings for research, policy making, and professional decision-making are discussed.

Socioeconomic crisis and humanitarian disasters can cause increased stress for women who experience inter-partner violence (IPV). This study analyzed the impact of the COVID-19 lockdown on this important issue, their related health and social services and working conditions from the perspectives of professionals in different sectors. Forty-three semi-structured interviews were carried out with 47 professionals (44 women and 3 men) from 40 different entities (September 2020-April 2021). This content analysis suggests that the pandemic and its associated prevention measures have had a negative impact on women exposed to IPV and their children, which affected their social wellbeing. Professionals described burnout, difficult and slow administrative processes, and problems with coordination and access to information. These negative impacts were mitigated, in part, by the work of professionals, but this suggests that a series of key strategies are needed to improve the response capacity of the service sector to IPV in situations of crisis. These improvements are related to the availability of human and material resources; an efficient coordination network between the professionals from different sectors; existence of informal support networks in the community; protocols/procedures and prior training for better implementation; and greater flexibility and accessibility of basic services that benefit women who experience IPV., Competing Interests: The authors have declared that no competing interests exist.

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

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 (β = -0.113; p = .023) (reference: lower education). Girls who had experienced dating violence reported higher HS (β = .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., (© 2021 Wiley Periodicals LLC.)

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

The aim of the article is to show the role of school social support and school social climate in dating violence victimization prevention among adolescents in Europe. Study participants were students from secondary schools (age 13-16) in Spain, Italy, Romania, Portugal, Poland and UK. The analysis in this text concern student with dating experience ( n = 993) (57.2% of girls and 66.5% of boys). School social support was measured by School Social Climate, Factor 1 Scale (CECSCE) and by Student Social Support Scale (CASSS), subscales teachers and classmates. The association between school social support and different types of dating victimization (physical and/or sexual dating violence, control dating violence and fear) was measured by calculating the prevalence ratios and their 95% confidence intervals, estimated by Poisson regression models with robust variance. All the models were adjusted by country and by sociodemographic variables. The results show that the average values of all types of social support are significantly lower in young people who have suffered any type of dating violence or were scared of their partner. The likelihood of suffering physical and/or sexual dating violence decreased when school social support increased [PR (CI 95%): 0.96 (0.92; 0.99)]. In the same way, the likelihood of fear decreased when school social climate increased [PR (CI 95%): 0.98 (0.96; 0.99)].There is an association between school social support and school social climate and experiences of being victim of dating violence among adolescents in Europe. Our results suggest that in the prevention of dating violence building a supportive climate at schools and building/using the support of peers and teachers is important.

Introduction: Despite public policies and legislative changes aiming to curtail men's violence against women (VAW) around the world, women continue to be exposed to VAW throughout their life. One in three women in Europe has reported physical or sexual abuse. Men who display unequitable masculinities are more likely to be perpetrators. VAW is increasingly appearing at younger ages. The aims of the project are fourfold: (1) to explore and position the discourses that young people (men and women, 18-24 years) in Sweden, Spain, Ireland and Israel use in their understanding of masculinities, (2) to explore how these discourses influence young people's attitudes, behaviours and responses to VAW, (3) to explore individual and societal factors supporting and promoting anti-VAW masculinities discourses and (4) to develop actions and guidelines to support and promote anti-VAW masculinities in these settings., Methods and Analysis: A participatory explorative mixed-method study will be used. In Phase 1, qualitative methods will be used to identify the discourses that young people and stakeholders use to conceptualise masculinities, VAW and the actions that are needed to support and promote antiviolence masculinities. In Phase 2, concept mapping will be used to quantify the coherence, relative importance and perceived relationship between the different actions to support and promote anti-VAW masculinities. Phase 3 is a knowledge creation and translation phase, based on findings from Phases 1 and 2, where actions and guidelines to promote and support anti-VAW masculinities will be developed., Ethics and Dissemination: Ethical clearance has been obtained from ethics review boards in each country. Results will be disseminated through peer-reviewed publications, presentations at international conferences, policy briefs, social media and through the project online hub. With its multicountry approach, our project results seek to inform policies and interventions aimed at promoting discourses which challenge hegemonic masculinities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and its prevalence rate significantly increases with age. The prognostic implication of AF in surgical patients with peripheral arterial disease (PAD) has not been analyzed. The aims of this study were to analyze the prevalence of AF among patients operated on with symptomatic PAD, and to determine whether these patients are at a higher risk of death or amputation., Methods: We designed a retrospective cohort study, from January 2013 to December 2017, in which we analyzed the medical records of all consecutive patients with symptomatic PAD admitted to our hospital and underwent a vascular procedure. We compared the outcomes of patients with and without AF. All statistically significant demographic variables that underwent a univariate analysis were inserted in the stepwise multivariate model along with AF. A survival analysis was performed to evaluate the factors associated with mortality through a Cox regression model. P-value of 0.05 was considered statistically significant., Results: Four hundred three patients were admitted in-hospital with symptomatic PAD and they underwent a vascular intervention. The mean follow-up was 2 years. Seventy-six patients (18.8%) had AF. These patients were older (78 ± 9.1 years) than the 327 patients without AF (68 ± 12.37 years) (P < 0.0001), and more likely to undergo emergency surgery (18.42% vs. 7.34%, P = 0.0029). Age and emergency admission were dependent associates of AF. The patients with AF were frequently men (69.7%) with previous hypertension (96% %). The presence of AF was associated with higher rate of all-cause mortality (55.26%, P < 0.0001, hazard ratio 2.24, confidence interval 1.55-3.25), but the multivariate analysis adjusted for risk factors showed that the mortality was only associated with age because these patients were older and with many comorbidities. The majority of this population with AF showed some tissue lesion when they were admitted in-hospital (Rutherford V-VI, AF 80.2%, P = 0.0004), and this fact justified that a 22.36% underwent a major amputation affecting the ischemic lower limb in admission (P = 0.018). During the follow-up the free amputation rate was similar between groups (60.5% AF vs. 78.3% non-AF)., Conclusions: This study showed the high prevalence of AF in patients with symptomatic PAD that required surgical admission in-hospital. The presence of AF was related with a greater and serious risk of mortality, but this was independently associated to age, because patients with AF were older and frailer. Clearly, this group of patients had a high risk of amputation when they arrived to the hospital and they needed emergency surgery., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: The Lights4Violence project was created to promote healthy relationships among adolescents using a school intervention in which participants developed video-capsules where they highlighted skills to resolve situations of dating violence. This study aims to assess the results of the Lights4Violence training program by identifying different types of violence and positive development assets that Spanish adolescents use in their video-capsule scripts., Methods: A thematic analysis of the Lights4Violence video capsules was carried out. Open coding was used to identify violence patterns. A deductive analysis was used to identify student assets using the "Positive Youth Development Model"., Findings: Adolescents describe different patterns of violence, such as psychological violence, sexist violence or verbal violence that is present on the scripts. However, they showed themselves capable of resolving these situations using language and personal empowerment skills as resources. Family, friends and community were identified in adolescents' scenarios as the most frequent assets to address situations of conflict., Conclusion: Adolescents can promote healthy relationships using protective factors against violence. Interventions that use this approach can potentially be useful in preventing violence.

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

Tobacco consumption is unequally distributed in society. The objective was to identify trends in tobacco use among the General and Spanish Roma populations in 2006 and 2014, years characterized by strengthening of anti-smoking policy in Spain. We calculated prevalences and logistical regression models based on the Spanish National Health Survey (2006/2012) and the National Health Survey of the Roma population (2006/2014). Smoking decreased only in men in the General population (OR 0.885). In the Roma population, there were no significant changes observed for the 2 years studied (OR: men 1.095, and women 1.147). In fact, Roma men smoke 4.2 cigarettes more, and they have a younger age of initial tobacco use. Smoking behavior of the Roma population has not changed, and there has been no reduction in inequalities in tobacco use among the two populations, despite public policies designed to reduce tobacco use in Spain.

Objectives: The effect of age on intimate partner violence (IPV) against women has received little attention. The objective of this study is to analyze the prevalence, risk factors and health impact of current IPV in different life stages., Methods: We analyzed a sub-sample of 8,935 ever-partnered women aged 16 years and older from the Spanish Macrosurvey on Gender Violence of 2014. Main outcomes: current physical/ sexual IPV and current psychological-only IPV. The impact of IPV on health was analyzed using the variables self-perceived health, mental health and activity limitations. Risk factors were assessed using the prevalence ratio (PR) from Poisson regression models with robust variance. Analyses were stratified by age (young people, adults, and elderly people)., Results: Abuse in childhood increases the likelihood of IPV in any life stage. A higher education level decreases the probability of physical/sexual IPV across all ages. Unemployment increases the probability of IPV in adult women (physical/sexual-IPV, PR:1.7; psychological-IPV, PR:1.3). Being an immigrant increases the likelihood of physical/sexual IPV in adult women (PRwomen:1.91). Women exposed to current physical/sexual IPV have a greater likelihood of reporting poor self-perceived health (PRyoungpeople:2.59; PRadults:1.68; PRelderly:1.28), poor mental health (PRyoungpeople:3.10; PRadults:2.61; PRedlerly:2.17) and activity limitations (PRyoungpeople:2.44; PRadults:1.98). For psychological IPV only, there is an increase in the probability of poor self-perceived health (PRadults:1.37; PRelderly:1.19), poor mental health (PRyoungpeople:2.24; PRadults:2.16; PRelderly:1.69), and activity limitations (PRadults:1.30; PRelderly:1.18)., Conclusions: We found both common factors and differential factors when looking at IPV by age group. This shows the need to link gender violence prevention with the social circumstances of the population across different life stages., Competing Interests: The authors have declared that no competing interests exist.

Background: Health-care professionals, and nurses especially among them, play an essential role in the health sector's response to gender-based violence. To be able to successfully address this major public health issue they need specific training in the topic., Objective: To analyse training on gender-based violence that nursing students receive at universities in Spain., Design: Mixed-methods approach., Setting: Spain., Methods: Systematic review of public documents followed by in-depth interviews with university lecturers., Results: Eighty per cent (92/115) of nursing training programmes included content regarding gender-based violence. There was great variability in the topics included in the training. Health consequences due to gender-based violence exposure and the role of the health sector in addressing these health consequences were the most frequently included topics. Ethical issues and legislation were the least frequent ones, as these were only dealt with in one and 18 training programmes, respectively. In the qualitative analysis of the interviews, two categories were identified: 'Supportive legislation and supportive lecturers are essential for integrating gender-based violence training' and 'Approach to gender-based violence shapes the contents and the subject in which it is incorporated'. The first category refers to the main drivers for training integration, while the second category refers to how lecturers' perceptions influenced the way in which training was implemented., Conclusions: As many as 80% of the nursing education programmes included specific training in gender-based violence, although with great variability in the contents among the universities. For this study's participants, enacted legislation, and lecturers interested in the topic and in decision-making positions were key drivers for this extensive implementation. The variability observed across universities might be explained by lecturers' different approaches to gender-based violence and the nursing profession., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To analyse how team level conditions influenced health care professionals' responses to intimate partner violence., Methods: We used a multiple embedded case study. The cases were four primary health care teams located in a southern region of Spain; two of them considered "good" and two s "average". The two teams considered good had scored highest in practice issues for intimate partner violence, measured via a questionnaire (PREMIS - Physicians Readiness to Respond to Intimate Partner Violence Survey) applied to professionals working in the four primary health care teams. In each case quantitative and qualitative data were collected using a social network questionnaire, interviews and observations., Results: The two "good" cases showed dynamics and structures that promoted team working and team learning on intimate partner violence, had committed social workers and an enabling environment for their work, and had put into practice explicit strategies to implement a women-centred approach., Conclusions: Better individual responses to intimate partner violence were implemented in the teams which: 1) had social workers who were knowledgeable and motivated to engage with others; 2) sustained a structure of regular meetings during which issues of violence were discussed; 3) encouraged a friendly team climate; and 4) implemented concrete actions towards women-centred care., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

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.

Objective: To reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into the Veterinary Medicine degree training., Methods: The 3rd Forum of University Professors of Public Health was held at the School of Veterinary Medicine of the University of Cordoba (12-13 January 2016). Forty-two university professors and lecturers from nine Spanish universities with veterinary degrees participated in the forum. They were divided into five working groups during three working sessions to identify and classify core public health competencies for the Veterinary Medicine degree, propose public health contents for the identified competencies and organize such contents in thematic blocks. The results were discussed in different plenary sessions., Results: The highest number of core competencies was identified in the activities related to the following public health functions: «Assessment of the population's health needs» and «Developing health policies». The final programme included basic contents organized into five units: 1) Fundamentals of public health; 2) Study and research in public health; 3) Production, animal health and environment; 4) Food security; and 5) Health education., Conclusions: The public health core competencies and contents identified in this Forum may be considered as a starting point to update public health training programmes for future veterinary professionals., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To analyse the Spanish primary care professionals' readiness to respond to intimate partner violence (IPV) in primary care and identify possible determinants that could facilitate a better response., Method: A cross-sectional study with a non-probabilistic sampling by convenience was performed among healthcare professionals working in 15 primary care centres in Spain. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), the version validated and translated into Spanish, was the instrument used to collect information about knowledge, opinions and practices regarding intimate partner violence. Descriptive analysis and, simple and multiple linear regression analysis were performed., Results: A total of 265 completed questionnaires were received, with a response rate of 80.3%. An exposure-response effect was observed, where at higher hours of training a higher score was obtained on the questionnaire sections (p <0.05). Age, type of profession, years of experience in primary care, hours of IPV training and reading the protocol showed positive association with knowledge (perceived preparation, perceived knowledge, actual knowledge), opinions (staff preparation, legal requirements, self-efficacy, workplace issues, constraints, understanding of the victim) and practice of healthcare professionals., Conclusions: Reading the regional/national protocol for action and receiving training in IPV were the most important interventions associated to a better primary care professionals' readiness to respond to IPV in Spanish primary care settings., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: This study analyzes whether there are time patterns in different intimate partner violence (IPV) indicators and aims to obtain models that can predict the behavior of these time series., Methods: Univariate autoregressive moving average models were used to analyze the time series corresponding to the number of daily calls to the 016 telephone IPV helpline and the number of daily police reports filed in the Community of Madrid during the period 2008-2015. Predictions were made for both dependent variables for 2016., Results: The daily number of calls to the 016 telephone IPV helpline decreased during January 2008-April 2012 and increased during April 2012-December 2015. No statistically significant change was observed in the trend of the number of daily IPV police reports. The number of IPV police reports filed increased on weekends and on Christmas holidays. The number of calls to the 016 IPV help line increased on Mondays. Using data from 2008 to 2015, the univariate autoregressive moving average models predicted 64.2% of calls to the 016 telephone IPV helpline and 73.2% of police reports filed during 2016 in the Community of Madrid., Conclusions: Our results suggest the need for an increase in police and judicial resources on nonwork days. Also, the 016 telephone IPV helpline should be especially active on work days., (Copyright © 2018 Elsevier Inc. All rights reserved.)

In Spain, in 2013, the 20% of women who were murdered by their partner had reported him previously. We analyze the 2011 Spanish-Macrosurvey on Gender Violence to identify and analyze the prevalence of and the principal factors associated with reporting a situation of intimate partner violence (IPV) and the main reasons women cite for not filing such reports, or for subsequently deciding to withdraw their complaint. Overall, 72.8% of women exposed to IPV did not report their aggressor. The most frequent reasons for not reporting were not giving importance to the situation (33.9%), and fear and lack of trust in the reporting process (21.3%). The main reasons for withdrawing the complaint were cessation of the violence (20.0%), and fear and threats (18.2%). The probability of reporting increased among women with young children who were abused, prevalence ratio (95% confidence interval [CI]): 2.14 [1.54, 2.98], and those whose mother was abused, prevalence ratio (95% CI): 2.25 [1.42, 3.57]. Always focusing on the need to protect women who report abuse, it is necessary to promote the availability of and access to legal resources especially among women who use them less: women who do not have children and women who do not have previous family exposure to violence.

This qualitative study identifies health professionals' dominant, adaptive, and liberating narratives regarding inter-ethnic relations when talking about intimate partner violence (IPV) and the health system responses to the way it affects Roma women. Dominant narratives are oppressive internalized stories that shape social perceptions of members of both dominant and minority groups, adaptive narratives refer to those that acknowledge asymmetry and inequality, and liberating narratives directly challenge oppression with resistant views of stereotypes and negative interpretations. A total of 25 in-depth interviews were carried out with healthcare professionals in Spain in 2015. A discourse analysis of the interview transcriptions was conducted, showing the way in which different narratives about Roma people and IPV are combined among health providers. Dominant narratives were more salient: they were used by health providers to reflect prejudicial social perceptions in Spain that depict the Roma as a marginalized and traditional group, to construct Roma women in negative and prejudicial terms as patients, and to explain the existence of the cultural normalization of IPV among Roma women. Adaptive and liberating narratives showed a prevailing ideology in terms of the tendency to socially discriminate against Roma people. Using liberating narratives to train and raise awareness among health professionals about IPV among Roma women could facilitate a positive change in their treatment of Roma women who could be affected by IPV, helping to ameliorate the maintenance of existing prejudices., (© Society for Community Research and Action 2018.)

Peer review in the scientific publication is widely used as a method to identify valuable knowledge. Editors have the task of selecting appropriate reviewers. We assessed the reasons given by potential reviewers for declining a request to review, and the factors associated with acceptance, taking into account the difference in the sex of the reviewer. This is a descriptive study of the review requests from a public health journal (Gaceta Sanitaria) with an enforced gender policy. The dependent variables were requests, response to requests, reasons potential reviewers gave for declining requests and time to review. We carried out a descriptive analysis of these indicators and applied logistic regression to analyze factors (professional and research/review experience) associated with having done at least one review in 2014-2015. Results were stratified by sex. Journal editors sent 1,775 requests to 773 potential reviewers; 52.3% of whom reviewed at least one manuscript. Of the 396 declined requests (22.3%), the most common reasons were lack of time and of experience (88.1%). No differences were observed by sex. In the multivariate analysis, having reviewed for the journal in previous years showed the strongest association with acceptance. Specific analyses of data on requests reviewers may be useful for improving the acceptance rates to review. This study did not show gender differences in several indicators of the reviewing process.

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.

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., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures., Methods: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15-64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI)., Results: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24-1.56, PR2012 = 1.56; 95% CI: 1.33-1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86-1.40, PR2012 = 1.34; 95% CI: 1.06-1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11-0.43, PR2012 = 1.20; 95% CI: 0.73-2.01)., Conclusions: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants' health status., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence., Methods: A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software., Results: The emerging programme theory highlighted the importance of the combination of each team's self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence., Conclusions: Interventions to improve primary health care teams' response to intimate partner violence should focus on strengthening team's self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the protocol combined with a large working experience in primary health care, and other factors such as training, a good team climate, and having a champion social worker on the team, also played a key role. Measures to sustain such interventions and promote these contextual factors should be encouraged.

Background: There are a significant number of studies assessing the negative health consequences of violence against women. However, a limited number of studies analyse the health consequences of violence committed against young women by different types of aggressors., Objectives: The goal of this study is to assess the prevalence of interpersonal violence against young women in Spain and analyse its impact on the physical and mental health of the victims., Methods: A total of 1076 women aged 18-25 years attending Spanish primary care services were selected. We estimated the prevalence of interpersonal violence and compared the health data and demographic characteristics of abused and non-abused young women, multi-logistic regression models were fitted. The Wald test was used to assess whether there were differences in the negative health consequences of intimate partner (IPV) versus non-IPV., Results: As many as 27.6% young women reported a history of abuse, of whom 42.7% had been assaulted by their partner, 41.1% by someone other than their partner and 16.2% both by their partner and another person. The distribution of social and demographic characteristics was similar for IPV and non-IPV victims. Young abused women were three times more likely to suffer psychological distress and have somatic complaints, and they were four times more likely to use medication as compared to non-abused women., Conclusion: Our results suggest that all forms of violence compromise young women's health seriously. Including patients' history of abuse in their health record may help make more informed clinical decisions and provide a more integrated care., (© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Intimate partner violence (IPV) is recognized as a worldwide public health problem. Most theories ascribe IPV to individual, family, or cultural factors. Authors analyzed different residential areas in Spain in terms of IPV frequency as well as its impact on health and the use of services. A standardized self-administered cross-sectional survey was administered to ever-partnered adult women ages 18 to 70 years receiving care at primary health care centers (N = 10,322). Logistic regression analyzed the association between the level of rurality and health indicators, IPV, and use of services. The lowest frequency of IPV among women is reflected in higher rurality. Women of medium and low rurality presented a poorer self-perceived health and more physical health problems. Women from medium and low rurality areas declared seeking health services more frequently. These results show the importance of the environment in health and indicate the need for research on urban-rural differences in health problems to develop specific public health programs for each country.

Background: At the international level PREMIS -"Physician Readiness to Manage Intimate Partner Violence Survey"- is amongst the most comprehensive instruments to evaluate primary health care professionals' readiness. The aim of this study is to assess the reliability, internal consistency and construct validity of the Spanish version of this questionnaire., Methods: After translation, back translation and assessment of content validity of the questionnaire, 200 questionnaires were distributed to medical doctors and nurses working in 15 primary health care centres located in 4 autonomous regions (Comunidad Valenciana, Castilla León, Murcia, Cantabria), in 2013. Cronbach's alpha, intraclass correlation and rho Spearman coefficients were calculated., Results: the Spanish version of PREMIS encompasses 64 items. Cronbach's alpha coefficient was greater than or close to 0.7 in most of indices. Intraclass correlation coefficient of 0.87 and Spearman coefficient of 0.67 showed a high reliability. All correlations for the scale of Opinions, which is the only one that was considered factorial structure of the questionnaire PREMIS, were higher than 0.30., Conclusions: the Spanish version of PREMIS obtained good internal validity, high reliability and predictive self-reported capacity of medical practitioners and nurses in Intimate Partner Violence cases in PHC centers.

Background: The new socio-demographic reality that came about with the incorporation of the immigrant population in Spain requires an analysis of the needs and priorities generated by this situation in all areas, including research in health. The objective of this study is to determine the general characteristics of a group of articles included in a literature review on the subject, carried out within the framework of the CIBERSP Subprogram on Migration and Health., Methods: Scoping Review of the literature published in the period 1998-2012. Articles in Spanish or English developed in Spain and that fulfil the definition of immigrant from the International Organization for Migration were selected. The literature search was performed in Medline and MEDES. The temporal distribution of the production and main characteristics of the articles are described trough absolute and relative frequencies., Results: The initial search identified 2.625 articles (Medline 2434; 191 Medes-MEDicina) 311 were including finally. Most epidemiological studies are cross-sectional design with primary data. 69% compared with native population. The main theme has been associated with infectious diseases (n=217, 70%). The period of maximum production is between 2004 and 2011(n=256, 82%). The country of origin is the most common way of classifying immigrants (n=220, 71%)., Conclusions: The epidemiology of infectious prevails as the main theme of the studies performed in Spain about the health of the immigrant population. Most of the studies include native population as a comparison group.

Introduction: Since 2008, Spain has been in the throes of an economic crisis. This recession particularly affects the living conditions of vulnerable populations, and has also led to a reversal in social policies and a reduction in resources. In this context, the aim of this study was to explore intimate partner violence (IPV) service providers' perceptions of the impact of the current economic crisis on these resources in Spain and on their capacity to respond to immigrant women's needs experiencing IPV., Methods: A qualitative study was performed based on 43 semi-structured in-depth interviews to social workers, psychologists, intercultural mediators, judges, lawyers, police officers and health professionals from different services dealing with IPV (both, public and NGO's) and cities in Spain (Barcelona, Madrid, Valencia and Alicante) in 2011. Transcripts were imported into qualitative analysis software (Atlas.ti), and analysed using qualitative content analysis., Results: We identified four categories related to the perceived impact of the current economic crisis: a) "Immigrant women have it harder now", b) "IPV and immigration resources are the first in line for cuts", c) " Fewer staff means a less effective service" and d) "Equality and IPV policies are no longer a government priority". A cross-cutting theme emerged from these categories: immigrant women are triply affected; by IPV, by the crisis, and by structural violence., Conclusion: The professionals interviewed felt that present resources in Spain are insufficient to meet the needs of immigrant women, and that the situation might worsen in the future.

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., (© The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)