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This study aimed to explore the effect of socioeconomic disadvantage accumulated in marginalised Roma communities (MRCs) on early childhood development and to assess the role of selected socioeconomic indicators in the association between belonging to MRCs vs. the majority and early childhood development. We obtained cross-sectional data from 232 mother-child dyads from MRCs and the majority population. The differences in early childhood development and background variables between the two groups were tested using chi-square and Mann-Whitney U tests. The moderated mediation was tested using PROCESS Macro in SPSS Model 14 on 5000 bootstrap samples. Statistically significant differences between children from MRCs and the majority were found in terms of maternal age, parental education, household equipment, as well as early childhood development. Household equipment moderated the indirect effect of being from MRCs vs. the majority on early childhood development through parental education. The indirect effect through parental education was high at a low household equipment level, reduced at an average level and non-significant at a high level of household equipment. Our study uncovered disparities in early childhood development between children from MRCs and the majority population. Parental education significantly influenced developmental outcomes, while household equipment mitigated its impact.

Background: Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic., Methods: The associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017-2022 were explored, using linear regression models., Results: The higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020-2022)., Conclusions: Life in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies., (© 2024. The Author(s).)

Objectives: This study aims to compare selected early childhood health risks and health outcomes of children from marginalized Roma communities (MRCs) in Slovakia with those of the majority., Methods: We obtained cross-sectional data from mother-child dyads from the majority (N = 109) and MRCs (N = 143) via questionnaires and from medical records. Socioeconomic status, health risks and health outcomes were compared using chi-square and Mann-Whitney U tests in SPSS., Results: Mothers from MRCs reported significantly worse socioeconomic status. Air quality in the households in MRCs was significantly worse, affected by heating with stoves, burning fresh wood and indoor smoking. The diet composition of children from MRCs was characterized by shorter breastfeeding and unhealthy diet composition less fresh fruits and vegetables, more processed meat products, and sweet and salty snacks. Children from MRCs more often suffered from respiratory and diarrheal diseases, used antibiotics and were hospitalized., Conclusion: The health and healthy development of children living in MRCs is endangered by various poverty-related factors. Persistent differences in exposures and health in early childhood should be a priority goal of the state's social and health policies., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Filakovska Bobakova and Dankulincova Veselska.)

Objectives: This study aims to compare the early childhood mental health of children from marginalized Roma communities (MRCs) in Slovakia with that of the majority and explore possible mediating pathways of mothers' perceived stress and harsh discipline practices. Methods: We used data from the first wave of the longitudinal RomaREACH study collected in 2021-2022. Two populations were included in the sample: 94 mother-child dyads from MRCs and 79 from the majority population (children aged 14-18 months). Data were analysed using linear regression, and mediation was tested using PROCESS Macro in SPSS. Results: Belonging to MRCs vs. the majority, perceived stress of mothers and harsh discipline were found to be associated with early mental health problems in children. Perceived stress of mothers partially mediates the relationship between belonging to MRCs vs. majority and harsh discipline and harsh discipline partially mediates the relationship between perceived stress of mothers and the mental health of children. Conclusion: Mothers from MRCs perceive more stress, which is associated with more frequent use of harsh discipline practices having a negative impact on the mental health of young children., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Filakovska Bobakova, Chovan and Van Laer.)

Background: Emotional and behavioural problems (EBP) are the most common mental health issues during adolescence, and their incidence has increased in recent years. The system of care for adolescents with EBP is known to have several problems, making the provision of care less than optimal, and attention needs to be given to potential improvements. We, therefore, aimed to examine what needs to be done to improve the system of care for adolescents with EBP and to assess the urgency and feasibility of the proposed measures from the perspective of care providers., Methods: We used Concept mapping, a participatory mixed-method research, based on qualitative data collection and quantitative data analysis. A total of 33 stakeholders from 17 institutions participated in our study, including psychologists, pedagogues for children with special needs, teachers, educational counsellors, social workers and child psychiatrists., Results: Respondents identified 43 ideas for improving of the system of care for adolescents with EBP grouped into 5 clusters related to increasing the competencies of care providers, changes at schools and school systems, support for existing services, transparency of the care system in institutions and public administration, and the adjustment of legislative conditions. The most urgent and feasible proposals were related to the support of awareness-raising activities on the topic of EBP, the creation of effective screening tools for the identification of EBP in adolescents, strengthening the role of parents in the process of care, comprehensive work with the family, creation of multidisciplinary support teams and intersectoral cooperation., Conclusions: Measures which are more accessible and responsive to the pitfalls of the care system, together with those strengthening the role of families and schools, have greater potential for improvements which are in favour of adolescents with EBP. Care providers should be invited more often and much more involved in the discussion and the co-creation of measures to improve the system of care for adolescents with EBP., (© 2024. The Author(s).)

Introduction: Limited access to healthcare services leads to lower vaccination rates in marginalized Roma communities (MRCs). This study aimed to explore health system barriers to HPV vaccination faced by people from MRCs from multiple perspectives., Methods: The qualitative study was conducted in Slovakia in 2021/22 with 43 community members and health professionals. Data were analyzed using a combination of content analysis and consensual qualitative research., Results: A substantial barrier to vaccination is limited coverage of vaccination expenses for certain age categories by health insurance. Moreover, Slovakia faces a significant shortage of healthcare personnel, leading to work overload and a lack of capacity and motivation to address HPV vaccination. Impaired relationships between health care providers and people from MRCs lead to the avoidance of healthcare services, which contributes to insufficient delivery of information and a lack of awareness regarding HPV-related diseases and vaccination., Conclusion: Strengthening the capacities of health care providers, expanding the age group covered by health insurance and providing tailored information to people from MRCs are necessary prerequisites to increase the availability of HPV vaccination and enable people to make informed decisions about HPV vaccination., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Filakovska Bobakova, Plavnicka, Urbancikova, Edelstein, Jansen and Dankulincova Veselska.)

Roma are the largest and most disadvantaged ethnic minority in Europe often facing generational poverty, and limited access to education, employment, housing, and various types of services. Despite many international and national initiatives, children from marginalized Roma communities face multiple risks and are being disadvantaged as early as from conception onward. We, therefore, aimed to identify measures and/or interventions targeting equity in early childhood health and development in marginalized Roma communities which implementation is considered to be urgent but not feasible. We used a group concept mapping approach-a participatory mixed research method-and involved 40 experts and professionals from research, policy and practice. From 90 measures and interventions proposed to achieve early childhood equity for children from marginalized Roma communities, 23 measures were identified as urgent but not feasible. These concerned particularly measures and interventions targeting living conditions (including access to income, access to housing, and basic infrastructure for families) and public resources for instrumental support (covering mainly topics related to financial and institutional frameworks). Our results reflect the most pressing issues in the area of equality, inclusion and participation of Roma and expose barriers to implementation which are likely to arise from public and political discourses perpetrating a negative image of Roma, constructing them as less deserving. Measures to overcome persistent prejudices against Roma need to be implemented along with the measures targeting equity in early childhood health and development., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Filakovska Bobakova, Chovan, Bosakova, Koky, de Kroon and Dankulincova Veselska.)

Background: This study aims to assess which measures could improve the healthy early childhood development of children from marginalized Roma communities and to identify priority measures., Methods: Concept mapping approach was used, using mixed methods. In total 54 professionals, including social workers, educators, health care providers, municipality representatives, and project managers participated in our study., Results: Four distinct clusters of measures targeting living conditions, public resources, healthcare and community interventions, and 27 individual priority measures of highest urgency and feasibility were identified. The cluster 'Targeting living conditions', was rated as the most urgent but least feasible, whereas the cluster 'Targeting health care', was considered least urgent but most feasible. Among the 27 priority measures, 'Planning parenthood' and 'Scaling up existing projects' had the highest priority., Conclusion: Our results reflect the public and political discourse and indicate significant barriers to implementation. Reducing inequalities in early childhood needs to be addressed through coordinated efforts., (© 2022. The Author(s).)

Background: Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic., Methods: We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation)., Results: Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies., Conclusions: Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies.

The aim of this study was to investigate the test-retest reliability of the motives for undertaking physical activity (PA) items from the Health Behavior in School-Aged Children (HBSC) study questionnaire among Slovak and Czech adolescents and to determine whether this reliability differs by gender, age group and country. We obtained data from 580 students aged 11 and 15 years old (51.2% boys) who participated in a test and retest study with a four-week interval in 2013 via the Health Behavior in School-Aged Children cross-sectional study in the Czech Republic and Slovakia. We estimated the test-retest reliability of all 13 dichotomized motives by using Intraclass Correlation Coefficients (ICC) and Cohen's Kappa statistics, for continuous and dichotomized motives, respectively. Test-retest reliability showed moderate agreement for nine motives (ICC from 0.41 to 0.60) and fair agreement for four motives (ICC from 0.33 to 0.40). Kappa statistics were similarly moderate to large (0.33 to 0.61), except for three motives with small or trivial correlations. The motives "To improve my health" and "To enjoy the feeling of using my body" had consistently low Kappas and correlations. Overall, the results of this study suggest that most questions on motives for PA on the HBSC questionnaire have acceptable test-retest characteristics for use among adolescents.

The objective of the present study was to compare the social structure and internal establishment of a Roma community in two historical periods: in the 18th century and the present. We analysed Samuel Augustini ab Hortis's work, " Von dem Heutigen Zustände, Sonderbaren Sitten und Lebensart, Wie Auch von Denen Übrigen Eigenschaften und Umständen der Zigeuner in Ungarn " (On the Contemporary Situation, Distinctive Manners and Way of Life, as Well as the Other Characteristics and Circumstances of Gypsies in Greater Hungary), written in 1775-1776. Using content analysis, we subsequently compared his findings with our recent data from analogous qualitative research in a geographically-defined area of north-eastern Slovakia, the same region in which Augustini lived. Data collection was intensely conducted in 2012-2013 and once more in 2017-2019. The qualitative methods included direct observation, semi-structured interviews and focus groups. Four key informants and more than 70 participants collaborated in the study. The greatest difference we observed compared to the 18th century was the absence of a leader of the community, a "vajda", whose status was taken over by a new social class of "entrepreneurs". The most vulnerable group of the segregated and separated Roma communities are the "degesa", the lowest social class. They face a phenomenon consisting of so-called triple marginalization: they live in one of the most underdeveloped regions of the country, they inhabit segregated settlements and they are excluded by their own ethnic group. The socioeconomic status of the richest classes has changed faces, while the socioeconomic status of the lowest has not. We found a misconception among helping professionals (e.g., social workers) regarding the homogeneity of the Roma community. This calls for more attention to the erroneous use of the ethnic-based approach in the helping professions.

Rationale: Unequal provision of health care contributes to the poor health status of segregated Roma in Central and Eastern Europe. Studies on the drivers and mechanisms behind this are lacking., Objective: We explored what kinds of substandard practices health care frontline professionals engage in regarding segregated Roma and what mechanisms support such practices during the professionals' careers in care services., Methods: Over a three-month period at five different locations in Slovakia we interviewed and observed 43 frontline professionals serving segregated Roma. Next, through qualitative content analysis we identified in the data three themes regarding kinds of substandard practices and 22 themes regarding supporting mechanisms. We organized these themes into an explanatory framework, drawing on psychological models of discrimination and intergroup contact., Results: The frontline staff's substandard practices mostly involved substandard communication and commitment to care, but also some overt ethnic discrimination. These practices were supported by five mechanisms: the staff's negative experiences with people labelled "problematic Roma patients"; the staff's negative attitudes regarding segregated Roma; adverse organizational aspects; adverse residential-segregation aspects; and poor state governance regarding racism. In the course of their careers, many professionals first felt obliged and diligent regarding segregated Roma patients, then failing, unequipped and abandoned, and ultimately frustrated and resigned regarding the equal standard of care towards the group., Conclusions: Health care frontline staff's practices towards segregated Roma are frequently substandard. The psychological processes underlying this substandard care are supported by specific personal, organizational and governance features. These mechanisms cause many frontline professionals gradually to become cynical regarding segregated Roma over the course of their careers. Health care staff should be supported with skills and tools for effectively handling their own and others' racism, the culturebound and structural vulnerabilities of patients as well as related professional expectations regarding equity., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Augustini studied Roma and published reports in 1775-1776 on their illnesses and death. Our intention was to compare the features of these two topics described by him in the late 18th century with those in the present time. We studied Augustini's work on illnesses and death in the past. The present qualitative study was conducted in 2012-2013 in the same geographical area in which Augustini lived and worked more than two hundred years ago, i.e., the Tatra Region in Slovakia; our findings were evaluated in 2017-2018. We carried out semi-structured interviews with more than 70 informants and organised two sessions of focus groups. Data were analysed using content analysis (Augustini) and an open coding process. Our findings suggest that illnesses in Roma are treated differently nowadays compared with 1775-1776. For example, the traditional forms of healing have completely disappeared in the area of investigation. We did not observe any differences in dying and death perceptions between the past and nowadays. Although data and knowledge on health disparities and related mechanisms exist, and much more about perceptions of Roma regarding illnesses is now known compared with 1775-1776, so far, this knowledge has not helped to design effective interventions to overcome them. Substandard living conditions in marginalised Roma communities have not significantly improved since 1775-1776, which may contribute to their higher morbidity and mortality also nowadays. Political and social consensus should lead to a comprehensive vision for enhancing the social situation and living conditions in segregated settlements, especially providing housing for the poorest classes and overcoming health disparities.

The family is a very important institution that provides relationships and contexts in which adolescents are included and where the trajectory of positive development can be activated. A family crisis can affect family functioning and endanger adolescent development. Therefore, we aimed to explore the association of crisis in the family with positive youth development (PYD), and further, whether adolescent-perceived family functioning mediates or moderates this relation. The sample consisted of Slovak adolescents ( N = 341, 44% boys, mean age = 13.16) who completed questionnaires that included questions on family crisis and joint family activities, the Alabama parenting questionnaire and the Very Short PYD questionnaire in the baseline measurement of the Care4Youth cohort study. We found a positive association of perceived positive parenting (B = 0.51; p < 0.001) and family activities (B = 0.50; p < 0.001) with PYD, whereas crisis in the family (B = -0.42; p = 0.01) and perceived poor supervision (B = -0.30; p < 0.001) were negatively associated with PYD. Using serial mediation model, we found following pathway which connected crisis in the family with PYD: crisis in the family → perceived poor parental supervision → joint family activities → PYD. This implies that family interventions and counselling to support parenting skills, especially parental supervision and family activities, to those with the signs of an ongoing family crisis may help to counteract the negative effect of the family crisis on PYD.

Objectives: Large socioeconomic inequalities in health are still present in the Central Europe. The aim was to explore socioeconomic inequalities in mortality in Visegrad countries-the Czech Republic, Hungary, Poland and Slovakia (V4), by three different socioeconomic indicators (unemployment, risk of poverty/social exclusion, education). The study was conducted within the H2020 Euro-Healthy project., Methods: The associations between selected socioeconomic indicators and the standardised mortality rates by four main causes (mortality related to cancer, circulatory, respiratory and digestive system) in the economically active population aged 20-64 years in the 35 NUTS 2 level regions of the V4 in the period 2011-2013 were explored, using linear regression models., Results: Lower education level was the most significant predictor of mortality in the V4. The lowest mortality rates by all causes of death were found in the regions of the Czech Republic, the highest in regions of Hungary., Conclusions: Despite the common origin, the pathways of the V4 countries in employment, poverty and education seem to be different, also having impact on health equity. Therefore, where you live in the V4 can significantly influence your health.

Objectives: The aim was to explore the associations of family composition, family support and communication with emotional and behavioural problems among adolescents as well as a possible moderating effect of gender on these associations., Methods: Data from the Health Behaviour in School-aged Children study conducted in 2014 in Slovakia were used. The final sample consisted of 2908 students (mean age 14.36; 49.7% boys). We explored the association using generalized linear models., Results: We found that non-intact family was significantly associated with a higher score in emotional and behavioural problems. Family support and communication were found to be significantly associated with a lower score in emotional and behavioural problems. Significant interactions of gender and family communication with emotional and behavioural problems were found, showing that family communication decreased emotional and behavioural problems only in girls., Conclusions: Family composition, family support and communication play an important role in the occurrence of emotional and behavioural problems in adolescence. Family communication lowers these problems only in girls. Prevention and intervention programmes could be focused on parent-child communication strategies with the importance of differences in the needs of boys and girls.

Youth subculture affiliation (SA) appears to be an important risk factor with regard to adolescents' problem behavior. Excessive Internet use (EIU) has emerged as a new type of problem behavior; however, it has not yet been studied in adolescents affiliated with youth subcultures. Thus, the aim of this study was to assess the association between SA and EIU and to explore the role of selected protective factors. We used data from the Health Behaviour in School-aged Children (HBSC) study conducted in 2014 in Slovakia. The final sample for this study comprised 532 adolescents (mean age: 15.4; 49.6% boys). Hierarchical linear regression analysis was conducted to examine the associations of EIU with SA. Adolescents with SA were more likely to report EIU. Adjustment for protective factors decreased the association between EIU and SA. From all tested interactions, only the interaction of SA with family support was found to be significant. The relationship between family support and EIU was mediated via Monitoring by the mother only in adolescents without SA. Our findings imply that the risk of EIU is higher in adolescents with SA. There was a difference in how protective factors worked in adolescents with and without SA.