title: The mediating effect of discrimination, social support and hopelessness on self-rated health of Roma adolescents in Slovakia.
abstract: BACKGROUND
  According to the EU-MIDIS report on discrimination, Roma are the most discriminated against group in Europe. Research suggests that experiencing discrimination may itself be detrimental to health. The aim of this paper is to investigate whether discrimination, hopelessness and social support mediate differences in self-rated health (SRH) between Roma and non-Roma adolescents.
  
  
  METHODS
  We conducted a cross-sectional study among Roma from separated and segregated settlements in the eastern part of Slovakia (N = 330; mean age = 14.50; interview) and non-Roma adolescents (N = 722; mean age = 14.86; questionnaire); only non-missing data were used for analyses (n = 759). The effect of perceived discrimination, mother and father social support, and hopelessness on SRH was analysed as crude and adjusted for ethnicity, age, gender, parental education and social desirability. Mediating effects were separately assessed using the Sobel test and structural equation modelling.
  
  
  RESULTS
  Roma adolescents reported poorer SRH and more discrimination, mother and father social support, hopelessness and social desirability. Roma ethnicity (Odds ratio/95 %-Confidence interval 3.27/2.40-4.47), discrimination (2.66/1.82-3.88), hopelessness (1.35/1.20-1.51) and mother (0.92/0.88-0.97) and father social support (0.96/0.93 - 0.997) were statistically significant predictors of poor SRH. Perceived discrimination, social support and hopelessness mediated the ethnicity-health association, with adjustment for social support increasing its strength and the other two variables decreasing it.
  
  
  CONCLUSIONS
  Perceived discrimination, social support and hopelessness mediate a part of the association between Roma ethnicity and poor SRH, with discrimination and hopelessness being risk factors and social support a protective factor.
authors.affiliation: Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. peter.kolarcik@upjs.sk.|Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. peter.kolarcik@upjs.sk.|Olomouc University Social Health Institute, Sts Cyril and Methodius Faculty of Theology, Palacky University Olomouc, Univerzitní 22, 771 11, Olomouc, Czech Republic. peter.kolarcik@upjs.sk.
authors.forename: Peter
authors.initials: P
authors.lastname: Kolarcik
authors.affiliation: Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. andrea.geckova@upjs.sk.|Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. andrea.geckova@upjs.sk.|Olomouc University Social Health Institute, Sts Cyril and Methodius Faculty of Theology, Palacky University Olomouc, Univerzitní 22, 771 11, Olomouc, Czech Republic. andrea.geckova@upjs.sk.
authors.forename: Andrea Madarasova
authors.initials: AM
authors.lastname: Geckova
authors.affiliation: Department of Social Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. s.a.reijneveld@umcg.nl.
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
authors.affiliation: Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. j.p.van.dijk@umcg.nl.|Department of Social Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. j.p.van.dijk@umcg.nl.
authors.forename: Jitse P
authors.initials: JP
authors.lastname: Van Dijk
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D065026:Hope; D006801:Humans; D008297:Male; D006178:Romani People / Q000208:ethnology / Q000523:psychology*; D057566:Self Report; D018154:Slovakia / Q000208:ethnology; D012923:Social Class; D063508:Social Discrimination / Q000208:ethnology* / Q000523:psychology; D011795:Surveys and Questionnaires