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Introduction: The significance of mental health and its impact on overall well-being is increasingly acknowledged across various sectors, including higher education. However, despite this growing recognition, the stigma associated with mental health issues and related help-seeking, particularly within certain cultural groups and socio-economic contexts, continues to pose a formidable barrier to effective care, especially among university students. Addressing these challenges, this study explores the intricate interplay of factors affecting mental health awareness and stigma, including help-seeking behaviors among Albanian university students in three Western Balkan countries: Kosovo, North Macedonia, and Albania. By dissecting these multi-layered influences, this study aims to develop targeted interventions to enhance mental well-being and dismantle barriers to care in these regions. Methods: This qualitative study involved 60 Albanian university students from Kosovo, North Macedonia, and Albania, using focus groups to gather data. The discussions were structured around the socio-ecological model, facilitating a comprehensive exploration of the individual, interpersonal, organizational, and societal factors influencing mental health awareness, stigma, and help-seeking behaviors. Results: Findings from the study indicate a moderate awareness of mental health issues among students. Familial and cultural stigma among Albanians in the Balkans hinder open discussions and access to professional help. There is a notable lack of support from higher education institutions, with only 20% of students reporting that their mental health needs are met. These needs include affordable and confidential counseling, empathetic faculty interactions, and a supportive campus environment. Additionally, there is a lack of continuous and professional help within the community. Societal attitudes deeply rooted in Albanian cultural norms and traditional beliefs perpetuate stigma, limiting effective health care and help-seeking behavior. Discussion: The results emphasize the need for a culturally sensitive and holistic approach to mental health interventions that integrates strategies across multiple levels of the socio-ecological model. Enhancing mental health literacy, reducing stigma, and advocating for supportive legislation and policies in the Western Balkan region are critical. Moreover, the study highlights the urgent necessity for universities in particular to improve their mental health services, which will significantly enhance both the academic success and personal development of students.

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Serbia preserves a high number of local grape varieties, which have been cultivated across the country for centuries. Now, these ancient varieties are in the spotlight, and there is a global trend towards their recovery and characterization because they can revitalize regional, national and international grape and wine sectors. In addition, their genetic study can be useful to find new pedigree relationships to reveal how local varietal assortment evolved over time. Here, the genetic characterization of 138 grapevines from old Serbian vineyards revealed 59 different genetic profiles, 49 of which were identified as grapevine varieties whose origin in the country could be linked to some major Serbian historical periods. Most of the genetic profiles found in this work arranged in a complex pedigree network that integrates numerous grapevine varieties from diverse Balkan countries, agreeing with an intense exchange of plant material among Balkan regions for centuries. This analysis identified some varieties as important founders of Balkan genetic resources, like 'Alba Imputotato', 'Braghina Rosie', 'Coarna Alba', and 'Vulpea'. After deepening into their genealogy, these major direct founders might have ultimately derived from 'Visparola', an ancient variety of likely Balkan origin with a major founding role in some European regions. Our results also indicated the genetic singularity of the grapevine resources from the Balkans when compared to those from other relevant winemaking regions, supporting the interest of their detailed study to evaluate their oenological potential and for the eventual identification of useful traits to counteract current viticulture challenges.

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This article proposes a mixed-blended model adapted for Western Balkan countries, advancing the connections between the Icelandic Model of Health Promotion and the assets models for health improvement through the whole school approach and non-formal education methodology. The need to reshape health promotion interventions in Western Balkan countries is urgent, and requires explicit synergies so that a more coherent approach can be taken in their utilization. To this end, we propose a new Albanian Health Promotion Model that integrates key concepts that are associated with the involvement of schoolchildren; parents/caregivers, grandparents, communities, and religious leaders; teachers and school staff; involvement of central and local governments; engagement of the private sector; involvement of non-governmental and civil society organizations; and, importantly, enables the development of supportive environments. The proposed model aims to contribute to a more in-depth theoretical understanding of health and development through integration of the key elements of various models, methods, approaches, and tools employed in health promotion practice. Making the theory of the Icelandic model more feasible for non-Nordic cultures could better contextualize the ideas in public health policy and practice. The Albanian Health Promotion Model may also support interventions to maximize their results in vulnerable communities that have specific requirements and, as a result, could be extrapolated to similar countries in the region and beyond.

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Background: The Potamophylaxwinneguthi species cluster comprises species with limited distribution, currently documented from Kosovo, Serbia, Bosnia and Herzegovina and Bulgaria. New information: In this paper, we describe a new species, Potamophylaxkosovaensis sp. nov., discovered in two tributaries of the Ibër River Basin, within the Kopaonik Mountains of the Republic of Kosovo. Morphologically, males of this species closely resemble those of P.idliri Ibrahimi, Bilalli & Kucinic, 2022 from Serbia's Jastrebac Mountain and P.humoinsapiens Ibrahimi & Bilalli, 2023 from the Sharr Mountains in the Republic of Kosovo. However, the new species can be distinguished by its smaller aedeagus, thicker and differently-shaped parameres, as well as distinctive patterns and elongated spines on the parameres. Notably, this species is restricted to spring areas, indicating sensitivity to water pollution and habitat degradation. Additionally, we provide a list of caddisfly species found in sympatry with the new species.Potamophylaxkosovaensis sp. nov. is the third known species within the Potamophylaxwinneguthi species cluster, identified in the Republic of Kosovo.

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The capacity of the state to develop and implement policy at the complex nexus of energy infrastructure, social inequality and housing is indicative of the political priorities of governing structures and, by extension, the nature of statecraft more generally. We compare and contrast the energy poverty amelioration policies of two former Yugoslav and two post-Soviet states located outside the European Union, but seeking to join its regulatory sphere - Serbia, Montenegro, Ukraine and Georgia - against the background of deep and persistent patterns of domestic energy hardship. We are particularly interested in uncovering the time horizons, socio-technical systems and target constituencies of different policy measures, as well as energy sector-specific responses to the COVID-19 pandemic. We find that most states in the region have done little to address some of the more substantive challenges around improving housing quality, energy efficiency and gender inequality. However, energy poverty is present in the policy lexicon of all case study countries, and Ukraine, in particular, has advanced a number of more sophisticated approaches and programmes.

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The "beautiful viviparous fly", Wohlfahrtia magnifica, may have a magnificent appearance due to its striking morphology; however, it is a potentially deadly agent of obligate traumatic myiasis in humans and animals, with a serious impact on welfare and economics. The fly is found across the Palearctic realm, including the Western Balkan region, with reports from former Yugoslavian countries from the first half of the 20th century. In this paper, a recent case of wohlfahrtiosis recorded in Northern Serbia is evidenced using morphological and molecular techniques. Larvae were collected from two adult sheep with severe hoof myiasis and two young sheep with genital and interdigital myiasis. Morphological identification was performed for adults bred from the infested vulva and third-stage larvae (L3) collected from the hoof wounds, supported with barcoding sequences of the COI gene obtained from larval pairs from the hoof wounds of older and the genitalia of younger sheep. W. magnifica was identified according to the appearance of male fly terminalia and the morphology of L3, which was confirmed after the comparison of representative sequences of the COI gene (deposited in GenBank™ under accession numbers MT027108-MT027114) to those available in GenBank™. This finding represents the first reported case of wohlfahrtiosis in the Western Balkans in 80 years, highlighting the need to re-inform relevant stakeholders to achieve adequate disease control.

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Ixodid ticks are distributed across all countries of the Western Balkans, with a high diversity of species. Many of these species serve as vectors of pathogens of veterinary and medical importance. Given the scattered data from Western Balkan countries, we have conducted a comprehensive review of available literature, including some historical data, with the aim to compile information about all recorded tick species and associated zoonotic pathogens in this region. Based on the collected data, the tick fauna of the Western Balkans encompasses 32 tick species belonging to five genera: Ixodes, Haemaphysalis, Dermacentor, Rhipicephalus and Hyalomma. A range of pathogens responsible for human diseases has also been documented, including viruses, bacteria and parasites. In this review, we emphasize the necessity for integrated surveillance and reporting, urging authorities to foster research by providing financial support. Additionally, international and interdisciplinary collaborations should be encouraged that include the exchange of expertise, experiences and resources. The present collaborative effort can effectively address gaps in our knowledge of ticks and tick-borne diseases.

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Being overweight and obese is associated with an elevated risk of developing noncommunicable diseases, which are the leading causes of mortality worldwide. It is a warning that global prevalence of overweight among university students ranges from 20 to 40%, which presents a significant public health problem. To date, there was no research conducted on medical students regarding the prevalence and associated factors of overweight and obesity in the countries of the Western Balkans (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia, and Serbia). The aim of this study was to determine the prevalence and potential demographic, socioeconomic, and health-related behavioral factors associated with overweight and obesity of medical students from Western Balkans. A cross-sectional study was conducted, surveying 2452 students from 14 medical faculties from 5 countries in the region. The prevalence of overweight was 12% and obesity was 2.3% among medical students from Western Balkans. Male gender and smoking status are significant positive predictors of overweight and obesity. Daily level of physical activity up to 1 h per day, going to preventive check-ups once a year or as a part of annual dormitory check-ups are associated with lower odds of being overweight and obese. By creating adequate public health educational programs, students can be influenced to acquire proper health-related lifestyle habits, which would lead to reducing the prevalence of overweight and obesity among the student population, as well as risk of developing noncommunicable diseases and improving the overall health of the population.

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Background: The Sharr Mountains are one of the most important hotspots of terrestrial and freshwater biodiversity in the Balkan Peninsula, with many endemic and rare species. The caddisfly studies in this area increased during the past years, although insufficiently investigated areas still remain. New information: In this paper, we describe a new species, Potamophylaxhumoinsapiens sp. n. from the Sharr Mountains in the Republic of Kosovo, which is morphologically closest to Potamophylaxidliri Ibrahimi, Bilalli & Kucinic, 2022 and Potamophylaxjuliani Kumanski, 1999. The males of the new species differ from all known species of the Potamophylaxwinneguthi Species Group by their uniquely-shaped parameres, which are long, bulbous in their basal half and thin in the remaining length, with a bunch of very thin and long, hair-like spines, grouped uniformly at the apex. The new species further differs from its most similar congeners by its very wide distance between the dorsal and ventral edges of the apical part of inferior appendages in lateral view. The new species was found at three localities from 1416 to 1505 m a.s.l.Similar to the other species of the Potamophylaxwinneguthi Species Group, which have very narrow distribution areas, we posit that Potamophylaxhumoinsapiens sp. n. is a microendemic of the Sharr Mountains. The new species is the second known caddisfly species occurring only in the Kosovan part of the Sharr Mountains.

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BACKGROUND: Bosnia and Herzegovina (BiH) and Serbia are countries in the Western Balkans that share parts of their social and political legacy from the former Yugoslavia, such as their health care system and the fact that they are not members of European Union. There are very scarce data on COVID - 19 pandemic from this region when compared to other parts of the world and even less is known about its impact on the provision of renal care or differences between countries in the Western Balkans. MATERIALS AND METHODS: This observational prospective study was conducted in two regional renal centres in BiH and Serbia, during the COVID - 19 pandemic. We obtained demographic and epidemiological data, clinical course and outcomes of dialysis and transplant patients with COVID - 19 in both units. Data were collected a via questionnaire for two consecutive time periods: February - June 2020 with a total number of 767 dialysis and transplant patients in the two centres, and July - December 2020 with a total number of 749 studied patients, corresponding to two of the largest waves of the pandemic in our region. Departmental policies and infection control measures in both units were also recorded and compared. RESULTS: For a period of 11 months, from February to December 2020, 82 patients on in-centre haemodialysis (ICHD), 11 peritoneal dialysis patients and 25 transplant patients who tested positive for COVID-19. In the first study period, the incidence of COVID - 19 positive in Tuzla was 1.3% among ICHD patients, and there were no positive peritoneal dialysis patients, or any transplant patients who tested positive. The incidence of COVID-19 was significantly higher in both centres in the second time period, which corresponds to the incidence in general population. Total deaths of COVID-19 positive patients was 0% in Tuzla and 45.5% in Nis during first, and 16.7% in Tuzla and 23.4% in Nis during the second period. There were notable differences in the national and local/departmental approach to the pandemic between the two centres. CONCLUSION: There was poor survival overall when compared to other regions of Europe. We suggest that this reflects the lack of preparedness of both of our medical systems for such situations. In addition, we describe important differences in outcome between the two centres. We emphasize the importance of preventative measures and infection control and highlight the importance of preparedness.

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In the wake of the international food crisis, many countries are paying more attention to food self-sufficiency to protect themselves from instability in the global food markets. Western Balkan region and the rest of the world are facing an array of challenges, including inflation and rising food prices. Recognizing the importance of producing sufficient food to cover a country's needs in circumstances of increasing risk of trade disruptions due to war or political tensions, this article aims to find the level of food self-sufficiency in the Western Balkan countries. The self-sufficiency ratio is calculated for different food groups and individual products over a 14-year period (2006-2019) based on the FAO data and calculation method. Also, using panel data, the impact of different factors-arable land, rural population, fertilizers efficiency, temperature change, precipitation, and GDP per capita change-on cereals self-sufficiency is estimated. Results showed that in the covered pre-crisis period, the Western Balkans achieved a satisfactory level of food self-sufficiency, suggesting that the region is ready to respond to future challenges. Four indicators positively and significantly affect cereal self-sufficiency: arable land, rural population, fertilizers efficiency and GDP per capita change, while one indicator-temperature change-had a negative and significant effect. This article can serve as a basis for post-crisis research on the topic.

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INTRODUCTION: Considering the geopolitical changes in the six Western Balkan countries-Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia-over the last three decades, particularly as it concerns the progress and changes in the healthcare systems, we argue that there is a need for a detailed analysis of people's trust in those healthcare systems and healthcare providers. METHODS: In this cross-sectional, intercountry study, we examine the trust trends of Western Balkans citizens in medical doctors and public and private healthcare institutions from 25 July 2021 to 30 October 2021, with 3789 participants using a self-reported questionnaire, and Google Forms. Snowball sampling is used to collect data from six Western Balkans countries: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia. FINDINGS: The primary findings of our study show that citizens in the Western Balkans have a low level of trust in their healthcare system (X̄ = 4.3/10). Medical doctors working in private healthcare institutions, on the other hand, are afforded a higher level of trust (X̄ = 6.6/10) than those working in public healthcare institutions (X̄ = 5.7/10). In the event that they or their family members need to visit a health institution, half of the study participants would choose private healthcare institutions over public ones. We found a statistically significant difference between countries on the mean points from the questions concerning one's trust in the healthcare system, private healthcare institutions and medical doctors working in public and private sectors (p < .05). CONCLUSION: Despite its limitations, this study is the first cross-sectional research on the 'trust interface' among western Balkan citizens, revealing that they have low trust in their healthcare systems. PUBLIC CONTRIBUTION: The information in this manuscript was gathered on the level of 3789 citizens from six Western Balkan countries. Before we began collecting data, we conducted a piloting procedure with 40 citizens who were clients of health institutions to validate the data collection questionnaire.

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The student population includes young adults who need nutrition and regular physical activity (PA) for mental, cognitive, and physical development. It is estimated that, globally, only 25-40% of the university student population is involved in regular PA. To date, no research has been conducted in the Western Balkans to address the PA of medical students. The aim of this study was to investigate the prevalence and factors influencing PA among medical students from the Western Balkans. A cross-sectional study included 2452 students from 14 medical faculties in five countries (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia and Serbia). There were significantly more students who engaged than those who did not engage in some type of regular (daily) PA. Gender, overweight or obesity, and household income are significantly associated with students' PA. Students who are more often involved in regular daily PA and have higher daily PA levels are more likely to be males whose household income is above average. In order to improve the health of the student population, the public health authorities need to continuously investigate the PA of students and introduce appropriate activities to increase their level of PA.

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University student's smoking is a significant public health problem. It is estimated that, globally, every fifth medical student is a smoker. So far, no research dealing with cigarette smoking among medical students has been conducted in the countries of the Western Balkans. The aim of this study was to examine the prevalence and risk factors of cigarette smoking among Western Balkans medical students. A cross-sectional study was conducted among 2452 students from 14 medical faculties in the Western Balkans (Republic of Slovenia, Republic of Croatia, Bosnia and Herzegovina, Republic of North Macedonia and Republic of Serbia). The data were gathered through an online survey. There were significantly more non-smokers than smokers among medical students. Only gender and parents smoking status were statistically significantly associated with students smoking status. The smokers were more often male students, who lived in urban areas prior their studies, and whose parents were both smokers. With the aim of monitoring and enhancing student population health, it is necessary for public health activists and health officials to continually survey the students' smoking status in order to recognize the smoking influencing factors, and form and take on appropriate activities to improve the prevention of cigarette smoking among students, as well as motivate those who smoke to give up smoking, which would contribute to improving the health of the student population.

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BACKGROUND: This paper shows that the tools of digital demography, such as Google Trends, can be used for determining, estimating, and predicting the migration of health care workers (HWs), in this case, from Croatia and the Western Balkans (WB) to Germany and Austria. OBJECTIVE: This study aims to test the usefulness of Google Trends indexes to forecast HW migration from Croatia and the WB to Germany and Austria. The paper analyzes recent trends in HW mobility in Europe and focuses specifically on mobility patterns among medical doctors and nurses using digital demography. Without increased emigration in the last 10 years, Croatia and the WB would have 50% more HWs today, and this staff is now crucial in the fight against a pandemic. Furthermore, the COVID-19 pandemic contributed to the increase in emigration. METHODS: A particular problem in analyzing the emigration of HCWs from Croatia and the WB is that there is no system for monitoring this process. Official data is up to 3 years late and exists only for persons deregistered from the state system. Furthermore, during the pandemic, the "normal" ways of data collection are simply too slow. The primary methodological concept of our approach is to monitor the digital trace of language searches with the Google Trends analytical tool. To standardize the data, we requested the data from January 2010 to December 2020 and divided the keyword frequency for each migration-related query. We compared this search frequency index with official statistics to prove the significance of the results and correlations, and test the model's predictive potential. RESULTS: All tested migration-related search queries, which indicate HCWs' emigration planning, showed a positive linear association between Google index and data from official statistics (Organisation for Economic Co-operation and Development: Serbia R2=0.3381, Bosnia and Herzegovina [B&H] R2=0.2722, Croatia R2=0.4515). Migration-related search activities such as "job application + nurses" from Croatia correlate strongly with official German data for emigrated HWs from Croatia, Serbia, and B&H. Decreases in Google searches were correlated with the decrease in the emigration of HWs. Thus, this method allows reliable forecasts for the future. CONCLUSIONS: This paper highlights that the World Health Organization's list of countries with HWs shortages should be updated to include Croatia and the countries from the WB. The issue of the European Union drawing HWs from the EU periphery (Croatia) and nearby countries (B&H, Serbia) clearly shows a clash between the EU freedom of movement and the right to health care and a need to ensure a health care workforce in all European regions. Understanding why HWs emigrate from Croatia and the WB, and the consequences of this process are crucial to enabling state agencies and governments to develop optimal intervention strategies to retain medical staff. The benefit of this method is reliable estimates that can enable a better response to a possible shortage of HWs and protect the functioning of the health system. The freedom of movement of workers in the EU must be supplemented with a common pension and health care system in the EU.

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Trade agreements with the European Union (EU) and Central European Free Trade Agreement (CEFTA) significantly influenced the liberalisation of agri-food products in Western Balkan (WB) countries. In all Western Balkan countries, there has been an intensification of the trade of agri-food products and a partial change in the regional and commodity structures of trade. This paper aims to identify comparative advantages of agri-food sectors and consider its tendencies during the EU integration process. Additionally, this paper will discuss some opportunities for improvement of the export positions of agri-food products. In that context and based on the literature review, the indexes of revealed comparative advantages and its modified version will be used as a main method for analysis in this research. Results showed that all Western Balkan countries, except Albania, have comparative advantages in exporting agri-food products. It is evident that Serbia has the highest level of comparative advantages in this sector. Moreover, this paper suggests that all countries should aim to provide the best possible positions for their agri-food products during pre-accession negotiations for EU membership and take the necessary steps towards increasing the level of competitiveness in the common EU market.

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This paper analyzes the determinant factors of tobacco consumption in Albania, which is one of the countries with the highest smoking prevalence in Europe. To empirically estimate the elasticity of cigarettes demand in Albania, the paper uses the Living Standard Measurement Survey (LSMS) applying Deaton's (1988) demand model. This paper estimates an Almost Ideal Demand System (AIDS), which allows disentangling quality choice from exogenous price variations using unit values from cigarette consumption. Following Deaton's model, the results suggest that the demand for tobacco is inelastic, with a price elasticity of -0.57. The price elasticity appears to be within the range of elasticity estimates frequently reported for low- and middle-income countries. The results suggest that total expenditure, household size, male-to-female ratio, and adult ratio are important determinants of tobacco demand in Albania. The increase in the tobacco price, which has been mainly driven by increased excises, has demonstrated a significant impact on reducing tobacco consumption. Consequently, the Albanian government may engage in gradual increases in excise taxes given the inelastic tobacco demand.

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Aim: Our aim was to assess the trends and correlates of the leadership competency level of female health professionals in Albania, a transitional country in the Western Balkans, based on a standardized international instrument. Methods: Two nationwide cross-sectional studies were conducted in Albania in 2014 (first wave; n = 105 women) and subsequently in 2018 (second wave; n = 121 women). A structured questionnaire was administered to all female participants aiming at self-assessing the current level of leadership competencies and the required (desirable) level of leadership competencies for their current job position. The questionnaire consisted of 52 items pertinent to eight domains. Answers for each item of the instrument ranged from 1 ("minimal competency level") to 5 ("maximal competency level"). Overall summary scores (range: 52-260) were calculated for both the current and the required leadership competency levels in both survey rounds, based on which the gap in leadership competency level was also computed (required minus current competency level). Binary logistic regression was used to assess the correlates of the gap in leadership competency level among study participants. Results: In multivariable-adjusted logistic regression models, there was evidence of a positive association between the gap in leadership competency level and: workplace in urban areas (OR = 3.2, 95%CI = 1.6-6.6); work experience (OR[for 1 year increment] = 1.1, 95%CI = 1.0-1.2); first round of the survey conducted in 2014 (OR = 2.1, 95%CI = 1.0-4.3); and, particularly, a high managerial job position/level (OR = 3.8, 95%CI = 1.6-9.3). Conversely, there was an inverse relationship with the age of women (OR[for 1 year increment] = 0.9, 95%CI = 0.8-1.0). Conclusion: Our study provides useful evidence about trends over time and selected correlates of the gap in leadership competencies among female health professionals in Albania. Policymakers and decision-makers in Albania and other countries should be aware of the unmet need for leadership training of female health professionals at all levels.

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Child-rearing practices and beliefs of what determines a 'good quality' of child-rearing differ across cultural contexts and more than one interpretation can be given to "a child's best interests". This study aims to examine the cultural factors that influence judgements of the quality of children's rearing environment, and the construct validity of the Best Interests of the Child-Questionnaire (BIC-Q) scale when used in the Western Balkans. In our research on migrant children who returned to Kosovo and Albania, the BIC-Q is used to assess the quality of the child-rearing environment from a local cultural perspective on child-rearing. To assess cultural differences in judgements of the child-rearing environment, we measured agreement through Cohen's kappa of BIC-Qs completed from a Western-Balkan and a Western-European perspective on child-rearing. The construct validity of the BIC-Q scale was assessed through a Mokken scale analysis. The findings show that - except for two items - there is substantial agreement between Western-European and Western-Balkan assessors regarding the direction of the judgement, i.e. if the scores on the child-rearing conditions are dichotomized (sufficient/insufficient). The judgements of the 'respect' and 'interest' conditions are sensitive to differences in the cultural or professional perspectives of the assessors. The findings of the Mokken scale analysis demonstrate a strong and reliable scale in the cultural context of the Western Balkans (H = .73; Rho = .97). Knowledge gained from using the BIC-Q to assess the living situation of returned migrant children in their countries of origin and insight into child-rearing standards provides input for the best interests of the child determination.

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OBJECTIVES: The objective of this research was to determine modern contraceptive use (MCU) and explore factors associated with MCU in the Western Balkans. METHODS: Multiple Indicator Cluster Survey (MICS) data from Bosnia and Herzegovina, Kosovo, Macedonia, Montenegro and Serbia, including the datasets from Roma settlements, were merged. Bivariate and multivariate analyses were used to assess which factors were associated with MCU among married women aged 15-49 in the region. RESULTS: Among the 11,381 women surveyed, 13.75% reported MCU and 23.74% justified domestic violence. While bivariate analysis indicated that women who expressed justification of domestic violence were less likely to report MUC, this was not the case after adjusting for sociodemographic factors. Multivariate analysis showed that Roma were less likely than non-Roma to engage in MCU. Additionally, increased education, increased wealth, and urban residency were significantly associated with increased likelihood of MCU. CONCLUSION: The results highlight the need for more attention from research, programming and policy communities in order to better understand and address the overall problematically low level of MCU and factors associated with low MCU. More efforts are needed to address the disparities in MCU among Roma women and women of lower socioeconomic status.

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