Elitsa Dimitrova
@iphs.eu
Department of Demography
Institute for Population and Human Studies
EDUCATION
2002 MA in Sociology in Sociology, Sofia University St. Kliment Ohridski
2003-2006 PhD in Sociology (Population Studies), Center for Population Studies at the Bulgarian Academy of Sciences
2007 - present Researcher at the Institute for Population and Human Studies at the Bulgarian Academy of Sciences
RESEARCH INTERESTS
Fertility and family studies, family and reproduction policy, research methods in social sciences, health and social inequalities, adolescent health and well-being
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Apolinaras Zaborskis, Aistė Kavaliauskienė, Sharon Levi, Riki Tesler, and Elitsa Dimitrova
MDPI AG
Regular toothbrushing is the primary self-care method to prevent the most common dental diseases and is considered an important public health indicator. This retrospective observational study aimed to examine cross-national time trends in adolescent toothbrushing behaviour and its association with sociodemographic factors between 1994 and 2018. We studied data from 20 countries that conducted seven surveys of the Health Behaviour in School-aged Children (HBSC) study. Adolescents aged 11, 13 and 15 years responded to questions on their toothbrushing frequency, family affluence and structure. Altogether, reports of 691,559 students were analysed using descriptive statistics and binominal logistic regression. The findings showed an overall positive trend in the prevalence of more-than-once-a-day toothbrushing frequency during the entire study period mainly due to a noticeable increase from 1994 to 2010 (except Denmark and Sweden); this trend continued significantly thereafter in 12 of 20 countries. Across all countries, girls and adolescents from more affluent families were more likely to brush their teeth regularly. These relationships remained unchanged throughout the study period, whereas the age-related difference in toothbrushing prevalence decreased noticeably, and the negative relationship between toothbrushing and living in a non-intact family became evident. While the prevalence of regular toothbrushing among adolescents has increased in recent decades, it is still far behind the recommended level of twice-daily brushing for everyone across all countries. The promotion of toothbrushing needs to start at an early age, with a special focus on boys and adolescents from low-affluence and non-intact families.
Elitsa Dimitrova and Anna Alexandrova-Karamanova
MDPI AG
The paper focuses on the association between Bulgarian adolescents’ health risk behaviours (cigarette smoking, vaping, alcohol use and drunkenness) and biopsychosocial factors at individual and interpersonal levels, using data from the pre-pandemic and the pandemic periods, i.e. Health Behaviour in School-aged Children (HBSC) study (2018) and the study of adolescent health and well-being in the context of the COVID-19 pandemic (2022/2023). Logistic regression models reveal a positive association with age in both periods, decreasing gender difference in smoking, presistant effect of family structure, strengthened effect of the material status of the family and a differenciating effect of ethnicity at the end of the pandemic. Family support is positively asociated with substance (mis)use in both periods. At the end of the pandemic generalized anxiety is positively associated with substance (mis)use, loneliness has a negative association with drunkenness, and limited social interaction and vaping are in a positive relationship. The experience of COVID-19 infection in the family is associated with higher risk of smoking, while treatment in hospital for COVID-19 of the adolescent or a family member is associated with a higher risk of vaping and drunkenness. Interactions with COVID-19 experience and psychosocial variables reveal a divergence in health risk behaviours, including also engagement in substance (mis)use. Effective interventions, targeting the identified risk factors and risk groups, are needed for promotion of healthy lifestyles among adolescents.
Apolinaras Zaborskis, Aistė Kavaliauskienė, Elitsa Dimitrova, and Charli Eriksson
MDPI AG
Background and Objectives: Despite the importance of life satisfaction for health and well-being, there is a paucity of cross-national comparative studies in life satisfaction related to the family environment. The present research examined the pathways of life satisfaction association with perceived family support and other family environment variables among adolescents aged from 11 to 15 years in 45 countries. Materials and Methods: Samples from the Health Behaviour in School-aged Children (HBSC) survey in 2017/2018 were analysed (n = 188,619). Path analysis was applied to evaluate the associations among the study variables. Results: A positive association between the life satisfaction score and high family support was identified in all 45 countries (standardized regression weight ranged from 0.067 to 0.420, p < 0.05). In majority of countries, living with both parents and higher levels of family affluence had a positive effect on adolescent life satisfaction both directly and indirectly through family support. In the described path model, the proportion of life satisfaction score variance that was accounted for by family support, family structure, family affluence, gender and age was up to 25.3%. The path models made it possible to group the participating countries into two clusters. In the first cluster (10 countries) the Eastern and Southern European countries dominated, while the second cluster (35 countries) united the countries of Western and Central Europe. Conclusions: There is evidence that countries with high level of adolescent life satisfaction differ in the high rate of intact family structure and the strong relation between family support and perceived life satisfaction.
Apolinaras Zaborskis, Aistė Kavaliauskienė, Charli Eriksson, Elitsa Dimitrova, and Joana Makari
MDPI AG
This study aimed to investigate how family structure varies and identify its time trends in European and North American countries using data from seven surveys conducted between 1994 and 2018 according to the Health Behaviour in School-aged Children (HBSC) study. The current family structure in 44 countries was described and time trend analysis of 28 countries was performed. Adolescents were asked whom they lived with in their home to describe family structures. Family structures showed distinct patterns and dynamics between countries. In 2018, in all countries, 73% of adolescents lived with both their mother and father; 14% and 5% of adolescents lived in a single-parent family and stepfamily, respectively; and around 9% of adolescents lived in another family type. In the period 1994–2018, the proportion of young people living in intact families decreased from 79.6% to 70.0%, on average about 10 percentage points. There were no significant changes in the prevalence of single-parent families and stepfamilies, but a significant increase in the number of adolescents living without either parent was revealed. The findings have implications for cross-national adjustment of adolescent health, well-being, and behaviours, and for critical analysis of socioeconomic family resources.
Elitsa Dimitrova and Tatyana Kotzeva
Cogitatio
The article focuses on the social differences in the attitudes toward female and male voluntary childlessness in Bulgaria and their dynamics over time. The analysis is based on data from the European Social Survey conducted in 2006 and 2018 in Bulgaria. By the means of multinomial logistic regression, we test the effect of the period, gender, age, marital status, number of children, education, employment, minority status, and religiosity on attitudes toward childlessness. The results reveal a decrease in negative attitudes and a strong increase of neutral stances. However, higher age of respondents is still associated with an increase in negative attitudes toward voluntary childlessness rather than neutrality. Women are significantly more likely to accept voluntary childlessness than to be neutral compared to men. Respondents who are married, parents, lowly educated, jobless or economically inactive, people belonging to ethnic minority groups, and highly religious people are more likely to disapprove of voluntary childlessness. Perceptions on female or male voluntary childlessness are significantly correlated with attitudes toward extramarital fertility, cohabitation, divorces when children are under twelve years old, and full‐time female employment when children are below the age of three. The analysis of variance reveals that the individuals who accept or are neutral to voluntary childlessness have stronger non‐conformist attitudes emphasizing self‐expression, the idea of “having a good time,” and rejection of traditional authorities compared to the respondents with negative attitudes.
Elitsa Dimitrova and T. Kotzeva
Abstract Background The paper focuses on Bulgarian adolescents’ behaviours that put their health at risk and their relationship to family-related characteristics: structure of family and material status, family support, communication with parents, parental monitoring and school-related parental support. It also discusses intervention programs with a focus on parent support gradient. Material and methods The analysis is based on the Bulgarian sample of Health Behaviour in School-Aged Children survey, the 2018 round. Logistic regression models of current cigarette smoking, regular alcohol consumption, sexual debut and current cannabis use are applied. Main national programs on adolescent health and the parental involvement component in them are also discussed. Results The statistical analyses reveal significant gender and age differences in Bulgarian adolescents’ health risk behaviours. Girls have significantly higher odds of smoking and are less likely to report an early start of sexual life. Odds of cigarette smoking and regular alcohol consumption increase with age. Children living with one parent have significantly higher odds of smoking, regular alcohol consumption and current cannabis use. Interactions between FAS and family support reveal that students who report low family support, regardless of the material status of the family, have significantly higher odds of health risk behaviours. Conclusion The main contribution of the analysis reveals the alleviating effect of family support on socio-economic inequalities between families. An evidence-based approach delineating a preventive potential of family support on Bulgarian adolescents’ health risk behaviours despite the level of family affluence provides solid arguments for increasing national family support programs.
Apolinaras Zaborskis, Aistė Kavaliauskienė, Charli Eriksson, Ellen Klemera, Elitsa Dimitrova, Marina Melkumova, and Daniela Husarova
MDPI AG
Family support has a beneficial impact on protecting health-risk behaviour in adolescents. This study aimed to explore whether family support is associated with risk of smoking during transition from early (11 years) to late (15 years) adolescence across 42 countries. The data from the cross-national Health Behaviour in School-aged Children (HBSC) study in 2017/2018 were employed (N = 195,966). Family support was measured using the four-item Family dimension of the Multidimensional Scale of Perceived Social Support (sum score 20 or more was categorised as high family support). Smoking was defined as a reported cigarette smoking at least 1–2 days in the last 30 days. The association between smoking and family support was assessed using a prevalence ratio (PR) obtained from the multivariate Poisson regression. Over two thirds of adolescents reported high levels of support from their family. Family support was found to significantly decrease with age in most of the countries, with the boys reported high level of family support more often than girls. The adolescents who reported having low family support also were more likely to smoke compared to their peers who reported having high family support (PR = 1.81; 95% CI: 1.71–1.91 in boys, and PR = 2.19; 95% CI: 2.08–2.31 in girls). The countries with a stronger effect of family support in reducing smoking risk indicated lower rates of adolescent smoking as well as lower increases in the cigarette smoking prevalence during the age period from 11 to 15 years. This study reinforces the need for family support, which is an important asset helping adolescents to overcome the risk of smoking during their transition from early to late adolescence.
E.K. Dimitrova and
Institute of Economics of the Ural Branch of the RAS
Satisfaction with working time gains increasing importance in the context of changing sphere of work, spread-out of flexible forms of employment, digitalisation and telework in the recent times of the Covid-19 pandemic. The paper focuses on the factors associated with satisfaction with working time in European countries before the pandemic based on data from the European Quality of Life Survey (2016). The study serves as a basis for further comparison of the trend in working time satisfaction in the pre-pandemic period across Europe and the recent period of increasing flexibilisation of work, digitalisation and spread-out of distant employment. For this purpose, descriptive statistical analyses and two-level random intercept model for binary responses are applied. The results show that women report higher satisfaction with working time compared to men. Satisfaction significantly increases after the age of 40. The number of children and the presence of children below the age of 6 in the household are negatively associated with satisfaction with working time. Satisfaction is positively associated with income and education. Structural conditions, such as economic development measured by gross domestic product (GDP), influence Europeans’ working time satisfaction. In the Balkan countries, satisfaction with working time is the lowest, while in the North-Western societies the highest percentage of workers are satisfied with working time before the Covid-19 pandemic.
Irina Todorova, Liesemarie Albers, Nicole Aronson, Adriana Baban, Yael Benyamini, Sabrina Cipolletta, Maria del Rio Carral, Elitsa Dimitrova, Claire Dudley, Mariana Guzzardo,et al.
Informa UK Limited
ABSTRACT Background The global COVID-19 pandemic has had a significant impact on the physical and mental health of people everywhere. The aim of the study is to understand how people living in 15 countries around the globe experience an unexpected crisis which threatens their health and that of loved ones, and how they make meaning of this disruption in their narratives. Methods Data were collected through an anonymous online survey during May–September 2020, which was during or just after the first wave of the COVID-19 pandemic, depending on the country. The questionnaire included demographic and three open-ended questions as prompts for stories about experiences during the initial months of the pandemic. The text was analyzed through inductive thematic content analysis and quantified for full sample description, demographic and subsequently international comparisons. Results The final qualitative dataset included stories from n = 1685 respondents. The sample was 73.6% women and 26.4% men. The mean age of participants was 39.55 years (SD = 14.71). The identified four groups of overarching themes were: The presence and absence of others; Rediscovering oneself; The meaning of daily life; Rethinking societal and environmental values. We discuss the prevalence of each theme for the sample as a whole and differences by demographic groups. The most prevalent theme referred to disruptions in interpersonal contacts, made meaningful by the increased appreciation of the value of relationships, present in (45.6%) of stories. It was more prevalent in the stories of women compared to men (χ² = 24.88, p = .001). Conclusions The paper provides a detailed overview of the methodology, the main themes identified inductively in the stories and differences according to select demographic variables. We identify several major ways of making meaning of the pandemic. The pandemic has impacted many aspects of people’s lives which give it meaning, no matter where they live.
Elitsa Dimitrova, Tatyana Kotzeva, and Anna Alexandrova-Karamanova
Springer Science and Business Media LLC
Rumiana Stoilova and Elitsa Dimitrova
Institute of Sociology of the Academy of Sciences of the Czech Republic
The aim of this article is to analyse the extent to which differences between young people’s education, employment status, and social background can explain the differences in their emigration intentions and actual experience with emigration. The goal is to create a profile of youth with emigration experience and examine the interrelation between two transitions, from education to work and from youth into adulthood, as measured by the degree of independence from parents, and also to investigate social inequalities among people with emigration experience in the transition from education to finding a first job. The analysis is based on theories of the individual life-course transition and social status theories. The empirical data were gathered from a representative survey conducted in Bulgaria in 2014 that focused on young people aged 15–34 who had left education within the previous five years. The results show that young people from large families with many siblings more often have emigration intentions and that previous emigration experience is the strongest predictor of emigration intentions. Emigration intentions are also more likely among people who have emigrated and later returned and ended up economically inactive. This fact is important in understanding the large number of young people who are not in education or employment (NEETs) in Bulgaria.
Irina L. G. Todorova, Anna Alexandrova-Karamanova, Yulia Panayotova, and Elitsa Dimitrova
Wiley
OBJECTIVES
Health care reform in Bulgaria has been ongoing for two decades. Since 1990, it has been transforming from a socialized system of medical care with free access, to one which is decentralized, includes private health care services, the general practitioner model and a National Health Insurance Fund. In this context, we are conducting an international EC Framework 7 project: 'Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care'. We focus on health professionals' perceptions of organizational hierarchies in Bulgarian hospitals and how doctors and nurses connect these to organizational justice.
METHODS
We conducted seven focus groups and four interviews, with a total of 42 participants (27 nurses, 15 physicians and medical residents) in three hospitals. Data were analysed through thematic analysis and discourse analysis with Atlas.ti.
RESULTS
From the perspective of health professionals, health reform has intensified traditional hierarchies and inequalities and has created new ones in Bulgarian hospitals. These hierarchies are continuously (re)constructed through language and practices and also destabilized through resistance. The health professionals protest fact that these hierarchies are permeated with unfairness and silence voices. All health professions (nurses, doctors, residents) in our study experience being unjustly positioned and disempowered in various hierarchies. They connect these experiences to stress and anxiety.
CONCLUSIONS
Participatory action research needs to address multiple dimensions of organizational relationships in Bulgarian hospitals, including hierarchical relationships and ways of promoting organizational justice.
STATEMENT OF CONTRIBUTION
What is already known on this subject? Health care organizations are hierarchically organized. Organizational injustice can contribute to burnout in health professionals. There is a high level of stress and burnout for health professionals in Bulgaria. What does this study add? This study adds understanding of changing hierarchies in hospitals during health care reform in the post-socialist period. Illuminates how health professionals' discourse sustains and resists hierarchical relationships in Bulgarian hospitals. Adds understanding of health professionals' perspectives on implications of injustice for their well-being.
Patrícia L. Costa, Ana M. Passos, Sílvia A. Silva, Ema Sacadura-Leite, Susana M. Tavares, Florina Spanu, Elitsa Dimitrova, Vera Basarovska, Milan Milosevic, Meral Turk,et al.
Colegio Oficial de Psicologos de Madrid
T. Kotzeva and Elitsa Dimitrova
Dieser Beitrag liegt nur in englischer Sprache vor. This paper aims to illuminate and provide a critical assessment of the nationalist discourse on declining population in Bulgaria. Nationalist discourse is one of the mainstream approaches in Bulgaria and is widely spread through mass media having been voiced by renowned intellectuals, policy experts, scholars and media celebrities. It can be recognised in the political programmes of left-wing and nationalist parties, but also in governmental documents at both national as well as regional levels. The nationalistically oriented advocates articulate current concerns regarding the declining birth rates and declining population in the country labelling the demographic situation as “Bulgarian national catastrophe” and “Bulgaria’s collapse”. They place an emphasis on the decreasing proportion of ethnic Bulgarians and the growth of the ethnic minorities, especially Roma. The latter trend was labelled by the derogatory term “gypsyisation”, i.e. a distortion of the Bulgarian nation and shrinkage of its core ethnicity – ethnic Bulgarians. The threat of the “gypsyisation” of the Bulgarian nation has not only been viewed in quantitative terms, but also through the lens of an alleged worsening of the national human capital (e.g. level of education, professional skills and civic culture of the population). Another set of arguments exploited in the nationalist discourse is the diminishing size of the Bulgarian nation as a threat to national sovereignty, territorial unity and economic stability. We use a qualitative content analysis and thematic analysis of media textual materials in order to reconstruct the main ideas, arguments and strategies of the proponents of the nationalist discourse regarding the consequences of the declining population in Bulgaria, its social policy implications and future demographic prospects.
Irina Todorova, Anna Alexandrova-Karamanova, Yulia Panayotova, Elitsa Dimitrova, and Tatyana Kotzeva
Springer Science and Business Media LLC
Aliaksandr Amialchuk and Elitsa Dimitrova
Max Planck Institute for Demographic Research
This paper studies the evolution of deliberate fertility control in fourteen historic German villages between 1700 and 1900. The fertility response to infant and child mortality and exogenous fluctuations in rye price are used as measures of the existence and extent of deliberate non-parity specific control. The results show that, even before the demographic transition, the breastfeeding effect associated with infant mortality decreases and the replacement effect associated with child mortality increases. A negative fertility response to high rye price is present only after 1800, supporting the existence and evolution of deliberate non-parity specific fertility control before the demographic transition.
Elitsa K. Dimitrova
Informa UK Limited
RECENT SCHOLAR PUBLICATIONS
MOST CITED SCHOLAR PUBLICATIONS
Publications
Dimitrova, E. 2012. “Stratifying the Reproduction: Social Inequalities and Second Birth in Bulgaria after 1990”. International Journal of Sociology, vol. 42, pp. 34-52.
Dimitrova, E., Panayotova, Y., Todorova, I. and Alexandrova-Karamanova, A. 2012. “Doctors’ and Parents’ Perspectives on Communication Regarding the HPV Vaccine in Bulgaria”. In: Ilkilic, I., Erkin, H., Bromer, R., Zeeb, H. (eds). Health, Culture and Human Body. Epidemiology, Ethics and History of Medicine, Perspectives from Turkey and Central Europe. Conference Proceedings. Istanbul, 13-15.08.2012. Istanbul: Betim Central Press.
Amialchuk, A. and Dimitrova, E. 2012. “Detecting the Evolution of Deliberate Fertility Control Before the Demographic Transition in Germany”. Demographic Research, vol. 27, art. 19, pp. 507-542.
Kotzeva, T. and Dimitrova, E. 2014. “Nationalism and Declining Population in Bulgaria after 1990”. Comparative Population Studies, vol. 39 (4), pp. 767-788.
Stoilova, R. and Dimitrova, E. 2017. “Emigration in the Perspective of the School to Work Transition in Bulgaria”, Czech Sociological Review, Vol. 53, No. 6, pp. 903–933.
Dimitrova, Е. 2019. Social determinants of self-rated health of the population in Bulgaria. Results of European Social Survey. Papers of BAS. Humanities and Social Sciences, 5, 2, pp. 200-215.
Dimitrova, E., Kotzeva, T. & Alexandrova-Karamanova, A. 2020. Psychosocial school
environment and health risk behaviours of adolescents in Bulgaria: results from multilevel analysis.