Background Roma people are commonly described as having an unhealthy lifestyle—for example, an unhealthy diet, intensive smoking, frequent alcohol consumption and a lack of physical activity. However, data about such health-endangering behaviours among Roma adolescents are scarce and of poor quality. The aim of our study is to assess the occurrence of health-endangering behaviours among Slovak Roma adolescents in comparison to non-Roma adolescents, and to assess the impact of parental education and social desirability on the differences found.

Methods A cross-sectional study among Roma from separated and segregated settlements in the eastern part of Slovakia (n=330; mean age 14.50 years; interview) and non-Roma adolescents (n=722; mean age 14.86 years; questionnaire) was conducted. The effect of ethnicity and parental education on smoking, drunkenness, drug use and physical activity was analysed separately for boys and girls using logistic regression and adjusted for social desirability.

Results Among girls, Roma adolescents had lower rates of smoking, drunkenness and drug use than non-Roma (ORs from 0.14 to 0.60 compared to non-Roma), but had higher rates of physical inactivity. Among boys, drug use was less frequent among Roma adolescents (OR 0.12, 95% CI 0.03 to 0.46); differences for the other health-endangering behaviours were small and statistically insignificant. The effects of parental education and social desirability were small.

Conclusions In contrast to the scarce evidence, Roma had lower rates of substance abuse, especially among girls. Only physical inactivity rates were higher among Roma girls. A challenge in health promotion among Roma is to maintain their relatively low substance use and to promote physical activity.