Financial-related discrimination and socioeconomic inequalities in psychological well-being related measures: a longitudinal study.

BACKGROUND: This study examined the prospective association between financial-related discrimination and psychological well-being related measures and assessed the role of financial-related discrimination in explaining socioeconomic inequalities in psychological well-being related measures. METHODS: Data of UK older adults (≥ 50 years) from the English Longitudinal Study of Ageing were used (baseline: Wave 5, 2010/2011; n = 8,988). The baseline total non-pension wealth (in tertiles: poorest, middle, richest) was used as a socioeconomic status (SES) measure. Financial-related discrimination at baseline was defined as participants who reported they had been discriminated against due to their financial status. Five psychological well-being related measures (depressive symptoms, enjoyment of life, eudemonic well-being, life satisfaction and loneliness) were examined prospectively across different follow-up periods (Waves 6, 2012/2013, 2-year follow-up; and 7, 2014/2015, 4-year follow-up). Regression models assessed associations between wealth, financial-related discrimination, and follow-up psychological measures, controlling for sociodemographic covariates and baseline psychological measures (for longitudinal associations). Mediation analysis informed how much (%) the association between wealth and psychological well-being related measures was explained by financial-related discrimination. RESULTS: Participants from the poorest, but not middle, (vs. richest) wealth groups were more likely to experience financial-related discrimination (OR = 1.97; 95%CI = 1.49, 2.59). The poorest (vs. richest) wealth was also longitudinally associated with increased depressive symptoms and decreased enjoyment of life, eudemonic well-being and life satisfaction in both 2-year and 4-year follow-ups, and increased loneliness at 4-year follow-up. Experiencing financial-related discrimination was longitudinally associated with greater depressive symptoms and loneliness, and lower enjoyment of life across follow-up periods. Findings from mediation analysis indicated that financial-related discrimination explained 3-8% of the longitudinal associations between wealth (poorest vs. richest) and psychological well-being related measures. CONCLUSIONS: Financial-related discrimination is associated with worse psychological well-being and explains a small proportion of socioeconomic inequalities in psychological well-being.

Dynamics of caste and early childbearing in India: a perspective of three decades.

BACKGROUND: Early childbearing disrupts girls' otherwise healthy growth into adulthood and adversely affects their education, livelihood, and health. Individual, sociocultural, economic, environmental, and health service-related factors contribute to childbearing among young females. In India, caste affects health outcomes despite several affirmative policies aimed at improving the health and welfare of the backward castes/tribes. However, there is a dearth of empirical evidence about the impact of caste on early childbearing, more specifically, regarding the trajectory of inter-caste disparities in early childbearing. METHOD: This study used data from all five rounds of the National Family Health Survey (NFHS) in India to assess the association between caste and early childbearing over the last three decades. All women aged 20-24 [NFHS-1 (n = 17,218), NFHS-2 (n = 15,973), NFHS-3 (n = 22,807), NFHS-4 (n = 122,955) and NFHS-5 (n = 118,700)] were considered to create a pooled data set (n = 297,653) for analysis. Bivariate analysis and binary logistic regression were conducted using Stata (v17). ArcMap (v10.8) presented the caste-wise prevalence of early childbearing among the states and Union Territories (UTs). RESULTS: Many women continue to have early childbearing despite a considerable reduction over the last three decades from 47% in 1992-93 to 15% in 2019-21. Compared to NFHS-1, the odds of early childbearing increased by 15% in NFHS-2 and, after that, declined by 42% in NFHS-3 and 64% in NFHS-4 and NFHS-5. The inter-caste disparity in early childbearing persists, albeit with a narrowing gap, with the Scheduled castes (SC) remaining the most vulnerable group. Adjusting the effects of socio-demographic and economic characteristics, SC women had significantly higher odds of early childbearing (OR = 1.07, CI = 1.04-1.11) than those from the General caste. CONCLUSION: To decrease early childbirth, a focus on adolescent marriage prevention and increasing contraceptive use among young SC women is necessary. Strengthening ongoing programs and policies targeting educational and economic empowerment of the socially weaker castes/tribes will help in reducing early childbearing. Efforts to prevent early childbearing will accelerate the achievement of the Sustainable Development Goals (SDGs)-especially those related to health, poverty, nutrition, education, and general wellbeing, in addition to protecting women's reproductive rights.

A high density of ultra-processed food, alcohol & tobacco retail stores, and social inequalities are associated with higher mortality rates of non-communicable diseases in Mexican adults: 2005 to 2021.

BACKGROUND: Non-communicable diseases (NCDs) are the leading causes of mortality in Mexico. Factors contributing to NCDs-related deaths may vary across small geographic areas such as municipalities. We aimed to predict municipal-level factors associated with NCD mortality in Mexican adults from 2005 to 2021 using the small-area analysis (SSA) approach. METHODS: We gathered data on population sociodemographic, access to healthcare services, and mortality records at the municipal-level from census and public institutions from 2005 to 2021. We identified municipal predictors of NCDs mortality rates (MR) using negative binomial regression models. RESULTS: A total of 584,052 observations of Mexican adults were analyzed. The national expected NCDs MR per 100,000 inhabitants was 210.7 (95%CI: 196.1-226.7) in 2005 and increased to 322.4 (95%CI: 300.3-346.4) by 2021. Predictors of NCDs mortality (quintile 5 vs. quintile 1) included; indigeneity (IRR = 1.15, 95%CI: 1.12-1.19), poverty (IRR = 1.14, 95%CI: 1.13-1.15), affiliation with Mexican Social Security Institute (IRR = 1.11, 95%CI: 1.09-1.14), households with television (IRR = 1.14, 95%CI: 1.11-1.17), and high density of ultra-processed food, alcohol & tobacco retail stores (IRR = 1.15, 95%CI: 1.13-1.17). The greatest increases in MR were observed in municipalities from Oaxaca (>200% increments). CONCLUSION: There was an overall increase in NCDs MR from 2005 to 2021, with a significant geographic variation among Mexican municipalities. The results of this study highlight the importance of identifying priority areas in the country that urgently require public policies focused on local factors associated with deaths from NCDs, such as the regulation of the ultra-processed food, alcohol & tobacco retail stores, and efforts to reduce social inequalities.

Social determinants of respiratory health from birth: still of concern in the 21st century?

Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.

Examining the Biological Impacts of Parent-Child Relationship Dynamics on Preschool-Aged Children who have Experienced Adversity.

Parent-child relationship dynamics have been shown to predict socioemotional and behavioral outcomes for children, but little is known about how they may affect biological development. The aim of this study was to test if observational assessments of parent-child relationship dynamics (cohesion, enmeshment, and disengagement) were associated with three biological indices of early life adversity and downstream health risk: (1) methylation of the glucocorticoid receptor gene (NR3C1), (2) telomere attrition, and (3) mitochondrial biogenesis, indexed by mitochondrial DNA copy number (mtDNAcn), all of which were measured in children's saliva. We tested hypotheses using a sample of 254 preschool-aged children (M age = 51.04 months) with and without child welfare-substantiated maltreatment (52% with documented case of moderate-severe maltreatment) who were racially and ethnically diverse (17% Black, 40% White, 23% biracial, and 20% other races; 45% Hispanic) and from primarily low-income backgrounds (91% qualified for public assistance). Results of path analyses revealed that: (1) higher parent-child cohesion was associated with lower levels of methylation of NR3C1 exon 1D and longer telomeres, and (2) higher parent-child disengagement was associated with higher levels of methylation of NR3C1 exon 1D and shorter telomeres. Results suggest that parent-child relationship dynamics may have distinct biological effects on children.

Do hospitalizations push households into poverty in India: evidence from national data.

Introduction: High percentage of OOP (Out-of-Pocket) costs can lead to poverty and exacerbate existing poverty, with 21.9% of India's 1.324 billion people living below the poverty line. Factors such as increased patient cost-sharing, high-deductible health plans, and expensive medications contribute to high OOP costs. Understanding the poverty-inducing impact of healthcare payments is essential for formulating effective measures to alleviate it. Methods: The study used data from the 75th round of the National Sample Survey Organization (Household Social Consumption in India: Health) from July 2017-June 2018, focusing on demographic-socio-economic characteristics, morbidity status, healthcare utilization, and expenditure. The analysis included 66,237 hospitalized individuals in the last 365 days. Logistic regression model was used to examine the impact of OOP expenditures on impoverishment. Results: Logistic regression analysis shows that there is 0.2868 lower odds of experiencing poverty due to OOP expenditures in households where there is the presence of at least one child aged 5 years and less present in the household compared to households who do not have any children. There is 0.601 higher odds of experiencing poverty due to OOP expenditures in urban areas compared to households in rural areas. With an increasing duration of stay in the hospital, there is a higher odds of experiencing poverty due to OOP health expenditures. There is 1.9013 higher odds of experiencing poverty due to OOP expenditures if at least one member in the household used private healthcare facility compared to households who never used private healthcare facilities. Conclusion: In order to transfer demand from private to public hospitals and reduce OOPHE, policymakers should restructure the current inefficient public hospitals. More crucially, there needs to be significant investment in rural areas, where more than 70% of the poorest people reside and who are more vulnerable to OOP expenditures because they lack coping skills.

The protective effect of CALD identity in the presence of low income on missing teeth of Australian adults over time.

BACKGROUND: 'Culturally And Linguistically Diverse (CALD)' populations have diverse languages, ethnic backgrounds, societal structures and religions. CALD populations have not experienced the same oral health benefits as non-CALD groups in Australia. However, the socio-demographic profile of Australian CALD populations is changing. This study examined how household income modifies the oral health of CALD and non-CALD adults in Australia. METHODS: Data were from two National Surveys of Adult Oral Health (NSAOH) conducted in 2004-06 (NSAOH 2004-06) and 2017-18 (NSAOH 2017-18). The outcome was self-reported number of missing teeth. CALD status was identified based on English not the primary language spoken at home and country of birth not being Australia. Social disadvantage was defined by total annual household income. Effect-measure modification was used to verify differences on effect sizes per strata of CALD status and household income. The presence of modification was indicated by Relative Excess Risk due to Interactions (RERIs). RESULTS: A total of 14,123 participants took part in NSAOH 2004-06. The proportion identifying as CALD was 11.7% and 56.7% were in the low-income group, and the mean number of missing teeth was 6.9. A total of 15,731 participants took part in NSAOH 2017-18. The proportion identifying as CALD was 18.5% and 38.0% were in the low-income group, and the mean number of missing teeth was 6.2. In multivariable modelling, the mean ratio (MR) for CALD participants with low household income in 2004-06 was 2% lower than the MR among non-CALD participants with high household income, with the RERI being - 0.23. Non-CALD participants from lower income households had a higher risk of having a higher number of missing teeth than low income CALD individuals (MR = 1.66, 95%CI 1.57-1.74 vs. MR = 1.43 95%CI 1.34-1.52, respectively). In 2017-18, the MR for CALD participants with low household income was 3% lower than the MR among non-CALD participants with high household income, with the RERI being - 0.11. Low income CALD participants had a lower risk of missing teeth compared to their non-CALD counterparts (MR = 1.43, 95% CI 1.34-1.52 vs. MR = 1.57, 95% CI 1.50-1.64). CONCLUSIONS: The negative RERI values indicate that the effect-measure modification operates in a negative direction, that is, there is a protective element to being CALD among low income groups with respect to mean number of missing teeth.

A Randomized Trial to Address Food Insecurity and Promote Smoking Cessation Among Low-Income Adults.

Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke.

Solving poverty or tackling healthcare inequalities? Qualitative study exploring local interpretations of national policy on health inequalities under new NHS reforms in England.

OBJECTIVES: Major reforms to the organisation of the National Health Service (NHS) in England established 42 integrated care systems (ICSs) to plan and coordinate local services. The changes are based on the idea that cross-sector collaboration is needed to improve health and reduce health inequalities-and similar policy changes are happening elsewhere in the UK and internationally. We explored local interpretations of national policy objectives on reducing health inequalities among senior leaders working in three ICSs. DESIGN: We carried out qualitative research based on semistructured interviews with NHS, public health, social care and other leaders in three ICSs in England. SETTING AND PARTICIPANTS: We selected three ICSs with varied characteristics all experiencing high levels of socioeconomic deprivation. We conducted 32 in-depth interviews with senior leaders of NHS, local government and other organisations involved in the ICS's work on health inequalities. Our interviewees comprised 17 leaders from NHS organisations and 15 leaders from other sectors. RESULTS: Local interpretations of national policy objectives on health inequalities varied, and local leaders had contrasting-sometimes conflicting-perceptions of the boundaries of ICS action on reducing health inequalities. Translating national objectives into local priorities was often a challenge, and clarity from national policy-makers was frequently perceived as limited or lacking. Across the three ICSs, local leaders worried that objectives on tackling health inequalities were being crowded out by other short-term policy priorities, such as reducing pressures on NHS hospitals. The behaviour of national policy-makers appeared to undermine their stated priorities to reduce health inequalities. CONCLUSIONS: Varied and vague interpretations of NHS policy on health inequalities are not new, but lack of clarity among local health leaders brings major risks-including interventions being poorly targeted or inadvertently widening inequalities. Greater conceptual clarity is likely needed to guide ICS action in future.

The experience of persons with disabilities as beneficiaries of Ghana's District Assemblies Common Fund.

Ghana's Disability Fund aims to build the capacity of persons with disabilities, particularly those outside of formal employment, to engage in livelihood generation activities as a way to reduce poverty. The objective of this paper is to investigate the kind of knowledge that exists on the District Assemblies Common Fund program, understand the experience of beneficiaries when they access the program, and examine the benefits on beneficiaries' livelihoods. The research consisted of five focus group discussions with 35 beneficiaries, key informant interviews with six member organizations of Ghana Federation of Disability Organizations, and interviews with eleven Disability Fund Management Committees members. This research found the experiences of beneficiaries on the program are varied yet the program on the whole has had a positive outcomes on their livelihoods. Persons with disabilities who participated in this study demonstrated knowledge of the program. Beneficiaries further described issues relating to the quality of purchased items, the procurement process, as well as reductions and changes to requested items. Disability-specific issues in accessing the funds were also noted. These limited the effectiveness of the Fund to meet its stated goals. The findings of the study can inform the Common Fund Secretariat efforts to improve the performance of the fund as well as the advocacy of the disability movement. The findings are also relevant to the design and implementation of other social protection programmes in low-and middle-income countries.

[Promoting implementation research and One Health approach to respond the four global health challenges: an interpretation of the Special Programme for Research and Training in Tropical Diseases (TDR) Strategy 2024-2029].

Tropical diseases, notably neglected tropical diseases and infectious diseases of poverty, remain major health problems endangering the poorest and most-marginalized people in the world. The Special Programme for Research and Training in Tropical Diseases (TDR), which is co-sponsored by the World Health Organization, the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP) and the World Bank, is an important programme that helps facilitate, support, guide and coordinate global efforts to combat tropical diseases. On July 2023, TDR formally issued its 2024-2029 strategy, which proposed the direction and proprieties of global tropical disease prevention and control in the next six years. Based on its original focus on supporting researchers and research institutions from low and middle-income countries to conduct research on tropical diseases and building their research capabilities, this strategy proposed some new developments, which mainly included incorporating tropical disease prevention and control into the overall framework of addressing major global health challenges and achieving the health goals set by the United Nations Sustainable Development Goals (SDGs) to combat tropical diseases and contribute to achieving health goals of SDGs in a collaborative and integrated manner; supporting implementation research and encouraging practitioners and social innovators to participate in research to enable generation of solutions that may be used to solve local health problems; promoting and encouraging the One Health concept and interdisciplinary and cross-departmental collaboration; shifting gradually its focus from disease prevention and control to addressing the health needs of the poorest and most-marginalized populations. These new developments deserve the attention of personnel and institutions in China dedicated to the prevention and control of tropical diseases in order to help their future researches and activities.

Tobacco control interventions for populations living in subsidised, low-income housing: a scoping review.

OBJECTIVES: People living in subsidised low-income housing are more likely to smoke and experience secondhand smoke exposure compared to the general population. While tobacco control interventions have yielded substantial population health benefits, people living in subsidised housing experience a greater burden of tobacco-related harms. We synthesised existing peer-reviewed and grey literature to determine tobacco control interventions that have been implemented in subsidised housing globally, and to understand their impact on smoking and secondhand smoke exposure. METHODS: We searched five databases for peer-reviewed research, and Google Advanced for grey literature. We adhered to the JBI Scoping Review Methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. RESULTS: Fifty-seven sources met the eligibility criteria. The most common type of intervention was mandatory smoking bans covering all indoor spaces (n = 32), followed by cessation-focused interventions (n = 19). Interventions that indirectly addressed smoking were the least common (n = 6). Our findings suggest smoking bans can increase smoking cessation and reduce secondhand smoke exposure, especially if implemented alongside cessation support strategies. CONCLUSION: Tobacco control interventions targeting subsidised housing demonstrate positive effects on tobacco-related outcomes for residents and provide an important opportunity to address health disparities. Future research should examine the long-term impacts of the interventions, including potential unintended consequences, in varied subsidised housing contexts.

Under-5 mortality surveillance in low-income and middle-income countries: insights from two Health and Demographic Surveillance Systems in rural Gambia.

Without complete data on under-5 mortality, tracking progress towards achieving Sustainable Development Goal 3.2 will be challenging. Such data are also needed to ensure proper planning and prioritisation of scarce resources in low-income and middle-income countries. However, most low-income and middle-income countries have weak Civil Registration and Vital Statistics (CRVS) systems, leaving a critical gap in understanding under-5 mortality dynamics. This paper outlines a community-based approach to enhance under-5 mortality surveillance in low-income countries, using The Gambia as a case study. The methodology involves Health and Demographic Surveillance Systems (HDSSs) in Basse and Fuladu West, employing unique identification numbers, periodical household visits and collaboration with communities, village reporters and project field workers to ensure comprehensive data collection. Verbal autopsies (VAs) are conducted by trained field workers, and causes of death are determined using the physician-certified VA method. Between 1 September 2019 and 1 September 2023, 1333 deaths were detected, for which causes of death were determined for 97.1% (1294 of 1333). The most common causes of death detected were acute respiratory infections including pneumonia, sepsis, diarrhoeal diseases and birth asphyxia. Challenges include the cost of maintaining the HDSSs, poor road infrastructure, Electronic Data Capture transition challenges, and the need for national integration of HDSS data into the CRVS system. The success of this model highlights its potential for scalable and adaptable under-5 mortality surveillance in resource-limited settings.

Access to healthcare for migrants in Tunisia in 2023-2024: Current situation and ethical challenges.

INTRODUCTION: Transformed progressively into a transit country towards Europe but also as a host, Tunisia has seen a diversification of migratory movements since the 2011 revolution, as well as the profiles of migrants who face multiple difficulties that can have an impact on their health. AIM: This update aimed to expose the situation of migrants in Tunisia regarding access to healthcare, and to raise the ethical issues that result from it. RESULTS: Providing care to vulnerable individuals, especially migrants, compels us to reevaluate our practices and question ourselves. Ethical questioning is constant to determine how to do well and not harm. The reflection on this more humane "social medicine" comprehending the patient in its entirety, is only in its beginnings. The critical health status of the poorest populations and their extreme vulnerability do not only call for adapted and specific care measures but also a more comprehensive questioning of social ties and the place that our society grants to the weakest and excluded. CONCLUSION: Migration must be considered as a central issue of the ethics of the health of a population in order to provide quality care without prejudice.

Spatial and temporal differences and convergence analysis of multidimensional relative poverty in ethnic areas.

Reducing multidimensional relative poverty is one of the important issues in the current global poverty governance field. This article takes 12 ethnic regions in China as the research object and constructs a multidimensional relative poverty measurement system. The calculated multidimensional relative poverty index is decomposed according to provinces, cities, dimensions, and indicators. Then, the Dagum Gini coefficient and convergence analysis are used to analyze spatiotemporal heterogeneity and convergence characteristics. The results show that the multi-dimensional relative poverty situation of various provinces in ethnic minority areas has improved from 2012 to 2021, among which Tibet province is the most serious and Shaanxi is the best. According to the analysis of convergence, it was observed that there is no σ-convergence of multidimensional relative poverty in ethnic areas in general, and there is absolute ß-convergence in general and in the southwest and northwest regions, and there is no absolute ß-convergence in the northeast region. Based on this, policy recommendations for reducing multidimensional relative poverty are proposed at the end of the article. Compared with previous studies, this article focuses on ethnic regions that are easily overlooked. Starting from the dimensions of economy, social development, and ecological environment, the poverty measurement system has been enriched.

Drivers of child marriages for girls: A prospective study in a low-income African setting.

Child marriage has adverse consequences for young girls. Cross-sectional research has highlighted several potential drivers of early marriage. We analyse drivers of child marriage using longitudinal data from rural Malawi, where rates of child marriage are among the highest in the world despite being illegal. Estimates from survival models show that 26% of girls in our sample marry before age 18. Importantly, girls report high decision-making autonomy vis-à-vis the decision to marry. We use multivariate Cox proportional hazard models to explore the role of 1) poverty and economic factors, 2) opportunity or alternatives to marriage, 3) social norms and attitudes, 4) knowledge of the law and 5) girls' agency. Only three factors are consistently associated with child marriage. First, related to opportunities outside marriage, girls lagging in school at survey baseline have significantly higher rates of child marriage than their counterparts who were at or near grade level. Second, related to social norms, child marriage rates are significantly lower among respondents whose caregivers perceive that members of their community disapprove of child marriage. Third, knowledge of the law has a positive coefficient, a surprising result. These findings are aligned with the growing qualitative literature describing contexts where adolescent girls are more active agents in child marriages.

Association between poverty, low educational level and smoking with adolescent's working memory: cross lagged analysis from longitudinal data.

Background: Working memory is a crucial element of cognitive function. Previous cross-sectional studies have identified various determinants of working memory in children and adolescents. Nonetheless, no study has yet demonstrated the causal relationship of social determinants with working memory in adolescents. Objective: This study explores the causal link between the level of education, smoking, and other factors with adolescent's working memory. Methods: This study analyzed secondary data from waves 4 and 5 of the Indonesia Family Life Survey (IFLS), utilizing cross-lagged analysis in Jamovi version 2.4.8. The variables included working memory score, maternal education, household income, stress, educational level, smoking, urbanicity, and physical activity. These variables were extracted from IFLS waves 4 and 5, and each dependent variable in IFLS wave four was controlled by the same dependent variables in IFLS 5. Then, we used cross-lagged analysis to assess the causality between each dependent variable and a working memory score in IFLS wave 5. Result: The findings indicate that level of education had a positive impact on working memory in adolescents aged 15-18 years, with a Beta value of 0.18 (95% CI 0.81-0.2; p < 0.001). Smoking and age were negatively associated with working memory, with Beta values of -0.07 (95% CI -0.65 -0.04; p < 0.029) and - 0.10 (95% CI -0.25 -0.05; p < 0.003), respectively. No evidence was found for a significant correlation between poverty and adolescents's working memory. Conclusion: The findings indicate that increased education levels are associated with improved working memory in adolescents aged 15-18. At the same time, smoking has a negative impact on working memory in this age group.