Document Type : original article
Authors
1
Faculty of Nursing, University of Jember, Indonesia.
2
Department of Maternity and Child Nursing, Faculty of Nursing, University of Jember, Indonesia.
3
Department of Community, Family & Geriatric Nursing, Faculty of Nursing, University of Jember, Indonesia.
10.22038/jpp.2026.98254.5727
Abstract
Background: Adolescent obesity is a growing global public health challenge associated with adverse physical, psychological, and metabolic outcomes. The Social Ecological Model (SEM) provides a comprehensive framework for understanding obesity through individual, interpersonal, organizational, community, and societal factors. However, evidence on the mediating role of school health programs remains limited, particularly in developing countries.
Objective: This study examined associations between SEM dimensions and adolescent obesity and investigated the mediating role of the School Health Program (UKS) in Indonesia.
Methods: A cross-sectional study was conducted among 292 junior high school students in Banyuwangi Regency, Indonesia. Five dimensions of the SEM the microsystem, mesosystem, exosystem, macrosystem, and chronosystem of UKS implementation and obesity status were assessed. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to evaluate direct and indirect relationships.
Results: All of the SEM dimensions were significantly associated with UKS implementation (p < 0.05). Among the ecological dimensions, only the exosystem was significantly associated with adolescent obesity (β = 0.245, p = 0.003). The microsystem, mesosystem, macrosystem, and chronosystem showed no significant associations (all p > 0.05). UKS implementation was not significantly associated with obesity (β = −0.061, p = 0.421) and did not mediate relationships between any SEM dimension and obesity (all indirect effects, p > 0.05). These findings suggest that socioeconomic and environmental conditions beyond the immediate school setting may exert greater influence on adolescent obesity than current school-based health programs.
Conclusions: Adolescent obesity prevention requires multilevel interventions extending beyond conventional school health programs. Strengthening collaboration among schools, families, healthcare providers, communities, and policymakers is essential to address broader ecological determinants and improve obesity prevention strategies.
Keywords
Subjects
