Mediation and Moderated Mediation in Relationships among Environmental Factors, Health-Related Knowledge, Attitudes, Practices, and Gender

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Edwin Balila
Ivonne Panjaitan
Dina Galang


This paper addresses the mediation effects of food, built, and social environments, knowledge and attitudes on health, and the influence of the technology environment on health practices, along with gender’s moderating effects. Adolescent respondents (n=365) aged 11 to 19 years from 13 private Christian schools in West, Central and East Indonesia were involved. Structural Equation Modeling was utilized to obtain the mediation and moderation effects. It was found that the food environment, social environment, and health attitude partially mediate the technology environment on health practices. Likewise, the built environment (i) fully mediates the technology environment on food environment, and (ii) partially mediates the social environment and health attitudes. Finally, the food environment, social environment, health attitudes, and knowledge on health fully mediate, respectively, the relationship between the built environment and health practices, while knowledge on health mediates between the social environment and health practices. Moderated mediation relationships were observed such that for males, (i) technology had a greater influence on the social environment; and (ii) the technology environment had a stronger positive influence on attitudes toward health than for females. On the other hand, the relationship between the built environment and knowledge on health had a stronger negative influence on males than on females.


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