Understanding Youth Health Risk Behaviours in Indonesia through a Structural Model of Social and Cognitive Determinants: A Longitudinal Analysis

Background: Cognitive development during adolescence plays a critical role in shaping decision-making and self-regulation. However, its role in influencing health risk behaviours particularly as a pathway linking early-life social conditions to later health outcomes remains underexplored in middle-income settings. This study investigates how cognitive status both directly and indirectly influences health risk behaviours among Indonesian youth, with a focus on the mediating role of cognition between early social structure and later health behaviours. Methods: Using longitudinal data from the Indonesia Family Life Survey (2007–2014), which tracked individuals aged 15–30, we applied structural equation modelling (SEM) to test three hypotheses: (1) the direct effect of adolescent cognitive status on health risk behaviours in young adulthood; (2) its mediating role between early-life social structure and risk behaviour; and (3) its contribution to behavioural change over time in smoking and physical activity. Results: Higher cognitive status in adolescence was significantly associated with lower engagement in health risk behaviours such as smoking, unhealthy diet, and physical inactivity in young adulthood (standardized coefficient = -0.12, p < 0.001). Cognitive status partially mediated the relationship between early social advantage and health risk behaviours (indirect effect = -0.06, p < 0.001), while the direct effect of social structure remained significant (direct effect = -0.08, p < 0.01). Although cognitive status did not independently predict behavioural change over time, its indirect influence through social structure remained substantial (indirect effect = -0.22, p < 0.001).Keywords: health risk behaviour, adolescents, youth Indonesia, cognitive status, social structure. Conclusions: Cognitive development plays a dual role as a product of social conditions and a protective factor against health risk behaviours. In rapidly developing countries like Indonesia, policies that enhance cognitive development alongside efforts to improve social-economic conditions may be particularly effective in supporting healthier behaviours during the transition from adolescence to young adulthood.