<![CDATA[Population health is strongly influenced by environmental conditions, particularly in coastal tourism areas where rapid development often outpaces sanitation infrastructure. This study aimed to analyze sanitation-related risks associated with the occurrence of environmentally based diseases in coastal tourism settlements in Biduk-Biduk District, East Kalimantan. A cross-sectional study was conducted in Biduk-Biduk Village and Teluk Sulaiman Village involving 139 households selected through purposive sampling based on predefined criteria. Data were analyzed using Chi-square tests and odds ratio analysis to examine associations between sanitation conditions and disease occurrence. The results showed that household solid waste management was statistically associated with disease occurrence (p = 0.035), although the direction of the association was inconsistent and should be interpreted with caution. In contrast, household wastewater management demonstrated a significant and more consistent association (p = 0.018), with inadequate wastewater management increasing the likelihood of environmentally based diseases (OR = 3.710; 95% CI: 1.307–10.527). These findings indicate that wastewater management represents a more direct and dominant pathway of environmental health risk compared to solid waste management in coastal tourism settings. Strengthening integrated environmental health risk assessment approaches and prioritizing sustainable household and communal wastewater management systems, supported by cross-sectoral collaboration, are essential to reduce environmental health risks and support sustainable coastal tourism development]]>
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