<![CDATA[Anemia remains an important public health concern among adolescent girls due to increased iron requirements, menstrual blood loss, and inadequate dietary and supplementation behaviors. Identifying modifiable factors is essential for strengthening school-based anemia prevention. Purpose: This study aimed to analyze the associations of dietary patterns, physical activity, and iron supplements adherence with anemia and identify the factors most strongly associated with anemia after adjustment for relevant covariates. Methods: An analytical observational cross-sectional study was conducted among 63 female students at SMK Sehati Karawang, West Java, Indonesia, in November–December 2025. Participants were selected proportionally by grade level and randomly within each stratum. Data were collected using structured questionnaires, anthropometric measurements, and capillary hemoglobin assessment. Associations were analyzed using Chi-square or Fisher's Exact Test and multiple logistic regression, with AOR, 95% CI, and a 5% significance level. Results: Anemia was identified in 28.6% of respondents. Poor dietary patterns and non-adherence to iron supplements were independently associated with anemia. Poor dietary patterns showed the strongest association (AOR=3.40; 95% CI: 1.20–9.62; p=0.021), followed by non-adherence to iron supplements (AOR=2.90; 95% CI: 1.04–8.10; p=0.041). Physical activity, nutritional status, menstrual duration, and nutritional knowledge were not independently associated with anemia. Implications: School-based prevention should prioritize dietary improvement and strengthen monitoring and behavioral support for regular iron supplements. Conclusion: Dietary patterns and iron supplements adherence were the main factors associated with anemia. Larger longitudinal studies with specific iron-status biomarkers are warranted.]]>
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