The implementation of Clean and Healthy Living Behavior (PHBS) among school-aged children remains suboptimal, increasing the risk of various health problems. A preliminary survey conducted at MTs Nahdhatul Islam, Langkat Regency, revealed that many students had not consistently practiced PHBS, as indicated by behaviors such as not washing their hands with soap, littering, and neglecting environmental cleanliness within the school. This study aimed to analyze the relationship between knowledge, attitudes, teachers’ roles, school policies, and the availability of PHBS facilities with the implementation of PHBS among students. This research employed a quantitative approach using a cross-sectional design. A total of 52 students were selected through proportionate stratified random sampling. Data were analyzed using univariate and bivariate analyses with the Chi-square test. The results showed that most students had poor PHBS practices (65.4%). Bivariate analysis indicated significant relationships between knowledge (p=0.015), attitudes (p=0.007), teachers’ roles (p=0.020), school policies (p=0.030), and the availability of PHBS facilities (p=0.010) with PHBS implementation. It was concluded that these factors were significantly associated with PHBS implementation among students. Therefore, schools should strengthen health education, enhance teachers’ involvement, optimize school policies, and provide adequate PHBS facilities to promote clean and healthy living behaviors among students.
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