The Influence of Knowledge, Peers and Social Media on

Immunonutrition Intake of Adolescent Girls in the New Normal Era

Dian Isti Angraini

, Merry Indah Sari

, Novita Carolia

and Fitria Saftarina

Department of Community Medicine and Public Health, Faculty of Medicine, Lampung University, Indonesia

Department of Medical Education, Faculty of Medicine, Lampung University, Indonesia

Departement of Pharmacology, Faculty of Medicine, Lampung University, Indonesia

Keywords: Adolescent Girls, Immunonutrition, Media, Knowledge, Peers.

Abstract: The purpose of this study was to determine the influence of knowledge, peers, and social media on the

immunonutrition intake of adolescent girls. This research is an analytic observational study using a cross

sectional design. The study was conducted at the Dinniyah Putri School in Lampung from August to October

2021. The sample was 82 students of Kulliyatul Mu'alimat El Islamiyah, which were taken using purposive

sampling technique. Data on immunonutrition intake using a 2x24 hour food recall questionnaire, data on

knowledge, peer influence and social media were obtained from interviews using a validated questionnaire.

Data were analyzed using univariate, bivariate (chi-square) and multivariate (logistical regression). The

results showed that inadequate immunonutrition intake was 73.2%. Most of the adolescent girls have good

knowledge (58.5%), no peer influence (56.1%), and no social media influence (52.4%). The results showed

that knowledge (p=0.019), peers (p=0.037), and social media (p=0.048) had an effect on the immunonutrition

intake of adolescent girls. The most influential factors on the immunonutrition intake of adolescent girls are

knowledge and social media.

1 INTRODUCTION

The World Health Organization (WHO) revealed that

the outbreak due to the COVID-19 virus was

designated a global pandemic on March 11, 2020.

This status was declared after there was a thirteen-

fold increase in positive cases outside China in 114

countries with the death toll at that time reaching

4,291 (Valerisha & Putra, 2020). Positive confirmed

cases of Covid 19 in Indonesia continue to increase.

Data on June 29, 2021, the number of positive

confirmed cases in Indonesia reached 2,156,465

cases, 1,869,606 cases recovered, and 58,024 cases

died. Meanwhile, the 10 provinces in Indonesia with

the highest confirmed cases are: East Java, DKI

Jakarta, South Sulawesi, Central Java, West Java,

South Kalimantan, South Sumatra, Papua, North

Sumatra and Banten (Kemenkes RI, 2021).

Maintaining a healthy diet is especially important

during the Covid 19 Pandemic. While no food or

dietary supplement can prevent COVID 19 infection,

maintaining a healthy balanced nutritional diet is

essential in promoting a good immune system and

lowering the risk of chronic disease and infection.

Things that can be done to increase endurance are:

eating balanced nutritious food, washing hands with

running water and soap, and exercising regularly

(Kemenkes RI, 2020).

Optimal nutritional status ensures the main

modulation of oxidative and inflammatory stress,

both of which are related to the immune system. In

fact, several nutrients and their metabolism are direct

regulators of gene expression in the immune

compartment and are involved in the maturation,

differentiation, and response of immune cells.

Basically, proper nutrition will form a state of the

immune system that can face any kind of

confrontation. Conversely, poor nutrition will make

the immune system unable to respond well (Di Renzo

et al., 2020). Specific nutrients that can modulate the

immune system are also called immunonutrients, to

maintain optimal immune system we need to increase

the consumption of these immunonutrient foods such

as foods containing vitamins A, C, E and zinc

(Angraini & Ayu, 2015).

Protein is very important in the body because it

plays a role in the formation of cells and body tissues,

repairing damaged cells and maintaining muscle

Angraini, D., Sari, M., Carolia, N. and Saftarina, F.

The Inﬂuence of Knowledge, Peers and Social Media on Immunonutrition Intake of Adolescent Girls in the New Normal Era.

DOI: 10.5220/0011644900003608

In Proceedings of the 4th International Conference on Social Determinants of Health (ICSDH 2022), pages 60-64

ISBN: 978-989-758-621-7; ISSN: 2975-8297

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

tissue (Tirtawinata, 2006). Protein is absorbed by the

body in the form of amino acids. Arginine and

glutamine are forms of amino acids that are more

effective in maintaining immune function and

reducing post-surgical infections (Fatmah, 2006).

Vitamin C has an important role in the formation

of collagen so it is needed to maintain the integrity of

blood vessels. Vitamin C is a powerful water-soluble

antioxidant, so it is spread throughout the body.

Vitamin C is very potent to scavenge free radicals,

and sometimes works together with vitamin E

(Hartono, 2006). Vitamin C increases interferon

levels and immune cell activity in the elderly,

increases lymphocyte and macrophage activity, and

improves leukocyte migration and mobility from viral

infections, such as the influenza virus (Fatmah,

2006), such as the corona virus that is currently

engulfing the world as a global pandemic.

Dietary behavior in adolescents, including the

behavior of immunonutrition intake is influenced by

many factors including knowledge, the influence of

social media, peers, family and others. According to

the perception of diet is influenced by knowledge of

nutrition and knowledge of the diet itself. The level

of knowledge affects a person's attitude. Another

influencing factor is self-esteem. Knowledge of diet

also turns out to have a relationship with dietary

behavior (Kumalasari, 2010).

The influence of the mass media, the influence of

family and the influence of peers is considered to

directly put pressure on young women, this makes

them dissatisfied with their body shape, causing the

desire to be thin by dieting. The influence of mass

media, the influence of the appearance of figures

appearing in the mass media, and pressure from their

parents make them go on a diet. Friends and family

can also provide information on how to diet. The

influence of friends and family will quickly affect the

behavior of teenagers to go on a diet (Firi, 2018). This

also applies not only to weight loss diets, but also

diets in the intake of immunonutrients, which are

currently needed to increase the body's immunity in

the face of viral, bacterial and other attacks.

Research on immunonutrition intake in adolescent

girls, especially in Indonesia, has not been widely

carried out. More research on children, obese

patients, infectious patients and not about the

immunonutrition intake. Whereas adolescents,

especially adolescent girls, are a group that is very

vulnerable to suffering from infectious diseases and

lacks in meeting immunonutrients. Immunonutrition

dietary behavior in adolescents is strongly influenced

by knowledge, social media and peers. This research

is important because it can be used as a basis for

activities to improve the health of adolescent girls, as

prospective mothers, which will indirectly improve

the health of mothers and children. The purpose of

this study was to determine the effect of knowledge,

peers and social media on dietary behavior, especially

related to immunonutrition intake in adolescent girls

in the new normal era.

2 SUBJECT AND METHOD

This research is an observational analytic study with

a cross-sectional research design. The study was

conducted at the Dinniyah Putri School in Pesawaran

district from August to October 2021. The population

in this study were students at the Dinniyah Putri

School in Pesawaran district. Based on the results of

the sample calculation, the minimum number of

samples that must be met is 82 people, which students

of Kulliyatul Mu'alimat El Islamiyah Dinniyah Putri

School in Pesawaran district. The sample size

calculation uses the sample size formula for unpaired

categorical comparative analytics with a 95%

confidence value, the power of the test is 80%.

Sampling was done by the purposive sampling

method. The inclusion criteria for this research

sample were adolescent girl students aged 16-18

years and willing to participate in the research

process. The exclusion criteria for this study were

adolescent girls with chronic infectious disease,

suffering from covid-19 and currently on a weight

loss diet program.

The independent variables in this study were

knowledge, peers and social media. The dependent

variable in this study is immunonutrition intake.

Immunonutrition intake (protein and vitamin C) data

was measured using a 2x24h food recall questionnaire

in weekday dan weekend, to assess consumption of

protein and vitamin C in grams/day, then compared

with the recommended nutritional adequacy rate

(RDA) so that the nutritional adequacy level is

obtained. data on knowledge, peer influence and

social media were obtained from interviews using a

validated questionnaire. Data collection was carried

out by researchers with the help of 2 enumerators who

had been given previous guidance and training. The

data was analyzed with a significant degree of 95%

(p<0.05) univariate, bivariate with chi-square test,

and multivariate logistic regression. This research

was carried out after obtaining a research ethical

clearance letter from the Ethics Committee of the

Faculty of Medicine, the University of Lampung with

number 228/UN26.18/PP.05.02.00/2021.

The Inﬂuence of Knowledge, Peers and Social Media on Immunonutrition Intake of Adolescent Girls in the New Normal Era

3 RESULTS

The results showed that inadequate immunonutrition

intake in adolescent girls was 60 people (73,2%) and

adequate immunonutrition intake was 22 people

(26,8%), poor knowledge was 34 people (41,5) and

good knowledge was 48 people (58,5%), have peers

influence was 36 people (43,9%) and no peers

influence was 46 people (56,1%), and have social

media influence was 39 people (47,6%) and no social

media influence was 43 people (52,4%).

Table 1: Characteristic of Study Subject.

Variable n %

Immunonutriton Intake

a. Inadequate

. Ade

uate

73,2

26,8

Knowledge

a. Poor

. Goo

41,5

58,5

Peers Influence

a. Yes

. No

43,9

56,1

Social Media Influence

a. Yes

. No

47,6

52,4

The results of cross-tabulation as shown in table 2, the

adolescent girls with poor knowledge and inadequate

immunonutrition intake, were 88,2% higher than

those with good knowledge and inadequate

immunonutrition intake, which was 62,5%. The

results showed that knowledge influence

immunonutrition intake of adolescent girls (p =

0,019) and poor knowledge was a risk factor for

inadequate immunonutrition intake in adolescent

girls with OR = 4,5 (95% CI; 1,36-14,87), which

means the adolescent girls with poor knowledge are

4,5 times more likely to have inadequate

immunonutrition intake than those with good

knowledge.

The results of cross-tabulation as shown in table 2,

the adolescent girls with peer’s influence and

inadequate immunonutrition intake, were 86,1%

higher than those with no peers influence and

inadequate immunonutrition intake, which was 63%.

The results showed that peers influence

immunonutrition intake of adolescent girls (p =

0,037) and peers influence was a risk factor for

inadequate immunonutrition intake in adolescent

girls with OR = 3,6 (95% CI; 1,18-11,12), which

means the adolescent girls who have peers influence

are 3,6 times more likely to have inadequate

immunonutrition intake than those with no peers

influence.

The results of cross-tabulation as shown in table 2,

the adolescent girls with social media influence and

inadequate immunonutrition intake, were 84,6%

higher than those with no social media influence and

inadequate immunonutrition intake, which was

62,8%. The results showed that social media

influence immunonutrition intake of adolescent girls

(p = 0,048) and social media influence was a risk

factor for inadequate immunonutrition intake in

adolescent girls with OR = 3,2 (95% CI; 1,12-9,47),

which means the adolescent girls who have social

media influence are 3,2 times more likely to have

inadequate immunonutrition intake than those with

no social media influence.

Table 2: The Influence of Knowledge, Peers and Social

Media on Immunonutrition Intake of Adolescent Girls.

Variable

Immunonutrition Intake

p OR

95%

Inadequate Adequate

n % n %

Knowledge

a. Poor

. Good

88,2

62,5

11,8

37,5

0,019 4,5

1,36-

14,87

Peers

Influence

a. Yes

. No

86,1

13,9

0,037 3,6

1,18-

11,12

Social Media

Influence

a. Yes

. No

84,6

62,8

15,4

37,2

0,048 3,2

1,12-

9,47

Based on the results of the bivariate analysis using

the chi-square test, the independent variables were

determined as candidates in the multivariate analysis;

is the variable with p-value <0,25. The candidate

variables included in the multivariate analysis were

knowledge, peers influence and social media

influence.The results of the multivariate analysis

using binary logistic regression with the backward

stepwise method as shown in table 3 found that the

factors that most contributed to the nutritional status

of pregnant women were knowledge and social media.

The null hypothesis in the Hosmer and Lemeshow

test has a p-value of 0.998 so that the null hypothesis

is accepted. This means that there is no difference

between the observed value and the expected

value/expectation so that it can be concluded that the

obtained equation is well-calibrated (Dahlan, 2012).

ICSDH 2022 - The International Conference on Social Determinants of Health

Table 3: Initial Model and Final Model of Binary Logistic

Regression Analysis of Factors Contribute to the

Immunonutrition Intake of Adolescent Girls.

OR 95% CI

Initial Model

a. Knowledge

b. Peers

c. Social Media

Constant

1,744

1,145

1,500

-8,154

0,008

0,062

0,013

7,4

8,6

1,21-46,31

1,47-50,21

1,12-32,75

Final Model

a. Knowledge

b. Social Media

Constant

1,887

1,593

-6,685

0,004

0,074

6,6

4,9

1,86-62,05

2,14-60,86

Based on the results of the analysis obtained the

following equation:

Inadequate Immunonutrition Intake in Adolescent

Girls = -6,685 + (1,887*knowledge) + (1,593*social

media influence)

4 DISCUSSIONS

This study shows adolescent girls in Pesawaran

District, Lampung Province, have inadequate

immunonutrition intake as many as 60 people

(73,2%). Low intake of immunonutrients risks

lowering the immune system. Low immunity will

cause the body to be susceptible to disease, especially

in the new normal era. Adequate intake of

immunonutrition is believed to be able to modulate

the immune system and improve inflammatory

processes that occur due to exposure to viruses,

bacteria, etc (Derbyshire & Delange, 2020).

The results of the study show that knowledge

affect the intake of immunonutrition. Good

nutritional knowledge will enable adolescent girls to

be able to choose good food and form healthy eating

behaviors so that they have adequate

immunonutrition intake (Naeeni et al., 2014).

Respondents poor of knowledge because they

generally do not know and do not understand well

about the importance of immunonutrition intake, lack

of information seeking in mass media or electronic

media, and have never been given health education on

immunonutrition.

The results of the study show that peers affect the

intake of immunonutrition. Peers can influence

dietary behavior and intake of immunonutrition in

adolescent girls. Peers play an important role in the

formation of adolescent self-concept. The influence

of peers is high because most of the adolescent girls

time is spent at school or other places with friends, so

that peers can change good and healthy behaviors and

habits related to healthy eating behaviors such as

immunonutrition intake (Chung et al., 2021).

The results of the study show that social media

affect the intake of immunonutrition. Adolescents

with an average age of 13 years are actively using

social media, 75% of girls and 70% of boys claim to

have at least one social media account. Social media

is influential in providing new knowledge about

everything related to human welfare in life (Kennedy,

2019). Knowledge spread by social media includes

knowledge on how to maintain a healthy body,

prevent disease, and eat well. Through social media,

adolescent girls know how to maintain a healthy

body, prevent disease (Chau et al., 2018), including

the importance of immunonutrition intake in the new

normal era.

Among female adolescents, the duration of

exposure to food and beverage content from social

media was associated with food selection after

controlling for body image. Food selection was

associated with energy and protein intake. Thus, the

duration of exposure to social media was associated

with energy and protein intake. The longer duration

of social media exposure on food and beverage

content led to higher energy and protein intake

(Adiba, 2020).

Social media plays both positive and negative

effects on health of adolescents. It is a fact that social

media is very benecial as it keeps us in contact with

everyone all over the world and provides us with the

latest information but everything has its draw backs

too and the most common drawback is that youth has

decreased spending time and enjoying healthy meals

with their families. They have moved on from these

healthy eating habits and become reserved to their

peer circle that is majorly inuencing their health as

they are more focused towards junk food (Aslam et

al., 2021).

5 CONCLUSIONS

The most influential factors on the immunonutrition

intake of adolescent girls are knowledge and social

media. Social media that contains information on how

to maintain health, prevent disease, and good eating

behavior can increase the knowledge of adolescent

girls to choose good food and form healthy eating

behaviors such as having adequate immunonutritio

intake.

The Inﬂuence of Knowledge, Peers and Social Media on Immunonutrition Intake of Adolescent Girls in the New Normal Era

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ICSDH 2022 - The International Conference on Social Determinants of Health