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Climate change adversely affects adolescent health through extreme outdoor heat, causing dehydration, cognitive impairment, chronic health risks, and potentially fatal heat stroke. Adolescents' high levels of physical activity and limited awareness about the impacts of extreme outdoor heat exacerbate these risks, highlighting the need for effective adaptation strategies. However, comprehensive studies on the physical and mental effects of heat exposure, adaptation practices adopted by adolescents, psychological determinants, microclimatic perceptions, and ambient-natural conditions remain limited. This study examined outdoor heat exposure in adolescents in urban areas, focusing on Yogyakarta City, Indonesia. We combined the Social-Ecological Model and the RANAS psychological theories in the analysis. Interviews with 439 adolescents revealed mild physical and mental symptoms due to outdoor heat exposure and low engagement in heat adaptation practices. Nearly half perceived a high likelihood of experiencing health problems when exposed to heat outdoors and had good knowledge about heat exposure. However, these two factors on risk perception and knowledge were not sufficient to spur respondents to adopt adaptation practices. Young women were more likely than young men to adopt heat adaptation practices, driven by higher psychological levels towards adaptation practices. The most influential variables on adaptation practices were having experienced the physical impacts of heat exposure, followed by having experienced the mental impacts, and perceptions about ambient sunlight. Among all psychological factors, self-regulation 'remembering' was significantly associated with adopting adaptation practices. This study provides key insights into developing adaptation strategies to improve climate adaptation behavior in urban adolescents.