Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Nicola Hawley


Obesity and overweight prevalence in American Samoan adults are among the highest in the world, and levels are also high and increasing in children and infants. Obesity levels are believed to be due ultimately to the dramatic changes in lifestyle and diet over the past half century. A shift away from breastfeeding and to early introduction of formula and solid foods feeding is a dietary habit effected in this change, and can potentially influence a child's future body size and other health outcomes. As decisions about infant feeding are associated with certain maternal demographics in other populations, this study specifically looked at how American Samoan mothers' biological and socio-demographic characteristics influenced how they fed their child and their child's BMI in American Samoa. 160 mothers of infants 0-12 months were recruited at the Tafuna Health Center Well Baby Clinic for this cross sectional study. Investigator-administered surveys collected information on maternal characteristics, their child's feeding behaviors, and their child's size. Most mothers in the sample stopped exclusively breastfeeding and started formula feeding by the first four weeks of the child's life. Single mothers compared to mothers with a partner, unemployed compared to employed mothers, and overweight compared to normal weight or obese mothers were more likely to have a longer duration of exclusive breastfeeding. Years of education and parity were also positively associated with duration of exclusive breastfeeding. Single mothers compared to mothers with a partner, overweight mothers compared to normal or obese mothers, and mothers with more years of education compared to those with less than a high school education were also more likely to introduce formula later in the child's life. There was no relationship between duration of exclusive breastfeeding, duration of any breastfeeding, initiation of formula or initiation of solid foods and the infant's body size. While future interventions targeting infant feeding can be aimed towards these maternal groups, general early cessation of exclusive breastfeeding and early introduction of formula in this sample show that universal maternal education efforts may be the key to changing infant feeding practices in American Samoa.


This is an Open Access Thesis.

Open Access

This Article is Open Access