Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sarah Lowe

Second Advisor

Nicola Hawley

Abstract

Adolescent mental health is an important public health concern in American Samoa, but limited research has examined how modifiable health behaviors relate to mental health outcomes in this population. This cross-sectional study examined associations of dietary patterns, sugar-sweetened beverage (SSB) consumption, and physical activity with depressive symptoms, anxiety symptoms, and substance use among 449 high school students in American Samoa. Depressive symptoms, anxiety symptoms, substance use, diet, and physical activity were assessed using self-reported survey measures, including the Patient Health Questionnaire-9 for Adolescents (PHQ-9A), Generalized Anxiety Disorder-7 scale (GAD-7), Dietary Screener Questionnaire (DSQ) items, and the Physical Activity Questionnaire for Adolescents (PAQ-A). Multivariable regression models were adjusted for demographic and sociodemographic covariates. High SSB consumption was associated with higher depressive symptom scores, while stronger adherence to a traditional Samoan dietary pattern was associated with lower depression and anxiety scores. Physical activity was not independently associated with depressive symptoms, anxiety symptoms, or substance use after adjustment. Gender was the most consistent correlate across outcomes, with female adolescents reporting higher internalizing symptoms and lower odds of substance use compared with males. These findings suggest that nutrition-related behaviors, particularly SSB consumption and culturally relevant dietary patterns, may be important targets for future adolescent health promotion efforts in American Samoa. Future longitudinal and mixed-methods research is needed to clarify causal pathways and identify culturally appropriate intervention strategies.

Comments

This is an Open Access Thesis.

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