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Yet, adolescent development research in rural areas of low\u2010resource communities is severely lacking. Conceptualized in the Adolescent Well\u2010Being Framework, where diet and activity form a core domain of well\u2010being, we examined two modifiable risk behaviors (sugar\u2010sweetened beverage consumption and physical activity) and their associations with mental health and substance use problems among 1351 adolescents aged 10\u201317\u2009years (51% girls) in a rural setting in Lesotho, southern Africa. Standardized screening measures showed at least one clinically relevant mental health problem among 3% of the overall sample and 5% among 15\u201317\u2009year\u2010olds. Among those in the overall sample meeting these criteria, 45% recognized a need for help, yet only 17% obtained any care, leaving an 83% treatment gap. After adjusting for age and sex, any sugar\u2010sweetened beverage consumption was associated with having at least one mental health symptom or recent substance use and with clinically relevant mental health and substance use problems. Physical activity showed no significant associations. Although the overall prevalence of clinically relevant mental health and substance use problems was relatively low, low levels of problem awareness suggest a need for adolescent\u2010appropriate demand\u2010side interventions for early treatment. Future research may explore possible indigenous protective factors underlying the low prevalence and clarify the pathway between health behaviors and mental health problems.<\/jats:p>","DOI":"10.1111\/jora.70062","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T07:15:09Z","timestamp":1756192509000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mental health and substance use problems among adolescents in Lesotho: Prevalence, access to care, and association with lifestyle factors"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8379-1183","authenticated-orcid":false,"given":"Natalie E.","family":"Johnson","sequence":"first","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Clinical Research University Hospital Basel  Basel Switzerland"},{"name":"University of Basel  Basel 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