Meals, Education, and Gardens for In-School Adolescents: A Cluster Randomized Trial of an Adolescent Nutrition Intervention Package in Tanzania.

PURPOSE: This study aimed to implement and evaluate integrated, school-based nutrition intervention packages for adolescents in Dodoma, Tanzania. METHODS: A cluster randomized controlled trial was conducted among six secondary schools in Dodoma, Tanzania. Two schools received the full-intervention package of school meals, nutrition education, school gardens, and community workshops. Two schools received the partial-intervention package without the school meals component. Two schools served as the controls and did not receive any intervention. The intervention was implemented over one academic year. The analytical sample included 534 adolescents aged 14 to 17 at baseline and 286 parents. Outcomes included nutrition knowledge, food preferences, diet quality, food insecurity, physical activity, growth, and anemia. Linear models were used to estimate mean differences, and logistic regression models were used to estimate odds ratios (ORs). RESULTS: Compared to the control, both the partial (OR: 0.59; 95% confidence interval [CI]: 0.35, 1.00) and full (OR: 0.49; 95% CI: 0.40, 0.59) interventions were associated with lower odds of poor diet quality among adolescents. Among the parents, both the partial (OR: 0.28; 95% CI: 0.20, 0.40) and full (OR: 0.28; 95% CI: 0.13, 0.58) interventions were associated with lower odds of poor diet quality. The partial (OR: 0.29; 95% CI: 0.18, 0.47) and full (OR: 0.47; 95% CI: 0.30, 0.72) interventions were associated with lower odds of adolescent overweight or obesity. DISCUSSION: School-based nutritional intervention packages incorporating multiple actions may improve the diet quality of adolescents and their household members and reduce the double burden of adolescent malnutrition.

Gender Differences in Civil Commitment Hearing Experience for Persons Who Use Opioids.

OBJECTIVES: Civil commitment has increasingly served as a court-based legal intervention for severe opioid use, but little research has examined the civil commitment (CC) hearing process from the perspective of the person who is committed. Despite documented gender differences in opioid use and experiences within the legal system, past research has also not investigated gender differences in perceptions of the CC process for persons who use opioids. METHODS: Participants were 121 persons (43% female) with opioid use who were interviewed upon arrival at the CC facility about their experience of the CC hearing process in Massachusetts. RESULTS: Two thirds of participants were taken to the commitment hearing by police, and 59.5% shared a cell with others while waiting. Overall, the commitment intake process at the courthouse took over 5 hours. Participants spent, on average, less than 15 minutes with their lawyer before the hearing, and a majority of CC hearings lasted less than 15 minutes. Once transferred to a CC facility, opioid withdrawal management began within 4 hours. Compared with women, men reported longer wait times between the hearing and transfer, as well as longer wait times for withdrawal management at the facility ( P < 0.05). Women perceived worse interactions with the judge and greater dissatisfaction with the commitment process compared with men ( P < 0.05). CONCLUSIONS: There were few gender differences in the experience of CC. However, overall, participants reported a lengthy court process and low levels of perceived procedural justice.

Opioid relapse and MOUD outcomes following civil commitment for opioid use.

INTRODUCTION: Opioid use disorder (OUD) continues to present a major public health problem in the United States. Civil commitment for substance use is one mandatory form of treatment for severe opioid use that has become increasingly available in recent years, but empirical data on this approach are lacking. This study examines clinical outcomes of civil commitment in a sample of adults with severe opioid use. METHODS: Participants were 121 persons with opioid use who were interviewed at the point of entry into civil commitment, then followed for 12 weeks after their release. RESULTS: Prior to civil commitment, this sample exhibited serious substance use characteristics (including high rates of illicit opioid use, other substance use, and injection drug use), as well as mental health problems (diagnoses of depression and anxiety disorders). During follow-up, approximately 41 % of the sample reported at least one illicit opioid use day. More than 64 % of the sample reported at least one day of medication for opioid use disorder (MOUD) receipt, and participants were significantly less likely to use illicit opioids on days that they received MOUDs. No participants died during the follow-up period. CONCLUSIONS: In this sample of persons with severe opioid use, clinical outcomes of civil commitment included illicit opioid relapse as well as varying levels of MOUD uptake. Civil commitment may be a viable method for short-term prevention of overdose for a subset of this vulnerable patient population.