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OBJECTIVES: To explore the potential for bouillon as a micronutrient fortification vehicle in northern Ghana, we assessed market availability, household purchase and consumption of bouillon products, and perceptions of bouillon and salt. METHODS: We selected 28 clusters in the Tolon and Kumbungu districts of the Northern region of Ghana (7 urban, 4 semi-urban, and 3 rural clusters per district). Among 369 randomly selected households, women of reproductive age (15–49 y; WRA) were interviewed about household bouillon purchasing habits, its use in food preparation, and perceptions about the positive/negative effects of bouillon consumption. Twenty focus groups of 5–6 participants each were held in 11 clusters (10 WRA, 5 men, 5 women > 49y). We also assessed availability of bouillon products for sale from vendors in clusters (n = 11) and major markets (n = 4). RESULTS: In the survey, almost all (99%) respondents had ever cooked with bouillon, and 77% reported typically cooking with bouillon at least twice per day. Seven brands and three flavors of bouillon products were for sale. Most households (87%) reported consuming shrimp flavor without other spice most frequently. On average, households purchased bouillon cubes weekly, most from open markets (74%) or kiosks (22%). Most common reasons for bouillon use included taste (98%) and family preference (46%). Economic access was also important: 59% reported purchasing less bouillon or switching bouillon brands (28%) or flavors (11%) when they had less money available. About two-thirds of respondents perceived having bouillon in a person's diet was “good” (vs 43% for salt); reasons provided included: “gives more energy” (43%) and “makes you stronger” (41%). Among the 18% of respondents who perceived having bouillon in a person's diet was “bad”, reasons included: stomach upset (63%) and high blood pressure (39%). High blood pressure (85%) was the most common concern among the 32% perceiving salt as “bad”. Focus groups revealed seasonal variation in quantity of bouillon used. CONCLUSIONS: Bouillon consumption is common and frequent in northern Ghana, indicating good potential as a micronutrient fortification vehicle. Understanding perceptions of bouillon by different household members will inform research and program messaging. FUNDING SOURCES: Funded by a grant to the University of California, Davis from Helen Keller International.

OBJECTIVES: Considering the known metabolic relationships between adiposity, inflammation, and iron status, we examined whether inflammation mediates the relationship between BMI and serum ferritin (SF) concentration among women of reproductive age (15–49 years) with normal to high BMI in a low-income country (Malawi) and an upper-middle income country (Azerbaijan). METHODS: Cross-sectional survey data were analyzed from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Women with underweight (BMI 5 μg/L or α-1-acid glycoprotein [AGP] >1 g/L), and iron deficiency (inflammation-adjusted SF

Background Use of repeated exposure in fostering development of food preferences has been examined; however, other techniques such as adult verbal communication have not. Child centered nutrition phrases (CCNP) have been developed, but the efficacy of adults’ use of these developmentally appropriate, nutritionally sound messages to improve children’s intake and liking of lentils has not been evaluated. Objective To determine whether repeated taste exposure (RE) and RE + CCNP would increase young children’s liking and intake of lentils. Methods Children (3–6 y; n = 29) were offered lentils on 14 occasions (baseline, 12 exposures, and post). Taste preference and consumption were recorded and lentil consumption was measured to the nearest 0.1 g. A generalized linear model was used to assess the potential group (RE or RE + CCNP) by exposure interaction on the proportional intake (weight eaten divided by weight offered). A subsequent logistic regression analysis was carried out to estimate the change in the odds of children reporting liking in the RE + CCNP group compared to the RE group. Results Children’s consumption and liking of lentils increased with repeated exposure. Children exposed to CCNPs consumed a greater amount of lentils, although it was not statistically significant; however their reported liking at the beginning (p = 0.04) and intermediate (p = 0.02) time periods was more frequent than children who did not receive CCNP. Conclusions Repeated taste exposure resulted in increased liking and intake of lentils in young children, and the use of CCNP may facilitate children’s liking and intake of certain foods.

ObjectiveTo examine the nutrition and young child feeding (YCF) education and training of nurses in public health clinics of Ghana’s Komenda-Edina-Eguafo-Abrem region (KEEA) in relation to global health guidelines, and how nurses served as educators for caregivers with children aged 0–5 years.DesignA qualitative study of semi-structured one-on-one and group interviews (n21) following a questionnaire of closed- and open-ended questions addressing child feeding, nutrition and global health recommendations. Interviews were conducted in English, audio-recorded, transcribed and coded. Descriptive data were tabulated. Content analysis identified themes from open-ended questions.SettingKEEA public health clinics (n12).SubjectsNurses (n41) purposefully recruited from KEEA clinics.ResultsA model capturing nurses’ nutrition and YCF education emerged with five major themes: (i) adequacy of nurses’ basic knowledge in breast-feeding, complementary feeding, iron-deficiency anaemia, YCF and hygiene; (ii) nurses’ delivery of nutrition and YCF information; (iii) nurses’ evaluation of children’s health status to measure education effectiveness; (iv) nurses’ perceived barriers of caregivers’ ability to implement nutrition and YCF education; and (v) a gap in global health recommendations on YCF practices for children aged 2–5 years.ConclusionsNurses demonstrated adequate nutrition and YCF knowledge, but reported a lack of in-depth nutrition knowledge and YCF education for children 2–5 years of age, specifically education and knowledge of YCF beyond complementary feeding. To optimize child health outcomes, a greater depth of nutrition and YCF education is needed in international health guidelines.

OBJECTIVES: To assess the prevalence and frequency of consumption of vegetables, fruits, sugar sweetened beverages (SSBs), salty and sweet snacks and the relationship between consumption and household characteristics (residence location, food insecurity, and socioeconomic status [SES]) among children 2–5 years of age in two districts in the Northern region of Ghana. METHODS: Households were recruited from 14 urban, 8 semi-urban and 6 rural clusters in the Tolon and Kumbungu districts in Northern Ghana. Primary caregivers of children 2–5 years (n = 242) reported the number of days in a typical week selected food items were consumed, and the number of servings per day. Household characteristics, food insecurity (USAID Household Food Insecurity Access Scale) and SES, were assessed via questionnaires administered to the head of household. We examined the relationships between consumption of each food and 1) residence (urban vs. semi-urban/rural), 2) household food insecurity (moderate/severe vs. none/mild) and 3) household SES (lowest quartile vs. other quartiles). RESULTS: The proportion of children who consumed each food in a typical week was: 98% vegetables, 81% sweet snacks, and 75% fruits; approximately half of children consumed salty snacks (51%) or SSBs (46%). Mean (SD) servings consumed in a typical week were: 7.85 (7.32) vegetables, 2.82 (2.51) sweet snacks, 2.54 (3.69) SSBs, 1.77 (1.70) fruits, and 1.17 (1.67) salty snacks. Consumption of fruits (82% vs 68%, p = 0.01) and sweet snacks (91% vs 71%, p

OBJECTIVES: Our aim was to develop a 24-hour recall program using open-source language that can be readily adapted for use on multiple platforms and in different settings. METHODS: We developed the Open Dietary Recall System (OpenDRS), a multi-pass, 24-hour recall survey using the XLSForm programming language. XLSForm operates in Microsoft Excel and is used by several free or subscription-based electronic survey platforms that deploy forms via Android devices or online. The first pass collects a brief list of foods consumed, the second pass collects descriptive details and added ingredients for each food, and the third pass collects portion size estimates. The final pass reviews the recorded data with the option to edit or add foods. The program references external food and ingredient lists in .csv format. These food and ingredient lists are customizable for each survey setting, can be coded to match nutrient composition or recipe tables, and can be amended over the course of a study. Questions or response options can be added or edited to fit study-specific data collection methods. Photos can be incorporated for food identification or portion size estimation. Two case studies from adaptations in Malawi and Haiti will be presented. RESULTS: OpenDRS was used to collect 24-hour dietary intake data among 6- to 15-month-old children in Malawi, for a randomized, controlled complementary feeding trial. The median number of foods reported was 6, and the median survey duration was 9 minutes. For a national nutrition survey of 6- to 59-month-old children and their caregivers in Haiti, the program was expanded to record recipe data and to capture caregiver and child intakes in one electronic survey form. Recipes reported during the caregiver's recall can be linked to the child's recall if both consumed the same mixed dish. CONCLUSIONS: OpenDRS is an open-source 24-hour recall program which has been used in low- and middle-income countries. The XLSForm program for data collection and Stata code for data formatting will be made available to researchers conducting nutrition surveys via the Open Science Framework. FUNDING SOURCES: The Bill & Melinda Gates Foundation and GAIN.

OBJECTIVES: The double burden of malnutrition (DBM) has received increased attention in research and policy arenas, with wide variation in how DBM is defined. We aimed to systematically identify current operational definitions for DBM (e.g., the coexistence of overnutrition and undernutrition) used in research and evaluate their frequency of use and implications for nutrition surveillance and programs. METHODS: We conducted a structured search for peer-reviewed articles published up to July 2017, using terms describing overnutrition (e.g., overweight, obesity) and undernutrition (e.g., stunting, anemia) in PubMed and Scopus. Additional references were added through snowball searches and online searches for gray literature. We included studies that reported DBM prevalence, including those with primary or secondary data analyses (see Figure 1). Screening of abstracts and full texts for inclusion was conducted in duplicate, with discrepancies resolved by discussion and consensus. Information extracted included the level of DBM assessment (population, household, or individual), measures of overnutrition and undernutrition (BMI, waist circumference, micronutrient status, etc.), and stated definitions of DBM. RESULTS: We identified 1920 titles and abstracts for screening through the structured search, and added an additional 66 papers and reports. Of these, 500 full-texts were reviewed and 239 were eligible for data extraction. Frequently-occurring DBM definitions included the coexistence of: 1) overweight/obesity and underweight within a population (e.g., entire country or region); 2) adult overweight/obesity and child stunting within a population or household; and 3) overweight/obesity and anemia or iron deficiency within an individual. DBM was most frequently measured at the population level, followed by the individual and household levels. CONCLUSIONS: The most common operational definitions of DBM relied on population-level analyses of anthropometric indicators, with many studies leveraging existing data, such as national health surveys. Further research exploring DBM definitions in relation to key health outcomes and country priorities may help select indicators that best inform public health program and policy development. FUNDING SOURCES: This work was supported by the USDA National Institute of Food and Agriculture Hatch Project. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

Graduation rates from drug courts are impressive and are often attributed to the delivered treatments. However, it is unclear whether graduation rates are bolstered by low severity of drug use problems upon entry into drug court. To address this question, this study examined the relationship between baseline substance use severity and graduation rates among 251 drug court clients. Results revealed that participants with subthreshold drug composite scores on the Addiction Severity Index (ASI) were significantly more likely to graduate than those scoring in the mild-to-moderate or severe range. Furthermore, results revealed that participants who provided a drug-negative baseline urine were significantly more likely to graduate than those who provided a drug-positive baseline urine. A binary logistic regression analysis revealed that ASI drug composite score, urine screen, race, and years educated were statistically significant predictors of drug court graduation.

Mental health courts are specialized courts that offer an alternative to standard prosecution for criminal offenders who have mental health problems. The goal of mental health courts is to prevent the incarceration of offenders with mental health problems by linking eligible offenders with community-based mental health and substance use treatment services. Program participation is monitored through judicial status hearings, and sanctions and rewards are used to increase compliance with program requirements. Upon completion of the mental health program, offenders typically receive reduced sentencing or their charges may be dropped. Although eligibility requirements and court operations vary across jurisdictions, research suggests that mental health courts increase access to and provision of behavioral health services and reduce recidivism rates in a cost-effective manner. There are nearly 200 mental health courts in the United States, with many more in the planning stages. Keywords: mental health; criminal justice; recidivism