A qualitative exploration of unintentional versus intentional exposure to fentanyl among people who use drugs in Austin, TX.

BACKGROUND: The prevalence of deaths involving synthetic opioids has historically been lower in Texas than most U.S. states but more than quadrupled from January 2020 to January 2022. This paper explores the emergence of fentanyl in a drug supply where black tar heroin predominates, a factor considered protective against fentanyl adulteration, through the perspectives of people who use drugs (PWUD). OBJECTIVES: We describe experiences of unintentional exposure to fentanyl, illustrate how some people identify fentanyl in their supply, and present harm reduction strategies that PWUD use to avoid overdose. METHODS: Thirty rapid assessment interviews were conducted in July 2021 at 2 mobile outreach sites of a harm reduction organization in Austin, Texas. The brief semistructured interviews were designed to assess participant fentanyl exposure experiences. RESULTS: Participants were clients who reported using heroin or fentanyl in the past week and had lived in Texas for at least 6 months. Seventeen participants identified as male, 10 as female, and 3 as nonbinary. Half identified as white; other participants were Latinx (6), black (2), American Indian (1), and mixed race (6). Two-thirds were unhoused or in transitional housing. The drug supply in Texas has evolved; most participants reported that the heroin and other drugs they obtained contain fentanyl. Participants detected differences by observing changes in the physical characteristics of the drug, experiencing unexpected effects, and using fentanyl test strips. Many had been unintentionally exposed to fentanyl and expressed concerns about fentanyl's presence. The presence of fentanyl had negative unintended consequences for participants, including adverse effects and developing a dependence on opioids. CONCLUSION: PWUD in Austin, Texas, report increasing prevalence of unintentional fentanyl exposure, despite the predominance of black tar heroin. Pharmacists can provide crucial supplies and education to safeguard the health of this vulnerable population.

Demographic differences in self-report pubertal status among rural adolescents in the US.

BACKGROUND: While sex and racial/ethnic differences in pubertal development have been noted, most of this research has been in urban areas. AIM: The purpose of this study is to examine demographic differences in pubertal status among a school-based sample of US rural adolescents aged 11-17 (n = 6425). METHODS: Pubertal status was measured using the Pubertal Development Scale (PDS), a self-report scale of secondary sexual characteristics. This study compared pubertal status means by age, sex and race/ethnicity. RESULTS: At all ages, females had a higher mean pubertal status than males. Most racial/ethnic differences were between White and Black youth. Between the ages of 11 and 13, Black youth reported more advanced development than White youth. However, contrary to research with urban samples, this pattern of development reversed in later adolescence and the reversal was more prominent among males than females. Although there were no differences in pubertal status between White and Latino males, White females had higher mean levels of development than Latino females. CONCLUSION: Demographic patterns were both consistent with and different from previous research with urban adolescents, suggesting the need for comparison of demographic patterns of pubertal development in samples that include youth from urban and rural areas.

Presidential youth fitness program implementation: An antecedent to organizational change.

INTRODUCTION: Grounded in organizational change theory, the purpose of this study was to investigate the efficacy of the Presidential Youth Fitness Program (PYFP) and its association with healthy cultures within schools. METHODS: Using a qualitative approach, data were collected through interviews, site visits and artifacts across 374 schools. An explanatory collective case study approach was used to identify key events related to implementation. RESULTS: Pivotal antecedents to organizational change included prolonged, continual PD, direct support of PYFP implementation, and recognition. Further, three key themes of leveling of the playing field, strategically overcoming barriers, and recruiting teacher fitness champions were identified. CONCLUSIONS: Creating a healthy school culture was an unexpected, but feasible outcome stemming from the implementation of the PYFP. A collective effort, led by physical education teachers and fitness champions and embraced by the administration, faculty, and community, is necessary for the school culture to unfreeze from its present status.