{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:37:31Z","timestamp":1787027851857,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: In 2022, 2.2 million adolescents were diagnosed with substance use disorders, including 265,000 with opioid use disorder. The National Survey on Drug Use and Health revealed that 130,000 adolescents misused prescription pain medications, often obtaining them from friends or relatives. This age group perceives weekly heroin use as less risky than those younger or older. Methods: A questionnaire was developed for 7th to 12th graders in a rural Texas school district as part of a fentanyl awareness curriculum.\u00a0The questionnaire included Likert scale, multiple choice, and yes\/no questions. The participants were categorized into younger (grades 7th and 8th) and older students (grades 9th through 12th), and associations were explored between demographic characteristics, responses, and grade groups using chi-square tests. To assess confidence, behavior, and the impact of education, we used chi-square and Fisher\u2019s exact tests. Results: The participants (n = 94; 85.11%) identified as Hispanic or Latino, with a smaller percentage identifying as White or more than one race. An association was found between feeling more in control of actions related to substances and fentanyl (p-value = 0.04) after receiving education. No association was found between education and confidence in identifying fentanyl. Conclusions: This study aligns with a surge in fentanyl-related overdose deaths in a high-intensity drug trafficking region. Recent fentanyl overdoses among school-age children prompted legislative changes in 2023, making this study valuable for understanding the epidemic within the geographical context. These results suggest that school-based education may play a role in strengthening adolescents\u2019 behavioral intentions to fentanyl exposure, though additional efforts are needed to improve risk identification.<\/jats:p>","DOI":"10.3390\/children12060794","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T11:53:14Z","timestamp":1750161194000},"page":"794","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Education Improves Perceived Control but Not Risk Identification in Adolescents Regarding Fentanyl"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9201-962X","authenticated-orcid":false,"given":"Christine","family":"Bakos-Block","sequence":"first","affiliation":[{"name":"Center for Behavioral Emergency and Addiction Research, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7914-0070","authenticated-orcid":false,"given":"Francine R.","family":"Vega","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Texas, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1834-3696","authenticated-orcid":false,"given":"Marylou","family":"Cardenas-Turanzas","sequence":"additional","affiliation":[{"name":"Center for Behavioral Emergency and Addiction Research, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0318-0807","authenticated-orcid":false,"given":"Bhanumathi","family":"Gopal","sequence":"additional","affiliation":[{"name":"Center for Behavioral Emergency and Addiction Research, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4186-9648","authenticated-orcid":false,"given":"Tiffany","family":"Champagne-Langabeer","sequence":"additional","affiliation":[{"name":"Center for Behavioral Emergency and Addiction Research, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"ref_1","unstructured":"SAMHSA (2024, May 24). Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58, Issue). S.A.a.M.H.S. Administration, Available online: https:\/\/library.samhsa.gov\/product\/results-2022-national-survey-drug-use-and-health-nsduh-key-substance-use-and-mental-health."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Champagne-Langabeer, T., Cardenas-Turanzas, M., Ugalde, I.T., Bakos-Block, C., Stotts, A.L., Cleveland, L., Shoptaw, S., and Langabeer, J.R. (2022). The Impact of Pediatric Opioid-Related Visits on U.S. Emergency Departments. Children, 9.","DOI":"10.3390\/children9040524"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e20162887","DOI":"10.1542\/peds.2016-2887","article-title":"Overdose Risk in Young Children of Women Prescribed Opioids","volume":"139","author":"Finkelstein","year":"2017","journal-title":"Pediatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e186558","DOI":"10.1001\/jamanetworkopen.2018.6558","article-title":"US National Trends in Pediatric Deaths from Prescription and Illicit Opioids, 1999\u20132016","volume":"1","author":"Gaither","year":"2018","journal-title":"JAMA Netw. Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.15585\/mmwr.mm7150a2","article-title":"Drug Overdose Deaths Among Persons Aged 10\u201319 Years\u2014United States, July 2019-December 2021","volume":"71","author":"Tanz","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_6","unstructured":"NIDA (2023). Reported Drug Use Among Adolescents Continued to Hold Below Pre-Pandemic Levels in 2023, NIDA."},{"key":"ref_7","unstructured":"Miech, R.A., Johnston, L.D., Patrick, M.E., O\u2019Malley, P.M., Bachman, J.G., and Shulenberg, J.E. (2023). Monitoring the Future National Survey Results on Drug Use 1975\u20132022: Secondary School Students, T. U. o. M. Institute for Social Research. (Monitoring the Future Monograph Series, Issue)."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/HTR.0000000000000706","article-title":"Prescription Opioid Misuse and Sports-Related Concussion Among High School Students in the United States","volume":"36","author":"Tham","year":"2021","journal-title":"J. Head. Trauma. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e191750","DOI":"10.1001\/jamapediatrics.2019.1750","article-title":"Association of Nonmedical Prescription Opioid Use with Subsequent Heroin Use Initiation in Adolescents","volume":"173","author":"Cho","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e1169","DOI":"10.1542\/peds.2015-1364","article-title":"Prescription Opioids in Adolescence and Future Opioid Misuse","volume":"136","author":"Miech","year":"2015","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"110819","DOI":"10.1016\/j.drugalcdep.2023.110819","article-title":"Fentanyl, Heroin, and Methamphetamine-Based Counterfeit Pills Sold at Tourist-Oriented Pharmacies in Mexico: An Ethnographic and Drug Checking Study","volume":"249","author":"Friedman","year":"2023","journal-title":"Drug Alcohol Depend."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1001\/jama.2022.2847","article-title":"Trends in Drug Overdose Deaths Among US Adolescents, January 2010 to June 2021","volume":"327","author":"Friedman","year":"2022","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"109398","DOI":"10.1016\/j.drugalcdep.2022.109398","article-title":"Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021","volume":"234","author":"Palamar","year":"2022","journal-title":"Drug Alcohol Depend."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1542\/peds.2016-2387","article-title":"Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976\u20132015","volume":"139","author":"McCabe","year":"2017","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1001\/jamapsychiatry.2015.2132","article-title":"Epidemiology of DSM-5 Drug Use Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III","volume":"73","author":"Grant","year":"2016","journal-title":"JAMA Psychiatry"},{"key":"ref_16","unstructured":"(2024, May 24). Tucker\u2019s Law, Texas Legislature, House Bill 3908, 88th Legislature, Available online: https:\/\/capitol.texas.gov\/tlodocs\/88R\/billtext\/pdf\/HB03908H.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1080\/08870446.2011.613995","article-title":"The theory of planned behaviour: Reactions and reflections","volume":"26","author":"Ajzen","year":"2011","journal-title":"Psychol. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/17437199.2014.947547","article-title":"How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis","volume":"10","author":"Cooke","year":"2016","journal-title":"Health Psychol. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kariisa, M., O\u2019Donnell, J., Kumar, S., Mattson, C.L., and Goldberger, B.A. (2024, May 15). Illicitly Manufactured Fentanyl\u2013Involved Overdose Deaths with Detected Xylazine\u2014United States, January 2019\u2013June 2022 (MMWR Morbidity and Mortality Weekly Report, Issue), Available online: https:\/\/www.cdc.gov\/mmwr\/volumes\/72\/wr\/mm7226a4.htm?s_cid=mm7226a4_w#suggestedcitation.","DOI":"10.15585\/mmwr.mm7226a4"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"949","DOI":"10.15585\/mmwr.mm7235a3","article-title":"Drug Overdose Deaths with Evidence of Counterfeit Pill Use\u2014United States, July 2019-December 2021","volume":"72","author":"Tanz","year":"2023","journal-title":"MMWR. Morb. Mortal. Wkly. Rep."},{"key":"ref_21","unstructured":"Centers for Disease Control and Prevention (2023). State Unintentional Drug Overdose Reporting System (SUDORS), US Department of Health and Human Services, CDC."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1001\/jamapsychiatry.2019.4013","article-title":"Computational Markers of Risky Decision-making for Identification of Temporal Windows of Vulnerability to Opioid Use in a Real-world Clinical Setting","volume":"77","author":"Konova","year":"2020","journal-title":"JAMA Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1111\/1556-4029.15334","article-title":"The impact of fentanyl on DUIDs and traffic fatalities: Blood and oral fluid data","volume":"68","author":"Harper","year":"2023","journal-title":"J. Forensic Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.drugpo.2018.08.005","article-title":"#Drugsforsale: An exploration of the use of social media and encrypted messaging apps to supply and access drugs","volume":"63","author":"Moyle","year":"2019","journal-title":"Int. J. Drug Policy"},{"key":"ref_25","first-page":"487","article-title":"Just Say KNOW: Fentanyl, Fakery & the New Drug Talk","volume":"119","author":"Ternan","year":"2022","journal-title":"Mo. Med."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/6\/794\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:53:51Z","timestamp":1760032431000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/6\/794"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":25,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["children12060794"],"URL":"https:\/\/doi.org\/10.3390\/children12060794","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,17]]}}}