Education Improves Perceived Control but Not Risk Identification in Adolescents Regarding Fentanyl
Abstract
1. Introduction
1.1. Opioid Trends and Overdose Deaths
1.2. Perceptions of Prescription Opioids
1.3. Fentanyl in Polydrug Use
1.4. Policy
1.5. Theoretical Framework
2. Materials and Methods
2.1. Study Overview
2.2. Statistical Analysis
3. Results
3.1. Sociodemographic Characteristics of the Sample
3.2. Knowledge and Attitudes Regarding Fentanyl
3.3. Perceived Risk of Exposure, Norms, and Behavioral Control
3.4. Intentions and Behavior
3.5. Knowledge and Behavior
4. Discussion
4.1. Perceived Risk of Fentanyl Overdose
4.2. Perception of Confidence in the Ability to Control Behavior
5. Conclusions
5.1. Summary of Findings
5.2. Limitations and Strengths
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
DOAJ | Directory of open access journals |
SUD | Substance use disorder |
CDC | Centers for Disease Control |
SUDORS | State Unintentional Drug Overdose Reporting System |
Appendix A
Appendix A.1. Fentanyl Education and Awareness, Questions Based on the Theory of Planned Behavior (Ajzen, 2011)
References
- SAMHSA. 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. 2023. Available online: https://library.samhsa.gov/product/results-2022-national-survey-drug-use-and-health-nsduh-key-substance-use-and-mental-health (accessed on 24 May 2024).
- Champagne-Langabeer, T.; Cardenas-Turanzas, M.; Ugalde, I.T.; Bakos-Block, C.; Stotts, A.L.; Cleveland, L.; Shoptaw, S.; Langabeer, J.R. The Impact of Pediatric Opioid-Related Visits on U.S. Emergency Departments. Children 2022, 9, 524. [Google Scholar] [CrossRef] [PubMed]
- Finkelstein, Y.; Macdonald, E.M.; Gonzalez, A.; Sivilotti, M.L.; Mamdani, M.M.; Juurlink, D.N.; Canadian Drug Safety and Effectiveness Research Network (CDSERN). Overdose Risk in Young Children of Women Prescribed Opioids. Pediatrics 2017, 139, e20162887. [Google Scholar] [CrossRef] [PubMed]
- Gaither, J.R.; Shabanova, V.; Leventhal, J.M. US National Trends in Pediatric Deaths from Prescription and Illicit Opioids, 1999–2016. JAMA Netw. Open 2018, 1, e186558. [Google Scholar] [CrossRef] [PubMed]
- Tanz, L.J.; Dinwiddie, A.T.; Mattson, C.L.; O’Donnell, J.; Davis, N.L. Drug Overdose Deaths Among Persons Aged 10–19 Years—United States, July 2019-December 2021. MMWR Morb. Mortal. Wkly. Rep. 2022, 71, 1576–1582. [Google Scholar] [CrossRef] [PubMed]
- NIDA. Reported Drug Use Among Adolescents Continued to Hold Below Pre-Pandemic Levels in 2023; NIDA: Bethesda, MD, USA, 2023. [Google Scholar]
- Miech, R.A.; Johnston, L.D.; Patrick, M.E.; O’Malley, P.M.; Bachman, J.G.; Shulenberg, J.E. Monitoring the Future National Survey Results on Drug Use 1975–2022: Secondary School Students; (Monitoring the Future Monograph Series, Issue); T. U. o. M. Institute for Social Research: Ann Arbor, MI, USA, 2023. [Google Scholar]
- Tham, S.W.; Palermo, T.M.; Chrisman, S.P.D.; Groenewald, C.B. Prescription Opioid Misuse and Sports-Related Concussion Among High School Students in the United States. J. Head. Trauma. Rehabil. 2021, 36, 338–344. [Google Scholar] [CrossRef] [PubMed]
- Kelley-Quon, L.I.; Cho, J.; Strong, D.R.; Miech, R.A.; Barrington-Trimis, J.L.; Kechter, A.; Leventhal, A.M. Association of Nonmedical Prescription Opioid Use with Subsequent Heroin Use Initiation in Adolescents. JAMA Pediatr. 2019, 173, e191750. [Google Scholar] [CrossRef] [PubMed]
- Miech, R.; Johnston, L.; O’Malley, P.M.; Keyes, K.M.; Heard, K. Prescription Opioids in Adolescence and Future Opioid Misuse. Pediatrics 2015, 136, e1169–e1177. [Google Scholar] [CrossRef] [PubMed]
- Friedman, J.; Godvin, M.; Molina, C.; Romero, R.; Borquez, A.; Avra, T.; Goodman-Meza, D.; Strathdee, S.; Bourgois, P.; Shover, C.L. Fentanyl, Heroin, and Methamphetamine-Based Counterfeit Pills Sold at Tourist-Oriented Pharmacies in Mexico: An Ethnographic and Drug Checking Study. Drug Alcohol Depend. 2023, 249, 110819. [Google Scholar] [CrossRef] [PubMed]
- Friedman, J.; Godvin, M.; Shover, C.L.; Gone, J.P.; Hansen, H.; Schriger, D.L. Trends in Drug Overdose Deaths Among US Adolescents, January 2010 to June 2021. JAMA 2022, 327, 1398–1400. [Google Scholar] [CrossRef] [PubMed]
- Palamar, J.J.; Ciccarone, D.; Rutherford, C.; Keyes, K.M.; Carr, T.H.; Cottler, L.B. Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug Alcohol Depend. 2022, 234, 109398. [Google Scholar] [CrossRef] [PubMed]
- McCabe, S.E.; West, B.T.; Veliz, P.; McCabe, V.V.; Stoddard, S.A.; Boyd, C.J. Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976–2015. Pediatrics 2017, 139, 949–956. [Google Scholar] [CrossRef] [PubMed]
- Grant, B.F.; Goldstein, R.B.; Saha, T.D.; Chou, S.P.; Jung, J.; Zhang, H.; Pickering, R.P.; Ruan, W.J.; Smith, S.M.; Huang, B.; et al. Epidemiology of DSM-5 Drug Use Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. JAMA Psychiatry 2016, 73, 39–47. [Google Scholar] [CrossRef] [PubMed]
- Tucker’s Law, Texas Legislature, House Bill 3908, 88th Legislature. 2023. Available online: https://capitol.texas.gov/tlodocs/88R/billtext/pdf/HB03908H.pdf (accessed on 24 May 2024).
- Ajzen, I. The theory of planned behaviour: Reactions and reflections. Psychol. Health 2011, 26, 1113–1127. [Google Scholar] [CrossRef] [PubMed]
- Cooke, R.; Dahdah, M.; Norman, P.; French, D.P. How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis. Health Psychol. Rev. 2016, 10, 148–167. [Google Scholar] [CrossRef] [PubMed]
- Kariisa, M.; O’Donnell, J.; Kumar, S.; Mattson, C.L.; Goldberger, B.A. Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine—United States, January 2019–June 2022 (MMWR Morbidity and Mortality Weekly Report, Issue). 2023. Available online: https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a4.htm?s_cid=mm7226a4_w#suggestedcitation (accessed on 15 May 2024).
- O’Donnell, J.; Tanz, L.J.; Miller, K.D.; Dinwiddie, A.T.; Wolff, J.; Mital, S.; Obiekwe, R.; Mattson, C.L. Drug Overdose Deaths with Evidence of Counterfeit Pill Use—United States, July 2019-December 2021. MMWR. Morb. Mortal. Wkly. Rep. 2023, 72, 949–956. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. State Unintentional Drug Overdose Reporting System (SUDORS); US Department of Health and Human Services, CDC: Atlanta, GA, USA, 2023. [Google Scholar]
- Konova, A.B.; Lopez-Guzman, S.; Urmanche, A.; Ross, S.; Louie, K.; Rotrosen, J.; Glimcher, P.W. Computational Markers of Risky Decision-making for Identification of Temporal Windows of Vulnerability to Opioid Use in a Real-world Clinical Setting. JAMA Psychiatry 2020, 77, 368–377. [Google Scholar] [CrossRef] [PubMed]
- Harper, C.E.; Mata, D.C.; Lee, D. The impact of fentanyl on DUIDs and traffic fatalities: Blood and oral fluid data. J. Forensic Sci. 2023, 68, 1686–1697. [Google Scholar] [CrossRef] [PubMed]
- Moyle, L.; Childs, A.; Coomber, R.; Barratt, M.J. #Drugsforsale: An exploration of the use of social media and encrypted messaging apps to supply and access drugs. Int. J. Drug Policy 2019, 63, 101–110. [Google Scholar] [CrossRef] [PubMed]
- Ternan, M. Just Say KNOW: Fentanyl, Fakery & the New Drug Talk. Mo. Med. 2022, 119, 487–488. [Google Scholar]
Demographics | n = 94 (%) |
---|---|
Grade | |
7 | 11 (11.70) |
8 | 10 (10.64) |
9 | 17 (18.09) |
10 | 32 (34.04) |
11 | 17 (18.09) |
12 | 7 (7.45) |
Gender | |
Male | 58 (61.70) |
Female | 35 (37.23) |
Prefer not to say | 1 (1.06) |
Race/Ethnicity | |
Hispanic or Latino | 80 (85.11) |
White | 5 (5.32) |
Multiracial | 5 (5.32) |
Other | 2 (2.13) |
Prefer not to say | 2 (2.13) |
Grades 7–8 n = 21 (22.34%) | Grades 9–12 n = 73 (77.66%) | Total n = 94 (%) | p-Value | |
---|---|---|---|---|
Knowledge of fentanyl | ||||
(2.1) I have heard of fentanyl (n = 93) | 0.31 * | |||
Strongly disagree/disagree | 5 (23.81) | 8 (11.11) | 13 (13.98) | |
Neutral | 2 (9.52) | 11 (15.28) | 13 (13.98) | |
Strongly agree/agree | 14 (66.67) | 53 (73.61) | 67 (72.04) | |
(2.2) I have heard what fentanyl is and its potential danger (n = 90) | 0.95 * | |||
Strongly disagree/disagree | 2 (10.56) | 9 (12.68) | 11 (12.22) | |
Neutral | 1 (5.26) | 3 (4.23) | 4 (4.44) | |
Strongly agree/agree | 16 (84.21) | 59 (83.10) | 75 (83.33) | |
Have you received education on fentanyl? (n = 88) | 0.30 * | |||
Yes | 10 (55.56) | 48 (68.57) | 58 (65.91) | |
No | 8 (44.44) | 22 (31.43) | 30 (34.09) | |
Attitudes toward fentanyl | ||||
(3.1) Fentanyl is highly potent and dangerous (n = 91) | 0.20 * | |||
Strongly disagree/disagree | 3 (15.0) | 4 (5.63) | 7 (7.69) | |
Neutral | 0 | 5 (7.04) | 5 (5.49) | |
Strongly agree/agree | 17 (85.0) | 62 (87.32) | 79 (86.81) | |
(3.2) Accidentally taking fentanyl is a serious concern (n = 91) | 0.40 * | |||
Strongly disagree/disagree | 3 (15.0) | 11 (15.49) | 14 (15.38) | |
Neutral | 0 | 6 (8.45) | 6 (6.59) | |
Strongly agree/agree | 17 (85.0) | 54 (76.06) | 71 (78.02) | |
Perceived risk of accidental exposure | ||||
(4.1) I believe there is a risk of taking fentanyl, even if it is not intentional (n = 90) | 0.69 * | |||
Strongly disagree/disagree | 1 (5.0) | 8 (11.43) | 9 (10.0) | |
Neutral | 4 (20.0) | 12 (17.14) | 16 (17.78) | |
Strongly agree/agree | 15 (75.0) | 50 (71.43) | 65 (72.22) | |
(4.2) Accidentally taking fentanyl is something I worry about (n = 92) | 0.74 * | |||
Strongly disagree/disagree | 9 (45.0) | 26 (36.11) | 35 (38.04) | |
Neutral | 6 (30.0) | 23 (31.94) | 29 (31.52) | |
Strongly agree/agree | 5 (25.0) | 23 (31.94) | 28 (30.43) | |
Subjective norms | ||||
(5.1) People important to me believe I should be cautious about fentanyl (n = 93) | 0.09 * | |||
Strongly disagree/disagree | 6 (28.57) | 7 (9.72) | 13 (13.98) | |
Neutral | 3 (14.29) | 11 (15.28) | 14 (15.05) | |
Strongly agree/agree | 12 (57.14) | 54 (75.0) | 66 (70.97) | |
(5.2) People whose opinions I value, think that accidentally taking fentanyl is a significant risk (n = 94) | 0.17 * | |||
Strongly disagree/disagree | 3 (14.29) | 3 (4.11) | 6 (6.38) | |
Neutral | 2 (9.52) | 14 (19.18) | 16 (17.02) | |
Strongly agree/agree | 16 (76.19) | 56 (76.71) | 72 (76.70) | |
Perceived behavioral control | ||||
(6.1) I believe I can take precautions to avoid accidentally taking fentanyl (n = 94) | 0.12 | |||
Strongly disagree/disagree | 2 (9.52) | 4 (5.48) | 6 (6.38) | |
Neutral | 0 | 12 (16.44) | 12 (12.77) | |
Strongly agree/agree | 19 (9.48) | 57 (78.08) | 76 (80.85) | |
(6.2) I am confident in my ability to identify substances that may contain fentanyl (n = 97) | 0.94 | |||
Strongly disagree/disagree | 5 (23.81) | 18 (24.66) | 23 (24.47) | |
Neutral | 6 (28.57) | 19 (23.06) | 25 (26.60) | |
Strongly agree/agree | 10 (47.62) | 36 (49.32) | 46 (48.94) | |
(6.3) I feel in control of my actions in situations involving substances and fentanyl (n = 93) | 0.91 | |||
Strongly disagree/disagree | 4 (19.44) | 14 (19.04) | 18 (19.35) | |
Neutral | 3 (14.29) | 13 (14.29) | 16 (17.20) | |
Strongly agree/agree | 14 (66.67) | 45 (66.67) | 59 (66.44) | |
Intentions and behavior | ||||
(7.1) I intend to take precautions to avoid accidentally taking fentanyl (n = 88) | 0.83 | |||
Strongly disagree/disagree | 1 (5.56) | 8 (11.43) | 9 (10.23) | |
Neutral | 2 (11.11) | 9 (12.86) | 11 (12.50) | |
Strongly agree/agree | 15 (83.33) | 53 (75.71) | 68 (77.27) | |
Have you ever been in a situation where you were unsure if a substance contained fentanyl? (n = 87) | 0.57 | |||
Yes | 5 (29.41) | 16 (22.86) | 21 (24.14) | |
No | 12 (70.59) | 54 (77.14) | 66 (75.86) | |
If you were unsure if a substance contains fentanyl, would you still consider using it? (n = 86) | 0.02 | |||
Yes | 5 (29.41) | 6 (8.70) | 11 (12.79) | |
No | 12 (70.59) | 63 (91.30) | 75 (87.21) |
No n (%) | Yes n (%) | p-Value | |
---|---|---|---|
Have you received education on fentanyl? (n = 88) | 30 (34.09) | 58 (65.91) | |
(6.1) I believe I can take precautions to avoid accidentally taking fentanyl (n = 88) | 0.99 | ||
Strongly disagree/disagree | 2 (6.67) | 4 (6.90) | |
Neutral | 4 (13.33) | 8 (13.79) | |
Strongly agree/agree | 24 (80.00) | 46 (79.31) | |
(6.2) I am confident in my ability to identify substances that may contain fentanyl (n = 88) | 0.19 | ||
Strongly disagree/disagree | 11 (36.67) | 11 (18.97) | |
Neutral | 7 (23.22) | 17 (29.31) | |
Strongly agree/agree | 12 (40.00) | 30 (51.72) | |
(6.3) I feel in control of my actions in situations involving substances and fentanyl (n = 87) | 0.04 ** | ||
Strongly disagree/disagree | 10 (33.33) | 8 (14.04) | |
Neutral | 2 (6.67) | 13 (22.81) | |
Strongly agree/agree | 18 (60.00) | 36 (63.16) | |
(7.1) I intend to take precautions to avoid accidentally taking fentanyl (n = 84) | 0.99 | ||
Strongly disagree/disagree | 3 (10.00) | 6 (11.11) | |
Neutral | 4 (13.33) | 7 (12.96) | |
Strongly agree/agree | 23 (76.67) | 41 (75.93) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Bakos-Block, C.; Vega, F.R.; Cardenas-Turanzas, M.; Gopal, B.; Champagne-Langabeer, T. Education Improves Perceived Control but Not Risk Identification in Adolescents Regarding Fentanyl. Children 2025, 12, 794. https://doi.org/10.3390/children12060794
Bakos-Block C, Vega FR, Cardenas-Turanzas M, Gopal B, Champagne-Langabeer T. Education Improves Perceived Control but Not Risk Identification in Adolescents Regarding Fentanyl. Children. 2025; 12(6):794. https://doi.org/10.3390/children12060794
Chicago/Turabian StyleBakos-Block, Christine, Francine R. Vega, Marylou Cardenas-Turanzas, Bhanumathi Gopal, and Tiffany Champagne-Langabeer. 2025. "Education Improves Perceived Control but Not Risk Identification in Adolescents Regarding Fentanyl" Children 12, no. 6: 794. https://doi.org/10.3390/children12060794
APA StyleBakos-Block, C., Vega, F. R., Cardenas-Turanzas, M., Gopal, B., & Champagne-Langabeer, T. (2025). Education Improves Perceived Control but Not Risk Identification in Adolescents Regarding Fentanyl. Children, 12(6), 794. https://doi.org/10.3390/children12060794