"Just another thing for me to stress off of": Responses to unintentional fentanyl use in a community-based study of people who use opioids.

The unintentional consumption of fentanyl is a serious health risk for people who use illicit drugs. In an ongoing community-based study regarding polysubstance use among people who use opioids, we found that 17 of 58 (29%) of participants who did not endorse fentanyl use in the past thirty days tested positive for fentanyl during point-of-care urinalysis (UA). This paper describes the reactions and experiences of participants who were informed they had consumed fentanyl unintentionally, as well as how the research team handled the unanticipated occurrence of discordant results. Consistent with other recent studies, we found that people learning of unintentional fentanyl use expressed strong concerns about accidental overdose. It was common for participants to reflect on recent substance use experiences that were atypical and might have involved fentanyl, as well as to examine sources of recent drug purchases. While not all participants were surprised that they had unintentionally consumed fentanyl, all felt that learning their positive results was important due to risk of overdose. Research and medical staff have an opportunity to promote awareness of possible contamination by sharing and discussing UA test results with people who use drugs in non-judgmental manner. In addition to the widely promoted harm reduction strategy of testing drugs with fentanyl test strips, self-administered point-of-care UA, particularly after an unexpected reaction to using a drug, could provide useful information for people buying and using illicit drugs.

Perceived social status and mental health among young adolescents: Evidence from census data to cellphones.

Adolescents in the United States live amid high levels of concentrated poverty and increasing income inequality. Poverty is robustly linked to adolescents' mental health problems; however, less is known about how perceptions of their social status and exposure to local area income inequality relate to mental health. Participants consisted of a population-representative sample of over 2,100 adolescents (ages 10-16), 395 of whom completed a 14-day ecological momentary assessment (EMA) study. Participants' subjective social status (SSS) was assessed at the start of the EMA, and mental health symptoms were measured both at baseline for the entire sample and daily in the EMA sample. Adolescents' SSS tracked family, school, and neighborhood economic indicators (|r| ranging from .12 to .30), and associations did not differ by age, race, or gender. SSS was independently associated with mental health, with stronger associations among older (ages 14-16) versus younger (ages 10-13) adolescents. Adolescents with lower SSS reported higher psychological distress and inattention problems, as well as more conduct problems, in daily life. Those living in areas with higher income inequality reported significantly lower subjective social status, but this association was explained by family and neighborhood income. Findings illustrate that adolescents' SSS is correlated with both internalizing and externalizing mental health problems, and that by age 14 it becomes a unique predictor of mental health problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Concurrent and Subsequent Associations Between Daily Digital Technology Use and High-Risk Adolescents' Mental Health Symptoms.

Adolescents are spending an unprecedented amount of time using digital technologies (especially mobile technologies), and there are concerns that adolescents' constant connectivity is associated with poor mental health, particularly among at-risk adolescents. Participants included 151 adolescents at risk for mental health problems (Mage  = 13.1) who completed a baseline assessment, 30-day ecological momentary assessment, and 18 month follow-up assessment. Results from multilevel regression models showed that daily reports of both time spent using digital technologies and the number of text messages sent were associated with increased same-day attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) symptoms. Adolescents' reported digital technology usage and text messaging across the ecological momentary assessment (EMA) period was also associated with poorer self-regulation and increases in conduct problem symptoms between the baseline and follow-up assessments.