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In recent years, there has been much focus on the use of wastewater‐based epidemiology (WBE) in urban centers, particularly for SARS‐CoV‐2 monitoring. However, less is known about the application of WBE in rural settings or in areas of limited resources. Most WBE programs in low‐resource communities have occurred outside the United States. To reap the benefits, WBE would need to be tailored to better reflect the socioeconomic challenges, technical barriers, communication limitations, and variable wastewater infrastructures associated with rural communities. The objective of this review is to evaluate the potential opportunities and challenges of deploying the current SARS‐CoV‐2 monitoring methodologies in small, rural communities, with a particular focus on rural Texas. For this, we conducted an inventory of rural communities in the state of Texas and their wastewater infrastructure. Based on specific rural examples, we evaluated the potential of current WBE methodologies used in urban settings to monitor for emerging biological agents of concern such as SARS‐CoV‐2. Our findings include an overview of rural wastewater capacity across rural Texas, a look at current WBE efforts to detect SARS‐CoV‐2, and recommendations for future implementation in two cities in rural counties, Kerrville and Valentine. WBE is a rapidly evolving public health tool with several notable advantages associated with cost, access, and adaptability. It is of particular use in resource‐limited communities that often exhibit healthcare disparities. This study presents the first overview of the feasibility of implementing WBE in the rural settings of Texas. We provide several recommendations and suggest alternatives that may be of use when planning an expansion of WBE into these areas. [ABSTRACT FROM AUTHOR]

Peer recovery support services (PRSS) for substance use disorder (SUD) are a flexible and evidence-based intervention employed across multiple settings and for a variety of populations. These services have expanded over the past two decades, but there is little research on recruitment and training of prospective peer workers – the peer to career pipeline. This study observed training outcomes for applicants to a peer worker scholarship program in Texas. A total of 448 participants provided baseline personal history information, and a subset of participants (n = 239) completed optional psychosocial surveys. Logistic regression analysis tested associations of personal history and psychosocial variables with three training stage completion outcomes: classroom training completion, placement at an internship site, and full certification. The greatest decline in advancement between stages occurred in the transition between classroom training (78.1 % of participants completed) and internship placement (43.3 % of participants completed). Participants were diverse in terms of race/ethnicity and life experiences salient to the peer worker role, but Hispanic/Latinx peer workers were under-represented. Past work with a SUD peer worker, age, and having a bachelor's degree were each positively associated with training stage completion across multiple models, while having basic technological access, being a woman, and veteran status were each positively associated with training stage completion in only one model. Years since recovery initiation date, non-monosexual orientation, White race, and quality of life were each negatively associated with training stage completion in only one model. The existing peer workforce may be a key source of recruitment for new peer workers; thus retention of existing workers is key to ensuring continued expansion of these services. Additional support may be required to recruit and retain younger peer worker trainees, men trainees, Hispanic/Latinx trainees, trainees who lack basic technological access, or trainees without bachelor's degrees. Unanswered questions about the peer workforce remain and must be addressed to ensure that an appropriately diverse workforce is recruited, that disparities in training outcomes are minimized or prevented, and that existing peer workers are well-supported. • Securing an internship is the greatest barrier in the peer to career pipeline. • Current peer workers may be an important source of training support. • Several key groups are under-recruited or may need more support during training. [ABSTRACT FROM AUTHOR]