Ligand binding initiates single-molecule integrin conformational activation.

Integrins link the extracellular environment to the actin cytoskeleton in cell migration and adhesiveness. Rapid coordination between events outside and inside the cell is essential. Single-molecule fluorescence dynamics show that ligand binding to the bent-closed integrin conformation, which predominates on cell surfaces, is followed within milliseconds by two concerted changes, leg extension and headpiece opening, to give the high-affinity integrin conformation. The extended-closed integrin conformation is not an intermediate but can be directly accessed from the extended-open conformation and provides a pathway for ligand dissociation. In contrast to ligand, talin, which links the integrin ß-subunit cytoplasmic domain to the actin cytoskeleton, modestly stabilizes but does not induce extension or opening. Integrin activation is thus initiated by outside-in signaling and followed by inside-out signaling. Our results further imply that talin binding is insufficient for inside-out integrin activation and that tensile force transmission through the ligand-integrin-talin-actin cytoskeleton complex is required.

A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients.

BACKGROUND: Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving. METHODS: Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n = 35) or no-prep meals (n = 35). Participants completed questionnaires at baseline and two-week follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation. RESULTS: Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp²=0.16, F(1,64) = 11.78, p < .001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp²=0.36, F(1,64) = 36.38, p < .001) and food security (ηp²=0.36, F(1,64) = 36.38, p < .001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp²=0.09, F(1,64) = 6.28, p = .015). CONCLUSIONS: Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes. TRIAL REGISTRATION: This trial was registered on 25/10/2022 on ClinicalTrials.gov, identifier: NCT05593510.

The Associations between Risky Psychosocial Environment, Substance Addiction Severity and Imprisonment: A Swedish Registry Study.

Objective: Both childhood and adult psychosocial stressors have been identified as links to both increased risk for substance use disorder (SUD) and increased risk of imprisonment. The aim of this retrospective study is to identify, for a sample of 14,914 adults who all were assessed for risky substance use or a SUD, the importance of having a history of psychosocial stressors compared to current addiction severity. The analyses control for age, gender and education on the likelihood of future imprisonment. Method: Baseline Addiction Severity Index data (ASI) were merged with national registry data on prison sentences from 2003 to 2016. In the analysis, a Cox regression was used to study the association between independent variables and the likelihood of future imprisonment. Results: In the regression, five variables showed significant association to increased risk of imprisonment: ASI drugs other than alcohol Composite Score (positive relationship), ASI alcohol Composite Score (negative relationship), age (younger), education (lower) and parental problems with drugs other than alcohol. The factor with strongest association with imprisonment was the ASI drugs other than alcohol Composite Score, which showed the highest HR = 10.63 (3.50-32.31) for women and HR = 5.52 (3.77-8.08) for men to predict the likelihood of imprisonment. Discussion: Research is needed on why individuals with history of psychosocial stressors have a higher likelihood of imprisonment compared to their counterparts. Findings indicate that a high ASI Composite Score for drugs other than alcohol are strong predictors of future criminality and criminal justice system involvement.

Is residual tendon a predictor of outcome following arthroscopic rotator cuff repair? A preliminary outlook at short-term follow-up.

BACKGROUND: Multiple factors including muscle atrophy, fatty infiltration, smoking, advanced patient age, and increasing tear size have been identified as risk factors for retear after rotator cuff repair. However, little is known about what effect the length of the residual rotator cuff tendon has on the success of repair and patient outcomes. METHODS: This study included 64 patients. Patients were stratified based on a residual tendon length of greater than 15 mm (group 1, residual tendon) or 15 mm or less (group 2, no residual tendon). Rotator cuff tendon integrity was then evaluated using ultrasound imaging at 6 months. Outcome measures included the Single Assessment Numeric Evaluation score, visual analog scale score, EQ5D Index score, Global Rating of Change score, and Penn Shoulder Score. RESULTS: No differences were found between groups regarding demographic data or repair configuration. Assessment of tendon healing demonstrated an increased rate of tendons that had "not healed" in group 2 (19.3% [n = 5] vs. 13.2% [n = 5]), but this difference was not statistically significant (P = .55). Functional outcome scores improved significantly from preoperatively to final follow-up in both groups and displayed no differences at 6-month follow-up. CONCLUSION: A smaller residual tendon length was not a negative predictor of clinical outcomes following arthroscopic rotator cuff repair in patients with short-term follow-up. Although there was a trend toward a decreased rate of healing in patients with smaller residual tendons, this was not significant.

Advancing Alcohol and Other Drug Education among Social Work Faculty: An Evaluation of Social Work Faculty Immersion Training.

This study is an educational evaluation of participants (N = 50) in a four-day immersion training program funded by the National Institute of Alcohol Abuse and Alcoholism. Using a pretest-posttest design, clinical social work faculty participants showed statistically significant (p < .001) improvement in overall alcohol and other drug-related knowledge (Baseline: Mean[SD] = 8.75 [2.44]; Post-Intervention: Mean[SD] = 13.88[1.96], Cohen's d = -2.16) in the domains of screening/assessment, brief intervention, medication-assisted treatment, and recovery and relapse prevention. Corresponding increases were also observed for faculty confidence in teaching clinical skills related to alcohol and other drug screening, assessment, and treatment.

Microwave spectral taxonomy: A semi-automated combination of chirped-pulse and cavity Fourier-transform microwave spectroscopy.

Because of its structural specificity, rotational spectroscopy has great potential as an analytical tool for characterizing the chemical composition of complex gas mixtures. However, disentangling the individual molecular constituents of a rotational spectrum, especially if many of the lines are entirely new or unknown, remains challenging. In this paper, we describe an empirical approach that combines the complementary strengths of two techniques, broadband chirped-pulse Fourier transform microwave spectroscopy and narrowband cavity Fourier transform microwave spectroscopy, to characterize and assign lines. This procedure, called microwave spectral taxonomy, involves acquiring a broadband rotational spectrum of a rich mixture, categorizing individual lines based on their relative intensities under series of assays, and finally, linking rotational transitions of individual chemical compounds within each category using double resonance techniques. The power of this procedure is demonstrated for two test cases: a stable molecule with a rich spectrum, 3,4-difluorobenzaldehyde, and products formed in an electrical discharge through a dilute mixture of C2H2 and CS2, in which spectral taxonomy has enabled the identification of propynethial, HC(S)CCH.

Initial results of DMEK combined with cataract surgery and implantation of the light-adjustable lens.

PURPOSE: To evaluate the use of light-adjustable intraocular lenses (LALs) to maximize visual acuity (VA) postoperatively in eyes undergoing combined Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery. SETTING: Private practice, tertiary referral center. DESIGN: Retrospective review of initial case series. METHODS: Patients with Fuchs endothelial dystrophy had DMEK combined with phacoemulsification and LAL implantation. Lenses were adjusted based on postoperative manifest refraction and locked-in 3 to 6 months postoperatively. Adjustments to the LAL were started after stabilization of refraction at sequential examinations. Outcomes were uncorrected near and distance VA and manifest refraction 3 to 6 months after locking the lens. RESULTS: A total of 27 eyes in 17 patients with mean age of 65 years (range 53 to 75 years) were included in this study. 6 eyes (22%) had either a near or intermediate target, and 21 eyes (78%) had a distance target. After lock-in, 57% of eyes with a distance target had uncorrected distance VA (UDVA) of 20/20 or better, 90% were 20/25 or better, and 100% were 20/40 or better. After lens lock-in, 100% of eyes had corrected distance VA (CDVA) of 20/20 or better, 86% had postoperative UDVA the same or better than preoperative CDVA, and 100% of eyes had UDVA within 1 line of the preoperative CDVA. In total, 93% of eyes were within 1 diopter (D) of spherical target, and 93% of eyes had ≤0.5 D of refractive cylinder postoperatively. CONCLUSIONS: Combining DMEK with LAL implantation provided significantly better UDVA and refractive outcomes than previously reported data on combined implantation of a standard monofocal lens.

Attitudes Toward Routine Vaccines and COVID-19 Vaccines Among Parents of Infants and Toddlers in an Urban Safety-Net Setting.

This study explores attitudes toward diphtheria-tetanus-acellular pertussis (DTaP), measles-mumps-rubella (MMR), influenza, and coronavirus disease 2019 (COVID-19) vaccines among English-speaking and Spanish-speaking parents of infants in a safety-net setting. Parents aged 18 years or older were recruited from outpatient clinics between December 2020 and December 2021. The interviews were then recorded, transcribed, translated, and qualitatively analyzed using the modified grounded theory. Thirty-two individuals participated (18 English-speaking and 14 Spanish-speaking). Almost all supported receiving routine childhood vaccines, DTaP, influenza, and MMR and believed that vaccines promote health. Vaccine concerns differed by each vaccine. Few participants expressed concerns about DTaP and MMR vaccines. Concerns around influenza vaccines often stemmed from personal experience and perceived increased risk of flu-like illnesses. Participants expressed the most concerns related to COVID-19 vaccinations, including age-based immunity of their infants. Based on these findings, future interventions to improve vaccine uptake may focus on benefits common to all vaccines, while addressing vaccine-specific concerns.

Attitudes towards Telemedicine among Pregnant People and Parents of Toddlers in an Urban Safety-net Setting.

OBJECTIVE: To understand attitudes towards telemedicine and to further elucidate benefits, disadvantages, and visit preferences in a largely minority, urban safety-net setting. METHODS: Between 2020 and 2021, pregnant people, and parents of children younger than two years old were recruited from outpatient clinics. Interviews were conducted via phone, recorded, transcribed, and translated. Data were analyzed using content analysis. RESULTS: Seventy-four (74) individuals participated including 42 pregnant people and 32 parents. Most participants cited advantages to telemedicine including safety, convenience, improved access, and less disruption of work schedules, and wished to continue to have the telemedicine option available after the pandemic. CONCLUSIONS: Patients seeking care in safety-net settings, many of whom are working parents, noted that telemedicine improves access to care by providing an efficient and accessible option that overcomes barriers related to transportation and work schedules. Their experiences highlight the importance of continuing to offer telemedicine services.

The Burden of Hate: How Nonwork Discrimination Experienced During the COVID-19 Pandemic Impacts Asian American Employees.

The COVID-19 pandemic has been accompanied by a sharp increase in prejudice and discrimination targeting Asian Americans in the USA. Thus, in addition to the public health risks associated with the virus, exposure to discrimination poses a unique threat to the health and well-being of Asian Americans. Indeed, empirical evidence has documented the linkage between experiencing anti-Asian discrimination during the pandemic and health decrements among Asian Americans. The goal of this study was to expand that research to also consider the ways experiencing discrimination in a nonwork context may spill over to affect the general and job-related well-being of Asian American employees as well as the potential mitigating role of coworker compassion. Results from a sample of 311 Asian American employees demonstrated that experiencing nonwork discrimination was associated with decrements in physical health and increased depression and job-related exhaustion. Further, there were significant interactions between nonwork discrimination and coworker compassion for engagement, emotional exhaustion, and depressive symptoms such that nonwork discrimination was more strongly related to each outcome when coworker compassion was low. The findings from the current study suggest that experiences of racial derogation, even those that occur outside the workplace environment, are detrimental to the well-being of employees and that coworker compassion is a positive resource that may foster healthier and more inclusive work environments. Supplementary Information: The online version contains supplementary material available at 10.1007/s10869-022-09848-6.

Comparison of attitudes toward routine maternal vaccines and COVID-19 vaccines among pregnant patients in an urban safety-net setting.

OBJECTIVE: To explore attitudes toward tetanus-diphtheria-acellular pertussis (Tdap), influenza, and COVID vaccines among English- and Spanish- speaking pregnant individuals in a safety net setting. METHODS: Pregnant people aged 18 years or older were recruited from outpatient clinics between August 2020 and June 2021. Interviews were conducted via phone in English or Spanish, recorded, transcribed, and translated verbatim. Data were qualitatively analyzed using modified grounded theory and content analysis. RESULTS: 42 patients participated (22 English-speaking, 20 Spanish-speaking). Most participants expressed positive attitudes towards both routine prenatal vaccinations and COVID-19 vaccines, endorsing the belief that vaccines promote health and considering vaccines a social norm. Positive attitudes were similar for the three vaccines, and among Spanish- and English-speaking individuals. Participants trusted their healthcare provider's recommendations and felt comfortable receiving booster doses of vaccines they had received successfully in the past. Vaccine concerns differed by each vaccine. Despite limited knowledge, few participants expressed concerns about Tdap vaccines. Concerns around influenza vaccines often stemmed from personal experience and centered around ineffectiveness and increased risk of flu-like illnesses. Participants expressed the most concerns related to COVID vaccinations, including misinformation about serious side effects and distrust around accelerated approval of the vaccines. Many participants wished to know more about the side effects and safety of vaccinating during pregnancy, especially regarding the fetus's health. CONCLUSIONS: Most participants supported routine prenatal vaccinations, including COVID vaccines. Clinicians are trusted information sources and can help reinforce positive attitudes and social norms of receiving vaccinations in pregnancy while addressing vaccine-specific concerns. FUNDING: This work was supported by Suzanne Cutler Vaccination Education & Research Fund at the Boston University Chobanian and Avedisian School of Medicine for funding and support.

A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients.

Background: Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving. Methods: Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n=35) or no-prep meals (n=35). Participants completed questionnaires at baseline and twoweek follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation. Results: Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp2=0.16, F(1,64)=11.78, p<.001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp2=0.36, F(1,64)=36.38, p<.001) and food security (ηp2=0.36, F(1,64)=36.38, p<.001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp2=0.09, F(1,64)=6.28, p=.015). Conclusions: Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes. Trial Registration: This trial was registered on 25/10/2022 on Clinicaltrials.gov, identifier: NCT05593510.

COVID-19 pandemic impacts on mental health, burnout, and longevity in the workplace among healthcare workers: A mixed methods study.

To explore the mental health impacts of the COVID-19 pandemic on healthcare workers in Massachusetts and identify potential strategies to maintain the healthcare workforce we conducted a sequential exploratory mixed methods study. Fifty-two individuals completed interviews from April 22nd - September 7th, 2021; 209 individuals completed an online survey from February 17th - March 23rd, 2022. Interviews and surveys asked about the mental health impacts of working in healthcare during the COVID-19 pandemic, burnout, longevity in the workplace, and strategies for reducing attrition. Interview and survey participants were predominantly White (56%; 73%, respectively), female (79%; 81%) and worked as physicians (37%; 34%). Interviewees indicated high stress and anxiety levels due to frequent exposure to patient deaths from COVID-19. Among survey respondents, 55% reported worse mental health than before the pandemic, 29% reported a new/worsening mental health condition for themselves or their family, 59% reported feeling burned out at least weekly, and 37% intended to leave healthcare in less than 5 years. To decrease attrition, respondents suggested higher salaries (91%), flexible schedules (90%), and increased support to care for patients (89%). Healthcare workers' experiences with death, feeling unvalued, and overworked resulted in unprecedented rates of burnout and intention to leave healthcare.

Healthcare workers' attitudes on mandates, incentives, and strategies to improve COVID-19 vaccine uptake: A mixed methods study.

Healthcare workers are a trusted health information source and are uniquely positioned to reduce the burden of the COVID-19 pandemic. The purpose of this sequential exploratory mixed methods study was to understand attitudes of healthcare workers working in Massachusetts during the COVID-19 pandemic regarding strategies to improve COVID-19 vaccine utilization, including vaccine mandates and incentives. Fifty-two individuals completed one-on-one interviews between April 22nd and September 7th, 2021. The survey was developed based on findings from the interviews; 209 individuals completed the online survey between February 17th and March 23rd, 2022. Both the interview and survey asked about attitudes toward COVID-19 vaccine and booster mandates, incentives, and strategies to improve vaccination rates. Most participants were female (79%-interview, 81%-survey), Caucasian (56%, 73%), and worked as physicians (37%, 34%) or nurses (10%, 18%). Overall, nuanced attitudes regarding vaccine and booster mandates were expressed; many supported mandates to protect their patients' health, others emphasized personal autonomy, while some were against mandates if job termination was the consequence of declining vaccines. Similarly, views regarding vaccine incentives differed; some considered incentives helpful, yet many viewed them as coercive. Strategies believed to be most effective to encourage vaccination included improving accessibility to vaccination sites, addressing misinformation, discussing vaccine safety, tailored community outreach via trusted messengers, and one-on-one conversations between patients and healthcare workers. Healthcare workers' experiences with strategies to improve utilization of COVID-19 vaccines and boosters have implications for public health policies. Generally, efforts to improve access and education were viewed more favorably than incentives and mandates.

Healthcare workers' perspectives on the COVID-19 vaccine and boosters for themselves, their patients, and their communities: a mixed methods study.

Aim: To examine experiences and attitudes of a diverse sample of clinical and non-clinical healthcare workers regarding COVID-19 vaccines and boosters for themselves, their patients, and their communities. Subject and methods: We conducted a sequential exploratory mixed methods study; 52 healthcare workers participated in qualitative interviews between April 22 and September 7, 2021, and 209 healthcare workers completed surveys between February 17 and March 23, 2022. Interviews and survey questions asked about personal attitudes toward COVID-19 vaccination and boosters and experiences discussing vaccination with patients. Results: Participants were predominantly White (56% and 73%, respectively) and female (79% and 81%, respectively). Factors motivating healthcare workers to take the vaccine were the belief that vaccination would protect themselves, their families, patients, and communities. Healthcare workers were accepting of and had high receipt of the booster, though some had diminished belief in its effectiveness after becoming infected with SARS-CoV-2 after initial vaccination. Race related mistrust, misinformation related to vaccine safety, and concerns about vaccine effects during pregnancy were the most common barriers that providers encountered among their patients and communities. Conclusions: Healthcare workers' primary motivation to receive COVID-19 vaccines was the desire to protect themselves and others. Healthcare workers' perception was that concerns about safety and misinformation were more important barriers for their patients than themselves. Race-related medical mistrust amplified concerns about vaccine safety and hindered communication efforts.

Revisiting the relationship between contact and physician attitudes toward patients with opioid use disorder.

INTRODUCTION: Prior research suggests that some physicians hold negative attitudes toward patients who misuse opioids and that this serves as a barrier which limits the availability and effectiveness of health care services. Interventions which improve physicians' attitudes have thus garnered attention, many of which have focused on increasing contact between physicians and patients who misuse opioids. However, drawing on recent literature on intergroup contact, the current paper argues that contact may not have uniformly positive effects on prejudice. METHODS: We surveyed 408 board-certified physicians in the state of Ohio where many opioid overdose deaths have been concentrated. We used regression to test for interactions between contact and three focal variables, bias, burnout, and stress, on physician willingness to work with patients who misuse opioids. RESULTS: The negative relationships between bias, physician burnout, and stress induced by working with patients who misuse opioids and physicians' willingness to work with this patient population are each exacerbated when contact with patients who misuse opioids is high. CONCLUSIONS: Although intervention studies have shown promise for the role that increased contact may have in reducing stigma toward patients who misuse opioids, these interventions may not be appropriate for physicians who are experiencing strain or who hold preexisting negative attitudes toward this patient population. Future interventions may need to target bias, burnout, and stress, in addition to facilitating contact, to increase physician willingness to work with these patients.

Dynamics of dust particles confined in imposed potential structures in strongly magnetized, low-temperature plasmas.

A new phenomenon called imposed ordered structures has been of particular interest to the dusty plasma community within the past several years. These structures are a new type of pattern formation within a dusty plasma in which the dust particles become fixed to a background confining potential whose spatial structure is determined by some conducting element present in the plasma. In previous works, this element has typically been a conducting wire mesh. One of the unanswered questions is whether the dust particles become trapped beneath the conducting surface of the mesh or in the gaps (holes) between the wires. This work makes use of a new electrode whose shape is designed to mimic that of wire mesh, but with much larger dimensions to facilitate in situ diagnostic measurements. Observations of the dust show that particles become confined to the regions beneath the holes of this new electrode. Measurements of the dust particle velocities allow for a determination of the kinetic energy within the dust cloud which show that the particles are in an energetic steady state. Comparisons of spatial profiles of the particle velocities also show that the dust particles typically reside in areas of increased plasma glow, possibly being trapped by plasma filaments.

Boston Offender Needs Delivery Project.

To bridge a gap in access to community services for releasing state inmates, the Boston Offender Needs Delivery (BOND) project was developed as a longitudinal study (2014-2016) of adult inmates with a history of substance use and co-occurring mental health disorders returning to the community following detention in one of Massachusetts' State correctional facilities. Pre-release inmates who were wrapping up their sentence (i.e., no community supervision) and presented with mental illness and/or substance use disorder were recruited. Participants were provided substance abuse treatment immediately post-release, as well as a variety of recovery supports for a follow-up period of 6 months. This first manuscript is intended to describe the rationale behind the BOND project, as well as the methods and procedure used to collect the data.

Mortality among a national population sentenced to compulsory care for substance use disorders in Sweden: descriptive study.

Sweden's compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n=4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR=1.28, narcotic users OR=1.16), gender [males were nearly 3 times more likely to die among narcotics users (p<.000) and 1.6 times more likely to die among alcohol users (p<.01)] and reporting serious health problems (for alcohol users p<.000, for narcotics users p<.05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users.