Increasing hurricane frequency and intensity with climate change is likely to affect soil organic carbon (C) stocks in tropical forests. We examined the cycling of C between soil pools and with depth at the Luquillo Experimental Forest in Puerto Rico in soils over a 30-year period that spanned repeated hurricanes. We used a nonlinear matrix model of soil C pools and fluxes (\"soilR\") and constrained the parameters with soil and litter survey data. Soil chemistry and stable and radiocarbon isotopes were measured from three soil depths across a topographic gradient in 1988 and 2018. Our results suggest that pulses and subsequent reduction of inputs caused by severe hurricanes in 1989, 1998, and two in 2017 led to faster mean transit times of soil C in 0-10 cm and 35-60 cm depths relative to a modeled control soil with constant inputs over the 30-year period. Between 1988 and 2018, the occluded C stock increased and δ13C in all pools decreased, while changes in particulate and mineral-associated C were undetectable. The differences between 1988 and 2018 suggest that hurricane disturbance results in a dilution of the occluded light C pool with an influx of young, debris-deposited C, and possible microbial scavenging of old and young C in the particulate and mineral-associated pools. These effects led to a younger total soil C pool with faster mean transit times. Our results suggest that the increasing frequency of intense hurricanes will speed up rates of C cycling in tropical forests, making soil C more sensitive to future tropical forest stressors.

Extreme weather events can act as \"focusing events\" that open windows of opportunity in the policy process for increasing resilience and transforming existing systems to be more sustainable and just. However, due to the multiple and contested meanings of resilience, it is uncertain to what extent a focusing event will foster transformational policy change as opposed to re-entrenching existing systems and structures. We conducted quantitative content and qualitative narrative analyses of Puerto Rican climate and energy policy before and after Hurricane Maria to assess the effect of a climate-induced disaster on the framings of resilience and transformation. We find that these terms are used predominantly in service of changes needed to promote the stability of the existing energy system. This suggests that after Hurricane Maria, achieving stability has been the dominant goal for resilience and transformation. As long as those responsible for the Puerto Rican energy system emphasize stability without actively working to enable longer-term transformational change, Puerto Ricans are unlikely to experience a rapid transition toward a sustainable, inclusive energy system.

To evaluate the impact of Hurricanes Irma and Maria on 3 major chronic diseases in Puerto Rico.
San Juan Overweight Adults Longitudinal study participants were re-evaluated after Hurricanes Irma and Maria (May 2019-July 2020) for the Preparedness to Reduce Exposures and Diseases Post-hurricanes and Augment Resilience study. This study compared the prevalence and incidence of asthma, depression, and hypertension within the same 364 individuals over time.
Asthma and depression prevalence and incidence did not change significantly after the hurricanes. The prevalence of hypertension increased significantly after the hurricanes (OR = 2.2, 95% CI: 1.2, 3.9). The incidence of hypertension after the hurricanes (IR = 9.0, 95% CI: 6.5, 12.4) increased significantly compared to before the hurricanes (IR = 6.1, 95% CI: 4.5, 8.0) (age-adjusted incidence rate ratio [aIRR] = 1.4, 95% CI: 4.5, 8.0) for similar time periods.
Hurricanes Irma and Maria were associated with a significant increase in the prevalence and incidence of hypertension in this study population. Contrary to expectations, no significant increases were observed in depression and asthma prevalence after the hurricanes. Results from this study can inform better strategies to prevent and manage hypertension in the population affected by a hurricane.

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Identifying the functional traits that enable recovery after extreme events is necessary for assessing forest persistence and functioning. However, the variability of traits mediating responses to disturbances presents a significant limitation, as these relationships may be contingent on the type of disturbance and change over time. This study investigates the effects of traits on tree growth-for short and longer terms-in response to two vastly different extreme climatic events (droughts and hurricanes) in a Puerto Rican forest. I found that trees display a dynamic functional response to extreme climatic events. Leaf traits associated with efficient photosynthesis mediated faster tree growth after hurricanes, while trees with low wood density and high water use efficiency displayed faster growth after drought. In the longer term, over both drought and hurricanes, tree size was the only significant predictor of growth, with faster growth for smaller trees. However, despite finding significant trait-growth relationships, the predictive power of traits was overall low. As the frequency of extreme events increases due to climate change, understanding the dynamic relationships between traits and tree growth is necessary for identifying strategies for recovery.

Fentanyl and fentanyl-related analogues are the main drivers of overdose death in the USA, particularly among people who inject drugs (PWID). Despite the fact that non-Hispanic whites exhibit higher population rates of synthetic opioid mortality, overdose deaths have increased among African American and Latinos in urban areas. Yet little attention has been paid to the introduction of fentanyl among rural PWID in Puerto Rico.
We conducted N = 38 in-depth interviews with PWID in rural Puerto Rico to document participants\' experiences of injection drug use after the arrival of fentanyl and the strategies they implemented to manage overdose death risks.
Participants suggest that the arrival of fentanyl in large scale happened after Hurricane Maria in 2017; this coincided with a dramatic increase in overdose episodes and deaths. Fear of overdose deaths motivated some participants to substitute intravenous drug use for other forms of substance use or to seek MOUD. PWID that continued injection use resorted to conducting \"hit tests,\" avoiding injecting alone, using naloxone, and employing fentanyl testing strips.
While overdose deaths would have been higher without participants\' willingness to adopt harm-reduction strategies, this paper illustrates the limits of these policies to address the current epidemic of fentanyl-related overdose deaths among this population. More studies are needed to understand how health disparities shape overdose risks for minority populations. However, major policy changes, in particular the revision of the harmful role of the War on Drugs and the termination of failed neoliberal economic policies that contribute to deaths of despair, should be addressed if we are to make a dent in this epidemic.

To explore the health impacts of Hurricane Maria (HM) on HIV care outcomes among people living with HIV who use drugs.
Using data from an ongoing cohort study in San Juan, Puerto Rico (Proyecto PACTo), we measured differences in HIV care outcomes (viral load, viral suppression, and CD4 counts) before and after HM using assessments conducted at 6-month intervals. Generalized estimating equations were used to assess factors associated with HIV care outcomes.
All HIV care outcomes showed a deterioration from pre-HM values to post-HM values (mean viral load increased, CD4 counts decreased, and rate of viral suppression decreased) after controlling for pre-HM sociodemographic and health characteristics. In addition to HM, age (aIRR = 1·01), being homeless (aIRR = 0·78) and having health insurance (aIRR = 1·6) were independently associated with viral suppression.
219 participants completed follow-up visits between April 2017 and January 2018, before and after HM.
People living with HIV who use drugs in Puerto Rico experienced poorer HIV outcomes following HM. Socio-environmental factors contributing to these outcomes is discussed in the context of disaster response, recovery, and program planning.

\"Big events\", such as wars, economic crises, pandemics, or natural disasters, affect the risk environment in which people use drugs. While the impact of big events on injection risk behaviors and access to drug-treatment services is well documented, less is known about the effects of big events on drug markets. Based on self-reporting data on drug availability among people who use drugs (PWUD) in the aftermath of Hurricane Maria in Puerto Rico and during the COVID-19 lockdown in a Midwestern US state, this study aims to document the effects of big events on drug markets. Qualitative data on the effects of Hurricane Maria on drug markets are based on participants\' self-reporting (N = 31). Data collection started after the hurricane and ended in 2020. Data on changes to the drug supply during the COVID-19 lockdown were collected based on semi-structured interviews with PWUD (N = 40) in a Midwestern US state. Findings show that while the drug markets might have initially been affected by big events, most effects were temporary. Drug availability, pricing, and quality might have suffered some initial fluctuations but stabilized as the drug markets absorbed the initial shocks caused by the hurricane and the lockdown measures. In preparation for increasingly more frequent and virulent pandemics and natural disasters, health infrastructures should be strengthened to prevent not only overdose episodes and deaths but also drug-related harms.

OBJECTIVE: Rooted in a trans-territorial framework, the present study was designed to provide new evidence regarding the patterns of communication among Hurricane Maria survivors who migrated to the U.S. in the aftermath of the storm.
METHODS: A total of 319 Hurricane Maria survivor adults ages 18 and older were recruited into the Adelante Boricua study between August 2020 and October 2021. Most participants had relocated to the U.S. between 2017 and 2018. We used latent profile analysis and multinomial regression to examine the relationship of technology-based communication with depressive symptoms, well-being, cultural connection, and migration stress.
RESULTS: We identified a five-class solution, consisting of (1) moderate communication (32%), (2) disengaged (24%), (3) no social media (18%), (4) daily with family in Puerto Rico (6%), and (5) daily trans-territorial (13%) typologies. Participants in the disengaged class were more likely to report elevated depressive symptoms and limited English proficiency, lower prosocial behaviors, lower levels of religiosity, lower attendance at religious services in the U.S., and less engagement in social activities, compared to participants in the Moderate Communication class.
CONCLUSIONS: Roughly one in four individuals in our sample reported very limited technology-based communication with friends/family in their sending and new-receiving communities. As technology and smartphones continue to become integrated into 21st-century life, it is vital that researchers explore how the tremendous potential for connectedness relates to trans-territorial crisis migrants\' well-being and adaptation.

Hurricane María had a profound impact on the way essential health services were given during the emergency period that followed its landfall on Puerto Rico. The main objective of this research was to find out what people with health conditions in need of essentials services from hospitals, clinics, and pharmacies did during the emergency period. Furthermore, we wanted to know people\'s view about the government\'s response to the aftermath of the hurricane. By conducting a series of interviews with different health specialists, students at the University of Puerto Rico-Cayey, and citizens of the community of Jájome Alto in Cayey, Puerto Rico, we were able to better understand aspects of the physical and social impact caused by Hurricane Maria. Interviews made at Casa Pueblo in Adjuntas, Puerto Rico, served as an inspiration for how we can prepare better for future natural disasters.