Javier Jusino, BS¹, José Espinal, BS¹, Laura Bou Delgado, BA¹, Nicole Estarellas, BS¹, Claudia Francia, BS¹,

Neshmaidy Negron, BS¹, Jose Quintana, BS¹, Gabriela Roldan, BS¹, Claudia Silva, BS¹, Awilda Ramos, MD²,

Melissa Valerio, MPH, PhD²

1 Universidad Central del Caribe School of Medicine, Bayamón, PR

2 University of Texas Health System, Houston, Texas

Background: Puerto Rican families across the island were drastically affected following the 2017 hurricanes Irma and María, 2019-2020 earthquakes and the ongoing COVID-19 pandemic. Basic health statistics in Puerto Rico indicate that the island faced significant health disparities prior to these disasters compared to the United States. There is concern that the stress level of Puerto Ricans has severely increased with the exposure to these major consecutive disasters. Thus, our research question is: What has been the experience of the Puerto Rican population (21-65 years of age) exposed to multiple disasters and how has this exposure contributed to their stress levels? While literature on stress due to natural disasters is available, literature related to cumulative stress due to multiple consecutive disasters is scarce.

Objective: The main objective of this project is to identify and define cumulative stress from a community perspective in Puerto Rico after experiencing multiple disasters in a relatively short period of time.

Methods: Six focus groups of 10-12 participants will be completed after IRB approval. Community leaders will assist with recruitment representing communities across the island. Participants between the ages of 21 – 65 will complete informed consent and a demographic survey prior to the focus groups. We will complete two groups from Metro region (largest COVID-19 impact), two from Caguas region (high hurricane impact) and two from Ponce region (closest to earthquakes’ epicenter). The 2-to-2.5-hour sessions will be via WEBEX and moderated by research investigators. All sessions shall be in Spanish and will be recorded and transcribed to complete qualitative coding and data analysis for generation of summary reports and development of a cumulative stress framework to guide future research.

Results: We will use NVivo data software to analyze the transcriptions and identify key themes across the groups. We hope to use these themes to identify an increase in community cumulative stress and address that increase to treat existing health inequities in Puerto Rico that could worsen such as depression and diabetes.

Conclusions & Impact: We hypothesize that having been exposed to a greater number of disasters will translate into an increase in the level of cumulative stress in the Puerto Rican community. With these results, we hope to contribute towards the body of knowledge for disaster response improvement and recuperation of the Puerto Rican as well as other Latino populations with disparate burden of illness and stress.

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