{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T07:32:51Z","timestamp":1773473571797,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:00:00Z","timestamp":1704844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["T32DA00725"],"award-info":[{"award-number":["T32DA00725"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Traumatic Stress"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Youth exposed to natural disasters are at risk of developing trauma\u2010related symptoms as well as engaging in substance use. Although previous research has established associations between disaster\u2010related stressors and substance use in youth, less has focused on how symptoms of posttraumatic stress disorder (PTSD) may underpin this association. The current study used network analysis to identify specific PTSD symptoms associated with substance use following a natural disaster. Participants were 91,732 youths (Grades 3\u201312) from across Puerto Rico who completed a needs assessment 5\u20139 months after Hurricane Maria made landfall in September 2017. We examined associations between PTSD symptoms and substance use, identified clusters of symptoms and bridges between them, and explored age\u2010 and binary gender\u2013related differences in associations between specific PTSD symptoms and substance use. Analyses identified two symptom communities: (a) arousal and reactivity, negative alterations in cognition and mood, and substance use, and (b) avoidance and intrusion. Broader findings suggested that substance use was most strongly associated with PTSD\u2010related irritability and angry outbursts among youths. Surrounding nodes explained only 4.1% of the variance in substance use, but this was higher among youths who reported not having a supportive adult, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 8.5; friend, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 7.9; or teacher\/counselor, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 7.7, in their life. The bridge symptoms of sleep disruption and physiological reactivity were identified as potentially critical intervention targets for disrupting PTSD symptom networks after a natural disaster. Implications for triaged mental health care following natural disasters and directions for future research are discussed.<\/jats:p>","DOI":"10.1002\/jts.23008","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T08:01:31Z","timestamp":1704873691000},"page":"267-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A network analysis of Hurricane Maria\u2013related traumatic stress and substance use among Puerto Rican youth"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6790-7534","authenticated-orcid":false,"given":"Alejandro L.","family":"V\u00e1zquez","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Department of Psychology University of Tennessee  Knoxville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia M. Navarro","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Department of Psychology University of Tennessee  Knoxville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2478-7827","authenticated-orcid":false,"given":"Daniel K.","family":"Feinberg","sequence":"additional","affiliation":[{"name":"Department of Counseling, Clinical, &amp; School Psychology University of California  Santa Barbara California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Carlos","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Counseling, Clinical, &amp; School Psychology University of California  Santa Barbara California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Mississippi  Oxford Mississippi USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regan W.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosaura E.","family":"Orengo\u2010Aguayo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.5055\/jem.0634"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10578\u2010020\u201000995\u20106"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dmr.2006.11.001"},{"key":"e_1_2_8_6_1","volume-title":"Skills for psychological recovery: Field operations guide","author":"Berkowitz S.","year":"2010"},{"key":"e_1_2_8_7_1","volume-title":"Psychological first aid: Field operations guide","author":"Brymer M.","year":"2006"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12963"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2011.06.006"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10935\u2010012\u20100266\u2010z"},{"key":"e_1_2_8_11_1","volume-title":"Trauma\u2010focused CBT for children and adolescents: Treatment applications","author":"Cohen J. 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