{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:06:57Z","timestamp":1786122417093,"version":"build-2736575974"},"reference-count":56,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"unspecified","delay-in-days":218,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["T42OH008455"],"award-info":[{"award-number":["T42OH008455"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["P30ES017885,R01ES026603,T32ES007062"],"award-info":[{"award-number":["P30ES017885,R01ES026603,T32ES007062"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disaster med. public health prep."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1935789326104108_sec1\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The increasing frequency and severity of climate-related disasters pose major threats to public health, particularly when they intersect with other crises like pandemics. Puerto Rico has faced multiple large-scale disasters in recent years, yet research on their cumulative health effects remains limited. This study examines associations between disaster exposure\u2014Hurricane Mar\u00eda and the COVID-19 pandemic\u2014and self-reported physical, mental, and behavioral health among Puerto Rican adults using Behavioral Risk Factor Surveillance System data (2015-2021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1935789326104108_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used multivariable linear and log-binomial models, adjusting for key sociodemographic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1935789326104108_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 35,517 respondents, post-disaster periods were mostly linked to worse health outcomes, including more days of poor mental health, increased substance use, and more negative health perceptions. The early post-hurricane period showed the greatest harm, with participants reporting 2.47 more poor mental health days (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.002), lower likelihood of exercise (PR = 0.65), and higher likelihood of smoking (PR = 1.20). Conversely, early and late pandemic periods showed apparent health improvements, though these findings require cautious interpretation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1935789326104108_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results underscore the need for disaster-responsive mental health care, resilient infrastructure, and policies addressing financial inequities that heighten vulnerability. Strengthening community networks and ensuring equitable preparedness and relief efforts are essential to reducing the health impacts of future disasters.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/dmp.2026.10410","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T09:46:38Z","timestamp":1786095998000},"source":"Crossref","is-referenced-by-count":0,"title":["Extreme Weather Events and Pandemic Threats: Analyzing the Health Impacts of Multiple Disaster Events in Puerto Rico"],"prefix":"10.1017","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3714-4326","authenticated-orcid":false,"given":"Mislael A.","family":"Valentin-Cortes","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00jmfr291","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie S.","family":"O\u2019Neill","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00jmfr291","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Elliott","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00jmfr291","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Fleming","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00jmfr291","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos E.","family":"Rodriguez-Diaz","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05qwgg493","id-type":"ROR","asserted-by":"publisher"}],"name":"Boston University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis J.","family":"Handal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00jmfr291","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"S1935789326104108_r13","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v9.31320"},{"key":"S1935789326104108_r21","doi-asserted-by":"publisher","DOI":"10.1080\/10714839.2024.2323395"},{"key":"S1935789326104108_r29","first-page":"175","article-title":"Explaining interviewer effects: a research synthesis","volume":"5","author":"West","year":"2017","journal-title":"J Surv Stat Methodol."},{"key":"S1935789326104108_r3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1817067"},{"key":"S1935789326104108_r15","doi-asserted-by":"publisher","DOI":"10.5055\/ajdm.2015.0216"},{"key":"S1935789326104108_r4","unstructured":"4. 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