{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:43:27Z","timestamp":1787503407088,"version":"build-2736575974"},"reference-count":56,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R21CA239457-02"],"award-info":[{"award-number":["R21CA239457-02"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["AGS-1444755"],"award-info":[{"award-number":["AGS-1444755"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["U54GM133807"],"award-info":[{"award-number":["U54GM133807"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane Mar\u00eda was a Category 4 when they hit PR). Objective: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. Methods: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018\u2013April 2019. Results: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. Conclusions: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care.<\/jats:p>","DOI":"10.3390\/ijerph182111183","type":"journal-article","created":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T21:40:21Z","timestamp":1635198021000},"page":"11183","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Environmental Stressors Suffered by Women with Gynecological Cancers in the Aftermath of Hurricanes Irma and Mar\u00eda in Puerto Rico"],"prefix":"10.3390","volume":"18","author":[{"given":"Pablo A.","family":"M\u00e9ndez-L\u00e1zaro","sequence":"first","affiliation":[{"name":"Environmental Health Department, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan 00921, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanina M.","family":"Bernhardt","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan 00936, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Calo","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M.","family":"Pacheco D\u00edaz","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan 00936, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra I.","family":"Garc\u00eda-Camacho","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan 00936, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirza","family":"Rivera-Lugo","sequence":"additional","affiliation":[{"name":"Center for Evaluation and Sociomedical Research, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan 00921, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna","family":"Acosta-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Center for Evaluation and Sociomedical Research, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan 00921, Puerto Rico"},{"name":"Hispanic Alliance for Clinical and Translational Research, Medical Sciences Campus, University of Puerto Rico, San Juan 00921, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naydi","family":"P\u00e9rez","sequence":"additional","affiliation":[{"name":"Hispanic Alliance for Clinical and Translational Research, Medical Sciences Campus, University of Puerto Rico, San Juan 00921, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana P.","family":"Ortiz-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan 00936, Puerto Rico"},{"name":"Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan 00921, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,25]]},"reference":[{"key":"ref_1","first-page":"104","article-title":"Potential impacts of climate change and variability on public health","volume":"1","year":"2012","journal-title":"J. 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