Artículos Científicos

Objective: This preliminary study aimed to examine the smoking rate among Puerto Rican cancer survivors and identify correlations with demographic, clinical, and psychological factors.

Methods: We conducted a secondary analysis using baseline data from 384 cancer survivors in Puerto Rico, collected between January 2018 and March 2023. Participants were recruited through community support groups and hospital settings. Data on sociodemographic characteristics, cancer type, treatments, psychological distress (assessed using the Patient Health Questionnaire-8 for depression and Generalized Anxiety Disorder-7 for anxiety), and smoking behaviors were analyzed. Significant associations with smoking were then tested in a logistic regression model, adjusted for all significant correlations.

Results: 7.5% of the sample reported smoking in the past 6 months, with a median consumption of six cigarettes per day. Depression was the only significant factor correlated with smoking, with participants who smoked reporting higher levels of depression. Other variables, such as age, gender, cancer type, and treatments, showed no significant correlation with smoking behavior. In the logistic regression model, elevated depressive symptoms were significantly associated with an increased likelihood of smoking, with individuals reporting such symptoms being 3.03 times more likely to smoke (95% CI [1.39, 6.63], P = .005). Other variables, such as age, gender, cancer type, and treatments, showed no significant correlation with smoking behavior.

Conclusion: Depressive symptoms are associated with smoking among Puerto Rican cancer survivors. This finding highlights the critical need for integrated mental health screening and support within smoking cessation programs tailored for this population.

Puerto Rico is aging more rapidly than almost any country, with 2020 estimates placing its population share of adults older than 65 as being the 10th highest in the world. Unlike most locales, Puerto Rico’s aging is driven by both (a) the culmination of long-running fertility and mortality trends and (b) high levels of outmigration of working-age adults, which contributes both directly (removal of young people) and indirectly (reduced births) to its pace of population aging. This article offers an overview of the main issues surrounding population aging in Puerto Rico. Policymakers and government leaders must plan for Puerto Rico’s unconventional population aging, which will exacerbate traditional concerns about the sustainability of government services and long-term economic prospects. Additional concerns emerge related to reduced social support networks and their impact on caregiving dynamics and implications for health. Puerto Rico’s unique history and political relationship with the United States present challenges and benefits for its aging population. Research on aging in Puerto Rico and public health policies must adapt to the needs of the country’s aging society.

Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States, there is a compelling need to investigate the intricate interplay between BMI, pregestational, and gestational maternal diabetes, and their potential impact on the occurrence of congenital heart defects (CHD) during neonatal development. Using the comprehensive System of Surveillance and Surveillance of Congenital Defects in Puerto Rico, we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020. Our assessment encompassed a range of variables, including maternal age, gestational age , BMI, pregestational diabetes, gestational diabetes, hypertension, history of abortion, and presence of preeclampsia. A cohort of 673 patients was included in our study. The average maternal age was 26 years, within a range of 22 to 32 years. The mean gestational age measured 39 weeks, with a median span of 38 to 39 weeks. Of the 673 patients, 274 (41%) mothers gave birth to neonates diagnosed with CHD. Within this group, 22 cases were linked to pre-gestational diabetes, while 202 were not; 20 instances were associated with gestational diabetes, compared to 200 without; and 148 cases exhibited an overweight or obese BMI, whereas 126 displayed a normal BMI.

Within disaster-affected communities, residents’ exposures and post-disaster mental health outcomes can vary widely. Yet, few studies have explored the relationship between such diverse disaster-related exposures and posttraumatic growth (PTG) in a Puerto Rican context.

Puerto Rico (PR) has faced environmental and public health challenges that could have significantly affected cancer screening access. Using administrative claims data from PR's Medicaid population, this study assessed trends in colorectal and breast cancer screening from 2016 to 2021, the impact of disasters in screening, and the absolute deficit in screening due to the pandemic. The monthly rates of claims were analyzed using Poisson regression. Significant reductions in breast and colorectal cancer screening utilization were observed. The colorectal cancer screening rate in 2017 was 77% lower a month after Hurricanes Irma and María [RRadj: 0.23; 95% CI: 0.20, 0.25] compared to the same time period in 2016. Breast cancer screening dropped 50% in November 2017 compared to November 2016 [RRadj: 0.50; 95% CI: 0.47, 0.54]. Prospectively, a recovery in utilization has been observed only for breast cancer screening. The results revealed that cancer screening utilization substantially declined after environmental disasters and the pandemic. These findings have potentially severe long-term implications for cancer health disparities and mortality in PR.

An effective and widely used vaccine could reduce the burden of dengue virus (DENV) around the world. DENV is endemic in Puerto Rico, where the dengue vaccine CYD-TDV is currently under consideration as a control measure. CYD-TDV has demonstrated efficacy in clinical trials in vaccinees who had prior dengue virus infection. However, in vaccinees who had no prior dengue virus infection, the vaccine had a modestly elevated risk of hospitalization and severe disease. The WHO therefore recommended a strategy of pre-vaccination screening and vaccination of seropositive persons. To estimate the cost-effectiveness and benefits of this intervention (i.e., screening and vaccination of seropositive persons) in Puerto Rico, we simulated 10 years of the intervention in 9-year-olds using an agent-based model. Across the entire population, we found that 5.5% (4.6%-6.3%) of dengue hospitalizations could be averted. However, we also found that 0.057 (0.045–0.073) additional hospitalizations could occur for every 1,000 people in Puerto Rico due to DENV-naïve children who were vaccinated following a false-positive test results for prior exposure. The ratio of the averted hospitalizations among all vaccinees to additional hospitalizations among DENV-naïve vaccinees was estimated to be 19 (13–24). At a base case cost of vaccination of 382 USD, we found an incremental cost-effectiveness ratio of 122,000 USD per QALY gained. Our estimates can provide information for considerations to introduce the CYD-TDV vaccine in Puerto Rico.

Objectives: The Puerto Rico Department of Health (PRDH) seeks to identify dengue epidemics as early as possible with high specificity.

Design: Development and prospective application of an early warning system for dengue epidemics using routine historical surveillance data. A weekly intercept-only negative binomial regression model was fitted using historical probable and confirmed dengue data. A range of threshold definitions was explored using three model-estimated percentiles of weekly dengue case counts.

Setting: Dengue is endemic in Puerto Rico with irregular occurrence of large epidemics with substantial impact on health burden and health systems. Probable and confirmed dengue data are routinely collected from all hospitals and private clinics.

Participants: A total of 86 282 confirmed or probable dengue virus cases were reported from 1 January 1986 to 30 June 2024, with an annual mean of 2212 cases (median: 1533; range: 40-10 356).

Primary and secondary outcome measures: The model was fitted retrospectively to mimic real-time epidemic detection and assessed based on sensitivity and specificity of epidemic detection.

Results: The 75th percentile threshold aligned best with historical epidemic classifications, balancing false alarms and missed detections. This model provides a robust method for defining thresholds, accounting for skewed data, using all historical data and improving on traditional methods like endemic channels.

Conclusions: In March 2024, PRDH declared a public health emergency due to an early, out-of-season surge in cases that exceeded the epidemic alert threshold developed in this study. This real-time application highlights the value of these thresholds to support dengue epidemic detection and public health response. Integrating thresholds with other tools and strategies can enhance epidemic preparedness and management.

This study aimed to describe the development of the Perceived Therapist’s Knowledge about Gender Identity Diversity Scale and to preliminarily validate this scale by describing its psychometric properties. This research instrument was constructed based on the existing literature and recommendations for instrument development. Initially, a 36-item scale was devised to assess perceived openness and knowledge about gender identity diversity in therapy. The content validation process involved 12 expert judges, leading to a refined 25-item scale. Participants consisting of 57 trans and non-binary Puerto Rican individuals completed the scale. Exploratory factor analysis revealed a unidimensional structure, supporting a single factor named “perceived knowledge about gender identity diversity in therapy.” The final scale demonstrated excellent reliability (α = 0.978; Sα = 0.980; ω = 0.979), indicating strong internal consistency. This validated scale contributes to assessing primarily Hispanic trans and non-binary individuals’ perceptions of their therapists’ knowledge about gender identity diversity.

Although the overall colorectal cancer (CRC) incidence has been steadily declining in the United States, a dramatic increase in the number of CRC cases among individuals younger than 50 years of age (early- onset CRC) has been observed. CRC is the second and first leading cause of cancer death in the United States and among Hispanic men and women living in Puerto Rico (PRH), respectively. We report CRC incidence rates from 2000 to 2021 among PRH and compare them to data in the Surveillance, Epidemiology, and End Results Program (SEER).

The year-over-year changes in economic growth across the Caribbean Antilles islands demonstrate sensitivity to climatic conditions. Daily wind and rainfall exceedances from passing storms are negatively related to the gross domestic product (GDP). Field regression of the GDP time series from 1971 to 2022 for Puerto Rico and the neighboring Antilles islands reveals links with eastern Pacific sea temperature. A zonal overturning atmospheric circulation over the equatorial Atlantic emerges in composite analysis. Alternating at an approximate 7-year interval, it modulates weather events and economic prosperity in the Caribbean. A multivariate algorithm is developed to predict changes in the annual GDP growth rate. The most influential predictor is precipitable water in the equatorial Atlantic 1 year earlier. Reduced moisture overlain by westerly winds in a global bottleneck at 5° S–5° N, 20–40°W tends to suppress Caribbean storms, leading to economic prosperity in the following year. Statistical methods and risk-reduction strategies are outlined.

: In the 6 months following Hurricane Maria the number of people who died from the hurricane was much higher than was initially estimated from death certificates. Disruption of health care services and displacement led to the exacerbation of pre-existing chronic diseases. The objectives of this study were to (1) estimate the excess deaths in Puerto Rico in the 6 months following Maria, (2) identify geographical areas experiencing higher risk of chronic disease mortality following Maria and (3) identify community-level vulnerability characteristics associated with some communities being at higher risk of increased chronic disease mortality after Maria. Methods: Death records were obtained from Puerto Rico’s Department of Health Demographic Registry. Mortality risks per 100 000 were calculated for chronic disease categories and all-cause mortality for the 6 months following Maria and the same months in the year before. Geospatial analysis using Getis–Ord Gi∗ Statistic was used to determine if mortality clusters of 6 month mortality risk following hurricane Maria by census tract were statistically significant. Multinomial logistic regression was used to model the association between census tract level social vulnerability and being classified as higher or sustained risk of mortality in the 6 months following Hurricane Maria compared to the previous year’s mortality risk. Odds ratios and 95% confidence intervals were estimated to measure associations between social vulnerability and mortality risk. Results: In the 6 months following Maria there were increases in mortality risk for cardiovascular disease, Alzheimer’s, diabetes, sepsis, chronic respiratory disease, hypertension and all-cause mortality. Examining community level characteristics associated with vulnerability to disasters, neighborhoods with higher proportion of people 65 and older, higher proportion of houses being multiunit structures and higher proportion of households with no vehicle, in comparison to other neighborhoods in Puerto Rico,were more likely to have sustained high risk for mortality before and after Maria or increased risk of being a hot spot for chronic disease mortality after Maria.

This cross-sectional study examines the mental and physical health-related quality of life in US territories compared with the 50 US states.

To evaluate the impact of Hurricanes Irma/Maria on diabetes incidence in Puerto Rico. Mortality increased substantially after the hurricanes, but morbidity was not assessed. We recruited 364 participants from the San Juan Overweight Adults Longitudinal Study (SOALS) aged 40–65 years who completed a three-year follow-up and were free of diabetes. We conducted additional questionnaires 1.7–2.5 years after hurricanes. Glycosylated hemoglobin (HbA1c), fasting glucose and insulin were assessed at all three visits. We compared diabetes incidence between pre-hurricane visits and between visits spanning the hurricanes using Generalized Estimating Equation (GEE) adjusting for within person repeated measures, age, and body mass index (BMI). Diabetes incidence was significantly higher spanning the hurricanes than pre-hurricane (multivariate GEE model: IRR = 2.1; 95% CI: 1.4–3.1). There was a significantly higher increase spanning the hurricanes compared to prehurricanes for Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (median: 0.3 uIU/mL vs. 0.2 uIU/mL). HbA1c levels increased by 0.4% spanning the hurricanes. Increases in diabetes incidence, HOMA-IR and HbA1c were higher spanning the hurricanes compared to the pre-hurricanes period. The increase in diabetes incidence remains significant after adjusting for age and BMI.

This study examined how the COVID-19 pandemic contributed to food insecurity in households in Puerto Rico with children with disabilities, compared to households with children without disabilities.

To examine how intergenerational support varies by parents’ living arrangements and whether there are gender differences in received support in Puerto Rico. Data come from the 2006–2007 Puerto Rican Elderly and Health Conditions Project, a representative longitudinal study of adults aged 60 and older in Puerto Rico (n = 2,288). We examined the association between parents’ living arrangements (alone, with spouse/partner only, with children) and their receipt of functional (help with errands/housework/transport) and health (help when sick) support from children, and whether parents’ gender moderates the association. Intergenerational coresidence was associated with higher odds of receiving functional and health support than living alone. Women were more likely than men to receive both forms of support. Parents’ gender significantly moderated the association between living arrangements and receiving health support—men living with their partners were less likely to receive health support from children than women in similar living arrangements. These associations persisted when analyses were restricted to those with disability. Our findings suggest that parents’ receipt of support from children is conditioned upon their living arrangement and gender, even when their functional health is jeopardized. We discuss these results in relation to the heterogeneous influence of living arrangements for older adults’ support needs and provide suggestions for policy and directions for future research in rapidly aging Puerto Rico.

A study was conducted to evaluate the mental health status and access to essential resources in a sample of schoolteachers impacted by earthquakes and the COVID-19 pandemic in Southwestern Puerto Rico.

The combined effects of declining fertility and increased longevity have accelerated population aging in different parts of the world. Unlike other countries, Puerto Rico is also experiencing unprecedented levels of working-age out-migration. The full impact of high out migration on Puerto Rican demography is not fully understood. Placing Puerto Rico’s aging process in an international context is useful in identifying the role out-migration is having on the accelerated aging of the Puerto Rican society. Using the World Population Prospects 2019 estimates, we compared the pattern of rapid aging found for Puerto Rico with the trajectories of six other countries with the highest population of 65+ in the World, Europe, and the Caribbean from 1960 to 2020. Prior to 2010, the aging process in Puerto Rico was comparable to the other countries. After 2010, the percent of the population over 65 years in Puerto Rico nearly doubled from 11% to 21%. The nearly doubling of the percent of older adults is not observed in any of the comparison countries. We find that the rapid aging of Puerto Rico, changing from a linear trend to an exponential one, is a result of accelerating levels of out-migration, which is concentrated in the working-age population.

Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.

Background Craniomaxillofacial (CMF) trauma is a significant problem in the United States, with estimated costs of nearly one billion dollars annually. Facial fractures occur based on factors such as facial structure, the direction and intensity of the impact, and the mechanism of injury. The most frequent facial fractures include the nose, orbits, zygomatic complex, mandible, maxilla, and frontal bone. Additionally, demographic, social, cultural, and environmental factors can contribute to particular trauma mechanisms like falls and motor vehicle accidents (MVAs), leading to different CMF injury rates among populations. Overall, CMF traumas have a significant potential for morbidity and mortality. This study aims to provide the first overview of the prevalence of CMF trauma in Puerto Rico. Methods This retrospective study includes patients aged 0-100 who presented with CMF trauma from 2018 to 2022 to the only trauma center in Puerto Rico. Demographic and clinical data were collected, including the mechanism of injury, craniofacial structures involved, treatment, and outcomes. Frequencies of demographic and clinical data were documented, and statistical analysis using one-way ANOVA and t-tests was performed. Results A total of 1,102 patients (83.1% male and 16.4% female) with CMF injuries were included. The mean age of the group was 40.67 years. The most common mechanisms were non-car-related MVA (23.6%), car-related MVA (22.9%), pedestrian accidents (18.4%), falls (15.9%), and gunshot wounds (10.4%). Cranial fractures occurred in 32.7% of patients with the following affected regions: temporal (16.2%), frontal (10.6%), parietal (7.8%), and occipital (5.3%). Facial fractures occurred in 70% of patients with the following affected regions: middle face including maxilla, nose, zygoma, and orbits (61.8%), lower face including mandible (17.7%), and upper face including frontal bone (9%). Approximately 19.8% of patients with CMF fractures underwent surgical management. The mortality rate in the cohort was 11.8%. The Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) were significantly worse in patients with cranial (p < 0.001) and/or facial (p < 0.001) fractures when compared to patients who suffered from CMF traumas without fractures. Conclusion To our knowledge, this is the first study characterizing CMF traumas in Puerto Rico. The majority of the affected patients were male and belonged to the adult population. Common etiologies of injury were comparable to others reported in the literature, including MVA, falls, and gunshot wounds. Facial fractures were more prevalent than cranial fractures in our cohort. Patients with high-severity injuries were more likely to be managed surgically. By establishing the epidemiological picture of CMF traumas in Puerto Rico, public health and clinical efforts may be employed to allow for improved patient outcomes.

Understanding virus-virus interactions is important for evaluating disease transmission and severity. Positive interactions suggest concurrent circulation, while negative interactions indicate reduced transmission of one virus when another is prevalent. This study examines interactions among seven respiratory viruses using a Bayesian approach that accounts for seasonality and long-term trends. 

The purpose of the study is to contribute to the literature regarding post-acute nursing home utilization and quality indicators among Medicare beneficiaries in Puerto Rico compared with the United States (US) mainland. Medicare data from 2015–2017 was used to identify new discharges to skilled nursing facilities (SNFs) using the Minimum Data Set and the Medicare Provider Analysis and Review. Setting and Participants: Post-acute care patients admitted to SNFs in Puerto Rico and the US. Our final cohort included 4,732,222 beneficiaries from Puerto Rico and the US enrolled in Medicare fee-for-service or Medicare Advantage programs admitted to a SNF (N=15,197) following an acute hospital stay. We compared demographic, clinical and facility-level characteristics among patients in Puerto Rico and the US. We also described two quality indicators among these groups: a) 30-day rehospitalization rates; and b) successful discharge from the facility to the community. Medicare patients in Puerto Rico were physically and cognitively healthier than patients in the US. Puerto Ricans were also more likely to be admitted to lower quality nursing homes than US patients (2.5 vs. 3.4). Finally, Puerto Ricans had higher rates of successful discharge to the community (17.6, 95% CI 13.0 – 22.3), but higher 30-day rehospitalization rates compared to US patients (11.2, 95% CI, 6.2 – 16.3). These differences were consistent even when comparing these quality outcomes among Puerto Ricans to US Hispanics only. SNFs in the US and Puerto Rico are now receiving financial penalties for high readmission rates. Currently, Medicare does not measure readmission rates for Medicare Advantage patients—even though some states, including Puerto Rico, have a high proportion of Medicare Advantage beneficiaries. As Medicare Advantage enrollment continues to increase, our results highlight the importance of measuring performance among Medicare Advantage patients and assessing disparities in quality of post-acute care among patients in Puerto Rico and the US. Medicare patients in Puerto Rico were admitted to lower-quality skilled nursing facilities and had over 8 percentage points higher 30-day rehospitalization rates than patients in the US mainland.

This is a descriptive study using healthcare claims data from patients with T2DM from public and private healthcare insurance companies providing services in Puerto Rico in 2013, aimed to estimate the prevalence of comorbidities in this population. Descriptive analyzes were performed by sociodemographic, and type of service variables using frequency and percent for categorical data or means (+/-SD) or median (IQR) for continuous variables. Chi-square, Fisher exact or twosample t-tests were used for comparisons. A total of 3,100,636 claims were identified from 485,866 adult patients with T2DM. Patients older than 65 years represented 48% of the study population. Most patients were women (57%) and had private health insurance (77%). The regions of Metro Area (17%) and Caguas (16%) had the highest number of persons living with T2DM. The overall estimated prevalence of T2DM was 17.4%. The number of claims per patient ranged from 1 to 339. A mean of 6.3 claims (SD±9.99) and a median of 3 claims (Q1 1- Q3 8) per subject were identified. Of the 3,100,636 claims most (74%) were related to the diagnosis of diabetes (59%) and associated with outpatient services (88%). The most prevalent comorbidities were hypertension (48%), hyperlipidemia (41%), neuropathy (21%); renal disease (15%), and retinopathy (13%). A high prevalence and co-prevalence of comorbidities and use of healthcare services were identified in patients with T2DM, especially in older adults. Since most comorbidities were due to diabetes-related conditions, this analysis highlights the importance of early diagnosis and adequate management of T2DM patients to avoid preventable burden to the patient and to the healthcare system.

We aimed to determine the relationship between socioeconomic and psychological factors and overall cardiovascular health (CVH), as defined by the American Heart Association’s Life’s Essential 8 (LE8), among young adults in Puerto Rico. Participants were 2156 young adults, between the ages of 18–29 years, enrolled in the PR-OUTLOOK study. The analysis included survey, laboratory, and physical measurement data collected from September 2020 to November 2023. Assessed socioeconomic indicators included food insecurity, housing instability, economic insecurity, and subjective social standing. Evaluated psychological factors comprised symptoms of depression, anxiety, post-traumatic stress, and overall perceived stress. LE8 scores were calculated and classified as suboptimal (poor/intermediate range) vs. ideal CVH. Logistic regression models estimated associations between each socioeconomic and psychological measure and suboptimal CVH, and dominance analysis assessed the importance of each measure. Participants’ mean age was 22.6 (SD = 3.1), 60.9 % were female, about one-third (34.2 %) had high school education or less, and over one-third had public or no health insurance (38.4 %). Participants reporting socioeconomic adversity (i.e., high food insecurity, housing instability and economic insecurity, and low subjective social standing) and elevated psychological symptoms (i.e., symptoms of anxiety, depression, posttraumatic stress, and overall perceived stress) had lower CVH scores. However, in the adjusted analysis, only lower subjective social standing (OR = 1.38, 95 % CI = 1.13–1.69) and elevated symptoms of anxiety (OR = 1.63, 95 % CI = 1.25–2.13) and depression (OR = 1.30, 95 % CI = 1.03–1.65) emerged as the primary contributors to suboptimal CVH (vs. ideal). Conclusion: Efforts to preserve and enhance CVH among young Puerto Ricans on the island should target these factors.

Puerto Rico (PR) is a United States (US) territory with a history of colonial violence, poverty, and government corruption. Due to these sociopolitical factors and natural disasters (e.g., hurricanes and earthquakes), there has been a sharp increase in PR residents migrating to the mainland US. Local media and professional health organizations focus on the impact of medical migration on the PR health system (e.g., health personnel shortages and long waiting periods for critical care). According to the PR College of Physicians and Surgeons, 365-500 physicians have left annually since 2014, which represents a crisis of access to health services. However, few studies have focused on ways to mitigate medical migration from PR to the US mainland. This article describes the recommendations provided by migrating and non-migrating Puerto Rican Physicians (PRPs) to mitigate medical migration from PR to the US mainland. We focus on qualitative data from a mixed-methods NIH-funded study (1R01MD014188) to explore factors that motivate or mitigate migration among migrating (n = 26) and non-migrating (n = 24) PRPs. Interviews were analyzed following thematic analysis guidelines. Results show the following themes: 1) strategies to retain early-career medical residents living in PR; 2) recommendations for local government on future health policy; and 3) work environment initiatives for health institutions to mitigate physician migration. Findings suggest multilevel efforts are required to mitigate medical migration in PR.

Although Hispanic population is growing rapidly, Latino students earn fewer STEM degrees than their peers. Therefore, it is mandatory to implement strategies that improve STEM retention and graduation rates for Hispanic students. There is little research about the ways in which multicampus collaborative CUREs combined with additional academic support, affect low-income, Hispanic students and none that focus solely on Puerto Rican students in STEM. Puerto Rico (PR) has a 99% Hispanic population; thus, it is imperative to include PR in education research literature. This study sought to examine the impacts of the Research for Improved Student Experiences (RISE) in STEM program at two campuses of the Inter American University of Puerto Rico. The program included multicampus collaborative CUREs, academic advising, and peer mentoring using quasi experimental design. Impact assessment included psychosocial metrics such as self efficacy, science identity and sense of belonging in a pre/posttest design. These findings were triangulated with the differences between treatment and control for retention, pass rate, and course grades. The findings revealed statistically significant improvements on all metrics. This study’s findings support multicampus collaborative CUREs, academic advising, and peer mentoring as useful and effective strategies for improving outcomes for low-income Hispanic students in Puerto Rico.