In the aftermath of Hurricane Maria, tens of thousands of Puerto Ricans sought refuge on the US mainland, with the majority relocating to South and Central Florida. More than one year after the hurricane, frontline journalism and our preliminary research make clear that many post-Maria survivors plan to stay on the US mainland for the foreseeable future. And yet, at present, our understanding of displaced Puerto Ricans remains very limited. Data from our pilot studies and our ongoing work suggests that, among the myriad issues faced by this population, alcohol misuse and mental health problems are particularly serious challenges. Of concern, in particular, is that stress and trauma caused by the storm will lead to greater alcohol misuse and mental health problems among Puerto Rican adults and their children, especially when coupled with the migration-related cultural stress stemming from an unplanned, abrupt, and long-term displacement from the island territory with its distinct culture and language. The proposed study is oriented around three objectives designed to build in a programmatic fashion. The first objective relates to the emerging public health needs of migrants in the aftermath of the storm; namely, to provide an epidemiologic portrait of the characteristics, experiences, and needs of post-Maria Puerto Rican families who relocated to Florida. The second objective focuses on broader theoretical issues related to post-disaster migration and adaptation; namely, to examine the prospective association between [a] trauma, cultural stress, family functioning and [b] alcohol misuse and mental health problems, and to conduct a differential test of cultural stress theory in South and Central Florida to inform intervention development in each region. Based on our prior research and cultural stress theory, our central hypothesis is that families relocating to South Florida (a bilingual region where Latino cultural influences are celebrated) will experience less migration-related cultural stress and, consequently, enjoy greater family functioning and fewer alcohol misuse and mental health problems compared to those in Central Florida (an area with a relatively recent uptick in Puerto Rican and other Latino migration). The third objective focuses on ensuring?via engagement with stakeholders and participants?that study findings are effectively translated to real world practice. The scientific premise for this study is to inform efforts to support displaced Puerto Ricans and advance theorizing on disaster-related migration and health. We will pursue the following specific aims:  Describe the characteristics, experiences, and needs post-Maria Puerto Rican families in Florida;  Examine prospective relationships to test cultural stress theory across distinct resettlement contexts; and  Engage with stakeholders and participants to develop guidelines, best practices, and intervention recommendations for dissemination and testing in future research. The contribution of this study is significant because it lays groundwork for the development of evidence-based interventions for the needs of an at-risk group, and promises to answer context-specific questions central to the advancement of cultural stress theory and broader theorizing around migrant adaptation and key outcomes.
Public Health Relevance The proposed research is relevant to public health because it will provide critical insight into the disaster- and migration-related experiences of Puerto Rican families in the aftermath of one of the costliest natural disasters in United States' history. Such research would provide information vital to the development of evidence-based programs designed to target alcohol misuse and mental health problems among a large and at-risk population of US-citizen migrants. The proposed project is highly relevant to NIMHD's mission in that it will directly inform efforts to address alcohol misuse and mental health problems among a subgroup of minority and vulnerable families who are experiencing significant health disparities related to stress, trauma, and migration-related consequences.