The health status of youth in Puerto Rico

Contributions of Ecosystem Services to Human Well-Being in Puerto Rico

Ecosystem services, including availability of greenspace, clean air, and clean water, can have benefits to human well-being, but their relative importance compared to economic or social services is often overlooked. In Puerto Rico, for example, improving community well-being, including economic and cultural opportunities, human health, and safety, are often overarching goals of environmental management decisions, but the degree to which improvements in ecological condition and provision of ecosystem services could impact local communities is complicated by wide variation in social and economic conditions. This study quantifies and maps neighborhood-scale indicators of human well-being and ecosystem services for Puerto Rico to better understand the degree to which ecosystem services provisioning, alongside co-occurring social and economic services, explains variability in a number of indicators of human well-being. In Puerto Rico, variability in indicators of human well-being were predominately explained by economic services related to accumulating income and personal savings, and social services, including availability of family services, healthcare services, and access to communication technology. Despite the large explanatory power of economic and social services, however, the analysis detected that substantial portions of well-being, in particular education and human health, could be explained by variability in ecosystem services over space and time, especially availability of greenspace. Linking ecosystem services to multivariate elements of human well-being can serve to complement more traditional community planning or environmental management efforts by helping identify potential unintended consequences or overlooked benefits of decisions.

Downscaling a Human Well-Being Index for Environmental Management and Environmental Justice Applications in Puerto Rico

Human well-being is often an overarching goal in environmental decision-making, yet assessments are often limited to economic, health, or ecological endpoints that are more tangible to measure. Composite indices provide a comprehensive approach to measuring well-being in terms of multi-dimensional components, such as living standards, health, education, safety, and culture. For example, the Human Well-Being Index (HWBI) framework, initially developed for the U.S. fifty states, was recently applied to quantify human well-being for Puerto Rico. However, the paucity of data at spatial scales finer than state or county levels, particularly for social metrics, poses a major limitation to quantifying well-being at neighborhood-scales relevant to decision-making. Here we demonstrate a spatial interpolation method to fill in missing fine-scale data where coarser-scale data is available. Downscaling from municipio (i.e., county-equivalent) to census-tract revealed a greater range of variability in well-being scores across Puerto Rico, in particular, a larger proportion of low well-being scores. Furthermore, while some components of wellbeing (e.g., Education, Health, Leisure Time, Safety and Security, Social Cohesion) showed consistent improvement over time from 2000-2017 across Puerto Rico, others (e.g., Connection to Nature, Cultural Fulfillment, Living Standards) were variable among census tracts, increasing for some but declining for others. We use a case study in the San Juan Bay estuary watershed to illustrate how approaches to quantify baseline levels of well-being can be used to explore potential impacts of management actions on communities, including to identify environmental justice inequalities among neighborhoods. Spatial clustering analysis was used to identify statistically significant cold or hot spots in well-being. This study demonstrates how indicators of well-being, coupled with interpolation methods to overcome limitations of data availability, can help to monitor long-term changes over time and to better communicate the potential value of ecosystem restoration or resource management.

Assessing Child Health and Health Care in the U.S. Virgin Islands Using the National Survey of Children's Health

OBJECTIVES

To characterize the health and health care experiences of children in the U.S. Virgin Islands (USVI), assess differences by household poverty status, and provide comparisons to the general U.S. child population.

METHODS

Data are from the 2011-2012 National Survey of Children's Health, which included 2342 USVI children, aged 0-17 years. Parent-reported measures of health status and health conditions, behavioral characteristics, and health care access and utilization were assessed. Weighted prevalence estimates were calculated and compared by household poverty status using Chi square tests.

RESULTS

Overall, 31.3% of USVI children lived in households below 100% of the federal poverty level (FPL). Children in these low-income households were more likely to have public insurance (33.0% vs. 8.4%) and unmet health needs (11.6% vs. 6.3%) as compared to those in households with incomes ≥ 100% FPL (all p < 0.01). They were also less likely to have a medical home (22.5% vs. 42.2%), including a usual source of sick care (p < 0.01). Compared with U.S. children in general, USVI children had lower rates of preventive medical visits, preventive dental visits, and care received in a medical home.

CONCLUSIONS

USVI children experience challenges in accessing and utilizing health care services, particularly those in low-income households, and fare worse than U.S. children on many of these measures. These findings will serve as a baseline comparison for an upcoming survey of maternal and child health to be conducted in eight U.S. territories including the USVI.

Sleep, Depressive/Anxiety Disorders, and Obesity in Puerto Rican Youth

OBJECTIVE

Adolescents from Puerto Rican backgrounds are found to have higher rates of obesity than adolescents from other ethnic groups in the US. The objective of this study is to examine whether sleeping the recommended number of hours and depression or anxiety disorder are independently related to risk for obesity in a sample of Island Puerto Rican adolescents, and whether the association between sleep and obesity is moderated by depression or anxiety disorder.

METHODS

Data from the study were derived from the third wave of an island wide probability sample of Puerto Rican youth residing on the Island, 10-25 years of age (N = 825), with a response rate of 79.59%. The current study focuses on youth 10 to 19 years of age (n = 436).

RESULTS

In this sample, youth who slept less than the recommended number of hours (defined as 7-9 h per night) had a significantly increased risk for obesity and were three times as likely to be obese. Youth who met criteria for a depressive/anxiety disorder were almost 2.5 times as likely to be obese. However, the presence of an anxiety/depressive disorders did not moderate the association between sleeping the recommended number of hours and risk for obesity.

CONCLUSION

Sleeping less than the recommended number of hours may be an important risk factor for obesity status in Island Puerto Rican youth. These findings suggest that attention to healthy sleep behaviors and a sleep environment that promotes high quality sleep may be important for Puerto Rican adolescents at risk for obesity.

Commentary on Caetano, Vaeth, Mills, and Canino (2016): Employment Status, Depression, Drinking, and Alcohol-Use Disorders in Puerto Rico

BACKGROUND

In this commentary, we discuss a study by Caetano and colleagues (in press) that examines the relation between depression, employment status, and drinking behaviors among adults (aged 18 to 64) living in San Juan, Puerto Rico.

METHODS

We discuss the contribution of Caetano and colleagues' (in press) study to the understanding of socioeconomic risk and protective factors associated with depression and drinking behaviors among Hispanics, specifically Puerto Ricans. We focus on 3 topics: (i) gender differences in the relation between depression and employment status, (ii) the relation between participation in the workforce and drinking behaviors, and (iii) the potential role of family and contextual factors mitigating the effects of unemployment on drinking behaviors.

RESULTS

Findings suggest that in Puerto Rico, employment status, although associated with depression and drinking behaviors, was not associated with alcohol-related outcomes.

CONCLUSIONS

Caetano and colleagues' (in press) article represents an important contribution to understanding differential effects in risk and protective factors associated with drinking behaviors and alcohol-related consequences among Hispanics. Future research should focus on examining the role of family and social support to mitigate the effects of unemployment, depression, and drinking behaviors among Puerto Ricans living in Puerto Rico.