Hola bella :-)

Terrific graphic

similar pattern was true for AIDS in 1980s. D'Aquila did a nice paper then

At some point could you comment on whether the data sources allowed individuals to code/be coded as only 1 Hispanic group or more than 1 (as if so, how were they coded. And if BLack plus HIspanic, (as with many Domincains for example, were they coded as H or B?

The word trampoline. How would you define trampoline in this context?

@ Janie, thank you for this important question. This is certainly an important limitation of the data source because there is so much variation within such a broad category as South American or Central American. First, while some individuals' death certificates may write in ethnicity such as "Guatemalan" which identifies a specific country, others use a broad category such as "Central American," so we cannot determine the numbers in smaller groups such as Guatemalan. Second, with the small numbers of deaths, we cannot produce reliable rates in any smaller categories, unfortunately.

@ Don, thank you for this very relevant point. Yes, certainly this is a big limitation, especially in subnational analyses. For example, in the slides with the rates by state, many states were missing for this very reason of small numbers. Unfortunately I do not have a solution other than pooling years together although this would be at the cost of recency

@ David , thank you for this important point. In the mortality data, each Hispanic is coded with one Hispanic heritage only, regardless if they may have identified with more than one heritage. This also brings up the very important limitation that the heritage listed on the death certificate is filled out by the funeral director, usually as informed by the next of kin, but we cannot know that the identification on the death certificate is how the person would have self-identified during life. For someone who was identified as both Hispanic and Black, in this analysis would be included in the Hispanic rate only, as the categories were mutually-exclusive (e.g., Non-Hispanic Black rather than Black)

What would they recommend as next steps?

Puerto Rico's drug situation is a multifactorial issue. There needs to be new strategy discussed as how Puerto Rican born males will be assisted and explore a harm reduction aspect. Best practices need to be looked at carefully.

I agree with the point of non-monolithic category. But I think we also need to explore how muc

Could you comment on the overdose mortality in Puerto Rico? As mentioned, the disparity between US born PR and non-US born is astounding. Unfortunately it seems like overdose mortality data in PR itself is almost non-existent.

I agree with Kyle Melin. This data is so important but there needs to be strategies rolled out. LatinX men are at risk

The different categories of "Hispanics" are also subjected to different forms of racial oppression and exploitation that may affect drug use and overdose mortality

While you had to use nativity as a surrogate for language/acculturation, do you think more meth/bup/ and SSP/harm reduction services in Spanish would be an important (if insufficient) step?

Thank you for clarifying trampoline.

Love your cat Dannie!

It's just so poorly recorded here :(

I have not heard Harm reduction linked to the "industrial complex" - do you think that SSPs have been too co-opted? if so, do you have suggestions as to how to redress/fix/avoid this to improve their potential positive impact?

Based on your analysis of the data thus far, can you give an example of the ways in which service providers might work with injectors from PR versus other Hispanic groups?

Thank you! Wonderful presentation!

Thank you both! Great (if horrifying) and important data and vital points! Thank you!!

What an elegant analysis!

I agree OUtstanding indeed!

Thank you so much to both speakers!!

Would the speakers be willing to share their slides following the presentation?

Thank you for this presentation.