Introduction: Chronic stress is a well-documented psychosocial driver of cardiovascular disease (CVD) disparities disproportionately affecting African American adults, yet the psychometric adequacy of patient-reported outcome measures (PROMs) in this population remains unexamined. This systematic review evaluated the scientific evidence on the psychometric quality of chronic stress PROMs in a racially specific population at elevated cardiovascular risk. Methods: PubMed/MEDLINE, Embase, CINAHL, and PsycINFO were searched (January 2000 to December 2025). Eligible studies reported psychometric properties of chronic stress PROMs in African American adults. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias checklist. Evidence quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Protocol registration: (OSF: https://osf.io/sn73g ). Results: Of 2,581 records identified, 1,781 were screened after duplicate removal; five studies evaluating five instruments met inclusion criteria: the Perceived Stress Scale-10 (PSS-10) and four race-specific PROMs. All instruments demonstrated acceptable internal consistency (total scale α = 0.83 to 0.89; subscale α = 0.70 to 0.94) and partial structural validity. No instrument achieved a COSMIN Category A recommendation, as content validity was not established for any instrument and evidence for responsiveness, measurement error, and measurement invariance was absent or limited. Conclusions: Psychometric gaps constrain the equitable use of chronic stress PROMs in African American adults and undermine the capacity to monitor stress-related CVD disparities. Validation studies prioritizing community-engaged content validity, responsiveness, and measurement invariance are needed to advance measurement equity for prevention.

Background: Miami-Dade County ranks first in Florida for HIV cases, yet broad epidemiological data often masks the “on-the-ground” reality of its most vulnerable residents. While standard reports suggest declining domestic violence, these statistics fail to account for community-defined health crises—the “SAVA” syndemic (substance use, violence, and HIV/AIDS)—occurring within localized micro-communities. Methods: Leveraging five years of Community-Based Participatory Research (CBPR) and Grounded Theory, this study engaged 97 community members and leaders to unmask these hidden burdens. We employed a multi-level sequential design and methodological triangulation, incorporating community forums, focus groups, and interviews with farm-workers, inner-city residents, and LGBTQ+ individuals. Results: Findings reveal a disconnect between official data and community reporting, including “Party and Play” methamphetamine/sex-trafficking networks in the LGBTQ+ scene, rampant youth vaping in inner cities, and child sexual abuse and opioids in farm-working communities. Mental health emerged as a pervasive need, masked by substance use and suppressed by cultural stigmas and institutional fears. Conclusions: Findings from this study highlight the value of community-level approaches in generating localized, culturally grounded insights that may not be fully captured in more aggregated geographic analyses (e.g., zip code, county, or state levels). We propose a collaborative, multi-sectoral model to address the systemic factors underlying the SAVA syndemic in these communities.