Gira J. Ravelo

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.

The COVID-19 pandemic has disproportionately affected Latino/a communities in the U.S., with limited research on vulnerable subgroups like recent Latino/a immigrants (RLIs). RLIs encounter various challenges including employment instability, healthcare access issues, limited social support, language barriers, and fears tied to immigration status, potentially hindering COVID-19 vaccine acceptance. This study, utilizing cross-sectional data from an NIH-funded project, examines COVID-19 vaccination status among RLIs who migrated to South Florida ~ 3 years prior. An eco-developmental framework is applied to analyze associations between sociocultural factors and vaccination status using hierarchical multiple logistic regression models. The sample comprised of 325 RLIs (43.4% females; M age = 27.4; SD = 5.09), of which approximately 72% received COVID-19 vaccinations. Seeking COVID-19 information from family/friends correlated with lower vaccination likelihood (aOR = 0.35, 95% CI: [0.14, 0.83], p = .018). Conversely, relying on religious coping moderately or significantly increased vaccination likelihood (aOR = 2.60, 95% CI: [1.02, 6.57], p = .046), as did experiencing COVID-19 related stigma (aOR = 6.04, 95% CI: [2.00, 18.21], p = .001) and adhering to traditional gender norms (aOR = 1.51, 95% CI: [1.03, 2.21], p = .034). Additionally, demographic factors such as immigration status and country of origin correlated with vaccination status. Findings from the present study allows us to understand the impact of sociocultural factors on vaccination status among young adult RLIs and is critical to informing culturally relevant public health efforts aimed at reducing COVID-19-related health inequities.

At 63.7 million, Latinxs constitute the largest racial/ethnic minority in the United States (US). Early during the COVID-19 pandemic, Latinxs were disproportionately impacted and exhibited lower vaccine uptake. Widespread infodemics contributed to confusion, eroded trust, and fostered vaccine hesitancy among this population. This study used a convergent parallel mixed-methods approach to analyze, integrate, and interpret concurrently collected data gathered as part of the Community Engaged Alliance (CEAL) Against COVID-19 Disparities project, initiated by the National Institutes of Health (NIH) in response to the COVID-19 pandemic in the US. Target populations were three underserved Latinx communities of Miami-Dade County (MDC), Florida, during the pandemic’s peak. Qualitative findings show six themes and subthemes that integrate with quantitative survey data (N = 451). Themes included a “wait-and-see” approach to vaccine uptake; concerns about infodemics; attitudes about science, education, healthcare providers; and personal sources of information. Our findings highlight cultural significance, trusted sources, and reasons for hesitancy before vaccination decisions as corroborated by quantitative results. However, divergence was found regarding media sources. Consistent with the literature, although participants report concerns about infodemics and media bias, they still rely on media for updates, particularly with established television networks and trusted personalities. The value placed on education throughout the study (quantitative and qualitative) highlights the importance of culturally appropriate educational interventions. Moreover, the complex nature of the impact that media has on health-related information and vaccine uptake in this population underscores the need for media literacy interventions alongside health education.

Previous studies have found Latinx cultural values to be positively associated with healthy behaviors. This study aims to examine socioeconomic and cultural correlates of alcohol use among Latinx adult men living in Miami-Dade County, Florida. The study sample included 122 Latinx adult men (mean age = 44, SD = 10), predominantly of South and Central American origin. Data was collected using REDCap. Interviews included the Timeline Follow-Back scale for alcohol use. Results indicate that Caribbean participants were significantly less likely to report drinking in the past 90 days (aOR = 0.08, p = 0.042) compared to their Venezuelan counterparts. Higher machismo scores were associated with low drinking frequency (aRR = 0.67, p = 0.043), while no significant associations were found between machismo and other drinking outcomes. Drinking quantity and frequency are significantly associated with higher income and authorized immigration status in the US among Latinx men in South Florida. Higher machismo scores were associated with low drinking frequency.

Importance The novel Coronavirus Disease 2019 (COVID-19), declared a pandemic in March 2020, may present with disproportionately higher rates in underrepresented racial/ethnic minority populations in the United States, including African American communities who have traditionally been over-represented in negative health outcomes. Study Objective To understand the impact of the density of African American communities (defined as the percentage of African Americans in a county) on COVID-19 prevalence and death rate within the three most populous counties in each U.S. state and territory (n=152). Design An ecological study using linear regression was employed for the study. Setting The top three most populous counties of each U.S. state and territory were included in analyses for a final sample size of n=152 counties. Participants Confirmed COVID-19 cases and deaths that were accumulated between January 22, 2020 and April 12, 2020 in each of the three most populous counties in each U.S. state and territory were included. Main outcome measures Linear regression was used to determine the association between African American density and COVID-19 prevalence (defined as the percentage of cases for the county population), and death rate (defined as number of deaths per 100,000 population). The models were adjusted for median age and poverty. Results There was a direct association between African American density and COVID-19 prevalence; COVID-19 prevalence increased 5% for every 1% increase in county AA density (p<.01). There was also an association between county AA density and COVID-19 deaths, such; the death rate increased 2 per 100,000 for every percentage increase in county AA density (p=.02). Conclusion These study findings indicate that communities with a high African American density have been disproportionately burdened with COVID-19. Further study is needed to indicate if this burden is related to environmental factors or individual factors such as types of employment or comorbidities that members of these community have. Question What is the impact of the density of African American communities (defined as the percentage of African Americans in a county) on COVID-19 prevalence and death rate by U.S. counties. Findings This ecological study including the three most populous counties in each U.S. state and territory, found that COVID-19 prevalence increased 5% for every percentage increase in county African American density, and that the death rate increased 2 per hundred thousand for every percentage increase in county African American density. Both were statistically significant increases. Meaning These study findings indicate that communities with a high African American density have been disproportionately burdened with COVID-19.

Latinas are often more affected by HIV due to their socio-economic and demographic profiles and are also less likely to receive proper mental health care. Latina immigrants are often even more vulnerable due to socio-economic and cultural factors that place them at higher risk. The current study seeks to examine the association between depression and risky sexual behaviors among adult Latina immigrants from a farm working community in South Miami-Dade County, (Florida, USA). Cross-sectional secondary data analysis was used for responses from a community-based participatory research (CBPR) study. Out of 234 Latina immigrants, 15% reported being depressed and 80% were reported as having engaged in risky sexual behavior. Although no association was found between depression and high-risk sexual behavior, significant secondary findings present associations between risky sexual behavior and low sexual relationship power, interpersonal violence, and relationship status. Implications for future research on depression and risky sexual behaviors among this population are discussed.

Few studies have examined the sociocultural determinants of risky sexual behavior trajectories among adult Latinas. To longitudinally examine the link between sociocultural determinants of risky sexual behaviors, we followed a sample of adult Latina mother-daughter dyads (n = 267) across a 10-year span through four waves of data collection. The present study investigates how risky sexual behavior (operationalized as sex under the influence of alcohol or other drugs, sex without a condom, or multiple sex partners) is affected by: (a) socioeconomic conditions; (b) mental health; (c) medical health; (d) acculturation to U.S. culture; (e) interpersonal support; (f) relationship stress; (g) mother-daughter attachment; (h) intimate partner violence; (i) religious involvement; and (j) criminal justice involvement. Results indicate the following factors are negatively associated with risky sexual behavior: drug and alcohol use, treating a physical problem with prescription drugs, religious involvement, and mother–daughter attachment. The following factors are positively associated with risky sexual behavior: higher number of mental health symptoms, being U.S.-born, and criminal justice involvement. We discuss implications for the future development of culturally relevant interventions based on the study findings.