Reducing Stroke Risk Among Young Adult African Americans: A Feasibility Study

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African Americans under 65 years of age are two to five times more likely than Caucasians to experience strokes (Kissela et al., 2012) and to have strokes at younger ages (Kissela et al., 2012; Kleindorfer et al., 2010; National Stroke Association, 2016). The racial disparities in stroke can partly be explained by a higher prevalence of modifiable cardiovascular risk factors, including hypertension, diabetes, and obesity, in African Americans (Howard et al., 2011; Kleindorfer et al., 2010; Pathak & Sloan, 2009). Improving health behaviors, such as physical activity, diet quality and smoking cessation, early in life can help to prevent most modifiable cardiovascular and stroke risk factors (Liu et al., 2012; Mozaffarian et al., 2016). While cardiovascular disease prevention programs have been tailored to African Americans (Connell, Wolfe, & McKevitt, 2008), stroke continues to be the leading cause of disability in the United States (Mozaffarian et al., 2016).
The incidence of stroke has increased among young adults (Feigin et al., 2013; George, Tong, Kuklina, & Labarthe, 2011). For young adults, a critical barrier to preventing stroke is their lack of awareness of how these lifestyle choices contribute to stroke (American Heart Association, 2011). Young to middle‐aged African Americans may have inadequate knowledge of stroke risk factors (Aycock et al., 2015; Kleindorfer et al., 2008; Sallar et al., 2010) and inaccurate perceptions of stroke risk (Aycock & Clark, 2016). Personal risk awareness is fundamental in the decision‐making process for behavior change (Sheeran, Harris, & Epton, 2014). Therefore, a starting point in preventing the incidence of stroke in young adults is to increase their awareness of stroke and their accuracy of perceived stroke risk.
Risk communication between patients and their primary care clinicians can increase discussions about treatments (Persell et al., 2015), improve decision‐making about risk reduction strategies (Powers et al., 2011), and increase the accuracy of risk perception and the intent to engage in prevention activities (Sheridan et al., 2010). However, like many primary prevention studies in cardiovascular disease, these studies were focused on older adults. In addition, communication of global risk alone is not enough to produce behavior change (Powers et al., 2011; Sheridan et al., 2010); more creative strategies are needed to empower individuals to initiate and sustain healthy lifestyles.
Stroke research aimed at African Americans without a history of stroke has been largely focused on increasing awareness and exploring risk factors to identify those at risk (Frank & Grubbs, 2008; Sallar, Williams, Omishakin, & Lloyd, 2010; Sharrief, Johnson, & Urrutia, 2015) and strategies to improve stroke preparedness or stroke literacy (Kleindorfer et al., 2008; Ravenell et al., 2015; Skolarus et al., 2013). Only one report was found of a behavioral intervention to reduce first stroke in African Americans (Williams et al., 2016). “Turn the Beat Around,” a church‐based program using trained community health workers, produced significant increases in knowledge and decreases in blood pressure, but limitations included a single‐group design, lack of measurement of change in dietary habits and physical activity, and a wide participant age range of 20–74 years.
The purpose of this study was to assess the feasibility of the Stroke Counseling for Risk Reduction (SCORRE) intervention, a tailored, theory‐based intervention designed to improve the accuracy of perceived stroke risk and to promote lifestyle behavior change in at‐risk African Americans ages 20–40 years. Feasibility was evaluated by assessing recruitment and retention numbers, adequacy of measurement tools, questionnaire and diary completion rates, and participant burden and satisfaction with SCORRE. Additional outcome measures included changes in accuracy of perceived stroke risk, knowledge of stroke risk factors, and health behaviors (physical activity, diet, and smoking).

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