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Introduction: Recognition of stroke symptoms is vital for accessing medical care and administration of thrombolytics and/or endovascular therapy for ischemic stroke. Awareness of stroke warning signs and risk factors is key to treatment and prevention, respectively.Methods: Surveys were conducted in 1995, 2000, 2005, 2011 and 2016 to respondents randomly drawn to reflect the age, race and sex distribution of the ischemic stroke population in the Greater Cincinnati/ Northern Kentucky Stroke Study. All surveys are based in the same biracial population of 1.3 million, subjects were contacted using random-digit dialing. Open-ended questions regarding stroke risk factors and warning signs were asked and demographic and stroke risk factor information collected. Multiple regression was used to examine changes over time and adjust for covariates.Results: Over the 20-year period, 10,393 surveys were completed. Survey respondents were 60% female, 27% black, with median age 67 years. As depicted in the Table, knowledge of risk factors and warning signs has significantly increased over time, however not within the past 5 years. This is also true after adjustment for age, race, sex and education of the respondents. Female sex and higher education levels were significantly associated with higher knowledge, but age and race had no independent effect.Conclusions: Public awareness of stroke risk factors and warning signs has improved over the past 20 years, although progress has slowed during the past five years despite numerous national and regional stroke awareness campaigns. Knowledge of risk factors continues to be significantly worse than knowledge of warning signs. Further study of the effectiveness of stroke public awareness campaigns are needed.