Centers

Proposal Abstract - Boden-Albala, pending review

Stroke has a particularly high burden for minority populations, especially among the younger age groups. It is also well known that race/ethnic minority populations have greater prevalence rates of important stroke risk factors which are more difficult to control, such as hypertension and diabetes. Significant reductions in stroke incidence and recurrence would result from more effective stroke prevention efforts, including strategies aimed at the identification and self-management of risk factors. However, primary and secondary stroke prevention strategies have not been optimal, particularly among minority populations, likely due to unique social, cultural and behavioral factors not addressed by such strategies. There remains a gap in the application of effective programs for stroke risk reduction leading to sustainable lifestyle changes. Our work from the observational Northern Manhattan Stroke Study (NOMASS) indicates that lack of social support is an independent risk factor for incident ischemic stroke, stroke outcomes and control of vascular risk factors. Interventions which promote social support and develop family strengths and abilities are likely to provide more successful long-term behavioral change.

It is our hypothesis that a culturally sensitive program of intensive counseling and education within a supportive family network setting will lead to better long-term behavior change for self-management of vascular risk factors among minority stroke survivors and family members than standard approaches. Further, our work from the Stroke Warning Information and Faster Treatment (SWIFT) study, demonstrates that the stroke event constitutes a “teachable moment” whereby family involvement, motivation and concerns about risk reduction for both the stroke/TIA patient and family members are optimal. We believe involving families of stroke survivors as support networks early in the time period after stroke occurs to promote long-term behavioral change for stroke prevention is both innovative and realistic.

It is the goal of the investigators to develop and implement a randomized clinical trial focused on self-management of stroke risk factors through sustainable behavioral change within family networks.

The aim of the Families Understanding Risk Reduction through Educational Reinforcement study (FURRThER) would be to implement a culturally sensitive, socially supportive, intervention program targeted at self-management of vascular risk factors through an intensive family-based counseling program to promote lifestyle behavioral changes in stroke and TIA survivors and their families. Since hypertension, diabetes, and smoking are traditionally recognized as the most important risk factors for stroke, baseline blood pressure measurements, fasting glucose levels, and current smoking history will be collected. In addition, pre- and post-intervention knowledge testing about stroke and stroke risk factors will be performed. Stroke survivors and family members would be randomized to the enhanced usual care group or to the intervention group to include 6 intensive family sessions with the FURRThER health team for 1 year. The three components of our intervention strategy will include: a) interactive vascular risk reduction strategies and resources; b) physical activity/exercise; and c) psychosocial issues, with emphasis on identification of barriers to implementation of these strategies in these high-risk multi-ethnic family networks. Intervention strategies will utilize strategies to link to existing culturally tailored community resources. The efficacy of the intervention will be evaluated by assessing changes in vascular risk factors, including blood pressure and average blood glucose (hemoglobin A1C), at one year post randomization assignment.

This study seeks to address health disparities by examining the role of intensive family support on risk factor management in high risk minority populations utilizing a rigorous scientific design.