Reducing stroke risk in African-American men

降低非裔美国男性的中风风险

• 批准号: 10417158
• 负责人: Martha X Sajatovic
• 金额: $ 56.44万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-05 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10417158
• 关键词: Acute; Adult; African American; African American population; Age; American; Anxiety; Attention; Awareness; Behavior; Biological Markers; Blood Pressure; Caring; Cause of Death; Cessation of life; Cholesterol; Chronic Disease; Climacteric; Clinical Trials; Communities; Data; Development; Diabetes Mellitus; Diastolic blood pressure; Discrimination; Disease; Education; Educational Curriculum; Elements; Emotional; Emotional Stability; Environment; Ethnic group; Evaluation; Event; Family; Family member; Friends; Funding; Future; Glycosylated hemoglobin A; Goals; Health; Health Promotion; Health Resources; Health behavior; High Density Lipoprotein Cholesterol; Home; Human Resources; Hypertension; Individual; Infrastructure; Intervention; Intervention Trial; Investigation; Knowledge; Lipids; Literature; Mediating; Medical; Mental Depression; Minority Groups; Minority Men; Modeling; Morbidity - disease rate; National Institute of Neurological Disorders and Stroke; Not Hispanic or Latino; Nurses; Obesity; Outcome; Participant; Patients; Pharmaceutical Preparations; Pilot Projects; Primary Health Care; Problem Solving; Process; Publishing; Qualitative Evaluations; Randomized Controlled Trials; Recovery; Recurrence; Reporting; Research; Risk Factors; Risk Reduction; Role; Self Efficacy; Self Management; Serum; Site; Smoking; Social support; Step Tests; Stress; Stroke; Support Groups; Testing; Time; Tobacco; Training; Transient Ischemic Attack; Triglycerides; Underemployment; Unemployment; United States National Institutes of Health; Waiting Lists; Work; acute care; blood lipid; blood pressure intervention; blood pressure reduction; caucasian American; community setting; comparative; comparison intervention; coping; cost; cost estimate; diabetes control; diet and exercise; disability; ethnic minority; experience; follow-up; future implementation; glycemic control; health literacy; high risk; high risk men; improved; inner city; male; male health; man; medical specialties; men; mortality; novel; patient home care; peer; peer support; person centered; post stroke; prevent; primary outcome; prospective; racial and ethnic; racial disparity; racial minority; recruit; response; scale up; secondary outcome; social health determinants; social stressor; stroke outcome; stroke recovery; stroke risk; stroke survivor; stroke-like episode; substance use; treatment as usual; trial design; work-study

PROJECT SUMMARY The burden of stroke among US adults is the fifth leading cause of death and the leading cause of disability, costing an estimated $19 billion. African-Americans (AA) have substantially higher stroke rates, compared to any other racial-ethnic group. Compared to whites, AA have greater stroke disability, more post- stroke complications, and slower recovery. Racial disparities in stroke outcomes are particularly high among AA men. Unfortunately, there is only a limited literature that has specifically focused on improving post-stroke care for AA men stroke survivors. Written In response to NIH PA-13-328: Health Promotion among Racial and Ethnic Minority Males (R01), the proposed project will test a curriculum-guided self-management support approach, TargEted MAnageMent (TEAM) focused specifically on AA men at high risk for stroke. TEAM is a group-format, nurse and patient co-led intervention focused on patient and family needs, practice in problem- solving, and attention to emotional and role management. The project builds upon promising pilot data from 2 previous R21 projects using TEAM. Novel project aspects include the: 1) Focus on AA men, 2) Use of Peer Dyads (stroke survivors and their care partners) as a key intervention component, 3) Use of curriculum-driven self-management, which has rarely been used in studies of AA men, and 4) Investigation of mechanistic factors that may help explain the most salient experimental elements of TEAM. Work by this study team in the landmark Systolic Blood Pressure Intervention Trial (SPRINT) suggests that intensive efforts to reduce blood pressure (BP) to appropriate target ranges can reduce acute events like stroke, and that the proposed study site is an ideal recruitment environment with invested key personnel, and supportive infrastructure to conduct a rigorous evaluation of the TEAM approach in high-risk AA men. The proposed project is a 6-month prospective randomized controlled trial evaluating the effects of TEAM vs. wait- list (WL) control in AA men who have experienced a stroke or TIA within the past 5 years. The primary outcome is change in systolic BP, while secondary outcomes include diastolic BP, cholesterol, triglycerides and glycemic control for individuals with diabetes. An exploratory analysis will evaluate posited mechanistic attitudinal targets (stroke knowledge, self-efficacy, perceived social support) as well as proximal behaviors to reduce stroke risk including diet, exercise, smoking, and tobacco/substance use. A complementary qualitative assessment will evaluate the perspective of TEAM and WL participants. If pilot results can be confirmed, TEAM represents a practical approach suitable for broad scale-up, with the potential to reverse the unacceptably high morbidity seen in AA men due to stroke.

项目概要 中风是美国成年人死亡的第五大原因，也是导致死亡的主要原因 造成的损失估计为 190 亿美元。非裔美国人 (AA) 的中风率要高得多， 与任何其他种族群体相比。与白人相比，AA 的中风致残率更高，术后遗症也更多。 中风并发症，恢复速度较慢。中风结果的种族差异特别大 AA 男。不幸的是，只有有限的文献专门关注改善中风后的症状 照顾 AA 男性中风幸存者。回应 NIH PA-13-328：种族和群体中的健康促进 少数民族男性（R01），拟议项目将测试课程引导的自我管理支持 目标管理 (TEAM) 专门针对中风高危 AA 男性。团队是一个 小组形式，护士和患者共同主导干预，重点关注患者和家庭的需求，实践问题 解决问题，并注意情绪和角色管理。该项目建立在来自 2 个有希望的试点数据的基础上 之前使用 TEAM 的 R21 项目。新颖的项目方面包括：1) 关注 AA 人，2) 使用同伴 双人（中风幸存者及其护理伙伴）作为关键干预组成部分，3）使用课程驱动 自我管理，这在 AA 男性的研究中很少使用，4) 机制调查 可能有助于解释 TEAM 最显着的实验元素的因素。 该研究团队在具有里程碑意义的收缩压干预试验 (SPRINT) 中的工作表明： 大力努力将血压 (BP) 降低至适当的目标范围可以减少急性事件，例如 中风，并且拟议的研究地点是一个理想的招聘环境，拥有投资的关键人员，并且 支持性基础设施，用于对高风险 AA 男性的 TEAM 方法进行严格评估。这 拟议项目是一项为期 6 个月的前瞻性随机对照试验，评估 TEAM 与等待的效果 列出过去 5 年内经历过中风或 TIA 的 AA 男性的 (WL) 控制。初级 结果是收缩压的变化，次要结果包括舒张压、胆固醇、甘油三酯 以及糖尿病患者的血糖控制。探索性分析将评估假设的机制 态度目标（中风知识、自我效能、感知的社会支持）以及最近的行为 降低中风风险，包括饮食、运动、吸烟和烟草/药物使用。互补的定性 评估将评估 TEAM 和 WL 参与者的观点。如果试点结果能够得到证实 TEAM 代表了一种适合广泛扩大规模的实用方法，有可能扭转现状 AA 男性中风的发病率高得令人无法接受。