PRAISE: Preventing recurrence of all inner-city strokes through education;

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More than one fourth of the 700,000 strokes that occur annually in the US are among stroke survivors. Blacks, or African Americans, both nationally and in Harlem, NYC, have a twofold increase in recurrent strokes, and our data reveal that Latinos in Harlem, have a threefold increase in risk relative to Whites. The primary risk factors for recurrent stroke include hypertension, hyperlipidemia, and underuse of antithrombotic agents. Controlling these risk factors may be particularly challenging for low-income, minority populations who often lack the healthcare, financial and community support needed to adhere to necessary and lifelong therapies. In Harlem, 72% of adults studied six months post- stroke did not have these three risk factors treated adequately. Peer-led patient education initiatives may help stroke survivors better manage their risk factors. Such initiatives may prove to be effective, low cost, sustainable stroke prevention strategies within communities of color, whose residents bear a disproportionate burden of suffering due to strokes. Over the past decade, we have been conducting studies to understand and reduce the health disparities related to stroke and associated conditions in Harlem. We have also built strong relationships with community leaders in Harlem that help us develop culturally appropriate interventions. Our team adapted the Stanford Chronic Disease Self-Management Program, a peer-led course for adults with all chronic diseases, to help acute stroke survivors reduce their risks for recurrence. Early results of a randomized controlled trial to test its effectiveness demonstrate that 24% more intervention subjects had all three risk factors controlled, compared with those randomized to usual care. However, the sample size was limited, based on our inpatient recruitment approach. We aim to work with our community partners to employ a novel, community based recruitment strategy that they proposed. Through this strategy, we will identify 600 Black, Latino and White community-dwelling residents of Harlem who have had strokes or transient ischemic attacks the past within five years. We will then conduct and rigorously evaluate a randomized, controlled trial to determine if participation in this program improves the control of risk factors for stroke recurrence. Finally, if the trial is successful, we will work to sustain the program locally, disseminate the results nationally, and use the lessons learned to inform health policy.