Reducing stroke risk in African-American men

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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.