African Americans suffer a disproportionate number of strokes resulting in greater post-stroke disability and mortality compared to European Americans. Despite the fact that tissue plasminogen activase (tPA), decreases post-stroke morbidity, mortality and is cost saving, it is underutilized especially among African Americans who are up to one-fifth as likely to receive tPA as European Americans. The primary reason for the underutilization of acute stroke treatments is delayed patient presentation to the hospital which would be remedied by increasing prompt 911 calls for stroke. If all patients presented to the hospital immediately over 25% of stroke patients would receive tPA compared with the 1-3% that are currently treated. The long-term goal of this career development award is to promote the candidate's development into a clinical and research leader in behavioral interventions focusing on health disparities of neurologic disease.
The aims of this project are 1)To develop and validate theory-based stroke education intervention materials and outcome measures that use simulated stroke patient video vignettes;2)To assess the feasibility and acceptability of a faith-based, scientific theory-driven, peer-led behavioral intervention to increase stroke awareness and behavioral intent to call 911 among African American youth and adults in Flint, Michigan. This project is based on a partnership with Bridges into the Future, an African American faith-based community group in Flint, Michigan who will help to design and pre test novel intervention materials and outcome assessments. Then a single group repeated measures design feasibility study will be conducted to obtain preliminary evidence for the impact of our adapted intervention and to test the novel stroke outcome measure. The candidate is committed to a career as a rigorously trained clinician scientist and requires additional training in order to accomplish her long-term goal of reducing health disparities in neurologic disease via behavioral interventions. A detailed career development plan will promote the candidate's development of expertise in the science of behavioral interventions, advanced statistical analysis and an interdisciplinary understanding of health disparities. The career development plan consists of a multidisciplinary team of experts in each of these areas who will oversee a range of formal coursework, working meetings and practical experiences in these areas to ensure the candidate's future success. Excellent resources of a top university and a mentoring team with demonstrated success in developing junior investigators in these topic areas makes the University of Michigan an ideal environment for this project.

Public Health Relevance

Getting to the hospital quickly is the key to treating stroke. African Americans suffer more strokes with worse outcomes and receive stroke treatments less often than European Americans. This project will work to reduce these health disparities by creating and testing the feasibility of a peer-led faith-based behavioral intervention in an African American community with a goal to increase calls to 911 so stroke patients can be treated quickly.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NS073685-03
Application #
8520407
Study Section
NST-2 Subcommittee (NST)
Program Officer
Waddy, Salina P
Project Start
2011-09-01
Project End
2016-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
3
Fiscal Year
2013
Total Cost
$187,380
Indirect Cost
$13,880
Name
University of Michigan Ann Arbor
Department
Neurology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Skolarus, Lesli E; Murphy, Jillian B; Dome, Mackenzie et al. (2015) Creating a Novel Video Vignette Stroke Preparedness Outcome Measure Using a Community-Based Participatory Approach. Health Promot Pract 16:533-9
Skolarus, Lesli E; Morgenstern, Lewis B; Scott, Phillip A et al. (2014) An emergency department intervention to increase warfarin use for atrial fibrillation. J Stroke Cerebrovasc Dis 23:199-203
Skolarus, Lesli E; Sanchez, Brisa N; Levine, Deborah A et al. (2014) Association of body mass index and mortality after acute ischemic stroke. Circ Cardiovasc Qual Outcomes 7:64-9
Skolarus, Lesli E; Burke, James F; Freedman, Vicki A (2014) The role of accommodations in poststroke disability management. J Gerontol B Psychol Sci Soc Sci 69 Suppl 1:S26-34
Callaghan, Brian C; Kerber, Kevin A; Pace, Robert J et al. (2014) Headaches and neuroimaging: high utilization and costs despite guidelines. JAMA Intern Med 174:819-21
Burke, James F; Freedman, Vicki A; Lisabeth, Lynda D et al. (2014) Racial differences in disability after stroke: results from a nationwide study. Neurology 83:390-7
Zahuranec, Darin B; Lisabeth, Lynda D; Sánchez, Brisa N et al. (2014) Intracerebral hemorrhage mortality is not changing despite declining incidence. Neurology 82:2180-6
Skolarus, Lesli E; Burke, James F; Morgenstern, Lewis B et al. (2014) Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke. Stroke 45:2472-4
Skolarus, Lesli E; Burke, James F; Brown, Devin L et al. (2014) Understanding stroke survivorship: expanding the concept of poststroke disability. Stroke 45:224-30
Goutman, Stephen A; Nowacek, Dustin G; Burke, James F et al. (2014) Minorities, men, and unmarried amyotrophic lateral sclerosis patients are more likely to die in an acute care facility. Amyotroph Lateral Scler Frontotemporal Degener 15:440-3

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