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)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NS073685-04
Application #
8706244
Study Section
Neurological Sciences Training Initial Review Group (NST)
Program Officer
Waddy, Salina P
Project Start
Project End
Budget Start
Budget End
Support Year
4
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Neurology
Type
Schools of Medicine
DUNS #
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Skolarus, Lesli E; Wing, Jeffrey J; Morgenstern, Lewis B et al. (2016) Mexican Americans are Less Likely to Return to Work Following Stroke: Clinical and Policy Implications. J Stroke Cerebrovasc Dis 25:1851-5
Skolarus, Lesli E; Freedman, Vicki A; Feng, Chunyang et al. (2016) Care Received by Elderly US Stroke Survivors May Be Underestimated. Stroke 47:2090-5
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; Meurer, William J; Shanmugasundaram, Krithika et al. (2015) Marked Regional Variation in Acute Stroke Treatment Among Medicare Beneficiaries. Stroke 46:1890-6
Skolarus, Lesli E; Lisabeth, Lynda D; Burke, James F et al. (2015) Racial and Ethnic Differences in Mental Distress among Stroke Survivors. Ethn Dis 25:138-44
Skolarus, Lesli E; Morgenstern, Lewis B (2015) Deprived of a good stroke outcome. Stroke 46:612-3
Burke, James F; Skolarus, Lesli E; Freedman, Vicki A (2015) Racial Disparities in Poststroke Activity Limitations Are Not due to Differences in Prestroke Activity Limitation. J Stroke Cerebrovasc Dis 24:1636-9
Dombrowski, Stephan U; Ford, Gary A; Morgenstern, Lewis B et al. (2015) Differences Between US and UK Adults in Stroke Preparedness: Evidence From Parallel Population-Based Community Surveys. Stroke 46:3220-5
Callaghan, Brian C; Kerber, Kevin A; Pace, Robert J et al. (2015) Headache neuroimaging: Routine testing when guidelines recommend against them. Cephalalgia 35:1144-52
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

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