As many as 30% of ischemic strokes in the U.S. population can be attributed to physical inactivity. With the goal of eliminating racial/ethnic stroke disparities, this interdisciplinary team proposes to develop, implement, and test a culturally-tailored behavioral intervention to reduce stroke risk (primary prevention) by increasing physical activity (walking) for 4 different racial/ethnic groups (Korean-Americans, Chinese-Americans, African-Americans and Latinos) in Los Angeles community senior centers. The intervenfion combines stroke and stroke risk factor knowledge (using materials developed by the American Heart Association and American Stroke Association) with theoretically-grounded behavioral change techniques and focuses on reducing stroke risk by increasing physical activity (walking). The study team will conduct focus groups (n=144) to identify culture-specific beliefs about stroke and stroke risk factors, to assess the feasibility and acceptability of the inten/ention, and will work with Community Acfion Panels to culturally-tailor the intervenfion. The intervention will consist of 4 weeks of twice-weekly 1-hour group sessions implemented at 4 community senior centers by trained case managers who are part of the regular senior center staff and supported by congressionally-mandated Older Americans Act Title III funding. The project team will test the effectiveness ofthe intervention in a randomized wait-list controlled trial (n=240) testing the hypothesis that the intervention will increase mean steps/day (measured by pedometer) at 1 and 3 months, and that the increase will be mediated by changes in stroke/stroke risk knowledge and self-efficacy. Blood pressure will be examined as a secondary outcome. In collaborafion with the SPIRP Biomarker Collecfion & Analysis Core, the team will collect biological specimens (fingerpricks) to explore the relafionship between the intervention and biological markers of health; they will also explore the relafionship between the intervenfion and healthcare seeking or taking medications to control stroke risk factors. The team will evaluate the barriers and facilitators of successfully integrating the intervention into the senior centers in order to inform large-scale implementafion ofthe culturally-tailored stroke risk factor reduction/walking intervention.

Public Health Relevance

Stroke is a cruel disease that disproportionately kills and disables racial/ethnic minority seniors. Our proposed study addresses the unmet need for identifying and testing feasible and sustainable intervenfions that reach high-risk minority seniors in their communities to prevent stroke by reducing a critical stroke risk factor - sedentary lifestyle. If successful, this intervenfion could be scalable and a model for the nation.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Specialized Center--Cooperative Agreements (U54)
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Special Emphasis Panel (ZNS1)
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Icahn School of Medicine at Mount Sinai
New York
United States
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Cheng, Eric M; Cunningham, William E; Towfighi, Amytis et al. (2018) Efficacy of a Chronic Care-Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors: A Randomized Controlled Trial. Circ Cardiovasc Qual Outcomes 11:e003228
Bharmal, Nazleen H; McCarthy, William J; Gadgil, Meghana D et al. (2018) The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. J Relig Health 57:33-46
Ramirez, Magaly; Wu, Shinyi (2017) Phone Messaging to Prompt Physical Activity and Social Support Among Low-Income Latino Patients With Type 2 Diabetes: A Randomized Pilot Study. JMIR Diabetes 2:e8
Ramirez, Magaly; Wu, Shinyi; Ryan, Gery et al. (2017) Using Beta-Version mHealth Technology for Team-Based Care Management to Support Stroke Prevention: An Assessment of Utility and Challenges. JMIR Res Protoc 6:e94
Towfighi, Amytis; Cheng, Eric M; Ayala-Rivera, Monica et al. (2017) Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Dispariti BMC Neurol 17:24
Cheng, Eric M; Myers, Laura J; Vassar, Stefanie et al. (2017) Impact of Hospital Admission for Patients with Transient Ischemic Attack. J Stroke Cerebrovasc Dis 26:1831-1840
Baca, Christine B; Barry, Frances; Vickrey, Barbara G et al. (2017) Social outcomes of young adults with childhood-onset epilepsy: A case-sibling-control study. Epilepsia 58:781-791
Bharmal, Nazleen; Lucas-Wright, Anna Aziza; Vassar, Stefanie D et al. (2016) A Community Engagement Symposium to Prevent and Improve Stroke Outcomes in Diverse Communities. Prog Community Health Partnersh 10:149-58
Robinson, Maisha T; Vickrey, Barbara G; Holloway, Robert G et al. (2016) The lack of documentation of preferences in a cohort of adults who died after ischemic stroke. Neurology 86:2056-62
Lin, Michelle P; Ovbiagele, Bruce; Markovic, Daniela et al. (2016) Association of Secondhand Smoke With Stroke Outcomes. Stroke 47:2828-2835

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