UCLA researchers and their partners across Los Angeles County have been awarded an $11 million grant to fund research on community-based interventions to reduce the higher rates of stroke and death from stroke among disadvantaged Hispanics, African Americans and Asian-Americans.
Stroke risk can be substantially lowered by increasing physical activity, controlling blood pressure, changing to a healthy diet, quitting smoking, lowering cholesterol, and - for certain people - taking medication like aspirin. However, the underserved populations targeted in this research program have numerous barriers to achieving these health goals. These barriers range from lack of transportation to visit a doctor, inability to afford medication, lack of knowledge about ways they can change their lifestyle to lower stroke risk, living in a neighborhood without sidewalks or where it is not safe to walk at night and inability to read food labels in English, among many others.
The Los Angeles Stroke Prevention/Intervention Research Program in Health Disparities is a multi-partnered research center, funded by the National Institutes of Health, which will conduct two randomized, controlled, community-based trials of stroke prevention interventions. One trial will measure how much the risk of a recurrent stroke is lowered by teaming community health workers with physicians and nurses at medical centers in Los Angeles serving low-income populations, said center director Dr. Barbara Vickrey, vice chair and professor of neurology at the David Geffen School of Medicine at UCLA.
"These community health workers will conduct home visits to outreach to patients with a recent stroke, and they will use mobile health technology to help them educate and empower these patients to make changes in their diet and physical activity and to promote use of home blood pressure monitors and of medications that substantially lower the risk of another stroke," she said.
A second trial will assess the impact and sustainability of a culturally-tailored stroke risk factor education and physical activity behavioral intervention designed to increase physical activity, primarily walking. This program will be delivered by staff at senior centers serving African-American, Latino, Chinese and Korean communities in Los Angeles and is designed to be self-sustained after the study is over.
A third study will analyze several decades of data from the National Health and Nutrition Examination Survey to identify changes in biological and social risk factors for stroke over time across different racial and ethnic groups and, hopefully, identify new risk factors that can be controlled through future interventions, Vickrey said.
"The goal of the program is to learn what is effective in reducing stroke risk in underserved minority populations, which are at higher risk and have worse outcomes," Vickrey said. "We know that we have effective treatments to control risk factors for stroke, and now we need to create and test effective and sustainable ways for patients to access medications and to succeed in lifestyle changes that will prevent stroke. What we learn from the center's research could improve stroke prevention for those in Los Angeles County and also could be exported to communities with underserved populations across the country."
The multi-disciplinary, collaborative center builds on established partnerships of UCLA with healthcare systems including Rancho Los Amigos National Rehabilitation Center, Harbor-UCLA Medical Center, Olive View-UCLA Medical Center and the University of Southern California. Partnerships also include many local community organizations such as Healthy African American Families, Watts Labor Community Action Committee, multiple senior centers, the American Heart Association and the City of Los Angeles Department of Aging.
A central component of the program will be the creation of a Community Action Panel, made up of individuals encompassing much of the racial and ethnic diversity of Los Angeles. This group will formally and regularly review and advise on the work in progress and products of the center overall, promote ways to effectively disseminate the work in the targeted communities and provide feedback to investigators at every stage of the research. An annual symposium also will be held to engage and foster the sharing of knowledge between community members and academic investigators in Los Angeles.
"At the end of five years we'll know we're successful if our interventions are effective and if we can identify new targets for future interventions to reduce disparities in stroke risk," Vickrey said, adding that they also will be identifying and educating future investigators and research staff - many of whom may be from these minority communities - to continue in disparities intervention research in the future.