Public Health Project NUR 455

Elizabeth Hotaling, RNHelen McDonald, RN

Healthy People 2020 Topic: Heart Disease & Stroke

Objective:

Reduce Stoke Deaths

Baseline Data

• According to Healthy People 2020, as of 2007 there were 42.2 stroke deaths per 100,000

Target• The target for 2020 is 33.8 stroke deaths per

100,000

Population of Focus

• African-Americans are at a higher risk for stroke

Stroke facts

• Stroke is the 4th leading cause of death in the U.S. • Up to 80% of strokes are preventable• More than 2/3 of stroke survivors will have some

type of disability• African Americans have almost twice the risk for

stroke compared to Caucasians. • The estimated cost of stroke in the U.S in 2010

was 73.7 billion dollars.

African Americans and Stroke

• In 2009 there were 55.7 per 100,000 African American stroke deaths compared to 37.8 per 100,000 Caucasian stroke deaths.

• African Americans have an increased prevalence of risk factors for stroke including: obesity, hypertension, high cholesterol, and cigarette smoking.

African Americans and Stroke Risk Factors

per the National Stroke Association:• One in three suffer from high blood pressure• Have a higher rate of diabetes• Sickle Cell Anemia is the most common

genetic disorder. A sickle shaped cell can block a blood vessel to the brain and stroke can result.

• Smoking doubles the risk of stroke.

Compared to Caucasians, African Americans:

• Have twice the mortality from stroke• Have more severe and disabling strokes• Women have a lower one year survival rate

following an ischemic stroke• Are significantly less likely to receive tPA which

is the only FDA approved treatment for stroke

African American DisparityA 2011 study published in the American Journal of Health Behavior reports the following possible factors for health disparity of African Americans:

• Genetic disposition• Developmental and environmental exposures• Racial discrimination and perceived racism• Life experiences and stressful events• Psychosocial exposures• Socioeconomic position• Lifestyle behaviors

Public Health Programs for Stroke Prevention

• States including New York began to receive funding from the CDC in 1998 for a heart disease and stroke prevention program

• NYS partners with other states to collaborate on stroke prevention programs.

• Public health partnerships with African American Churches.

• Development of a multi-media stroke prevention program

• Designated Stroke Centers

Partnerships with African American Churches

• Pastors have a strong influence on individuals in the community and play an important role in successful implementation of health programs.

• Partnerships decrease health disparities in this population by reaching individuals who lack transportation and funds.

• Early interventions in the community setting can help decrease incidence of stroke.

Multi-Media Campaign

(Per the Northeast Cerebrovascular Consortium)

• Television Ads “Reverse Hospital” and “Stroke Heroes ACT FAST”

• Radio Ad – “Ticking Clock” developed by Utah DOH• Information through transit – at bus shelters,

inside and outside public buses• Printed Materials – table tents, pharmacy cards,

and magnets

Television Ads

• The Act F.A.S.T. Campaign includes multiple TV commercials including this one developed by the Massachusetts Department of Public Health

• Stroke Heroes Act Fast – YouTube• There are also television ads developed by the

American Heart Association and American Stroke Association

• American Heart Association Stroke Awareness Campaign Symptoms spot - YouTube

Radio Ads

• There are multiple radio ads that help educate individuals on stroke signs and symptoms

• Stroke Awareness Campaign, VDH - Meeting - Radio Announcement – YouTube

Educational elements of Multi-Media Campaign

• Uses the F.A.S.T. mnemonic• Emphasizes to call 9-1-1• Uses a catchy jingle to help the audience

memorize important information• Discusses five warnings signs in relation to

“Walk, Talk, Reach, See, Feel”

NYS Designated Stroke Centers

• The NYS DOH designates stroke centers statewide to improve the standard and access to quality of care for patients with a presumptive diagnosis of stroke.

• The Bureau of Emergency Medical Services (EMS) works with the DOH to maintain a list of designated stroke centers, allowing any potential stroke victims to be brought directly to a stroke center, and have the NYS BLS Stroke Protocol initiated immediately.

The Capital Region Stroke Network

• In the Capital Region Albany Medical Center, St. Peter’s Health Partners (including Albany Memorial, Samaritan, and St. Mary’s hospitals), and Ellis Hospital are designated stroke centers

Effectiveness

Per Healthy People 2020:• Between 2007 and 2010 there was a decrease in

the number of stroke deaths per 100,000 for the general population of 3.1 deaths per 100,000

• For African Americans, there was a decrease in the number of stroke deaths per 100,000 of 7.3

• This demonstrates effectiveness of educating African Americans on stroke prevention, signs, symptoms, and actions to take.

Effectiveness2007 2008 2009 2010

Total Population Stroke Deaths per 100,000

42.2 40.7 38.9 39.1

African American Stroke Deaths per 100,000

60.3 57.4 54.5 53.0

Effectiveness of Multi-Media• A study conducted by the NYS DOH and University at

Albany School of Public Health examined four focus groups regarding stroke prevention, and their reaction to the multi-media campaign.

• Two of these focus groups were African American• In regards to knowledge of stroke symptoms and response

to symptoms, the study found that African Americans were more influenced by culture and family history, more likely to wait and watch the symptoms and then decide, and they were less likely to use 911 prior to seeing any of the multi-media campaign.

Effectiveness of Multi-Media (cont.)

• After exposure to the TV, radio, and bus ads, the study demonstrated an overall increase in the number of people who would NOT wait, and WOULD dial 911.

• The study concluded that a multi-media stroke prevention campaign can increase the number of individuals who dial 9-1-1, and recommends consistent, sustained media messages.

Effectiveness of Designated Stroke Centers

• A 2011 meta-analysis study published in the American College on Emergency Physicians, reports that stroke unit care is associated with a 21% reduction in death from stroke.

• Stroke Centers:– Improve clinical outcomes – Increase the use of TPA– Provide more efficient care and are more effective at

initiating secondary medications– Reduce death

Beth’s Analysis

(Per Sullivan, White, Young, & Scott):• Stroke prevention programs should utilize

four factors regarding health beliefs:– Benefits of preventative care– Barriers to preventative care– Perceived Illness– Severity

Beth’s Analysis

• The multi media campaign provides stroke information in a manner that may be extremely effective for the population of African Americans. By using TV, radio, and bus advertisements the campaign is able to reach millions of people including African Americas.

• The media campaign appears to take into account the factors regarding health beliefs.

• Appealing to all educational levels and reading levels• Could be more effective if campaigns were nationally

consistent instead of varying from state to state.

Beth’s Analysis

• Designated Stroke Centers are effective for decreasing stroke deaths in African Americans by ensuring best practices of care, as long as they are utilized. This reinforces the need for all populations to know when to dial 9-1-1, and arrive at a stroke center via ambulance. No time to waste going to a non-designated facility

• Partnerships with community churches can help to reinforce the media messages and spread the word regarding the designated stroke centers.

Helen’s Analysis

• The multi-media campaign will be effective to educate mass populations of individuals, regardless of race, ethnicity and income.

• Campaign ad placement will be integral to reaching focus populations.

• Ads need to be high quality, interesting and culturally sensitive to catch the attention of focus populations.

Helen’s Analysis

• People in general may not perceive stroke as an immediate problem needing to be addressed. They may dismiss campaign ads. They may be reluctant to change behaviors to decrease risk factors.

• People need to feel empowered to have an active role in their healthcare decisions.

• People need to have– Access and control over needed resources– Decision-making and problem solving ability– The ability to communicate and obtain needed resources

Helen’s Analysis

• Collaborating with African American Churches will help target the high risk population identified. Early interventions to decrease risk factors can be implemented. Ex: Blood pressure and diabetes checks, health fairs.

• Pastors of the community need to be a part of early program planning to assist with cultural sensitivity and strategies to reach the targeted group.

Helen’s Analysis

• Increasing awareness of designated stroke centers as well as increasing the amount and availability of these centers will help to decrease time intervals for transportation to treatment.

The End

Any Questions????

References• Butler-Ajibade, P., Booth, W., & Burwell, C. (2012). Partnering with the Black Church: Recipe for Promoting Heart Health in the Stroke

Belt. ABNF Journal, 23(2), 34-37.

• Deuster, P. A., Su Jong, K., Remaley, A. T., & Poth, M. (2011). Allostatic Load and Health Status of African Americans and Whites. American Journal Of Health Behavior, 35(6), 641-653. Retrieved from: http://search.ebscohost.com.ezproxy.sunyit.edu/login.aspx?direct=true&db=rzh&AN=2011471715&site=ehost-live

• Johnston, C. (2011). Does Stroke Center Designation Improve Patient Outcomes? The American College of Emergency Physicians. Retrieved from: http://www.acep.org/MobileArticle.aspx?id=82874&coll

• National Stroke Association. (2013). African Americans and Stroke. Retrieved from: http://www.stroke.org/site/PageServer?pagename=AAMER

• New York State Department of Health. (2012) Stroke Centers. Retrieved from: http://hospitals.nyhealth.gov/learn.php?t=SC&PHPSESSID=728a3d329e1d6b4b6130acce22a33a99

• Spicer, D., Howland, T., Brissette, I., Dennison, B., Maniccia, D., Jurkowski, J. (n.d.) Stroke Awareness – Impact of a Multi-Media Campaign. The Northeast Cerebrovascular Consortium. Retrieved from: http://www.thenecc.org/images/Howland.pdf

• Sullivan, K., White, K., Young, R., & Scott, C. (2010). The Cerebrovascular Attitudes and Beliefs Scale (CABS-R): the factor structure and psychometric properties of a tool for assessing stroke-related health beliefs. International Journal Of Behavioral Medicine, 17(1), 67-73. doi:10.1007/s12529-009-9047-3 Retrieved from: http://search.ebscohost.com.ezproxy.sunyit.edu/login.aspx?direct=true&db=rzh&AN=2010551377&site=ehost-live

• Stanhope, M. & Lancaster, J. (2012). Public Health Nursing Population-Centered Health Care in the Community. Missouri: Mosby.