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Health Perceptions, Stroke Risk, and Readiness for Behavior Change: Gender Differences in Young Adult African Americans

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Abstract

The presence of traditional cardiovascular risk factors has increased among young African American (AA) adults, making them more susceptible to stroke. We examined baseline data from the Stroke COunseling for Risk REduction (SCORRE) study to describe health perceptions, stroke risk, and readiness for behavior change along with gender differences in a cohort of young AA. Self-administered questionnaires were used to assess perceptions of general health, stroke risk, competence to live a healthy lifestyle, and readiness for behavior change. Actual stroke risk was measured using the American Heart Association (AHA) Life’s Simple 7® (LS7) program. Data were collected from 116 participants (86 women, 30 men) who had a mean age of 24.6 (SD = 4.5). On average, participants had 2.6 (SD = 1.1) out of 7 risk factors for stroke, rated their overall health at the midpoint of the scale (“good”), perceived a low risk of future stroke, felt competent they could live a healthy lifestyle, but were not at a stage of readiness for behavior change. A significantly higher proportion of men than women met AHA recommendations for physical activity (77% vs. 49%; p < 0.01), but had blood pressure readings > 120/80 (70% vs. 34%; p < 0.01), and smoked cigarettes/cigars (20% vs. 2%; p < 0.01). Fewer men than women were at a stage of readiness for behavior change to reduce stroke risk (13% vs. 40%; p < 0.01). Stroke risk needs to be assessed early in AA and the LS7 can be used to assess and communicate risk. Understanding gender differences may help with tailoring stroke prevention education and treatment programs.

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References

  1. Kissela BM, Khoury JC, Alwell K, Moomaw CJ, Woo D, Adeoye O, et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology. 2012;79:1781–7. https://doi.org/10.1212/WNL.0b013e318270401d.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67–e492. https://doi.org/10.1161/CIR.000000000000558.

    Article  Google Scholar 

  3. George MG, Tong X, Bowman BA. Prevalence of cardiovascular risk factors and strokes in young adults. JAMA Neurol. 2017;74:695–703. https://doi.org/10.1001/jamaneurol.2017.0020.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kulshreshtha A, Vaccarino V, Judd S, et al. Life’s Simple 7 and risk of incident stroke: the reasons for geographic and racial differences in stroke study. Stroke. 2013;44(7):1909–14. https://doi.org/10.1161/STROKEAHA.111.000352.

    Article  PubMed  Google Scholar 

  5. Ommerborn MJ, Blackshear CT, Hickson DA, Griswold ME, Kwatra J, Djoussé L, et al. Ideal cardiovascular health and incident cardiovascular events: the Jackson Heart Study. Am J Prev Med. 2016;51(4):502–6. https://doi.org/10.1016/j.amepre.2016.07.003.

    Article  PubMed  PubMed Central  Google Scholar 

  6. American Heart Association. My life check - Life’s Simple 7. 2018. http://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check%2D%2Dlifes-simple-7.Accessed 5 Jan 2018.

  7. Liu K, Daviglus ML, Loria CM, Colangelo LA, Spring B, Moller AC, et al. Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: the Coronary Artery Risk Development in (young) Adults (CARDIA) study. Circulation. 2012;125(8):996–1004. https://doi.org/10.1161/CIRCULATIONAHA.111.060681.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Aycock DM, Clark PC. Incongruence between perceived long-term risk and actual risk of stroke in rural African Americans. J Neurosci Nurs. 2016;48:35–41. https://doi.org/10.1097/JNN.0000000000000180.

    Article  PubMed  Google Scholar 

  9. Aycock DM, Clark PC, Hayat M. Reducing stroke risk among young adult African Americans: a feasibility study. Res Nurs Health. 2016;40:153–64. https://doi.org/10.1002/nur.21776.

    Article  PubMed  Google Scholar 

  10. Aycock, DM. Stroke counseling for risk reduction in young adult African Americans. 2015. Unpublished application (NIH K01NR015494) funded by National Institute of Nursing Research. Copy in possession of author, School of Nursing Georgia State University, Atlanta, Georgia.

  11. DeSalvo KB, Fisher WP, Tran K, et al. Assessing measurement properties of two single-item general health measures. Qual Life Res. 2006;15:191–201.

    Article  PubMed  Google Scholar 

  12. Aycock DM, Clark PC, Araya S. Measurement and outcomes of the perceived risk of stroke: a review. West J Nurs Res. 41:134–54. https://doi.org/10.1177/0193945917747856.

  13. Godin G, Shephard RJ. A simple method to measure exercise behavior in the community. Can J Appl Sport Sci. 1985;10:141–6.

    CAS  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention. Adult tobacco use questions on the National Health Interview Survey- 1997- Forward. n.d. Accessed 28 Sept. 2018. https://www.cdc.gov/nchs/data/nhis/tobacco/1997_forward_tobacco_questions.pdf

  15. Consortium T. Recommended standards for assessing blood pressure in human research where blood pressure or hypertension is a major focus. Clin Exp Hypertens (New York, NY: 1993). 2018;40(6):509–13. https://doi.org/10.1080/10641963.2017.1281939.

    Article  Google Scholar 

  16. Boden-Albala B, Carman H, Moran M, Doyle M, Paik M. Perception of recurrent stroke risk among black, white and Hispanic ischemic stroke and transient ischemic attack survivors: the SWIFT study. Neuroepidemiology. 2011;37(2):83–7. https://doi.org/10.1159/000329522.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Williams GC, Freedman ZR, Deci EL. Supporting autonomy to motivate glucose control in patients with diabetes. Diabetes Care. 1998;21:1644–51.

    Article  CAS  PubMed  Google Scholar 

  18. SelfDeterminationTheory.org. An approach to human motivation and personality, perceived competence scales. Self Determination Theory website. http://selfdeterminationtheory.org/perceived-competence-scales/. Accessed December 28, 2018.

  19. Weinstein PK, Amirkhosravi A, Angelopoulos TJ, Bushy A, Covelli MM, Dennis KE. Reducing cardiovascular risk in women with lupus: perceptions of risk and predictors of risk-reduction behaviors. J Cardio Nurs. 2014;29(2):130–9. https://doi.org/10.1097/JCN.0b013e31827f0d53.

    Article  Google Scholar 

  20. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/AphA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71(19):2199–269. https://doi.org/10.1016/j.jacc.2017.11.006.

    Article  PubMed  Google Scholar 

  21. Gibbs BB, King WC, Belle SH, Jakicic JM. Six-month changes in ideal cardiovascular health vs. Framingham 10-year coronary heart disease risk among young adults enrolled in a weight loss intervention. Prev Med. 2016;86:123–9. https://doi.org/10.1016/j.ypmed.2016.02.033.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ramírez-Vélez R, Saavedra JM, Lobelo F, Celis-Morales CA, Pozo-Cruz BD, García-Hermoso A. Ideal cardiovascular health and incident cardiovascular disease among adults: a systematic review and meta-analysis. Mayo Clin Proc. 2018;93(11):1589–99. https://doi.org/10.1016/j.mayocp.2018.05.035.

    Article  PubMed  Google Scholar 

  23. Gooding HC, Shay CM, Ning H, et al. Optimal lifestyle components in young adulthood are associated with maintaining the ideal cardiovascular health profile into middle age. J Am Heart Assoc. 2015;4(11):e002048. https://doi.org/10.1161/JAHA.115.002048.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Younus A, Aneni EC, Spatz ES, Osondu CU, Roberson L, Ogunmoroti O, et al. A systematic review of the prevalence and outcomes of ideal cardiovascular health in US and non-US populations. Mayo Clin Proc. 2016;91(5):649–70. https://doi.org/10.1016/j.mayocp.2016.01.019.

    Article  PubMed  Google Scholar 

  25. Bucholz EM, Gooding HC, de Ferranti SD. Awareness of cardiovascular risk factors in U.S. young adults aged 18-39 years. Am J Prev Med. 2018;54(4):e67–77. https://doi.org/10.1016/j.amepre.2018.01.022.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Trejo R, Cross W, Stephenson J, Edward K. Young adults’ knowledge and attitudes towards cardiovascular disease: a systematic review and meta-analysis. J Clin Nurs. 2018;27:4245–56. https://doi.org/10.1111/jocn.14517.

    Article  PubMed  Google Scholar 

  27. Pu J, Chewning BA, Johnson HM, Vanness DJ, Young HN, Kreling DH. Health behavior change after blood pressure feedback. PLoS One. 2015;10(10):1–12. https://doi.org/10.1371/journal.pone.0141217.

    Article  CAS  Google Scholar 

  28. Williams LB, Franklin B, Evans MB, Jackson C, Hill A, Minor M. Turn the beat around: a stroke prevention program for African-American churches. Public Health Nurs. 2016;33(1):11–20. https://doi.org/10.1111/phn.12234.

    Article  PubMed  Google Scholar 

  29. Kleindorfer D, Miller R, Sailor-Smith S, et al. The challenges of community-based research: The beauty shop stroke education project. Stroke (00392499). 2008;39(8):2331–5. https://doi.org/10.1161/STROKEAHA.107.508812.

    Article  Google Scholar 

  30. Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, et al. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation. 2017;136(21):e393–423. https://doi.org/10.1161/CIR.0000000000000534.

    Article  PubMed  Google Scholar 

  31. Fox ER, Samdarshi TE, Musani SK, Pencina MJ, Sung JH, Bertoni AG, et al. Development and validation of risk prediction models for cardiovascular events in Black adults: the Jackson Heart Study cohort. JAMA Cardiol. 2016;1(1):15–25. https://doi.org/10.1001/jamacardio.2015.0300.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Murphy MP, Coke L, Staffileno BA, Robinson JD, Tillotson R. Improving cardiovascular health of underserved populations in the community with Life’s Simple 7. J Am Assoc Nurse Pract. 2015;27(11):615–23. https://doi.org/10.1002/2327-6924.12231.

    Article  PubMed  Google Scholar 

  33. Watkins DC, Mitchell J, Mouzon D, Hawkins J. Physical and mental health interventions for Black men in the United States. Research Integration Strategies Evaluation (RISE). 2018.http://www.equalmeasure.org/wp-content/uploads/2017/08/Physical-and-Mental-Health-Interventions-for-Black-Men-in-the-United-States.pdf. Accessed 28 Sept 2018.

  34. Garbers S, Hunersen K, Nechitilo M, Fisch M, Bell DL, Byrne MW, et al. Healthy weight and cardiovascular health promotion interventions for adolescent and young adult males of color: a systematic review. Am J Mens Health. 2018;12(5):1328–51. https://doi.org/10.1177/1557988318777923.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Griffith DM, Metzl JM, Gunter K. Considering intersections of race and gender in interventions that address US men’s health disparities. Public Health. 2011;125(7):417–23. https://doi.org/10.1016/j.puhe.2011.04.014.

    Article  CAS  PubMed  Google Scholar 

  36. Thomas SJ, Booth JN 3rd, Dai C, et al. Cumulative incidence of hypertension by 55 years of age in blacks and whites: the CARDIA study. J Am Heart Assoc. 2018;7(14):e007988. https://doi.org/10.1161/JAHA.117.007988.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hooker SP, Hutto B, Zhu W, Blair SN, Colabianchi N, Vena JE, et al. Accelerometer measured sedentary behavior and physical activity in White and Black adults: the REGARDS study. J Sci Med Sport. 2016;19:336–41. https://doi.org/10.1016/j.jsams.2015.04.006.

    Article  PubMed  Google Scholar 

  38. Williams WM, Yore MM, Whitt-Glover MC. Estimating physical activity trends among blacks in the United States through examination of four national surveys. AIMS Public Health. 2018;5(2):144–57. https://doi.org/10.3934/publichealth.2018.2.144.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Peters SAE, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775 385 individuals and 12 539 strokes. Lancet. 2014;383(9933):1973–80. https://doi.org/10.1016/S0140-5736(14)60040-4.

    Article  PubMed  Google Scholar 

  40. Madsen TE, Khoury JC, Alwell KA, Moomaw CJ, Demel SL, Flaherty ML, et al. Sex differences in cardiovascular risk profiles of ischemic stroke patients with diabetes in the Greater Cincinnati/Northern Kentucky Stroke Study. J Diabet. 2018;10(6):496–501. https://doi.org/10.1111/1753-0407.12567.

    Article  CAS  Google Scholar 

  41. Pucci G, Alcidi R, Tap L, Battista F, Mattace-Raso F, Schillaci G. Sex- and gender-related prevalence, cardiovascular risk and therapeutic approach in metabolic syndrome: a review of the literature. Pharmacol Res. 2017;120:34–42. https://doi.org/10.1016/j.phrs.2017.03.008.

    Article  PubMed  Google Scholar 

  42. Camhi SM, Bray GA, Bouchard C, Greenway FL, Johnson WD, Newton RL, et al. The relationship of waist circumference and BMI to visceral, subcutaneous, and total body fat: sex and race differences. Obesity. 2011;19(2):402–8. https://doi.org/10.1038/oby.2010.248.

    Article  PubMed  Google Scholar 

  43. Jackson AS, Stanforth PR, Gagnon J, Rankinen T, Leon AS, Rao DC, et al. The effect of sex, age and race on estimating percentage body fat from body mass index: the Heritage Family Study. Int J Obes Relat Metab Disord. 2002;26:789–96.

    Article  CAS  PubMed  Google Scholar 

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Funding

Funding for this study was supported by a K01 training grant (K01 NR015494) from National Institute of Nursing Research, National Institutes of Health.

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Authors and Affiliations

  1. Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA, 30302, USA

    Dawn M. Aycock, Patricia C. Clark & Dhruvangi Sharma

  2. Department of Neurology 201 Dowman Drive, Emory University School of Medicine, Atlanta, GA, 30322, USA

    Aaron M. Anderson

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  1. Dawn M. Aycock
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  2. Patricia C. Clark
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  4. Dhruvangi Sharma
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Correspondence to Dawn M. Aycock.

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This study was approved by a University Institutional Review Board, and all activities have been performed in accordance with the ethical standards as described by the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Conflict of Interest

The grant above was awarded to Dawn M. Aycock; Patricia C. Clark, Aaron M. Anderson, and Dhruvangi Sharma have no conflicts of interest.

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Aycock, D.M., Clark, P.C., Anderson, A.M. et al. Health Perceptions, Stroke Risk, and Readiness for Behavior Change: Gender Differences in Young Adult African Americans. J. Racial and Ethnic Health Disparities 6, 821–829 (2019). https://doi.org/10.1007/s40615-019-00581-0

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