UCLA researchers and their partners across Los Angeles County have been awarded an $11 million federal grant to fund research on community-based interventions aimed at reducing the higher rates of stroke and death from stroke among disadvantaged Hispanics, African Americans and Asian Americans.
Research has shown that stroke risk can be substantially lowered by increasing physical activity, controlling blood pressure, adopting a healthy diet, quitting smoking, lowering cholesterol and, for certain individuals, taking medication like aspirin.
However, the underserved populations targeted by this research program are frequently prevented from achieving these health goals by a variety barriers, including a lack of transportation for doctor visits, an inability to afford medication, insufficient knowledge about how to change their lifestyle, living in neighborhoods where infrastructure or safety concerns prevent walking, and an inability to read food labels in English, among others.
The Los Angeles Stroke Prevention/Intervention Research Program in Health Disparities is a multi-partner research center funded by the National Institutes of Health that will conduct two randomized, controlled, community-based trials of stroke-prevention interventions. One will measure how much the risk of recurrent stroke is lowered by teaming community health workers with physicians and nurses at Los Angeles medical centers serving low-income populations.
"These community health workers will conduct home visits to outreach to patients with a recent stroke," said the research center's director, Dr. Barbara Vickrey, vice chair and professor of neurology at the David Geffen School of Medicine at UCLA. "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 the use of home blood-pressure monitors and medications that substantially lower the risk of another stroke."
A second trial will assess the impact and sustainability of a culturally tailored behavioral intervention designed to provide stroke risk–factor education and 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.
An additional 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. Hopefully, Vickrey said, this research will identify new risk factors that can be controlled through future interventions.
"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 UCLA's established partnerships with other health care 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, the Watts Labor Community Action Committee and multiple senior centers, as well as 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 representing the racial and ethnic diversity of Los Angeles. This group will formally and regularly review and present advice on the work in progress and the 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 community members and academic investigators in Los Angeles and foster the sharing of knowledge.
"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.
She added 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.