Rapid identification and treatment of ischemic stroke can lead to improved patient outcomes. Public education campaigns in selected communities have helped to increase knowledge about stroke, but most data represent large metropolitan centers working with academic institutions. Much less is known about knowledge of stroke among residents in rural communities.
In 2004, 800 adults aged 45 years and older from two Montana counties participated in a telephone survey using unaided questions to assess awareness of stroke warning signs and risk factors. The survey also asked respondents if they had a history of atrial fibrillation, diabetes, high blood pressure, high cholesterol, smoking, heart disease, or stroke.
More than 70% of survey participants were able to correctly report two or more warning signs for stroke: numbness on any side of the face/body (45%) and speech difficulties (38%) were reported most frequently. More than 45% were able to correctly report two or more stroke risk factors: smoking (50%) and high blood pressure (44%) were reported most frequently. Respondents aged 45 to 64 years (odds ratio [OR] 2.44; 95% confidence interval [CI], 1.78–3.46), women (OR 2.02; 95% CI, 1.46–2.80), those with 12 or more years of education (OR 1.96; 95% CI, 1.08–3.56), and those with high cholesterol (OR 1.68; 95% CI, 1.17–2.42) were more likely to correctly identify two or more warning signs compared with respondents without these characteristics. Women (OR 1.48; 95% CI, 1.07–2.05) and respondents aged 45 to 64 years (OR 1.35; 95% CI, 1.01–1.81) were also more likely to correctly identify two or more stroke risk factors compared with men and older respondents.
Residents of two rural counties were generally aware of stroke warning signs, but their knowledge of stroke risk factors was limited.
Stroke is a leading cause of death and functional impairment. While older people are particularly vulnerable to stroke, research suggests that they have the poorest awareness of stroke warning signs and risk factors. This study examined knowledge of stroke warning signs and risk factors among community-dwelling older adults.
Randomly selected community-dwelling older people (aged 65+) in Ireland (n = 2,033; 68% response rate). Participants completed home interviews. Questions assessed knowledge of stroke warning signs and risk factors, and personal risk factors for stroke.
Of the overall sample, 6% had previously experienced a stroke or transient ischaemic attack. When asked to identify stroke risk factors from a provided list, less than half of the overall sample identified established risk factors (e.g., smoking, hypercholesterolaemia), hypertension being the only exception (identified by 74%). Similarly, less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exception. Overall, there were considerable gaps in awareness with poorest levels evident in those with primary level education only and in those living in Northern Ireland (compared with Republic of Ireland).
Knowledge deficits in this study suggest that most of the common early symptoms or signs of stroke were recognized as such by less than half of the older adults surveyed. As such, many older adults may not recognise early symptoms of stroke in themselves or others. Thus, they may lose vital time in presenting for medical attention. Lack of public awareness about stroke warning signs and risk factors must be addressed as one important contribution to reducing mortality and morbidity from stroke.
Studies of stroke awareness suggest that knowledge of early warning signs of stroke is low in high-risk groups. However, little is known about stroke knowledge among individuals with a history of prior stroke who are at significant risk for recurrent stroke.
Data from 2,970 adults with a history of prior stroke from the 2003 Behavioral Risk Factor Surveillance System were examined. Recognition of the five warning signs of stroke and appropriate action to call 911 was compared across three racial/ethnic groups: non-Hispanic white, non-Hispanic black, and Hispanic/other. Multiple logistic regression analyses were used to: (1) determine the association between race/ethnicity and recognition of multiple stroke signs and appropriate first action and (2) identify independent correlates of recognition of multiple stroke signs and taking appropriate action to seek treatment among individuals with prior stroke.
Recognition of all five signs of stroke and taking appropriate action to call 911 was lowest among the non-Hispanic black group (22.3%) and Hispanic/other group (16.7%). In multivariate models, Hispanic/other (odds ratio [OR] 0.42 [0.25, 0.71]), age 50–64 (OR 0.64 [0.43, 0.97]), age ≥65 (OR 0.36 [0.23, 0.55]), and >high school education (OR 1.79 [1.22, 2.63]) emerged as independent correlates of recognition of all five signs of stroke and first action to call 911.
Less than 35% of people with prior stroke can distinguish the complex symptom profile of a stroke and take appropriate action to call 911. Targeted educational activities that are sensitive to differences in race/ethnicity, age, and education levels are needed for individuals with prior stroke.
Although stroke is a leading cause of morbidity and mortality in Nigeria, there is no information on awareness of its warning signs. This study was designed to assess awareness of stroke warning signs in Nigerians at increased risk.
A hospital-based cross-sectional study conducted at Irrua Specialist Teaching Hospital, in southern Nigeria. Patients with a diagnosis of hypertension, diabetes or both were interviewed for the warning signs of stroke in the outpatient clinic by trained interviewers. The main outcome measure was ability to identify at least one stroke warning sign.
There were 225 respondents with a mean age of 58.0 ± 11.7 years. Only 39.6% could identify at least one stroke warning sign while the commonest sign identified was sudden unilateral limb weakness (24.4%). On multivariate logistic regression analysis, male sex (β = 0.26, 95% CI = 0.14–0.39, p < 0.001) and 11 or more years of education (β = 0.16, 95% CI = 0.03–0.29, p = 0.02) emerged the independent predictors of ability to identify at least one warning sign.
Awareness of stroke warning signs is poor among Nigerians at increased risk for the disease. Efforts should be made to improve on the level of awareness through aggressive health education.
National initiatives to improve the recognition of heart attack and stroke warning signs have encouraged symptomatic people to seek early treatment, but few have shown significant effects in rural American Indian (AI) communities.
During 2009 and 2010, the Montana Cardiovascular Health Program, in collaboration with 2 tribal health departments, developed and conducted culturally specific public awareness campaigns for signs and symptoms of heart attack and stroke via local media. Telephone surveys were conducted before and after each campaign to evaluate the effectiveness of the campaigns.
Knowledge of 3 or more heart attack warning signs and symptoms increased significantly on 1 reservation from 35% at baseline to 47% postcampaign. On the second reservation, recognition of 2 or more stroke signs and symptoms increased from 62% at baseline to 75% postcampaign, and the level of awareness remained at 73% approximately 4 months after the high-intensity campaign advertisements ended. Intent to call 9-1-1 did not increase in the heart attack campaign but did improve in the stroke campaign for specific symptoms. Recall of media campaigns on both reservations increased significantly from baseline to postcampaign for both media outlets (ie, radio and newspaper).
Carefully designed, culturally specific campaigns may help eliminate disparities in the recognition of heart attack and stroke warning signs in AI communities.
The present study was aimed at investigating the awareness level about warning signs of cancer and its determinants in an Iranian general population. This cross-sectional interview-based survey investigated 2,500 people aged 18 years and over, as a representative sample of Tehran population. Latent class regression was applied for analyzing data. A small (18.8%) proportion of the respondents had high level of knowledge, and 54.5% had moderate awareness, and 26.7% had low level of awareness. Most effective predictors for awareness were educational attainment, sex, and marital status. The findings suggest that the overall level of knowledge about warning signs of cancer among the public is low, particularly about some specific signs. Accordingly, educational and intervention programmes, with special attention placed on particular at-risk populations, to increase awareness about the disease leading to its early diagnosis are needed.
Awareness; Cancer; Cross-sectional studies; Health education; Neoplasms; Public education; Signs and symptoms; Iran
Previous studies have demonstrated poor knowledge of stroke among patients with established risk factors. This study aims to assess the baseline knowledge, among patients with increased risk for stroke in Oman, of warning symptoms of stroke, impending risk factors, treatment, and sources of information.
In April 2005, trained family practice residents at Sultan Qaboos University Hospital Clinics (cardiology, neurology, diabetic, and lipid clinics), using a standardised, structured, pre-tested questionnaire, conducted a survey of 400 Omani patients. These patients all demonstrated potential risk factors for stroke.
Only 35% of the subjects stated that the brain is the organ affected by a stroke, 68% correctly identified at least one symptom/sign of a stroke, and 43% correctly identified at least one stroke risk factor. The majority (62%) did not believe they were at increased risk for stroke, and 98% had not been advised by their attending physician that their clinical conditions were risk factors for stroke. In the multivariable logistic regression analysis, lower age and higher levels of education were associated with better knowledge regarding the organ involved in stroke, stroke symptoms, and risk factors.
Because their knowledge about stroke risk factors was poor, the subjects in this study were largely unaware of their increased risk for stroke. Intensive health education is needed to improve awareness of stroke, especially among the most vulnerable groups.
In Georgia, mortality from stroke is 16% higher and from cardiovascular disease is 9% higher than it is nationally. Although 75% of Georgia adults have 2 or more modifiable risk factors for cardiovascular disease, less than half recognize all major heart attack and stroke warning symptoms. To reduce disability and prevent death from cardiovascular events, high-risk population groups should be able to recognize symptoms and seek immediate medical attention.
We evaluated a 4-month education intervention in 40 senior centers in Georgia. The intervention focused on improving knowledge of heart attack and stroke symptoms and on promoting lifestyle behaviors that prevent and manage cardiovascular disease and diabetes. Participants in a convenience sample completed a pretest questionnaire, the intervention, and a posttest questionnaire (N = 693, mean age, 75 years, 84% female, 45% black).
After the intervention, recognition of all 5 symptoms of heart attack increased from 29% at the pretest to 46% at the posttest, and recognition of all 5 symptoms of stroke increased from 42% at the pretest to 65% at the posttest (for both conditions, P < .001). In linear regression analyses, independent positive predictors of change in knowledge were younger age and higher education. Most risk factors for cardiovascular disease were not predictive.
The results of this evaluation provide an evidence base for the effectiveness of this intervention in improving knowledge about heart attack and stroke symptoms, which may translate to greater preparedness in these older adults for response to cardiovascular events.
This paper presents the level of colorectal cancer awareness among multi-ethnic rural population in Malaysia.
A rural-based cross sectional survey was carried out in Perak state in Peninsular Malaysia in March 2011. The survey recruited a population-representative sample using multistage sampling. Altogether 2379 participants were included in this study. Validated bowel/colorectal cancer awareness measure questionnaire was used to assess the level of colorectal cancer awareness among study population. Analysis of variance (ANOVA) was done to identify socio-demographic variance of knowledge score on warning signs and risk factors of colorectal cancer.
Among respondents, 38% and 32% had zero knowledge score for warning signs and risk factors respectively. Mean knowledge score for warning signs and risk factors were 2.89 (SD 2.96) and 3.49 (SD 3.17) respectively. There was a significant positive correlation between the knowledge score of warning signs and level of confidence in detecting a warning sign. Socio-demographic characteristics and having cancer in family and friends play important role in level of awareness.
Level of awareness on colorectal cancer warning signs and risk factors in the rural population of Malaysia is very low. Therefore, it warrants an extensive health education campaign on colorectal cancer awareness as it is one of the commonest cancer in Malaysia. Health education campaign is urgently needed because respondents would seek medical attention sooner if they are aware of this problem.
Colorectal cancer; Rural population; Cancer awareness; Bowel/colorectal CAM
Objectives. To determine the awareness of the warning signs, risk factors, and treatment of tuberculosis among urban Nigerians. Methods. This was a cross-sectional survey among 574 adults in Ilorin, Nigeria. Semistructured questionnaire was administered by trained interviewers to obtain information about awareness of tuberculosis warning signs, risk factors, and treatment. Results. Majority of the subjects (71.4%) were aware of at least one warning sign of tuberculosis. Cough (66.2%), weight loss (38.0%), and haemoptysis (30.7%) were the most identified warning signs. The predictors of awareness of warning sign were increasing age (r + 0.12), higher family income (r + 0.10), higher level of education (r + 0.10), and belonging to Christian faith (r + 0.11). Awareness of risk factors for tuberculosis was higher for tobacco smokers (77.0%) and history of contact with a case of TB (76.0%). Less than half were aware of HIV infection (49.8%), alcohol consumption (42.5%), chronic kidney disease (40.4%), extremes of ages (39.4%), cancers (36.9%), and diabetes mellitus (27.5%) as risk factors for TB. Tuberculosis was reported to be curable by 74.6% of the subjects and 67.9% knew that there are medications for treatment of tuberculosis, while 11.5% knew the duration of treatment. Conclusion. This study has revealed that the awareness of HIV and noncommunicable diseases as risk factors for TB is poor. This study has therefore demonstrated the need for health education programs that will emphasize recognition, identification, and modification of risk factor for TB.
Migraine and cerebrovascular disease are linked in different ways: migraine may be a potential cause of stroke as in migrainous infarction, headache may be a symptom of cerebrovascular disease and also a risk factor for stroke, the association of migraine and stroke may constitute specific syndromes such as CADASIL and MELAS. The new IHS 2003 criteria, though preserving their main structure, have changed the terminology regarding secondary headaches, now described as “attributed to” another disease rather than “associated with” it. The more detailed knowledge of causal links between the underlying disorder and headache, has allowed to strengthen the terminology. Many cerebrovascular disorders as cerebral haemorrhage, venous sinus thrombosis, carotid or vertebral dissections and ischaemic stroke may present with a headache or be followed by it. In subarachnoid haemorrhage (SAH) headache may constitute an important warning sign before the bleeding. An interesting issue is the hypothesis that migraine may be a potential risk factor for stroke. Recent studies have underlined the increased relative risk of ischemic stroke in female migraineurs. Many potential mechanisms have been hypothesized: (1) alterations of vasoreactivity due to vessel wall dysfunction, (2) release of vasoactive substances during migraine, (3) platelet hyperactivity as expression of serotoninergic dysfunction in migraineurs, (4) intriguing studies have described a high prevalence of migraine with aura in stroke patients with patent foramen ovale (PFO). Differential diagnosis between migraine and stroke remains fundamental: some types of migraine can mimic cerebrovascular disease such as familial hemiplegic migraine, and basilar migraine. Migraine and stroke may be part of syndromic complexes as in CADASIL and MELAS. In conclusion migraine is a risk factor for cerebrovascular disease, it may be the cause of stroke as in migrainous infarctions, stroke may induce headache which may be a relevant symptom of cerebrovascular disease, yet migraine remains an essentially benign condition.
Migraine; Cerebrovascular disease; IHS criteria
Health warnings on cigarette packages are among the most common means of communicating the health risks of smoking. However, few studies have evaluated the impact of package warnings on consumer knowledge about tobacco risks.
The aim of the current study was to use nationally representative samples of adult smokers from the United States (USA), the United Kingdom (UK), Canada (CAN), and Australia (AUS) from the International Tobacco Control Four Country Survey (ITC‐4) to examine variations in smokers' knowledge about tobacco risks and the impact of package warnings.
A telephone survey was conducted with 9058 adult smokers from the following countries: USA (n = 2138), UK (n = 2401), CAN (n = 2214) and AUS (n = 2305). Respondents were asked to state whether they believed smoking caused heart disease, stroke, impotence, lung cancer in smokers, and lung cancer in non‐smokers. Respondents were also asked whether the following chemicals are found in cigarette smoke: cyanide, arsenic and carbon monoxide.
Smokers in the four countries exhibited significant gaps in their knowledge of the risks of smoking. Smokers who noticed the warnings were significantly more likely to endorse health risks, including lung cancer and heart disease. In each instance where labelling policies differed between countries, smokers living in countries with government mandated warnings reported greater health knowledge. For example, in Canada, where package warnings include information about the risks of impotence, smokers were 2.68 (2.41–2.97) times more likely to agree that smoking causes impotence compared to smokers from the other three countries.
Smokers are not fully informed about the risks of smoking. Warnings that are graphic, larger, and more comprehensive in content are more effective in communicating the health risks of smoking.
warning labels; health knowledge; smoking behaviour; tobacco constituents; tobacco control policy
Despite lack of outward signs, most individuals after non-disabling stroke (NDS) and transient ischemic attack (TIA) have significant cardiovascular and cerebrovascular disease and are at high risk of a major stroke, hospitalization for other vascular events, or death. Most have multiple modifiable risk factors (e.g., hypertension, physical inactivity, hyperlipidaemia, diabetes, tobacco consumption, psychological stress). In addition, accelerated rates of depression, cognitive decline, and poor quality of sleep have been reported following TIA, which correlate with poor functional outcomes and reduced quality of life. Thus, NSD and TIA are important warning signs that should not be overlooked. The challenge is not unlike that facing other 'silent' conditions - to identify a model of care that is effective in changing people's current behaviors in order to avert further morbidity.
A single blind, randomized controlled trial will be conducted at two sites to compare the effectiveness of a program of rehabilitative exercise and education versus usual care in modifying vascular risk factors in adults after NDS/TIA. 250 adults within 90 days of being diagnosed with NDS/TIA will be randomly allocated to a 12-week program of exercise and education (PREVENT) or to an outpatient clinic assessment and discussion of secondary prevention recommendations with return clinic visits as indicated (USUAL CARE). Primary outcome measures will include blood pressure, waist circumference, 12-hour fasting lipid profile, and 12-hour fasting glucose/hemoglobin A1c. Secondary measures will include exercise capacity, walking endurance, physical activity, cognitive function, depression, goal attainment and health-related quality of life. Outcome assessment will be conducted at baseline, post-intervention, and 6- and 12-month follow-ups. Direct health care costs incurred over one year by PREVENT versus USUAL CARE participants will also be compared. Ethical approval for the trial has been obtained from the relevant Human Research Ethics Boards.
Whether timely delivery of an adapted cardiac rehabilitation model is effective in attaining and maintaining vascular risk reduction targets in adults after NDS/TIA is not yet known. We anticipate that the findings of this trial will make a meaningful contribution to the knowledge base regarding secondary stroke prevention.
This trial is registered with the Clinical Trials.gov Registry (NCT00885456).
In 2003, only 18% of Massachusetts adults were aware of all signs and symptoms of stroke, but 80% would call 9-1-1 if they thought someone was having a stroke or heart attack. Because early recognition leads to early treatment and improved clinical outcomes, increasing symptom recognition could have an impact on stroke survival and stroke patients' quality of life.
We conducted secondary research to identify messages with evidence-based effectiveness for communicating stroke signs and symptoms. From these results, a Stroke Heroes Act FAST animation was created and concept-tested. Non-Hispanic white and non-Hispanic black women aged 40 to 64 years received education on stroke signs and symptoms. Knowledge change about stroke signs and symptoms was calculated immediately following and 3 months after the education session.
Using Stroke Heroes Act FAST educational materials that were developed, 72 women (mean age, 54 years; 15.5% were non-Hispanic blacks) received education about signs and symptoms of stroke and took the pretests and posttests to assess knowledge change. Immediately after the education session, significant increases were seen in the percentage of participants who recognized that facial droop (92% vs 99%, P = .02) and arm weakness or numbness (86% vs 97%, P = .004) were symptoms of stroke. Of the 65 participants who were given the 3-month follow-up survey, 100% remembered slurred speech and facial drooping as symptoms; 98.5% recalled arm weakness or numbness; and 97% would call 9-1-1 if they thought someone was having a stroke. None of these is a significant change from the posttest.
The Stroke Heroes Act FAST kit may be a useful tool for improving knowledge of stroke signs and symptoms among adults.
Awareness of stroke warning symptoms and risk factors (stroke literacy), as well as knowledge of available treatment options, may be poor in high-risk populations. We sought to evaluate stroke literacy among residents of Central Harlem, a predominantly African American population, in a cross-sectional study.
Ten community-based sites in Central Harlem were identified between 2005 and 2006 for administration of a stroke knowledge survey. Trained volunteers administered in-person closed-ended questionnaires focused on stroke symptoms and risk factors.
A total of 1,023 respondents completed the survey. African Americans comprised 65.7% (n = 672) of the survey cohort. The brain was correctly identified as the site where a stroke occurs by 53.7% of respondents, whereas the heart was incorrectly identified by 20.8%. Chest pain was identified as a symptom of stroke by 39.7%. In multivariable analyses, African Americans (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.09–4.45) and Hispanics (OR 5.27, 95% CI 2.46–11.30) were less likely to identify the brain as the damaged organ in stroke. Hispanics were more likely to incorrectly identify chest pain as a stroke symptom, compared with whites (OR 3.40, 95% CI 1.49–7.77). No associations were found between calling 911 and race/ethnicity and stroke knowledge, although women were more likely than men to call 911 (OR 0.50, 95% CI 0.30–0.80).
Significant deficiencies in stroke literacy exist in this high-risk population, especially when compared with national means. Culturally tailored and sustainable educational campaigns should be tested in high-risk populations as part of stroke public health initiatives.
= Behavioral Risk Factor Surveillance Survey;
= confidence interval;
= Second Delay in Accessing Stroke Healthcare;
= emergency medical services;
= face, arm, speech, time;
= odds ratio.
After publication of the results of the National Institute of Neurological Disorders and Stroke study, the application of intravenous thrombolysis for ischemic stroke was launched and has now been in use for more than 10 years. The approval of this drug represented only the first step of the therapeutic approach to this pathology. Despite proven efficacy, concerns remain regarding the safety of recombinant tissue-type plasminogen activator for acute ischemic stroke used in routine clinical practice. As a result, a small proportion of patients are currently treated with thrombolytic drugs. Several factors explain this situation: a limited therapeutic window, insufficient public knowledge of the warning signs for stroke, the small number of centers able to administer thrombolysis on a 24-hour basis and an excessive fear of hemorrhagic complications. The aim of this review is to explore the clinical efficacy of treatment with alteplase and consider the hemorrhagic risks.
rt-PA; acute ischemic stroke; intracranial hemorrhage
This study investigated the self-reported awareness of the presence of product warning messages and signs among random samples of Hispanics in San Francisco surveyed in 1990 and in 1991. The messages that were tested related to cigarettes, alcoholic beverages, and other consumer products. A random sample of 1,204 Hispanics (43.5 percent males) were interviewed by telephone in 1990. The corresponding figure for the second survey in 1991 was 1,569 Hispanics (41.1 percent males). In general, respondents reported low levels of awareness of the presence of product warning messages and signs. The exception was warning messages on cigarette packets which approximately 70 percent of the respondents reported having seen within the 12 months before the survey. There was an increase from 1990 to 1991 in the reported awareness of warning messages for wine, beer, and cigarettes. Smokers and drinkers of alcoholic beverages reported the highest levels of awareness of the relevant warning messages and signs. Length of exposure to warning messages and multiplicity of sources (for example, advertisements and products) seem to produce greater levels of awareness of the presence of product warning messages. Less acculturated, Spanish-speaking Hispanics are less likely to report being aware of the warnings, particularly those that appear only in English (for example, alcoholic beverages).
Effective stroke intervention and risk reduction depend on the general public's awareness and knowledge of stroke. In Korea, where both traditional Oriental medicine and Western medicine are practiced, estimates of the general public's awareness and knowledge of stroke are poor. The present study sought to describe the inception cohort of the Ansan Geriatric Study (AGE study) and to determine baseline stroke awareness and preferred medical treatment for stroke in this Korean sample.
A total of 2,767 subjects selected randomly from the Ansan Geriatric Study in South Korea were questioned about stroke. Their answers were compared with their sociodemographic data and other variables.
Only 44.8% of participants correctly identified stroke as a vascular disease in the human brain. Sudden numbness or weakness was the most frequently identified stroke warning sign (60.2%). Hypertension (66.7%) and mental stress (62.2%) were most frequently identified as stroke risk factors. The contributions of diabetes mellitus and cardiovascular disease to stroke were underestimated; they were identified as risk factors by 28.3% and 18.6% of participants, respectively. The predictors for poor knowledge of stroke warning signs and risk factors were similar irrespective of preference for Western or Oriental medical treatment, and included those with lower levels of education and inaccurate definition of stroke. Television and radio (40.3%) were the most frequent sources of stroke information for both groups.
This study shows that knowledge of stroke is similar among Koreans with preferences for either Western or Oriental medical treatment and that misunderstandings about stroke are common among the Korean elderly. In order to prevent and manage stroke effectively, public health education regarding basic concepts of stroke is necessary. This should target those with a lower level of education and a misunderstanding of the definition of stroke.
This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were “noticing warning labels during last month,” “reading or looking closely at warning labels,” “avoiding looking at labels during last month,” “thinking about health risks of smoking because of the warning labels, “more likely to quit because of the warning labels,” and “stopping from having a cigarette when about to smoke one because of the labels.”
A total of 2,006 adult smokers in Malaysia were surveyed in face-to-face interviews using a standardized questionnaire. Of those, 1,919 male smokers were included in the analyses.
The responses “more likely to quit because of the warning labels” and “stopped from having a cigarette when about to smoke one” significantly predicted all stages of change and self-efficacy, independent of the other measures. In addition, thinking about the health risks and reading the warnings more often added extra predictive capacity but only in the early stages of contemplating change.
Less intense processing of the information may be important in initiating thoughts, but cognitions about quitting and foregoing cigarettes are the key mechanisms by which warnings stimulate quitting intentions and help smokers feel capable of succeeding. Malaysian smokers appear to respond to warnings in ways comparable with those from developed countries.
Four hundred two residents of a disadvantaged African American community in New Orleans were surveyed to determine their knowledge, attitudes, and beliefs regarding cancer and cancer screening. The residents were interviewed in their homes by trained community members. Two hundred ninety members of the Ochsner Health Plan (OHP) were also surveyed and the results from both groups were compared. Both groups were health conscious and expressed a willingness to participate in cancer screening. Mean cancer knowledge scores were lower in the target population (4.95) when compared with the OHP group (5.84). Thirty-two percent of the target population could identify the 7 cancer warning signs versus 47% of the OHP group. Similar percentages of women in both groups could identify risk factors for breast cancer, but a number of etiologic myths were prevalent in the African American community. Participants in the African American community had a more fatalistic view of cancer and were less trusting of the medical community. Cancer screening rates were similar for cervical and colorectal cancer, but a significantly higher percentage of women in the OHP group received regular mammograms, 83% versus 43% in the target population. Thirty-two percent of the target population and 75% of the OHP group stated they had received a digital rectal examination. Only 34% of the African American males had received a Prostate Specific Antigen test versus 46% in the OHP group. The results of the survey identify a number of barriers to cancer screening among the African American community and support the need for a culturally sensitive, community-based cancer education program.
The objective of this research was to compare the response of adult smokers in Malaysia to newly proposed pictorial cigarette warnings against the current text-only warnings. The study population included 140 adult male smokers who were enrolled in a randomized trial to view either the new pictorial warnings (intervention) or the old text-only warnings (control). Participants completed pre-exposure and post-exposure questionnaires that assessed their awareness of the health risks of smoking, response to the package warnings, and interest in quitting smoking. Exposure to the pictorial warnings resulted in increased awareness of the risks of smoking, stronger behavioral response to the warnings and increased interest in quitting smoking. The new warnings in Malaysia will increase smokers’ knowledge of the adverse health effects of smoking and have a positive effect on interest in quitting.
pictorial cigarette package warning labels; smoking behavior; awareness of health risk; interest in quitting; Malaysia; adult smokers; randomized trial; questionnaire; knowledge score
Stroke is a leading cause of disability and the third leading cause of death among adults in the United States and in the Great Lakes states of Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. The Great Lakes Regional Stroke Network was created to enhance collaboration and coordination among the Great Lakes states to reduce the burden of stroke and stroke-related disparities associated with race, sex, and geography. Three priorities were identified for reducing the effects of stroke in the Great Lakes region: 1) build epidemiologic capacity to improve stroke prevention and control efforts, 2) facilitate systems-level changes and collaborative efforts to improve acute stroke care and rehabilitation, and 3) promote awareness of the warning signs of stroke and the need to call 911. The Great Lakes Regional Stroke Network has work groups in the areas of epidemiology and surveillance, health care quality improvement, and public education. These groups recommend initiatives to states for their efforts to reduce the effects of stroke within the Great Lakes region. Examples of recommended initiatives include identifying and prioritizing state research evaluation needs for stroke, conducting a stroke education media campaign, and developing a statewide emergency medical services protocol for stroke.
STUDY OBJECTIVE—Transient ischaemic attack (TIA) is often a precursor to stroke, so identification of people experiencing TIA could assist in stroke prevention by indicating those at high risk of stroke who would benefit most from intervention for other stroke risk factors. The objective of this study was to investigate whether answers to a simple questionnaire for TIA could predict the occurrence of stroke in the following 20 years.
DESIGN—Prospective cohort study, conducted between 1972 and 1976, with 20 years of follow up.
SETTING—Renfrew and Paisley, Scotland.
PARTICIPANTS—7052 men and 8354 women aged 45-64 years at the time of screening completed a questionnaire and attended a physical examination. The questionnaire asked participants if they had ever, without warning, suddenly lost the power of an arm, suddenly lost the power of a leg, suddenly been unable to speak properly or suddenly lost consciousness. These four questions were taken as indicators of TIA and were related to subsequent stroke mortality or hospital admission.
MAIN RESULTS—For women, each question was significantly related to stroke risk, whereas for men only the question on loss of power of arm was significantly related to stroke risk. Men and women answering two or more questions positively had double the relative rate of stroke compared with men and women answering none of the questions positively, even after adjusting for other risk factors for stroke.
CONCLUSIONS—A simple questionnaire for TIA could help predict stroke over 20 years of follow up. Targeting men and women who report TIA with early treatment could help to prevent strokes from occurring.
Keywords: prospective study; stroke
Adverse drug events (ADEs) are a significant problem in health care. While effective warnings have the potential to reduce the prevalence of ADEs, little is known about how patients access and use prescription labeling. We investigated the effectiveness of prescription warning labels (PWLs, small, colorful stickers applied at the pharmacy) in conveying warning information to two groups of patients (young adults and those 50+). We evaluated the early stages of information processing by tracking eye movements while participants interacted with prescription vials that had PWLs affixed to them. We later tested participants’ recognition memory for the PWLs. During viewing, participants often failed to attend to the PWLs; this effect was more pronounced for older than younger participants. Older participants also performed worse on the subsequent memory test. However, when memory performance was conditionalized on whether or not the participant had fixated the PWL, these age-related differences in memory were no longer significant, suggesting that the difference in memory performance between groups was attributable to differences in attention rather than differences in memory encoding or recall. This is important because older adults are recognized to be at greater risk for ADEs. These data provide a compelling case that understanding consumers’ attentive behavior is crucial to developing an effective labeling standard for prescription drugs.
Background and purpose
Women face a higher mortality after stroke and have different risk factors than men. Despite educational campaigns, women continue to underestimate their own risk for stroke. We present a theoretical model to understand risk perception in high-risk women.
805 women, ages 50 to 70, were selected from the University of Connecticut Cardiology Center with at least one risk factor for stroke. A five-part questionnaire addressed stroke knowledge, risk perception, risk factors, access to health care and demographics. 215 women responded by mail (28% response rate) and de-identified data was entered in SPSS. Descriptive, bivariate and multivariate techniques assessed the proposed model.
The cohort was predominantly white (91.5%), higher income (33.1% of the population earned >$75,000) and well-educated (28.6% attended graduate or professional school). Only 7 of the 37 (18.9%) women with atrial fibrillation and 11 out of the 71 women with heart disease (15.5%) identified their health condition as a risk factor for stroke. Predictors of risk perception included: other women’s risk (B=.336, p<.001), worrying about stroke (B=.734, p<.001), having hypertension (B=.686, p=.037) and diabetes (B=.893, p=.004). Only 63.9% of women with atrial fibrillation (n=23) reported taking warfarin.
Women were often unable to identify their health condition as a risk factor for stroke. In addition, many women were not undertaking primary prevention behaviors. Risk perception was low, and high risk women perceived their risk of stroke to be the same as their peers. Educational strategies must advocate for and target high-risk women.
Organized Stroke Care; Prevention; Psych & Behavior; Public Policy; Women & Minorities; Risk Perception