1. Team 5 Jennifer Housel, Miranda Lindsey, Theresa Maliskey, Rachal Trigger, Marcos Vergez

2. The purpose of this presentation is to discuss the stroke risk in the African American population. Demographic data, risk factors, cultural and environmental characteristics, as well as population statistics will be used to demonstrate high level of stroke in this population. Additionally, the Health Belief Model will be used to support the central focus of this presentation.

3.  What is the stroke belt?  Stroke Belt States  Alabama  Arkansas  Georgia  Indiana  Kentucky  Louisiana  Mississippi  North Carolina  South Carolina  Tennessee  Virginia *Stroke Belt State locations and definitions of the region have changed over the years (2008)*

4.  10 published explanations.  Higher prevalence of hypertension and diabetes.  Socio-economic factors.  Rural or urban nature of environment (2008).  Environmental exposures (2008).  Micronutrients in the drinking water and food supply  Lifestyle choices (2008).  Diet, exercise, cigarette smoking

5.  Population estimated at 44.5 million  14.2% of the total US population  Largest concentrations in the South  38% of residents in Mississippi

6.  Recent immigrants vs. Many generations  Genetics vs. Environment and Lifestyle  Poverty rate 3x greater (24.5%)

7. Medical Conditions  History of stroke or transient ischemic attack  Hypertension  Hypercholesterolemia  History of heart disease  Diabetes mellitus  Sickle cell disease Behavior  Diet high in fat, cholesterol, and salt  Physical inactivity  Obesity  Alcohol use  Tobacco use Other  Family history of stroke  Age  Race or ethnicity

8.  The stroke mortality rate for African Americans aged 45 to 64 years is 3 to 4 times higher than for whites of the same age.  Stroke mortality rates are approximately 50% higher in African Americans than in whites.  The black-to-white stroke mortality ratio was consistently higher for southern states, with an average black-to-white stroke mortality ratio that ranged from 6% to 21% higher among southern states than in non-southern states

9.  Lack of access to medical care  Lack of access to medications  Lack of grocery stores/grocery stores with limited selections  Large number of fast food restaurants  Poor economic conditions  Lack of access to recreational facilities  High rate of unemployment  Social conflict leading to stress

10. Excerpt from British Dental Journal, 1999

11.  Educate on healthy eating/cooking habits  Print healthy recipes on pharmacy bags, back of receipts  Encourage early screening for risk factors  Conduct health fairs and set up booths at local event to help identify & educate the public  Educate on warning signs & importance of immediate action in event of stroke symptoms  Public service advertisements on local tv & radio stations

12.  Improve Cardiovascular Health  Prevention of modifiable risk factors  Detection of risk factors  Treatment of risk factors for a stroke  Improve Quality of Life  Early identification to improve outcomes  Treatment  Prevention of repeat cardiovascular events

13. The increased stroke risk in the African American community is rising at a startling rate. It is critical to improve direct healthcare education, access to healthcare, and treatment of early risk factors for stroke. While a large effort is needed to curve these statistics in the adult African American population, it is of vital importance to begin health education during the early childhood years.

14.  Ashford, R., & Blinkhorm, A. (1999). Marketing dental care to the reluctant patient. British Dental Journal, 186, 436. doi: doi:10.1038/sj.bdj.4800135  Center for Disease Control and Prevention (CDC). (2014). Black or African American populations. Examples of important health disparities. Retrieved from http://www.cdc.gov/minorityhealth/populations/remp/black.html#Demographics  Centers for Disease Control and Prevention. (2014). Heart healthy and stroke free. Retrieved from http://www.cdc.gov/dhdsp/seh_handbook.htm  Centers for Disease Control and Prevention. (2014). Risk factors. Retrieved from http://www.cdc.gov/stroke/risk_factors.htm  Fashionbrew. (2013). Inspiring: Two beauty pageant winners promote African fashion during their humanitarian missions [Photograph]. Retrieved from http://www.thefashionbrewery.com/2013/11/two-beauty-pageant-winners-display- cultural-fashions-in-the-forefront-during-their-humanitarian-missions/  Healthy People 2020. (2013). Heart disease and stroke. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=21  Howard, G., Labarthe, D., Hu, J., Yoon, S., & Howard, V. (2008). Regional differences in African Americans’ high risk for stroke: the remarkable burden of stroke for southern African Americans. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1995237  Pender, N., Murdaugh, C., & Parsons, M. A. (2011). Health promotion in nursing practice. (6th ed.). Upper Saddle River, NJ: Pearson Education.