title: Effect of peer education on stroke prevention: the prevent recurrence of all inner-city strokes through education randomized controlled trial.
abstract: OBJECTIVE
  Efforts to reduce disparities in recurrent stroke among Black and Latino stroke survivors have met with limited success. We aimed to determine the effect of peer education on secondary stroke prevention among predominantly minority stroke survivors.
  
  
  METHODS
  Between 2009 and 2012, we enrolled 600 stroke or transient ischemic attack survivors from diverse, low-income communities in New York City into a 2-arm randomized clinical trial that compared a 6 week (1 session/week), peer-led, community-based, stroke prevention self-management group workshop (N=301) to a wait-list control group (N=299). The primary outcome was the proportion with a composite of controlled blood pressure (<140/90 mm Hg), low-density lipoprotein cholesterol <100 mg/dL, and use of antithrombotic medications at 6 months. Secondary outcomes included control of the individual stroke risk factors. All analyses were by intent-to-treat.
  
  
  RESULTS
  There was no difference in the proportion of intervention and control group participants achieving the composite outcome (34% versus 34%; P=0.98). The proportion with controlled blood pressure at 6 months was greater in the intervention group than in the control group (76% versus 67%; P=0.02). This corresponded to a greater change in systolic blood pressure in the intervention versus control group (-3.63 SD, 19.81 mm Hg versus +0.34 SD, 23.76 mm Hg; P=0.04). There were no group differences in the control of cholesterol or use of antithrombotics.
  
  
  CONCLUSIONS
  A low-cost peer education self-management workshop modestly improved blood pressure, but not low-density lipoprotein cholesterol or antithrombotic use, among stroke and transient ischemic attack survivors from vulnerable, predominantly minority urban communities.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov/show/NCT0102727. Unique identifier: NCT01027273.
authors.affiliation: From the Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY (I.M.K.); Departments of Medicine (J.Z.G., C.R.H.), Health Evidence and Policy (R.N., K.F., C.R.H.), and Neurology (S.T.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Family Medicine, Institute for Family Health, New York, NY (G.A.). ik2293@columbia.edu.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.affiliation: From the Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY (I.M.K.); Departments of Medicine (J.Z.G., C.R.H.), Health Evidence and Policy (R.N., K.F., C.R.H.), and Neurology (S.T.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Family Medicine, Institute for Family Health, New York, NY (G.A.).
authors.forename: Judith Z
authors.initials: JZ
authors.lastname: Goldfinger
authors.affiliation: From the Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY (I.M.K.); Departments of Medicine (J.Z.G., C.R.H.), Health Evidence and Policy (R.N., K.F., C.R.H.), and Neurology (S.T.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Family Medicine, Institute for Family Health, New York, NY (G.A.).
authors.forename: Rennie
authors.initials: R
authors.lastname: Negron
authors.affiliation: From the Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY (I.M.K.); Departments of Medicine (J.Z.G., C.R.H.), Health Evidence and Policy (R.N., K.F., C.R.H.), and Neurology (S.T.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Family Medicine, Institute for Family Health, New York, NY (G.A.).
authors.forename: Kezhen
authors.initials: K
authors.lastname: Fei
authors.affiliation: From the Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY (I.M.K.); Departments of Medicine (J.Z.G., C.R.H.), Health Evidence and Policy (R.N., K.F., C.R.H.), and Neurology (S.T.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Family Medicine, Institute for Family Health, New York, NY (G.A.).
authors.forename: Stanley
authors.initials: S
authors.lastname: Tuhrim
authors.affiliation: From the Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY (I.M.K.); Departments of Medicine (J.Z.G., C.R.H.), Health Evidence and Policy (R.N., K.F., C.R.H.), and Neurology (S.T.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Family Medicine, Institute for Family Health, New York, NY (G.A.).
authors.forename: Guedy
authors.initials: G
authors.lastname: Arniella
authors.affiliation: From the Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY (I.M.K.); Departments of Medicine (J.Z.G., C.R.H.), Health Evidence and Policy (R.N., K.F., C.R.H.), and Neurology (S.T.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Family Medicine, Institute for Family Health, New York, NY (G.A.).
authors.forename: Carol R
authors.initials: CR
authors.lastname: Horowitz
mesh_terms: D000368:Aged; D004493:Education / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D014505:Urban Population
keywords: disparities; randomized trial; secondary prevention; self-management; stroke