title: Hip Hop Stroke: Study Protocol for a Randomized Controlled Trial to Address Stroke Literacy.
abstract: OBJECTIVE
  Stroke is the fifth leading cause of death and the leading cause of serious long-term adult disability in the US. Acute stroke treatments with intravenous thrombolysis and endovascular therapy are proven to reduce disability, however a critical limitation on their effectiveness is the narrow time window for administration, which is 4.5 hours and 6 hours respectively from the onset of symptoms. Our overarching goal is to reduce pre-hospital delays to acute stroke treatments in economically disadvantaged minority communities where the greatest delays exist, using Hip Hop Stroke.
  
  
  METHODS
  Hip Hop Stroke (HHS) is a school-based, child-mediated, culturally-tailored stroke communication multimedia intervention developed using validated models of behavior change and designed to improve stroke literacy (knowledge of stroke symptoms, the urgent need to call 911, and prevention measures) of 4th, 5thand 6thgrade students and their parents residing in poor urban communities. Children in the intervention arm will receive the HHS intervention, while those in the attentional control arm will receive standardized nutrition education based on the USDA's MyPyramid program. Children will be trained and motivated to share stroke information with their parents or other adult caregiver. Both children and parents will complete a stroke knowledge assessment at baseline, immediately following the program, and at 3-months post-program. The primary outcome is the effect of the child mediation on parental stroke literacy.
  
  
  CONCLUSIONS
  Stroke literate children, a captive audience in school systems, may represent a viable channel for spreading stroke information into households of poor urban communities where mass media stroke campaigns have shown the lowest penetration. These children may also call 911 when witnessing a stroke in their homes or communities. The HHS program may highlight the potential role of children in the chain of stroke recovery as a strategy for reducing prehospital delays to acute stroke treatment.
authors.affiliation: Department of Neurology, Columbia University Medical Center, USA.
authors.forename: Olajide
authors.initials: O
authors.lastname: Williams
authors.affiliation: Department of Neurology, Columbia University Medical Center, USA.
authors.forename: Ellyn
authors.initials: E
authors.lastname: Leighton-Herrmann
authors.affiliation: Department of Neurology, Columbia University Medical Center, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: DeSorbo
authors.affiliation: Department of Neurology, Columbia University Medical Center, USA.
authors.forename: Mindy
authors.initials: M
authors.lastname: Hecht
authors.affiliation: Department of Neurology, Columbia University Medical Center, USA.
authors.forename: Monique
authors.initials: M
authors.lastname: Hedmann
authors.affiliation: Department of Neurology, Columbia University Medical Center, USA.
authors.forename: Saima
authors.initials: S
authors.lastname: Huq
authors.affiliation: Department of Biobehavioral Health, The Pennsylvania State University, USA.
authors.forename: William
authors.initials: W
authors.lastname: Gerin
authors.affiliation: Department of Public Health Sciences, The Pennsylvania State University College of Medicine, USA.
authors.forename: Vernon
authors.initials: V
authors.lastname: Chinchilli
authors.affiliation: Department of Population Health, NYU School of Medicine, USA.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: Department of Neurology, Columbia University Medical Center, USA.
authors.forename: James
authors.initials: J
authors.lastname: Noble
keywords: Child-mediated communication; Health communication; Health disparities; Randomized trial; Stroke; Stroke health education