title: Community-Level Measures of Stroke Knowledge among Children: Findings from Hip Hop Stroke.
abstract: BACKGROUND
  Community-level determinants of stroke knowledge among children are unknown but could meaningfully impact public stroke education campaigns. We explored for associations between community- and school-level quality measures relative to baseline stroke knowledge among children participating in the Hip Hop Stroke program.
  
  
  METHODS
  Baseline stroke knowledge assessments were performed in 2839 fourth-, fifth-, and sixth-grade students (ages 9-11 years) from November 2005 to April 2014. Knowledge was assessed relative to school performance grade (SPG, graded A-F; a school-level measure determined by the New York City [NYC] Department of Education) and economic need index (ENI, range: 0-2; a community-level, within-school measure of subsidized housing and meals with higher scores indicating more socioeconomic distress).
  
  
  RESULTS
  Schools studied included those with SPG = B (n = 196), SPG = C (n = 1590), and SPG = D (n = 1053) and mean ENI = .85 (standard deviation: .23). A composite assessment of knowledge, including 4 stroke symptoms (blurred vision, facial droop, sudden headache, and slurred speech), was conducted consistently since 2006. Overall, students correctly identified a mean of 1.74 stroke symptoms (95% confidence interval: 1.70-1.79; possible range: 0-4, expected value of chance response alone or no knowledge = 2). For quartiles of ENI, mean knowledge scores are as follows: ENIQ1= 2.00, ENIQ2= 2.09, ENIQ3= 1.46, and ENIQ4= 1.56 (ENIQ3and ENIQ4versus ENIQ1, P < .001). For SPG, SPG = B schools: 2.09, SPG = C: 1.83, and SPG = D: 1.56 (SPG = C and SPG = D versus SPG = B schools, P ≤ .05).
  
  
  CONCLUSIONS
  Children's stroke knowledge was lowest in NYC communities with greater economic need and lower school performance. These findings could guide stroke education campaign implementation strategies.
authors.affiliation: Albany Medical College, Albany, New York.
authors.forename: Cailey
authors.initials: C
authors.lastname: Simmons
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York; G.H. Sergievsky Center, Columbia University, New York, New York. Electronic address: jn2054@columbia.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Noble
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: Ellyn
authors.initials: E
authors.lastname: Leighton-Herrmann
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: Mindy F
authors.initials: MF
authors.lastname: Hecht
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: Olajide
authors.initials: O
authors.lastname: Williams
mesh_terms: D000367:Age Factors; D002648:Child; D004522:Educational Status; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009519:New York City; D010290:Parents / Q000523:psychology; D012111:Residence Characteristics; D012189:Retrospective Studies; D012923:Social Class; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology* / Q000517:prevention & control*
keywords: Stroke; cerebrovascular disease; health education; health literacy; knowledge translation; socioeconomic position; stroke prevention