Community-Level Measures of Stroke Knowledge among Children: Findings from Hip Hop Stroke.
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 (ENIQ3 and ENIQ4 versus 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.
['Simmons|Cailey|C|', 'Noble|James M|JM|', 'Leighton-Herrmann|Ellyn|E|', 'Hecht|Mindy F|MF|', 'Williams|Olajide|O|']
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 D012111:Residence Characteristics D012189:Retrospective Studies D012923:Social Class D020521:Stroke
Stroke cerebrovascular disease health education health literacy knowledge translation socioeconomic position stroke prevention