The impact of the 2014 military conflict in the east of Ukraine and the Autonomous Republic of the Crimea among patients receiving opioid agonist therapies

BACKGROUND

Opioid agonist therapies (OAT) for people with opioid use disorders (OUD) have been available in Ukraine since 2004. This study assessed the effect of 2014 Russian invasion of Ukraine on OAT re-enrollment and retention in conflict areas.

METHODS

We analyzed the Ukraine national registry of OAT patients containing 1868 people with OUD receiving OAT as of January 2014 in conflict areas (Donetsk, Luhansk, and the Autonomous Republic [AR] of the Crimea). We developed logistic regression models to assess the correlates of re-enrollment of OAT patients in government-controlled areas (GCA) from conflict areas and retention on OAT at 12 months after re-enrollment.

RESULTS

Overall, 377 (20.2 %) patients were re-enrolled at an OAT site in a GCA from confict areas, of whom 182 (48.3 %) were retained on OAT through 2021. Correlates of re-enrollment were residing in Donetsk (adjusted odds ratios (aOR) = 7.06; 95 % CI: 4.97-10.20) or Luhansk (aOR = 6.20; 95 % CI: 4.38-8.93) vs. AR Crimea; age 18-34 (aOR = 2.03; 95 % CI: 1.07-3.96) or 35-44 (aOR = 2.09; 95 % CI: 1.24-3.71) vs. ≥55 years, and being on optimal (aOR = 1.78; 95 % CI: 1.33-2.39) or high OAT dosing (aOR = 2.76; 95 % CI: 1.93-3.96) vs. low dosing. Correlates of retention were drug use experience 15-19 years (aOR = 3.69; 95 % CI: 1.47-9.49) vs. <14 years of drug use; take-home (aOR = 3.42; 95 % CI: 1.99-5.96) vs. daily on-site dosing, and optimal (aOR = 2.19; 95 % CI:1.05-4.72) vs. low OAT dosing.

CONCLUSION

Our study showed that one-fifth of patients were re-enrolled at sites in GCA areas, less than half of re-enrolled patients were retained. Disruption of OAT has implications for drug-, HIV-, and HCV-related morbidity and mortality.

FUNDING

AM was funded by NIH-funded grant D43TW010562; DCO was funded by the NIDA-funded Center for Drug Use and HIV|HCV Research (P30DA011041).

Awareness and willingness to use HIV self-testing among people who inject drugs in Iran

BACKGROUND

Most people who inject drugs (PWID) in Iran have not undergone recent HIV testing. While PWID face barriers when seeking HIV testing at health facilities, HIV self-testing (HIVST) could be a promising approach to improve HIV testing uptake. We examined the awareness and willingness to use HIVST among PWID in Iran. We also identified participants' characteristics associated with a higher willingness to use HIVST.

METHODS

PWID were recruited in 11 cities using a respondent-driven sampling method. Willingness to use HIVST was defined as a binary variable (very low/low willingness vs. high/very high willingness). We performed multivariable modified Poisson regression to examine associated factors and report adjusted prevalence ratios (aPR) and 95% confidence intervals (CI).

RESULTS

Of 2,252 PWID, 362 (16.2%; 95% CI 14.7, 17.8) had ever heard of HIVST; however, 1,658 (73.6%; 95% CI 71.7, 75.4) reported high/very high willingness to use HIVST. Willingness to use HIVST was higher among PWID who reported having a high/moderate HIV risk perception (aPR 1.22; 95% CI 1.09, 1.37), ever experiencing homelessness (aPR 1.15; 95% CI 1.03, 1.28), > 10 years of injecting history (aPR 1.16; 95% CI 1.00, 1.34), and high injection frequency in the last three months (aPR 1.18; 95% CI 1.05, 1.32).

CONCLUSION

Most PWID in Iran, particularly those experiencing homelessness, have a longer injecting history, engage in more frequent injection practices, and possess a heightened perception of HIV risk would be willing to adopt HIVST. Enhancing HIVST awareness through increased access to HIVST and health education programs are needed. Additionally, conducting implementation science studies to effectively design and run HIVST programs in Iran can also increase PWID's access to HIV testing.

Pre-pandemic mental health and coping strategy usage during the COVID-19 pandemic: a cross-sectional analysis of the Southern Cities Study

BACKGROUND

Little is known about the usage of coping strategies recommended by the World Health Organization and the Centers for Disease Control and Prevention during the COVID-19 pandemic and whether coping strategy usage varies by pre-pandemic mental health. This study examined the prevalence of different coping strategies and associations of their usage with pre-pandemic mental health.

METHODS

Data were collected from adults residing in metropolitan areas of the U.S. South in May/June 2020 using random-digit-dialing and web-based surveys (n = 1,644). We estimated the prevalence of each coping strategy: (1) keeping up-to-date about COVID-19; (2) taking breaks from the news or social media; (3) taking care of physical health; (4) engaging in relaxing activities; (5) reaching out to and spending time with others; and (6) trying to find comfort in religious or spiritual beliefs. We examined the association between the use of each strategy and pre-pandemic mental health using modified Poisson regression, adjusting for covariates. We also analyzed the association between pre-pandemic mental health and the number of coping strategies employed using ordered logistic regression.

RESULTS

The most prevalent strategies were: "keeping up-to-date about COVID-19" (53%), "taking care of physical health" (52%), and "reaching out to and spending time with others" (52%). Good pre-pandemic mental health was associated with an increased prevalence of "reaching out to and spending time with others" (adjusted prevalence ratio, 1.43; 95% confidence interval, 1.07-1.91). The use of other coping strategies and the number of coping strategies used during the pandemic did not vary by pre-pandemic mental health.

CONCLUSIONS

Our findings suggest that people who had good pre-pandemic mental health were more likely to connect with other people during the COVID-19 pandemic. Given the well-documented impact of social support on mental health in disaster contexts, efforts to promote safe social connections for those with pre-existing mental health concerns are needed.

State-level unemployment and negative emotions throughout the Covid-19 pandemic in the United States

Although prior research has assessed public mental health in the U.S. throughout the COVID-19 pandemic, it is unclear how area-level unemployment impacted psychological well-being; moreover, studies that examine potential effect heterogeneity of the impact of area-level unemployment on well-being by employment status are lacking. To address these shortcomings, this study utilized data from Gallup's repeated cross-sectional, nationally representative COVID-19 web survey collected between April 2020 and July 2021 (n = 132,971). Survey modified Poisson regression models were estimated to determine the association between current unemployment rate in respondents' state of residence and experience of each of the following negative emotions during a lot of the prior day: sadness, worry, stress, anger, loneliness, depression, and anxiety. These models were stratified by employment status and sequentially adjusted for individual-level covariates, state fixed effects, and current state-level COVID-19 mortality. State-level unemployment was most strongly associated with sadness, followed by worry, anger, loneliness, stress, and anxiety; no associations were observed for depression. For sadness, worry, and stress, associations were strongest among full-time employed and retired individuals, and weakest among unemployed respondents and homemakers. Moreover, there was some evidence that state-level unemployment was negatively associated with the experience of anger in the early stages of the pandemic, and positively in its later stages. In sum, these findings suggest that Americans' emotional experience during the COVID-19 pandemic was considerably impacted by the state of the economy, highlighting the need for risk-buffering social policies.

Country-level determinants of gender differences in major depression and alcohol use disorder

Background

Major depressive disorder (MDD) and alcohol use disorder (AUD) are leading causes of disease burden in Europe, with MDD disproportionately affecting women and AUD being more prevalent among men. However, it is unclear how country-level political and socio-cultural characteristics contribute to gender differences in these conditions.

Methods

Data for 30,416 participants from 16 countries were obtained from the 2014 European Social Survey. Depressive symptoms were ascertained using the 8-item CES-D scale, and alcohol use was assessed with items on past-year alcohol use frequency and quantity, as well as frequency of heavy episodic drinking. Country-level data for attitudes to gender equality, needs-adjusted public social expenditure, and other covariates came from the 2012 International Social Survey Programme and the OECD. Modified Poisson and linear regression with log link examined additive and multiplicative interactions of country-level characteristics with gender for MDD, AUD, and their specific symptoms/dimensions.

Results

Public social expenditure was not associated with gender differences in MDD (CES-D&gt;10), but with greater differences in the prevalence of the loneliness and sadness symptoms; support for gender equality was associated with smaller differences in loneliness (p &lt; 0.05). For AUD, there was evidence of increased alcohol use frequency and quantity among women, and decreased frequency and quantity among men associated with support for gender equality, resulting in lower gender differences in predicted probabilities (from 23% to 5% across exposure levels; p &lt; 0.001). Heavy episodic drinking was strongly positively associated with support for gender equality among women (p &lt; 0.001), but not among men.

Conclusions

Country-level characteristics appear to exert differential impact on the prevalence of AUD and certain psychological symptoms of MDD among men and women in Europe. Pending replication, future research should examine underlying mechanisms.

Key messages

Trends in Negative Emotions Throughout the COVID-19 Pandemic in the United States

Objectives

Study design

Methods

Results

Conclusions

Presence of Content Appealing to Youth on Cannabis-Infused Edibles Packaging

BACKGROUND

There is a lack of consistent regulation of cannabis edibles packaging to restrict youth-appealing content in the United States.

OBJECTIVE

To describe content appealing to youth on U.S. cannabis-infused edibles packaging.

METHODS

We analyzed 256 photos of cannabis-infused edibles packaging collected from U.S. adults from 25 states, District of Columbia, and Puerto Rico between May 2020 to August 2021. We coded the presence of product knockoffs, human and non-human creatures, images indicating flavor, text indicating flavor, and the number of colors. We compared these codes across states' legalization status (medical and non-medical cannabis, medical cannabis only, or limited cannabis legalization).

RESULTS

Overall, 15% of packages resembled product knockoffs, 23% contained human/non-human creatures, 35% contained flavor images, 91% contained flavor text, and median number of colors was 5 (range from 1 to 10+). Packages purchased in states with medical and non-medical cannabis, medical cannabis only, or limited cannabis legalization differed significantly on product knockoffs (11%, 26%, 38%, p = 0.007), human/non-human creatures (19%, 33%, 63%, p = 0.002), flavor text (93%, 81%, 100%, p = 0.046), and number of colors (median of 5, 5, and 10, p = 0.022).

CONCLUSIONS

Existing laws have not adequately limited content appealing to youth on U.S. cannabis-infused edibles packaging. Robust and consistent regulations in the U.S. are needed to ensure that the packaging of such products does not contain content that appeal to youth and lead to initiation or inadvertent ingestion.

An examination of racial and ethnic disparities in mental health during the Covid-19 pandemic in the U.S. South

BACKGROUND

The mental health of racial/ethnic minority groups in the United States may be disproportionately impacted by the COVID-19 pandemic due to greater experience of peri-pandemic stressors. Yet, few studies have systematically examined racial/ethnic differences in mental health outcomes in this context.

METHODS

Data came from the COVID-19 Southern Cities Study, a probability-based, cross-sectional study conducted in May/June 2020 among adults living in the metropolitan statistical areas of Atlanta, Austin, Dallas, Houston, and New Orleans. Unadjusted and adjusted associations between racial/ethnic identity and past-week depression and/or anxiety symptoms (Patient Health Questionnaire-2 score ≥ 3 or Generalized Anxiety Disorder-2 score ≥ 3), trouble sleeping, physical reactions when thinking about COVID-19, and self-rated worsened mental health due to the pandemic were estimated in separate logistic regression models.

RESULTS

Over 30% of respondents reported depression and/or anxiety symptoms, 21% reported physical reactions, 25% had trouble sleeping, and 33% worsened mental health since the pandemic began. Adjusting for sociodemographic and health-related characteristics and pandemic-related stressors, odds of anxiety symptoms (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.30-0.95) and worsened mental health (OR 0.58, 95% CI 0.36-0.94) were lower among non-Hispanic Black vs. non-Hispanic white respondents.

LIMITATIONS

No diagnostic assessments were used, and results may not be generalizable to later phases of the pandemic and the entire U.S. South.

CONCLUSIONS

Despite greater pandemic-related stressor experience, poor mental health outcomes were not more common among racial/ethnic minority individuals. However, interventions to reduce disparities in stressor experience and promote mental health are needed.

Abstract P600: Social Network Structure and Function Are Associated With Blood Pressure Reduction in Stroke Survivors

Background: The risk of recurrence of stroke has been found to be modifiable through changes in health behavior and reducing key risk factors such as hypertension. Evidence suggests social networks can influence health behaviors and health outcomes; however, there is a lack of literature on the relationship between stroke survivor’s social network and secondary prevention efforts. In this study, we assessed the association between social network structure and systolic blood pressure (SBP) reduction at one-year post stroke.

Methods: Using data from the DESERVE (Discharge Educational Strategies for Reduction of Vascular Events) trial, we assessed the social networks of 552 participants who have had a mild/moderate stroke or transient ischemic attack (TIA). At baseline enrollment, participants were asked to identify up to 5 persons, or “alters,” with whom they discuss important matters, such as health. The data on the alters were then classified into structural and functional characteristics. The combination of the number of alters and the amount of alters that met the “optimal” level for each characteristic were used to determine the characteristics of the social network. We used linear regression models to quantify the SBP change on social network characteristics adjusting for age, gender, race-ethnicity, education, marital status, and prior stroke history.

Results: Stronger social networks were associated with greater SBP reduction. The overall mean SBP reduction at 12-month follow-up was 5.6 (±24.5) mmHg. On fully adjusted models having 3-5 alters compared to none (mean SBP reduction of 11.4 mmHg, p = 0.01) and having a family and friend network compared to a family-only network (mean SBP reduction of 7.6 mmHg, p = 0.01) were significantly associated with a larger SBP reduction.

Conclusion: Social networks may play an important role in blood pressure reduction in patients post stroke. Future interventions should involve social networks to help reduce vascular risk and enhance secondary prevention efforts.

Student-led research team-building program may help junior faculty increase productivity in competitive biomedical research environment

BACKGROUND

Interdisciplinary research teams can increase productivity among academic researchers, yet many junior investigators do not have the training or financial resources to build productive teams. We developed and tested the acceptability and feasibility of three low-cost services to help junior faculty build and maintain their own research teams.

METHODS

At an urban academic medical centre, we implemented three types of consultation services: 1) giving talks on evidence-based best practices for building teams; 2) providing easy-to-use team building resources via email; and 3) offering a year-long consultation service-co-led by students-that taught faculty to build and maintain research teams. Our primary outcome was the number of faculty who used each service. For the yearlong consultation service, we asked faculty participants to complete three online self-assessments to rate their leadership confidence, the team's performance, and which of the consultation components were most helpful. We used descriptive statistics to evaluate faculty assessment scores at three timepoints by comparing median scores and interquartile ranges.

RESULTS

We gave 31 talks on team building to 328 faculty and postdoctoral fellows from 2014 to 2020. Separately, 26 faculty heard about our research team building expertise and requested materials via email. For the consultation service, we helped build or enhance 45 research teams from 2014 to 2020. By the end of the consultation, 100% of the faculty reported they were still maintaining their team. In the initial survey, the majority of participants (95.7%, n = 22) reported having no or few experiences in building teams. Further, when asked to rate their team's performance at 12-months, faculty highly rated many elements of both teamwork and taskwork, specifically their team's productivity (6/7 points), morale (6/7 points), and motivation (6/7 points). By the end of the program, faculty participants also highly rated two components of the consultation program: recruitment assistance (7/10 points) and provision of team management tools (7/10 points).

CONCLUSIONS

For participating faculty, our program provided valued guidance on recruitment assistance and team management tools. The high demand for team-building resources suggests that junior faculty urgently need better training on how to develop and manage their own team.

Association between same-sex marriage introduction and attitudes towards homosexuality in Europe

Background

Existing research suggests a positive relationship between the introduction of same-sex marriage and country-level acceptance of homosexuality across Europe in the first decade of the 21st century. Between 2010 and 2018, another 8 countries in Europe introduced same-sex marriage. Given the well-established association between greater social acceptance of sexual minorities and LGBT health, it is important to continue to monitor the effect of same-sex marriage policies on public attitudes.

Methods

Using data from waves 1 through 9 of the European Social Survey (ESS), the lagged association between same-sex marriage and acceptance of homosexuality in the subsequent wave was analysed for 12 European countries that introduced same-sex marriage between 2002 and 2018. Acceptance of sexual minorities was assessed using the statement, “Gay men and lesbians should be free to live their own life as they wish”, which was dichotomised into two groups: “agree strongly” or “agree” vs. “neither agree nor disagree”, “disagree”, or “disagree strongly”. The association between same-sex marriage laws and acceptance was analysed in mixed-effects logistic regression models adjusting for country-level and individual-level confounders and survey year.

Results

On the country level, acceptance of homosexuality ranged from 61% in Portugal in 2006 to 96% in Iceland in 2016. Based on the total sample of 171,683 observations, acceptance increased from 77% in 2002 to 88% in 2018. Preliminary analyses indicate that existence of same-sex marriage at the time of data collection was associated with 24% increased odds of acceptance of homosexuality in fully adjusted models (95% CI: 1.05-1.48).

Conclusions

This study provides further evidence of an association between same-sex marriage laws and public acceptance of homosexuality. Additional research will be needed in order to further investigate this relationship beyond Western Europe and in relation to sexual minority health and well-being.

Key messages

For 12 European countries, evidence of an association between the introduction of same-sex marriage between 2002 and 2018, and subsequent accepting public attitudes towards homosexuality was found. Given their role as a key social determinant of health, further research on the association between social norms accepting of sexual minority populations and inclusive social policies is warranted.

Association between marital status and mental health among cohabitating same-sex couples in the UK

Background

A large body of research suggests that the formalisation of opposite-sex relationships is associated with favourable mental health outcomes, particularly among males. Despite the recent introduction of same-sex civil partnership and/or marriage in many countries, there is little evidence as to whether this salutary effect of formalised partnership extends to same-sex couples.

Methods

Using data from wave 8 (2016-18) of Understanding Society: the UK Household Longitudinal Study (UKHLS), respondents living with a same-sex partner were included in the analytical sample (n = 225). Respondents from Northern Ireland were excluded, as same-sex marriage did not exist there at the time of data collection. Mental health status was assessed using the General Health Questionnaire (GHQ)-12 (range: 0-36) and the established cut-off point of 11/12 to identify psychiatric caseness. The association between marital status (marriage, civil partnership, and cohabitation only) and psychiatric caseness was examined in logistic regression models in the overall sample and stratified by sex.

Results

A total of 112 respondents (40%) were cohabitating, 81 (40%) were living in civil partnership, and 32 (19%) were married. In bivariable analyses, respondents living in civil partnership had a lower prevalence of psychiatric caseness (30%) than those who were married (50%) or cohabitating only (51%) (p = 0.041). In models adjusted for age, sex, and education, civil partnership was associated with 84% reduced odds of psychiatric caseness (95% CI: 0.39-0.66) compared to cohabitation among females; no statistically significant effect was found for marriage or among males.

Conclusions

This study provided evidence of a inverse association between civil partnership and psychiatric caseness among females in same-sex couples. Given that same-sex marriage was only introduced in England, Wales, and Scotland in 2014, further research will be needed as more same-sex couples formalise their relationships.

Psychological impact of anti-Asian stigma due to the COVID-19 pandemic: A call for research, practice, and policy responses

The COVID-19 pandemic is linked to a rise in stigma and discrimination against Chinese and other Asians, which is likely to have a negative impact on mental health, especially when combined with additional outbreak-related stressors. We discuss the need to consider the potential harms of these anti-Asian sentiments during both the height of the pandemic and longer-term recovery through (a) research-examining how it affects mental health and recovery; (b) practice-implementing evidence-based stigma reduction initiatives; and (c) policy-coordinating federal response to anti-Asian racism including investment in mental health services and community-based efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Positive Health Beliefs and Blood Pressure Reduction in the DESERVE Study

Background There is growing recognition that positive health beliefs may promote blood pressure (BP) reduction, which is critical to stroke prevention but remains a persistent challenge. Yet, studies that examine the association between positive health beliefs and BP among stroke survivors are lacking. Methods and Results Data came from the DESERVE (Discharge Educational Strategies for Reduction of Vascular Events) study, a randomized controlled trial of a skills-based behavioral intervention to reduce vascular risk in a multiethnic cohort of 552 transient ischemic attack and mild/moderate stroke patients in New York City. The exposure was perception that people can protect themselves from having a stroke (ie, prevention self-efficacy) at baseline. The association between systolic BP (SBP) reduction at 12-month follow-up and self-efficacy was examined using linear regression adjusted for key confounders, overall and stratified by age, sex, race/ethnicity, and intervention trial arm. Approximately three quarters endorsed self-efficacy. These participants had, on average, 5.6 mm Hg greater SBP reduction compared with those who did not endorse it (95% CI, 0.5-10.7 mm Hg; P=0.032). Self-efficacy was significantly associated with greater SBP reduction, particularly among female versus male, younger versus older, and Hispanic versus non-Hispanic white patients. Sensitivity analysis adjusting for baseline SBP instead of elevated BP yielded no association between self-efficacy and SBP reduction, but showed sex differences in this association (women: β=5.3; 95% CI, -0.2 to 10.8; P=0.057; men: β=-3.3; 95% CI, -9.4 to 2.9; P=0.300; interaction P=0.064). Conclusions Self-efficacy was linked with greater SBP reduction among female stroke survivors. Targeted strategies to improve health beliefs after stroke may be important for risk factor management. REGISTRATION URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT01836354.

Abstract WP366: Exploring the Association Between Physician Trust and Recurrent Stroke and Transient Ischemic Attack (TIA)

Purpose: More positive health behaviors, fewer symptoms, higher quality of life, and greater treatment satisfaction have been reported among those with greater physician trust. This study assessed the relationship between physician trust and recurrent stroke/TIA within 1 year of discharge among stroke survivors in Northern Manhattan.

Methods: This study used data from the Stroke Warning Information and Faster Treatment (SWIFT) study, a randomized controlled trial conducted from 2005-2012 in a multiethnic cohort of 1,193 mild/moderate ischemic stroke and TIA survivors. The goal was to assess the impact of a stroke preparedness educational intervention on emergency department arrival time after subsequent stroke symptom onset. Physician trust, assessed at baseline, was measured with one item: “What percentage of the time do you trust doctors?”. For the analysis, it was dichotomized with the cutoff at 80%. Recurrent stroke/TIA was assessed at 1 month and 1 year. The association between recurrent stroke/TIA and patient trust was evaluated using multivariate logistic regression adjusted for sociodemographics and comorbidities.

Results: In the analytic sample (n=1108), those who answered both exposure and outcome, the prevalence of recurrent stroke/TIA and lack of physician trust was 10.75% and 36.46%, respectively. Consistent with the literature, Hispanics compared to whites had a higher prevalence of lack of physician trust (42.71% vs. 34.11%, p<0.001). Adjusting for race/ethnicity, intervention status, age, sex, education, marital status, smoking, insurance, hypertension, diabetes, body mass index, physical activity, and depression, those who lacked trust had greater odds of recurrent stroke/TIA (OR=1.36, 95% CI:0.86-2.18) than those who had trust. When observing the association among Hispanics and Blacks, those who lacked trust had (OR=1.27, 95% CI: 0.66-2.42) and (OR=1.26, 95% CI: 0.36-4.38) respectively, greater odds of a recurrent episode than those who had trust.

Conclusion: Despite insignificant findings, a national study with a greater range of stroke severity and additional measures such as medication compliance may be warranted to provide greater insight on the effects of physician trust on stroke outcomes.

Efficacy of a Discharge Educational Strategy vs Standard Discharge Care on Reduction of Vascular Risk in Patients With Stroke and Transient Ischemic Attack: The DESERVE Randomized Clinical Trial

Importance

Despite secondary prevention strategies with proven efficacy, recurrent stroke rates remain high, particularly in racial/ethnic minority populations who are disproportionately affected by stroke.

Objective

To determine the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack.

Design, Setting, and Participants

Randomized clinical trial with 1-year follow-up. Participants were white, black, and Hispanic patients with mild/moderate stroke/transient ischemic attack prospectively enrolled from 4 New York City, New York, medical centers during hospitalization or emergency department visit between August 2012 and May 2016. Through screening of stroke admissions and emergency department notifications, 1083 eligible patients were identified, of whom 256 declined to participate and 275 were excluded for other reasons. Analyses were intention to treat.

Interventions

The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention is a skills-based, culturally tailored discharge program with follow-up calls delivered by a community health coordinator. This intervention was developed using a community engagement approach.

Main Outcomes and Measures

The primary outcome was systolic blood pressure reduction at 12 months postdischarge.

Results

A total of 552 participants were randomized to receive intervention or usual care (281 women [51%]; mean [SD] age, 64.61 [2.9] years; 180 Hispanic [33%], 151 non-Hispanic white [27%], and 183 non-Hispanic black [33%]). At 1-year follow-up, no significant difference in systolic blood pressure reduction was observed between intervention and usual care groups (β = 2.5 mm Hg; 95% CI, -1.9 to 6.9). Although not powered for subgroup analysis, we found that among Hispanic individuals, the intervention arm had a clinically and statically significant 9.9 mm Hg-greater mean systolic blood pressure reduction compared with usual care (95% CI, 1.8-18.0). There were no significant differences between arms among non-Hispanic white (β = 3.3; 95% CI, -4.1 to 10.7) and non-Hispanic black participants (β = -1.6; 95% CI, -10.1 to 6.8).

Conclusions and Relevance

Few behavioral intervention studies in individuals who have had stroke have reported clinically meaningful reductions in blood pressure at 12 months, and fewer have focused on a skills-based approach. Results of secondary analyses suggest that culturally tailored, skills-based strategies may be an important alternative to knowledge-focused approaches in achieving sustained vascular risk reduction and addressing racial/ethnic stroke disparities; however, these findings should be tested in future studies.

Trial Registration

ClinicalTrials.gov identifier: NCT01836354.

Gender differences in depression across Europe: a systematic review of cross-national studies

Background

Across countries and cultures, depressive disorders are more common among females than among males; however, the magnitude of gender differences varies between populations and may be a result of different country-specific social policies and cultural factors. This systematic review seeks to synthesise evidence from nationally representative, cross-national studies across Europe (EU-28 plus Switzerland and Norway) and to describe the impact of country-specific factors on gender differences in depression.

Methods

PubMed, Web of Science, PsycInfo, and Embase were searched through March 2019 for peer-reviewed, nationally representative studies that included at least two European countries, used structured assessment for depressive disorders or symptoms, and reported or allowed for the calculation of gender ratios or differences. No restrictions on language or publication date were applied. Risk of bias was assessed using a tool specifically designed for population-based prevalence studies.

Results

Twenty-one studies were included in this review, ten of which were based on surveys limited to older populations. Despite the use of different analytical approaches, metrics, scales, and cut-off points, depressive disorders were more common among females than among males in all but a few instances, with substantial variation in the magnitude of gender differences between countries and across studies. There is evidence of smaller gender differences in Northern Europe and greater gender gaps in Southern and Eastern Europe, as well as among older populations.

Conclusions

Despite methodological heterogeneity between studies, there is evidence that gender differences in depression vary substantially across Europe. These differences may be associated with welfare state regimes and appear to be less pronounced in younger cohorts. Further cross-national research on gender disparities in depression between age groups, birth cohorts, and ethnic subpopulations is warranted.

Key messages

While depressive disorders are more prevalent among females than among males in virtually all of Europe, the magnitude of gender differences varies substantially between countries. There is some evidence that gender differences in depressive disorders are greater in countries with weaker welfare states and lower macro-level gender equality, as well as among older populations.

Suicidal ideation is associated with cardiovascular disease in a large, urban cohort of adults in the Southern Cone of Latin America

INTRODUCTION

To examine the relationship between suicidal ideation (SI) and cardiovascular disease (CVD) in the general adult population of four cities in the Southern Cone of Latin America (Argentina, Uruguay, Chile) and the role that depression, stressful life events (SLEs) and physical functional impairment may play in this association.

METHODS

A population-based cross-sectional study was conducted among 7524 adults between 35 and 74 years old, randomly selected. History of CVD included acute myocardial infarction, stroke and central or peripheral revascularization. SI in the past two weeks was measured using the last item of the Patient Health Questionnaire (PHQ-9), quality of life was assessed with the 12-item Short Form Survey (SF-12), and having experience of a SLE was determined by asking participants whether they had experienced at least one of a list of events in the past year. Multiple logistic regression was used to examine the association between SI and CVD overall and by sex.

RESULTS

The prevalence of SI was 8.3% (95% CI = 7.5, 9.0) and twice as high among women than men (11.1% vs. 5.1%). History of CVD was associated with almost twice the odds of SI (OR = 1.9, 95% CI = 1.5, 2.4). This association remained strong and significant after adjusting for potential confounders (OR = 1.8, 95% CI = 1.2, 2.7). Three additional models were tested to further adjust for depression severity, functional impairment, and SLEs separately. Adjustment for depression severity yielded no association between CVD and SI (OR = 1.1, 95% CI = 0.6, 1.7), adjustment for functional impairment yielded a marginal statistically significant association (OR = 1.5; 95% CI = 1.0, 2.4) and adjustment for SLE didn't modify either the magnitude or the statistical significance of the association.

CONCLUSIONS

There is a significant association between SI and CVD, particularly among women, which may be driven, at least in part, by depression and physical functional impairment.

Abstract WP225: Exploring the Relationship between Sleep Duration and Stroke Severity in Mild/moderate Stroke and TIA patients: Evidence from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) Study

Introduction: Prior research has shown that sleep duration is associated with risk of stroke and other cardiovascular events. However, evidence is sparse linking sleep duration with stroke severity. The aim of this study is to investigate the association between pre-stroke sleep duration and stroke severity at hospital admission in a cohort of mild/moderate stroke and TIA survivors.

Methods: The present analysis used baseline data from the DESERVE study, a randomized controlled trial of a skills-based educational intervention. Sleep duration was measured using patients’ self-reported average hours of sleep per night during the past four weeks. Hours of sleep were then categorized into four groups with three non-normative groups, “Very Short Sleep” (1-4 hours), “Short Sleep” (5-6 hours), and “Long Sleep” (9-12 hours), and one normative sleep group (7-8 Hours). Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS). The distribution of NIHSS was not normal; therefore the Kruskal Wallis test was used to assess bivariate associations. Multivariable analysis was conducted for sleep duration and stroke severity assuming a negative binomial distribution, due to overdispersion of variance. The final model was adjusted for gender, age, race/ethnicity, stroke history, hypertension, alcohol, and BMI.

Results: A total of 453 patients were included in the analysis (51% Female; 28% Non-Hispanic white, 35% Non-Hispanic black, 31% Hispanic, and 6% Other; mean age 64.6). Median NIHSS was significantly different across the sleep categories, (Very Short Sleep=4; Short Sleep=2; Normative Sleep=2; Long Sleep=1; p=0.0024). The unadjusted model did not show significant differences in stroke severity between non-normative groups and the normative group (Very Short Sleep, p=0.068; Short Sleep, p=0.235; Long Sleep, p=0.203). Further adjustment for sociodemographic and clinical factors did not alter the pattern of results.

Conclusions: We found no significant association between normative and non-normative sleep duration and stroke severity among mild/moderate stroke and TIA survivors. However, future studies may be needed to examine this relationship with a greater range of stroke severity.

Abstract WP215: Stroke Knowledge Over Time among Multi-ethnic Stroke Survivors in New York City

Background: Stroke knowledge, which includes awareness of symptoms, risk factors and treatment options, is critical to preventing stroke and improving outcomes. In recent years there have been significant state, federal, and private initiatives to improve “door to needle time” including efforts towards lay education about acute stroke as an emergency; however, their impact is unknown. We assessed stroke knowledge over time among mild/moderate stroke/TIA patients in New York City in two large clinical trials, the Stroke Warning Information and Faster Treatment (SWIFT) study and the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study.

Methods: Basline data from SWIFT was collected between 2005-2009 and for DESERVE between 2012-2016. Before randomization, patients were asked closed-ended questions focused on stroke symptoms, risk factors and preparedness behaviors. Proportions of correct responses were calculated and logistic regression was used to assess the change in knowledge over time while controlling for education, age, gender, and race/ethnicity. We also assessed whether stroke knowledge changed differentially over time by race or gender using product terms.

Results: A total of 1,190 participants from SWIFT and 552 from DESERVE were included in the analysis. The pooled sample was 50.1% female, 23.9% non-Hispanic black, 43.4% non-Hispanic white, and 48.4% Hispanic, mean age 64.3. The brain was correctly identified as the site where stroke occurs by 78.14%, all 5 symptoms of stroke were correctly identified by 40.64% (replying ‘yes’ to hemiparesis, hemisensory loss, difficulty speaking, blurred vision and ‘no’ to chest pain), and 6 or more risk factors were identified by 75.55% of participants in both cohorts. The odds of identifying the brain as the location of a stroke increased each year (OR=1.05, p<0.01) as did correctly identifying 6 or more risk factors of stroke (OR=1.03, p<0.01) . Correct responses to all 5 symptoms did not significantly change over time. Knowledge over time did not change differentially by race or gender.

Conclusion: There was a small increase in stroke knowledge over time between 2005-2016 in our urban, multi-ethnic cohorts, though levels remain suboptimal.

Abstract TMP44: Gender and Race/ethnic Disparities in Psychotropic Medication Prescription at Discharge Among TIA and Mild/moderate Stroke Patients in the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) Study

Depression and anxiety are common after stroke. Little is known about the factors associated with prescription of antidepressants (AD) and anti-anxiety (AA) medications post-stroke. The study used data from DESERVE, a randomized educational trial to reduce vascular risk in a multi-ethnic cohort of TIA and mild/moderate stroke patients in New York City. The study outcome was any AD or AA prescription at discharge, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic and tetracyclic antidepressants, norepinephrine-dopamine reuptake inhibitors, serotonin antagonist and reuptake inhibitors, anxiolytics, and benzodiazepines. Chi-square, Fisher’s exact, and Wilcoxon rank sum tests were used to examine the association between patient characteristics and AD/AA prescription. Factors associated with the outcome at p<0.10 in bivariate analysis were examined using multiple logistic regression. Of the 236 patients with medication information, 21.2% were prescribed an AD or AA, most commonly SSRIs/SNRIs (82.0%) and benzodiazepines (31.4%). In the adjusted model, males (OR=0.37 95% CI: 0.16, 0.84) and Non-Hispanic black/other race patients (OR=0.08, 95% CI: 0.03, 0.24) had significantly lower odds of AD/AA prescription. Probable depression pre-discharge (Center for Epidemiologic Studies-Depression scale ≥ 16) (OR=4.11, 95% CI: 1.46, 11.55) and prior psychiatry history (OR=2.82, 95% CI: 1.02-7.83) were associated with greater odds of AD/AA prescription. Non-significant differences in AD/AA prescription were noted on the basis of stroke severity, modified Rankin scale, and Hispanic ethnicity (Table 1). Prescription of ADs/AAs at stroke discharge was common and associated with gender and race/ethnicity independent of other factors. Further research is needed to better understand disparities in post-stroke psychotropic medication prescription.

Abstract WP521: Health Beliefs and Blood Pressure Reduction in the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) Study

Introduction: Hypertension is a leading risk factor for stroke recurrence. Previous studies have found that patients’ health attitudes and beliefs play a critical role in shaping health behaviors. The aim of this analysis is to investigate the relationship between specific health beliefs and blood pressure reduction following stroke.

Methods: DESERVE is an RCT of a skills-based educational intervention vs. standard care in a multi-ethnic cohort of mild/moderate stroke and TIA survivors. The relationship between participants’ baseline health beliefs and systolic blood pressure (SBP) reduction from baseline to one-year follow-up was assessed. Health beliefs were measured by asking participants to agree or disagree with five health belief questions such as, ‘I worry about having a stroke,’ ‘I can protect myself against having a stroke,’ and ‘Some people are more likely to have a stroke than others.’ Multivariable linear regression models were used to assess the relationship between each health belief and SBP reduction.

Results: A total of 434 patients were included in the analysis (50.2% female; mean age 64.2; 29.7% non-Hispanic white, 32.0% non-Hispanic black, 32.5% Hispanic, 5.8% other). Of those participants, 77.9% agreed with the statement, “I can protect myself against having a stroke” and had a significantly greater mean SBP reduction compared to those who disagreed (6.29 vs. 1.57 mmHg, p=0.02). No other health belief questions were found to be significantly associated with SBP reduction. In the multivariable model, adjusting for age, gender, race, education, intervention status, stroke history, and marital status, agreeing that you can protect yourself against having a stroke was associated with a 6.44 mmHg greater mean SBP reduction compared to disagreeing (p=0.02).

Conclusion: In this cohort of stroke/TIA patients, participants who agreed that they could protect themselves against having a stroke had an average mean SBP reduction of more than two times that of participants who disagreed with that statement. Certain health beliefs, such as those related to patient empowerment, may play an important role in secondary stroke prevention.

Abstract TMP114: Exploring the Role of Cognitive Function in Secondary Stroke Prevention: Evidence from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) Study

Studies suggest that cognitive impairment is common, even following mild stroke. Yet, secondary prevention strategies typically do not take into account patients’ cognitive functioning. Data from DESERVE, a secondary stroke prevention trial, were used to investigate relationships between cognition 6 months post-stroke and changes in medication adherence (MA) and total cholesterol (TC) between baseline and 12-month follow-up among mild/moderate stroke and TIA patients. Patients with any documented history of cognitive impairment and those unable to provide informed consent were excluded from the study. At six months, cognition was measured using three cognitively focused variables from the Stroke Impact Scale: Concentration, Remember Things Told to You (‘Memory’) and Orientation in Time. Items were scored from 1 to 5, with 1-3 = severe impairment, 4 = mild impairment, and 5 = no impairment. MA was measured using the 8-item Morisky Medication Adherence Scale. ANCOVA models were used to analyze associations between cognition and changes in MA and TC, and association between MA and TC, adjusting for key socio-demographic and clinical characteristics and intervention status. The analytic sample (n=396) was 48% male, 27% white, 32% black, 35% Hispanic, with mean age 64. Impairment in Memory was 13.4% severe, 13.6% mild, 44.7% none. In fully adjusted models, patients who were severely impaired in Memory, showed less improvement in MA compared to mild and no impairment: 0.3 vs. 0.2 vs 1.3 points (p<0.001, n=275), respectively. There was a U-shape trend relationship between cognitive status and cholesterol change, with no impairment performing best, mild performing worst, and moderate in between (decreases of 27.6 vs 13.1 vs 30.7 mg/dl; p=0.104, n=278 in Memory). The other cognitive domains showed similar relationships in both MA and TC. Cognition was thus related to MA, and MA in turn directly related to TC (b=-7.5, p<0.001, n=223). This is one of the first studies to identify post-stroke cognitive impairment as a potential barrier to effective secondary stroke prevention.

Abstract WP234: Seasonal Differences in Sleep and Incident and Recurrent Strokes: Evidence From the Stroke Warning Information and Faster Treatment (SWIFT) Study

Introduction: Studies have documented seasonal patterns in stroke outcomes. While results are equivocal most report increased rates of these outcomes in the winter-spring and hypothesize this is explained by ambient temperature. Sleep disturbance, which also varies by season, may also explain this pattern. In this analysis we leverage a unique cohort to test whether incident or recurrent strokes vary by season, and whether this co-varies with sleep disturbance.

Methods: Data comes from SWIFT, a stroke preparedness RCT conducted in northern Manhattan. Season of stroke was classified as winter (W; Dec - Feb), spring (Sp; Mar - May), summer (Su; Jun - Aug), fall (F; Sept - Nov). We restricted our analysis to the period Feb 2005 - Jan 2009. Incident strokes were individuals enrolled at baseline without radiological or clinical evidence of prior stroke. Recurrent strokes were captured as part of follow-up protocol. Sleep was measured with the MOS sleep scale, a 12 item questionnaire that produces 8 validated scales. For brevity, we report results using the sleep problem index 2 (9 questions). We assessed seasonal variation in stroke incidence using a one-way goodness of fit chi-square test assuming a distribution based on the number of days per season. The relationship between seasonal variation in stroke and sleep was assessed using ANOVA.

Results: A total of 835 incident strokes were enrolled (25% white, 15.5% black, 53.1% Hispanic, 6.4% other; 49.8% female; mean age 63.4±15.6). Incident stroke was not significantly different by season (24.3% W; 22.8% Sp; 28.6% Su; 24.3% F; p=0.09). Mean sleep problems did not vary by season (32.3 W; 30.8 Sp; 31.9 Su; 31.4 F; p=0.86) for incident strokes. A total of 120 first recurrent strokes were captured (20.8% white, 17.5% black, 5% Hispanic, 6.7% other; 49.2% female; mean age 66.0±15.0). Recurrent stroke was significantly different by season (21.7% W; 14.2% Sp; 36.7% Su; 27.5% F; p<0.01). Mean sleep problems did not vary by season (32.4 W; 29.9 Sp; 31.7 Su; 35.1 F; p=0.70) for recurrent strokes.

Conclusion: We find no variation in incident strokes but an increased proportion of first recurrent strokes in the summer. Neither incident nor recurrent strokes co-varied with sleep problems. Future studies in non-urban samples are warranted.

Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke

Background: Stroke patients are known to be at risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD). Objective: To determine the overlap between anxiety, depression, and PTSD in patients after stroke and to determine the association between these disorders and quality of life, functional status, healthcare utilization, and return to work. Methods: A cross-sectional telephone survey was conducted to assess for depression, anxiety, PTSD, and health-related outcomes 6-12 months after first ischemic stroke in patients without prior psychiatric disease at a single stroke center. Results: Of 352 eligible subjects, 55 (16%) completed surveys. Seven subjects (13%) met criteria for probable anxiety, 6 (11%) for PTSD, and 11 for depression (20%). Of the 13 subjects (24%) who met criteria for any of these disorders, 6 (46%) met criteria for more than one, and 5 (39%) met criteria for all three. There were no significant differences in baseline characteristics, including stroke severity or neurologic symptoms, between those with or without any of these disorders. Those who had any of these disorders were less likely to be independent in their activities of daily living (ADLs) (54 vs. 95%, p < 0.001) and reported significantly worse quality of life (score of 0-100, median score of 50 vs. 80, p < 0.001) compared to those with none of these disorders. Conclusions: Anxiety, depression, and PTSD are common after stroke, have a high degree of co-occurrence, and are associated with worse outcomes, including quality of life and functional status.

Posttraumatic stress disorder in the short and medium term following the World Trade Center attack among Asian Americans

This study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predictors among 2,431 Asian American and 31,455 non-Hispanic White World Trade Center (WTC) Registry participants 2-3 years and 5-6 years after the WTC attack. Participants were divided into four PTSD pattern groups: resilient, remitted, delayed onset, and chronic. Asians had a lower proportion in the resilient group (76.5% vs. 79.8%), a higher proportion in the chronic (8.6% vs. 7.4%) and remitted (5.9% vs. 3.4%) groups, and a similar proportion in the delayed onset group (about 9%) compared to Whites. In multinomial logistic regression analyses, disaster exposure, immigrant status, lower income, pre-attack depression/anxiety, and lower respiratory symptoms were associated with increased odds of chronic and delayed onset PTSD (vs. resilience) among both races. Education and employment were protective against chronic and delayed onset PTSD among Whites only. These results can inform targeted outreach efforts to enhance prevention and treatment for Asians affected by future events.

Health Issues Associated with Commercial Sexual Exploitation and Sex Trafficking of Children in the United States: A Systematic Review

This article reviews studies examining health issues associated with commercial sexual exploitation and sex trafficking (CSE/ST) of children in the United States. We searched five health and social sciences databases for peer-reviewed articles published in English between January 1990 and April 2017. After independent screening of the records, we identified 27 studies that met the inclusion criteria. Descriptions of the included studies and their definitions of CSE/ST are provided. Most of the studies sampled children and youth in urban, metropolitan areas and employed cross-sectional surveys or reviewed case files and medical records of convenience samples. Studies differed widely in their operationalization of CSE/ST, which limit systematic comparison across studies and the generalizability of findings. Qualitative analysis of the included studies shows that among commercially sexually exploited/trafficked children, there are elevated burdens of substance use and abuse, mental health disorders such as depression, PTSD, suicidal behaviors, and sexual and reproductive health issues including STIs, HIV, and pregnancy. This review underscores the need for more empirical studies, to guide an evidence-based understanding of and response to the range and complexity of the health issues in this population. Of particular utility are studies that address some of the methodological limitations of prior research in this field (e.g., cross-sectional, convenience samples) and those that assess overlooked health issues (e.g., malnutrition, eating disorders, post-trauma growth, and long-term health consequences).

The New York City Mental Health Needs Assessment Study (MHNAS): Objectives, design, and methods

OBJECTIVES

This paper describes the objectives, design, and methods of the Mental Health Needs Assessment Study (MHNAS). The objective of the MHNAS was to assess the needs of individuals transitioning to the community following psychiatric hospitalization and again 3-5 months later to inform community service planning. Needs were defined broadly to include domains like housing, employment, treatment, and social support.

METHODS

The MHNAS used a 2-stage clustered sampling approach where the primary sampling units were hospitals and secondary sampling units were patients. The study included an in-person patient interview, an assessment of need from a key hospital worker, and a follow-up telephone interview 3-5 months after discharge.

RESULTS

One thousand one hundred twenty-nine patients from 8 randomly selected hospitals participated. The overall response rate was 54.3% with a cooperation rate of 71.8%. The sample was similar to the overall population of psychiatric patients with respect to several key demographics.

CONCLUSION

The MHNAS demonstrates the feasibility of conducting a needs assessment with a random sample of psychiatric inpatients in a large urban setting. Results from this study may improve community service planning to better meet individuals' needs, with the ultimate goal of reducing rehospitalization and promoting recovery.

Teaching Epidemiology at the Undergraduate Level: Considerations and Approaches

The rapid growth in undergraduate public health education has offered training in epidemiology to an increasing number of undergraduate students. Epidemiology courses introduce undergraduate students to a population health perspective and provide opportunities for these students to build essential skills and competencies such as ethical reasoning, teamwork, comprehension of scientific methods, critical thinking, quantitative and information literacy, ability to analyze public health information, and effective writing and oral communication. Taking a varied approach and incorporating active learning and assessment strategies can help engage students in the material, improve comprehension of key concepts, and further develop key competencies. In this commentary, we present examples of how epidemiology may be taught in the undergraduate setting. Evaluation of these approaches and others would be a valuable next step.

Abstract TP180: Racial/Ethnic Differences in Sleep Duration and Sleep Disturbances Among Stroke Survivors

Introduction: Sleep disorders and short sleep duration have been associated with increased incidence of stroke. Despite evidence of racial/ethnic disparities in stroke, few studies have examined differences in sleep duration and disturbances by race/ethnicity among stroke survivors.

Methods: Data on self-reported sleep duration and sleep disturbances came from the baseline interview of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study, a randomized clinical trial of a skills-based intervention to reduce vascular risk in a multi-ethnic cohort of 552 mild stroke/TIA patients. Sleep duration was defined as average hours of sleep per night in the past month, and sleep disturbances were measured using the Medical Outcomes Study (MOS) Sleep Disturbances Index, which ranges from 0-100, with higher scores indicating more frequent disturbances. Differences in sleep duration and disturbance score by race/ethnicity were assessed using t-tests and multiple linear regression adjusted for age, sex, education, current smoking and alcohol consumption, body mass index, marital/cohabitation status, number of household members, and depression score.

Results: Overall, patients reported an average of 6.37 hours of sleep per night, and mean Sleep Disturbance Index score was 35.8. Mean sleep duration was significantly lower among non-Hispanic blacks than non-Hispanic whites (6.12 vs. 6.69 hours, p=0.004). Mean disturbance score was significantly higher among both non-Hispanic blacks and Hispanics compared to non-Hispanic whites (35.7 vs. 27.8, p=0.013 and 42.6 vs. 27.8, p<0.001, respectively). In adjusted models, sleep duration was no longer significantly associated with race/ethnicity. However, mean sleep disturbance scores remained significantly greater among non-Hispanic blacks and Hispanics compared to non-Hispanic whites (β=11.6, p=0.006, and β=8.8, p=0.039, respectively).

Conclusion: Sleep disturbances were more frequent among Hispanics and non-Hispanic blacks, two populations that are disproportionately affected by stroke. Further research is warranted to understand the role differences in sleep may play in racial/ethnic disparities in stroke.

Abstract TP177: Previous Stroke/TIA History is Associated With Low Medication Adherence in a Multi-ethnic Cohort of Stroke Survivors

Introduction: Proper adherence to medication regimens including antihypertensive, antidiabetic, and lipid-lowering medications has been shown to reduce risk of stroke-related events. Yet stroke and TIA survivors have suboptimal levels of adherence. Few studies have investigated how medication adherence differs between patients with previous stroke/TIA history compared to patients admitted for a first stroke event.

Methods: The present analysis examined baseline data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study, an RCT of a skills-based educational intervention in a multi-ethnic cohort of stroke/TIA patients (n=458). The primary outcome measure was medication adherence, which was self-reported using the 8-item Morisky Medication Adherence Scale (MMAS-8). Medication adherence was calculated and categorized as low adherence (score<6; 39%) and medium/high adherence (score 6-8; 61%). The exposure was previous stroke/TIA events, and was categorized as no previous stroke/TIA events (67%) and at least one previous stroke/TIA event (33%). Unadjusted and adjusted logistic regression models were used to investigate the relationship between previous stroke/TIA events and medication adherence. The multivariable model adjusted for relevant clinical and socio-demographic characteristics.

Results: The unadjusted logistic regression model assessing the relationship between previous stroke/TIA and medication adherence was not significant (OR: 0.70 , p=0.08, 95% CI: 0.47-1.05). But, after adjusting for select clinical and socio-demographic characteristics the model showed that patients with a history of previous stroke/TIA events were significantly less likely to have medium/high medication adherence compared to patients admitted for a first stroke event (OR: 0.59 , p=0.02, 95% CI: 0.38-0.93).

Conclusions: As part of continued preventive efforts, educational interventions such as DESERVE are necessary after a first stroke/TIA to improve medication adherence and reduce risk of future stroke/TIA events.

Abstract TP176: Risk Perception in a Multi-ethnic Cohort of Stroke Survivors

Introduction: Accurate risk perception is critical for secondary prevention of stroke. Few studies have focused on perceived risk of a recurrent stroke among stroke survivors in a diverse population.

Methods: The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial tested the efficacy of a skill-based intervention on blood pressure reduction among stoke/TIA patients. Using baseline data from DESERVE, the relationship between patient demographics, health beliefs and risk perception was assessed. Risk perception was evaluated by the participant’s perception of their risk of having a stroke in the next 10 years using a scale of 0-10 (with 0 being extremely unlikely and 10 being extremely likely), which was then re-categorized into three levels of risk perception: underestimate (<2), accurate (2-4) and overestimate (>4). Risk perception of having a cold within the next 10 years was also collected as a comparison measure. Differences in risk perception across race-ethnic groups were assessed using Chi-squared tests.

Results: At baseline, 552 stroke/TIA patients were recruited for DESERVE (29.4% white, 35.6% black, 35.0% Hispanic). Overall, 53.4% of patients overestimated their risk; 30.7% underestimated their risk; and only 15.9% accurately perceived their risk of a recurrent stroke. Accurate risk perception for a second stroke was significantly lower than for a cold (15.9% vs. 35.2%, p=0.002). Hispanics were more likely to overestimate their stroke risk compared to non-Hispanics (59.6% vs. 50.2%, p=0.031). Additionally, people who agreed vs. disagreed with the statement “I worry about having a stroke,” were much more likely to overestimate their risk of a recurrent stroke (61.1% vs. 38.6%, p=0.000).

Conclusion: In this sample of mild stroke/TIA patients, only 15.9% accurately perceived their risk of recurrent stroke. Overestimation of risk was more common among Hispanics than non-Hispanics, which might be explained by the health belief of “fatalism” in Hispanic culture. Future interventions should focus on improving stroke risk perception, especially among Hispanics.

Abstract WP174: Factors Associated With Medication Knowledge Among Stroke Survivors

Introduction: Adequate medication knowledge among stroke patients has been shown to be associated with a reduction in vascular risk factors and recurrent stroke. Yet, limited research has investigated the clinical and sociodemographic factors associated with adequate medication knowledge among stroke survivors.

Methods: The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial was an RCT of a skills-based educational intervention in a multi-ethnic cohort of mild stroke/TIA patients. As part of the trial, patients randomized to the intervention arm were called 72 hours post-discharge and asked about their knowledge of the discharge medications reported in their medical record. They received 1 point each for correctly reporting the name, purpose and dosage of the medication; medication knowledge scores ranged from 0 to 3 for each medication. For each patient, medication knowledge scores were averaged across all of their medications, and the average score was categorized as “adequate” (score ≥ 2) and “inadequate” (score < 2). Multivariable logistic regression analysis was used to evaluate the independent associations between having adequate medication knowledge and select sociodemographic and clinical factors measured pre-discharge.

Results: A total of 235 patients were included in the analysis. On average, patients were able to accurately recall 50% of their medication names, 57% of their medication purposes, and 39% of their medication dosages. Thirty-seven percent had adequate medication knowledge. In the adjusted model, the odds of having adequate medication knowledge was higher for patients taking less than 5 medications vs. those taking 11 medications or more (odds ratio [OR]: 9.99; 95% confidence interval [CI]: 4.01-24.88), patients younger than 60 years vs. those 60 years or older (OR: 2.05; 95% CI: 1.10-3.80), and patients who had no stroke history vs. those who previously had a stroke (OR: 2.66; 95% CI: 1.25-5.64).

Conclusion: Understanding the factors associated with medication knowledge among stroke survivors can help tailor discharge education plans to maximize medication adherence and improve stroke outcomes.

Abstract WP312: Using Qualitative Analysis to Explore the Themes of Follow-Up Calls to Discharged Stroke Patients

Introduction: Few studies have explored unscripted conversations with stroke survivors during the post-discharge period to determine areas of need and concern. Additional contact during the transition period may provide a better understanding of patient needs once home.

Methods: Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) was an RCT of a skills-based educational intervention among mild stroke/TIA patients, which included follow-up calls from a research coordinator at 72 hours, 1 month and 3 months post discharge. Follow-up forms (N=651, 242 patients) were reviewed and a codebook, consisting of 30 unique codes, was created to capture conversational themes. Two coders independently conducted systematic-content-analysis on the textual data. Discrepancies were examined and adjudicated by a third coder. Frequencies were calculated to determine the most prevalent conversational themes. Associations between themes and patient demographics were then assessed using chi-square tests.

Results: The most frequent conversation topics identified were: 1) setting up medical and neurological appointments (70.97%), 2) good medication adherence (16.28%) and 3) complaints of post-stroke symptoms (12.29%). Additionally, we found a significantly higher prevalence of non-Hispanic blacks and Hispanics complaining of post-stroke symptom to the health coordinator (54.4% and 49.2%, respectively) compared to non-Hispanic whites (25.0%, P=0.008). Although not statistically significant, we observed a higher prevalence of complaints of post-stroke symptoms among unmarried individuals (51.2% vs 40.2%, P=0.149) and people who live alone (53.2% vs 41.0%, P=0.248).

Conclusions: In this sample of mild stroke/TIA patients from the DESERVE study, we found that stroke survivors’ main concerns during the post-discharge period include setting up medical appointments, medication adherence, and post-stroke symptoms. Furthermore, these concerns varied by race-ethnic group, marital status and living arrangement. Future interventions should be tailored to address these concerns, especially once the patient has transitioned home.

Abstract TMP111: Physical Activity among Stroke Patients in the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) Study

Introduction: Previous research has emphasized the importance of physical activity in preventing secondary stroke. However, approaches to improving physical activity after stroke have been suboptimal, particularly among race-ethnic groups.

Methods: The DESERVE study was an RCT of a skills-based educational intervention in a multi-ethnic cohort of mild stroke/ TIA patients. The current analysis compared physical activity at one year post-discharge between intervention and usual care arms in DESERVE. Patients reported whether or not they participated in any moderate or vigorous physical activity for at least 10 minutes in the past month. Participation in any physical activity was compared between trial arms overall and stratified by race/ethnicity using chi-square tests.

Results: A total of 338 patients were included in the analysis (n=171 intervention, n=167 usual care; 29.2% non-Hispanic white, 34.2% non-Hispanic black, 33.9% Hispanic). Overall, 50.3% of patients participated in any physical activity in the past month. There was no difference in physical activity between the trial arms (p=0.91). Among Hispanics, participating in any physical activity was significantly greater in the intervention arm than in the usual care (intervention 43.6% vs. usual care 22.4%, p=0.01). There was no association between intervention arm and physical activity among non-Hispanic whites (intervention 58.1% vs. usual care 72.0%, p=0.16) and non-Hispanic blacks (intervention 50.9% vs. usual care 54.2%, p=0.74).

Conclusion: Participation in a skills-based intervention was associated with significantly greater physical activity one year post-discharge among Hispanic stroke/TIA patients. Providing culturally-tailored, skills-based tools and strategies that focus on behavior modification, such as improving physical activity, has the potential to improve stroke outcomes and reduce stroke disparities.

Abstract WP153: Depressive Symptom Trajectories Are Associated With Blood Pressure Reduction Among Stroke Survivors

Little is known about the longitudinal course of post-stroke depression and its impact on vascular risk reduction, a key secondary prevention strategy. Data for this study came from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial of a skills-based intervention to reduce vascular risk in 552 mild/moderate stroke/TIA patients. Depressive symptom severity was measured pre-discharge and at 6 and 12 months post-discharge as the total score on the Center for Epidemiologic Studies - Depression (CES-D) scale (range 0-60). Discrete mixture models identified distinct trajectories of depressive symptom severity over time and assigned patients to trajectory groups. Poisson models with linear and quadratic parameters were run to select the best-fitting model based on Bayesian information criterion and interpretability. The outcome, systolic blood pressure (BP) reduction, was defined as the difference between BP at baseline and 12 months post-discharge (mmHg). The association between trajectory group membership and BP reduction was examined using ANOVA and multinomial logistic regression adjusted for trial arm, baseline BP, sex, age, race/ethnicity, marital status, and NIH Stroke Scale score. A total of 465 individuals completed at least 1 depression assessment. A model was selected with four distinct trajectories: 1) resistance - low depressive symptom levels at all waves (35% of patients); 2) recovery - clinically significant baseline symptom levels (CES-D>16), dropping to low levels at subsequent waves (32%); 3) delayed - low levels at baseline, increasing to clinically significant levels (20%); 4) chronic - high levels at all waves (13%). Mean BP reduction was significantly higher in the resistance group compared to the other trajectory groups (10.7 vs. 2.3 in recovery group, 2.3 in delayed group, 4.5 in chronic group, p=0.017) and remained significantly higher compared to each of the other trajectory groups in the adjusted model (betas = 5.0-5.5 mmHg, all p<0.05). Mean BP reduction did not differ significantly between other trajectory groups. Rapid reduction of depressive symptoms and prevention of symptom onset following stroke may be important targets for helping stroke survivors reduce vascular risk.

Abstract 185: Social Network Structure and Function is Associated With Blood Pressure Reduction in Stroke Survivors

Although family and friends typically provide informal care after a stroke, little is known about the relationship between social network structure and function and post stroke outcomes. As part of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial, stroke/TIA patients were asked to identify up to 5 persons (“alters”) with whom they discuss important matters and provide information about each relationship. Network characteristics included number of alters, having an alter in the same household, having a family-only (vs. family and friend) network, frequency of contact with each alter, likelihood of discussing health concerns, relationship “closeness,” and educational level of each alter. Our outcome was the difference in systolic blood pressure (BP) between baseline and the 12 month follow-up (mmHg). We regressed BP change on our social network variables adjusting for trial arm, age, gender, race-ethnicity, and education. Of the 478 participants, 14% identified no alters, 58% identified 1 or 2 alters, and 28% identified 3-5 alters. Of those with at least one alter, 61% reported having an alter in the same household and 73% reported having a family-only network. Twenty-one percent of respondents reported talking to at least 3 alters at least several days per week, 22% reported having at least 3 alters whom they were very likely to discuss health concerns with, 23% reported having extremely or very close relationships with at least 3 alters, 14% of respondents reported having 3 or more alters with more than a high school education. In fully adjusted models, having 3-5 alters compared to none (beta = 10.86; p = 0.01), not having a family only network (beta = 6.11; p = 0.03), having at least 3 health matters network members compared to none (beta = 9.81; p = 0.01), having at least 3 extremely or very close relationships compared to none (beta = 9.18; p = 0.02), and having 3-5 network members with more than a high school education (beta = 11.77; p < 0.01) or 1-2 network members with more than a HS education (beta = 7.04; p = 0.04) compared to none was associated with greater mean BP reduction. Interventions that involve social networks may help reduce vascular risk and enhance secondary prevention efforts.

Street Audits to Measure Neighborhood Disorder: Virtual or In-Person?

Neighborhood conditions may influence a broad range of health indicators, including obesity, injury, and psychopathology. In particular, neighborhood physical disorder-a measure of urban deterioration-is thought to encourage crime and high-risk behaviors, leading to poor mental and physical health. In studies to assess neighborhood physical disorder, investigators typically rely on time-consuming and expensive in-person systematic neighborhood audits. We compared 2 audit-based measures of neighborhood physical disorder in the city of Detroit, Michigan: One used Google Street View imagery from 2009 and the other used an in-person survey conducted in 2008. Each measure used spatial interpolation to estimate disorder at unobserved locations. In total, the virtual audit required approximately 3% of the time required by the in-person audit. However, the final physical disorder measures were significantly positively correlated at census block centroids (r = 0.52), identified the same regions as highly disordered, and displayed comparable leave-one-out cross-validation accuracy. The measures resulted in very similar convergent validity characteristics (correlation coefficients within 0.03 of each other). The virtual audit-based physical disorder measure could substitute for the in-person one with little to no loss of precision. Virtual audits appear to be a viable and much less expensive alternative to in-person audits for assessing neighborhood conditions.

Age-Related Differences in Antihypertensive Medication Adherence in Hispanics: A Cross-Sectional Community-Based Survey in New York City, 2011-2012

Introduction

US Hispanics, particularly younger adults in this population, have a higher prevalence of uncontrolled hypertension than do people of other racial/ethnic groups. Little is known about the prevalence and predictors of antihypertensive medication adherence, a major determinant of hypertension control and cardiovascular disease, and differences between age groups in this fast-growing population.

Methods

The cross-sectional study included 1,043 community-dwelling Hispanic adults with hypertension living in 3 northern Manhattan neighborhoods from 2011 through 2012. Age-stratified analyses assessed the prevalence and predictors of high medication adherence (score of 8 on the Morisky Medication Adherence Scale [MMAS-8]) among younger (<60 y) and older (≥60 y) Hispanic adults.

Results

Prevalence of high adherence was significantly lower in younger versus older adults (24.5% vs 34.0%, P = .001). In younger adults, heavy alcohol consumption, a longer duration of hypertension, and recent poor physical health were negatively associated with high adherence, but poor self-rated general health was positively associated with high adherence. In older adults, advancing age, higher education level, high knowledge of hypertension control, and private insurance or Medicare versus Medicaid were positively associated with high adherence, whereas recent poor physical health and health-related activity limitations were negatively associated with high adherence.

Conclusion

Equitable achievement of national hypertension control goals will require attention to suboptimal antihypertensive medication adherence found in this study and other samples of US Hispanics, particularly in younger adults. Age differences in predictors of high adherence highlight the need to tailor efforts to the life stage of people with hypertension.

Abstract TMP103: A Culturally-tailored, Skills-based Intervention to Reduce Vascular Risk in a Multi-ethnic Group of Mild/Moderate Stroke Survivors: An Interim Analysis from the DESERVE Trial

Introduction: Secondary stroke prevention strategies have proven suboptimal in underserved communities and minority populations.

Methods: The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial tested the efficacy of an innovative skills-based intervention focused on risk perception, medication adherence, and patient-physician communication (vs. usual care enhanced with educational material [EUC]) on blood pressure (BP) reduction among mild/moderate stroke (NIH Stroke Scale ≤ 15) or TIA patients at 1 year post discharge. Study participants were stratified by interview language (English/Spanish) and randomized to intervention or EUC. BP reduction was the difference between systolic BP at baseline and 1-year post-discharge. We assessed differences in baseline characteristics and mean BP reduction between trial arms, overall and by race/ethnicity. Linear regressions evaluated mean difference in blood pressure reduction between trial arms, adjusting for characteristics that differed between trial arms at baseline and language of interview.

Results: To date, 290 of 552 stroke/TIA patients recruited at baseline (25% white, 32% black, 36% Hispanic) were evaluated at 1 year (n=145 in each arm). Overall, there was a trend toward greater mean BP reduction in the intervention vs. EUC group (9.3 vs. 6.0 mmHg, p=0.259). Mean BP reduction was significantly greater in the intervention vs. EUC group among Hispanics (9.9 vs. -0.7 mmHg, p=0.040). Among Hispanics, after adjusting for interview language, sex, and place of birth, mean BP reduction was 10.9 mmHg greater in the intervention vs. EUC group (p=0.041). Mean BP reduction did not differ significantly between trial arms among non-Hispanics. We are currently gathering information to evaluate the impact of the intervention on secondary stroke incidence.

Conclusions: Few behavioral intervention studies in stroke survivors have reported significant differences in vascular risk reduction in the longer term, and fewer have focused on a skills-based approach. Culturally-tailored, skills-based interventions may be more useful than knowledge-focused interventions in achieving sustained vascular risk reduction and addressing race/ethnic disparities in stroke.

Abstract TMP48: Longitudinal Course of Depressive Symptoms Following Stroke: Preliminary Results From the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) Study

It is well-established that depression is common after stroke. Much less is known about the longitudinal course of depressive symptoms in stroke survivors. Data for this study came from the DESERVE trial of a skills-based intervention to reduce vascular risk in mild/moderate stroke/TIA patients. Depressive symptoms were assessed at baseline (pre-discharge), 6 months and 1 year post-discharge using the Center for Epidemiologic Studies - Depression (CES-D) scale. Discrete mixture models identified distinct trajectories of depressive symptom severity over time and assigned patients to trajectory groups. We ran Poisson models using linear and quadratic parameters and chose the best-fitting model based on Bayesian information criterion and interpretability. Associations between baseline characteristics and trajectory group membership were examined using ANOVA and bivariable multinomial logistic regression. So far, 285 patients completed all three study waves and ≥ 1 depression assessment. A four-group model was selected: 1) resistance - low depressive symptom level at all waves (50% of patients); 2) delayed - low baseline symptom level, increasing to clinically significant levels (CES-D > 16) by 6 months, remaining high at 1 year (18%); 3) recovery - clinically significant baseline symptom levels, dropping to low levels by 6 months, remaining low at 1 year (22%); 4) chronic - severe symptoms at all waves (10%). Hispanic patients had greater odds of delayed symptoms vs. resistance compared to non-Hispanics. Moderate stroke patients had greater odds of delayed and chronic symptoms vs. resistance compared to mild stroke patients. Patients with stroke history had greater odds of delayed symptoms and recovery vs. resistance compared to those without; those with psychiatric history had greater odds of recovery and chronic symptoms vs. resistance compared to those without. Those with chronic symptoms had significantly greater baseline disability compared to other groups. The course of post-stroke depressive symptoms is heterogeneous and associated with race/ethnicity and several clinical factors. Targeted interventions may be required to prevent the development of depression and address chronic symptoms that may interfere with stroke recovery.

Abstract TP307: Anxiety, Depression and Posttraumatic Stress Disorder (PTSD) are Associated With Worse Outcomes After Stroke: Preliminary Results

Introduction: The impact of anxiety, depression, and PTSD on outcome after stroke is incompletely understood. We aim to evaluate the prevalence of these disorders after stroke and evaluate associations with outcomes including healthcare utilization, medication adherence, return to work, and quality of life.

Methods: We performed telephone surveys on stroke patients discharged to home or acute rehabilitation 6-12 months after discharge from a comprehensive stroke center. Patients with preexisting psychiatric disease, prior stroke, and those unable to communicate were excluded. Demographics, including education, relationship status, and household size were recorded. Stroke etiology, location, and severity (NIHSS) were abstracted from medical records. Surveys included: employment status, the Hospital Anxiety and Depression Scale, PTSD Checklist-Stressor Specific Version (PCL-S), Stanford Healthcare Utilization Survey, Morisky Medication Adherence Scale, modified Rankin Scale (mRS) and quality of life (Euro QOL-5D).

Results: Data collection is ongoing. Currently, 36 of 118 eligible subjects completed the survey. Responders and non-responders did not differ by demographic or clinical features. Of the 36 subjects, 31% screened positive for anxiety, depression, or PTSD. Subjects screening positive were similar to those who did not with respect to demographics, stroke etiology and location, and NIHSS (median 2 vs 2, p=0.44). Good functional outcome (mRS 0-2) was less likely in those who screened positive, 55% vs 96%, p=0.01. These subjects were less likely to return to work (14% vs 100%, p<0.001) and reported lower scores on the Euro QOL-5D (any problem with mobility 81% vs 36%, p=0.03; self-care 55% vs 8%, p=0.005; usual activities 82% vs 40%, p=0.031; anxiety/depression 73% vs 16%, p=0.002, and quality of life median 55 vs 80, p=0.002).

Conclusions: Preliminary results show anxiety, depression, and PTSD are common after stroke and are associated with not returning to work, worse functional outcome and quality of life. More research is needed to characterize whether these associations are causal and determine if treating mood disorders can improve outcomes.

Abstract TP409: Reporting of Key Demographic Characteristics in Neurological Trials Registered on ClinicalTrials.gov

Introduction: To increase the transparency of clinical trial information, U.S. Congress passed the Food and Drug Administration (FDA) Amendments Act of 2007, which expanded prior legislation to mandate inclusion of specific trial characteristics, such as funding source and gender demographics, in a new basic results section on ClinicalTrials.gov. Few studies have examined the extent to which key demographic characteristics such as sex and race/ethnicity are reported for neurological trials on ClinicalTrials.gov.

Methods: As part of the National Initiative for Minority Involvement in Neurological Clinical Trials (NIMICT), we systematically identified neurological clinical trials on ClinicalTrials.gov (for stroke, epilepsy, Alzheimer’s Disease [AD]) and examined the proportion that reported sex, race, and ethnicity (Hispanic/Latino or not) of study participants. We used the website’s advanced search feature to evaluate demographic information reported from trials conducted between 1999 and 2015. We first calculated frequencies of trials reporting these characteristics, then assessed differences in reporting of each characteristic (yes/no) by condition (stroke, epilepsy, AD) and between trials conducted before and after the basic results section update (pre- and post-2008) using chi-square tests.

Results: Our sample comprised 251,847 subjects across 393 trials (147 stroke, 127 epilepsy, 115 AD). Overall, sex was reported for nearly all trials (99.0%), while reporting of race and ethnicity was low (ethnicity: 14.0%, race: 19.8%). Reporting of these characteristics did not differ significantly across the three conditions or between periods preceding and following the FDA act.

Conclusion: While ClinicalTrials.gov mandates reporting of sex, it does not require reporting of race/ethnicity, and few trials report these characteristics. This lack of information prevents understanding of neurological trial participation and how interventions might impact patients differently by race/ethnicity. Mandatory reporting of race/ethnicity would enhance transparency and increase awareness of the limited participation of racial/ethnic minorities-who suffer disproportionately from neurological diseases-in neurological trials.

Abstract TP183: Race/ethnic Differences in Social Network Characteristics Among Stroke Survivors

Family and friends have become increasingly responsible for providing informal care for stroke survivors. Studies have noted race/ethnic variation in caregiving of older adults and those with dementia or cancer, but few have described social networks of stroke survivors and examined network characteristics by race/ethnicity. As part of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial, stroke/TIA patients were asked to identify up to 5 persons (“alters”) with whom they discuss important matters and provide information about each relationship. Network characteristics included median number of alters; having an alter in the same household, someone who talks with the participant every day, or with whom they discuss health concerns; relationship “closeness”; and having a family-only (vs. family and friend) network. Household composition was also recorded. Network characteristics were described overall and by race/ethnicity using frequencies and Wilcoxon rank-sum and Chi-square tests. Of the 500 study participants, most identified at least one alter (86%), 61% had an alter in their household, 88% talked to an alter every day, 82% were extremely/very close with all alters identified, 96% discuss health concerns with an alter, and 74% had a family-only network. Less than 27% lived alone, 21% with a spouse only, 15% with a non-spouse, and 38% with >1 person. NHBs and Hispanics were more likely than NHWs to identify no alters (19% and 16% vs. 8%, p=0.006) but talk to an alter every day (90% and 92% vs. 79%, p=0.007). NHWs were more likely to live in the same household as an alter than NHBs and Hispanics (67% vs. 53% and 59%, p=0.006). Hispanics had greater prevalence of having a family-only network than NHWs and NHBs (83% vs. 71% and 68%, p=0.014). NHWs were more likely to live with a spouse, while NHBs and Hispanics were more likely to live with a non-spouse or with >1 person (p<0.001). Given the importance of social networks in the aftermath of stroke, understanding the structure of different types of networks will help inform targeted interventions to promote vascular risk factor management and reduce race/ethnic disparities in stroke outcomes.