Nicol and Thrift being hypertensive (Pancioli et al 1998; Yoon et al 2001b; Reeves et al 2002; Schneider et al 2003); having hypercholesterolemia (Schneider et al 2003); drinking more than two alcoholic drinks per day (Schneider et al 2003); having poor health (Reeves et al 2002). Furthermore, the strongest predictors of awareness of self- risk of stroke were TIA, younger age, and poor current health status (p < 0.001) (Samsa et al 1997). There appears to be a lack of knowledge about risk factors for stroke among diverse groups of people, particularly older people, males, and those with less education. It may be that targeting these specific groups for risk factor awareness and prevention campaigns may be the most effective way of improving awareness in the population. Knowledge that reducing/treating risk factors will reduce likelihood of stroke Few investigators have assessed whether people are aware that stroke is preventable and that behavior can be changed to modify risk. In an urban community sample of 822 participants, 23% considered strokes only slightly or not at all preventable, while 70% considered stroke to be moderately or completely preventable (Yoon et al 2001a). If high-risk patients are unaware that preventive practices can reduce their likelihood of a stroke, then there is little, if any, impetus to change behaviors. This specific information may need to be included in any preventive campaigns. In summary, there is a lack of knowledge about stroke risk factors among the population, although those at higher risk seem to be more aware. The elderly, males, and those with lower educational attainment are less aware of risk factors and may need to be a focus of risk prevention/ awareness strategies. Finally, there is limited evidence of peoples’ knowledge about the ability to reduce their risk of stroke. Behavioral change is the ultimate goal if improvement in risk factor self management is the desired outcome. Although knowledge or awareness do not necessarily equate to behavioral change, the knowledge that changing behavior can reduce stroke risk may be important in altering an individual’s behavior and is an area that could be a focus of future research. There is a great deal of variation in the methodology used in the studies reviewed here, particularly in terms of the size of the population being studied. The largest study (Greenlund et al 2003) covered an enormous geographic 146 range and more than 61 000 people, while the smallest study (Carroll et al 2004) comprised a total of 40 individuals. Those studies conducted in higher risk groups tended to have study participants with a higher mean age than the community-based studies, a result that is not entirely surprising as stroke risk increases with age. The age difference between the high-risk and population-based studies could also explain some of the variation among the findings of the studies reported here. As mentioned previously, the use of open- and closed-type questions can also have some degree of influence on survey outcomes. Knowledge of stroke warning signs was generally low in the studies where respondents were asked to identify these signs without prompting, and improved substantially in those studies where warning signs were identified from a list. Regression analysis of predictors of increased knowledge of stroke warning signs identified younger age and higher education levels as the most common factors associated with improved knowledge. It is apparent from the studies reviewed here that public levels of awareness of stroke warning signs and risk factors are relatively low, notably in the higher risk, older age groups. There is a need for public health campaigns to address this knowledge gap, with high- risk groups being of primary concern. Acknowledgments This work was supported by grants from the National Health & Medical Research Council. References Australian Bureau of Statistics 2003. Population projections (2002–2101), Australia. Catalogue nr 3222.0. Birbeck GL, Cui X, Zingmond DS, et al. 2004. Intravenous tissue plasminogen activator for acute stroke in California: recipients and resources. Cerebrovasc Dis, 17:341–3. Carroll C, Hobart J, Fox C, et al. 2004. Stroke in Devon: knowledge was good, but action was poor. J Neurol Neurosurg Psychiatr, 75:567–71. Chen Z, Sandercock P, Pan H, et al. 2000. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40 000 randomized patients from the Chinese Acute Stroke Trial and the International Stroke Trial. On behalf of the CAST and IST collaborative groups. Stroke, 31:1240–9. Dewey HM, Thrift AG, Mihalopoulos C, et al. 2001. The cost of stroke in Australia from a societal perspective: results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke, 32:2409–16. Greenlund KJ, Neff LJ, Zheng ZJ, et al. 2003. Low public recognition of major stroke symptoms. Am J Prev Med, 25:315–19. Gupta A, Thomas P. 2002. Knowledge of stroke is lacking [letter]. BMJ, 325:392. Hacke W, Brott T, Caplan L, et al. 1999. Thrombolysis in acute ischemic stroke: controlled trials and clinical experience. Neurology, 53: S3–14. Hux K, Rogers T, Mongar K. 2000. Common perceptions about strokes. J Community Health, 25:47–65. Vascular Health and Risk Management 2005:1(2)