Nicol and Thrift 100% ) s(%90% rs tcotro 80% ac ffa 70% k isk rirs 60% g ng i n iftyiify 50% nt iedend 40% i e ageg 30% ta t n ceen 20% rc r e PeP 10% 0% Cincinnati, USA 1998 (a) Cincinnati, USA 2003 (b) Michigan, USA 2002 (c) Newcastle, Australia 2001 (d) None 1 2 Figure 4 The number of risk factors correctly identified using free recall (community-based studies). (a) Pancioli et al 1998, (b) Schneider et al 2003, (c) Reeves et al 2002, (d) Yoon et al 2001b. identify three risk factors for stroke using free recall correctly listed at least one of the established stroke risk factors (Figure 4). A similar study, conducted 5 years later in the same area, yielded 72% (of 2173 participants) correctly naming at least one risk factor (Schneider et al 2003). In other studies conducted in similar community groups in Australia and the USA, comparable but slightly higher proportions of people correctly identified at least one risk factor (Yoon et al 2001b; Reeves et al 2002). Interestingly, those aged ≥ 75 years (56%) correctly listed at least one risk factor less often than those < 75 years of age (72%; p < 0.001) (Pancioli et al 1998). Importantly, a minimum of 20% of people could not correctly name at least one risk factor for stroke. The proportion of people who correctly identified at least two risk factors was significantly lower, ranging from 25% to 62% (Pancioli et al 1998; Yoon et al 2001b; Reeves et al 2002; Schneider et al 2003), and this decreased to between 24% and 28% for those identifying at least three risk factors among the two studies where this was reported (Yoon et al 2001b; Reeves et al 2002). This represents a lack of general awareness of risk factors for stroke. Hypertension was the most commonly identified risk factor on free recall, ranging from 27.5% to 51.2% (Figure 5) (Pancioli et al 1998; Yoon et al 2001b; Reeves et al 2002; Schneider et al 2003; Carroll et al 2004). This increased to about 95% when people were provided with a list and asked to identify the risk factors for stroke (Rowe et al 2001; Parahoo et al 2003). Smoking was the next most commonly identified risk factor, being identified between 18.7% and 50.0% of the time (Pancioli et al 1998; Yoon et al 2001b; Reeves et al 2002; Schneider et al 2003; Carroll et al 2004). Interestingly, a considerable proportion of people stated that stress (21%–35%) and a poor diet (11%–32%) were risk factors (Pancioli et al 1998; Yoon et al 2001b; Reeves et al 2002; Schneider et al 2003; Carroll et al 2004). Although there is minimal evidence that these are risk factors for stroke, there seems to be general perception in the community that these factors play a major role in stroke risk. Important risk factors for stroke such as age, atrial fibrillation, and diabetes were identified by less than 5% of participants in all studies (Pancioli et al 1998; Yoon et al 2001b; Reeves et al 2002; Schneider et al 2003; Carroll et al 2004), except among those where a list was provided (Rowe et al 2001; Parahoo et al 2003). The discrepancy between studies is most likely to be because of the different manner in which the respondents were asked to identify risk factors. Awareness of risk factors may be underestimated in those asked to identify risk factors by free recall, as participants may not be clear on what is being asked or may stop after the three requested risk factors are provided. On the other hand, awareness is likely to be overestimated when people are provided with a list as it is then possible to guess the response. This is supported by the fact that conditions that are clearly not risk factors for stroke, such as cancer (26.2%), arthritis (15.4%), and poor eyesight (14.4%) were identified using this method (Rowe et al 2001). In addition, as mentioned previously, the responses for stroke warning signs were considerably better when a list was provided than when an unaided response was required. 144 Vascular Health and Risk Management 2005:1(2)