Parahoo et al (2003) further asked participants to identify the main risk factor for stroke. Only 36.1% correctly identified hypertension, and 23.9% identified smoking, while the remainder predominantly stated that an unhealthy lifestyle, such as poor diet and lack of exercise, was the main risk factor. Of note is the fact that younger people (18–30 years) were more likely to identify an unhealthy lifestyle (32.8%) while those aged 65 years and over were more likely to identify hypertension (44.8%) as the main risk factor. Knowledge of risk factors for stroke appears to be higher among those who have an established risk factor for stroke, although this argument does not hold true for older people. In their community study of 1880 participants, Pancioli et al (1998) reported that those who have a stroke risk factor (hypertension, diabetes, and smoking) were more likely to name these as stroke risk factors than those who did not have these particular risk factors (Figure 6). These findings were all statistically different and were repeated in a later study conducted in the same region (Schneider et al 2003) and in another study in the UK (Gupta and Thomas 2002). This identifies a potential opportunity for public education intervention. In contrast, other investigators have reported With Risk Factor Without Risk Factor Hypertension Smoking Diabetes Figure 6 Comparison of awareness of risk factors for stroke and presence (or absence) of a risk factor (Pancioli et al 1998). Vascular Health and Risk Management 2005:1(2) ) 70.0% r % o ( t co60.0% r a t f c k isrfk50.0% a s gi ing40.0% r y f in i enro30.0% t iedrp20.0% e g e a g t entan10.0% c r e e Pre c 0.0% P 70% ggn 60% i n it tro ) 50% rtraeegpotrageenp ft(rcao%iftsrcako3400%% rerce riskr 20% ne ceP 10% P 0% Hypertension Smoking Stress Poor diet Obesity Pinhaycstiicvaitly Hyperlipidemia Heredity Coarrhdeioavratsdcisuelaarse Figure 5 Community studies of awareness of stroke risk factors (free recall). (a) Reeves et al 2002, (b) Pancioli et al 1998, (c) Yoon et al 2001b, (d) Carroll et al 2004, (e) Schneider et al 2003. Knowledge of risk factors and warning signs of stroke Michigan USA, 2002 (a) Cincinnati USA, 1998 (b) Newcastle, Australia, 2001 (c) Devon UK, 2004 (d) Cincinnati USA, 2003 (e) that high-risk people have similar levels of awareness to those reported for community samples above (Kothari et al 1997; Carroll et al 2004). The disparity between findings most likely relates to the small number of observations in these latter two studies, thus resulting in a large degree of uncertainty about the estimates. Not only do people with risk factors identify these factors more commonly as risk factors for stroke, they also identify themselves as being at higher risk of stroke (Yoon et al 2001a). Despite this, only 41% of high-risk people in one study were aware that they were at greater risk of stroke, and only 27% recalled being told by a physician that they were at increased risk of stroke (Samsa et al 1997). Interestingly, people with a past history of TIA were more likely to be aware that they were at increased risk of stroke (62%) than people with a history of stroke (42%) (Samsa et al 1997). Importantly, high-risk patients who were aware of their increased risk for stroke were more likely to report that they were following at least one stroke prevention practice than those who were not aware (98% versus 87%, p < 0.01) (Samsa et al 1997). These are significant findings as these high-risk people are the ones who need to be targeted for education campaigns. Some investigators performed multivariate analyses to determine which factors independently predicted knowledge of stroke risk factors. The factors identified in this way were: younger age (Pancioli et al 1998; Reeves et al 2002; Schneider et al 2003); female sex (Pancioli et al 1998; Reeves et al 2002; Schneider et al 2003); white race (Pancioli et al 1998; Reeves et al 2002; Schneider et al 2003); higher level of education (Pancioli et al 1998; Reeves et al 2002; Schneider et al 2003); family history of stroke (Yoon et al 2001b); 145