Abstract P334: Primary Prevention Aspirin Use in an African American Population: The Impact of Health Beliefs and Social Norms

Abstract

Background: Cardiovascular disease (CVD) is a leading cause of death that disproportionately impacts African Americans. Aspirin (ASA) is a simple, low-cost medication that lowers the risk of a first heart attack or stroke by 12-22%. This study investigates the prevalence of primary prevention ASA use among a metropolitan, predominantly African American population. It examines the association between primary prevention ASA use and measures of health beliefs, social norms, and perceptions of CVD risk hypothesized to influence ASA use. Methods: Between April and August 2015, trained community health workers administered 10 minute, in-person surveys to a convenience sample of adults ages 45-79 years within the Minneapolis-St. Paul metro area. The survey defined demographics, CVD history, atherosclerosis risk factors and ASA use. CVD risk perceptions and ASA-related health beliefs and social norms were evaluated using a 4 point Likert scale. Logistic regression with adjustment for age and number of risk factors was used to examine the association of demographics and health beliefs with ASA use. Results: Of the 797 survey participants, 590 had no CVD history. Of these, 460 (78%) were between the ages of 50-69, the range recently defined in the 2016 United States Preventive Services Task Force (USPSTF) recommendation. Overall primary prevention ASA use was 38% and increased as the number of CVD risk factors (RF) increased, from 21% (0 RF) to 62% (≥ 3 RF). After adjusting for age and risk factors, ASA use was associated with diabetes (OR 2.6, 95% CI: 1.6-4.2) and current smoking (OR 0.4, 95% CI: 0.2-0.6). If a participant discussed ASA use with a doctor, they were much more likely to use ASA (OR 5.5, 95% CI: 3.7-8.1). Participants who believed ASA could prevent a heart attack or stroke were also more likely to use it (OR 4.6, 95% CI: 1.9-11.4). ASA use was higher among participants who perceived that their peers were using ASA (OR 3.7, 95% CI: 2.0-6.6), and among participants who believed those close to them thought they should use ASA (OR 6.6, 95% CI: 4.1-10.5). Perceived safety and ease of use were also positively associated with ASA use, (OR 9.8, 95% CI: 5.0-19.3 and OR 23.2, 95% CI: 8.2-65.5 respectively). Conclusion: Increased primary prevention aspirin use was associated with positive beliefs regarding the expectations and behaviors of participants’ social network, and about perceived effectiveness, safety and convenience of the medication. Novel interventions to increase primary prevention ASA use could focus on promoting conversations with physicians about appropriate ASA use, and normalizing ASA for at-risk individuals within communities.