Several RCTs have tested secondary stroke pre- vention interventions in predominantly Black, Hispanic, and low-socioeconomic-status populations.815,856 859 The optimal approaches for reducing recurrent stroke risk in high-risk populations are unclear; however, key strate- gies include evaluating and addressing social determi- nants of health, implementing evidence-based protocols, monitoring adherence to evidence-based guidelines on a population level, enhancing health and stroke literacy and self-management skills, and using the Agency for Healthcare Research and Quality Universal Precautions Toolkit of Health Literacy. Recommendation-Specific Supportive Text 1. Socioeconomic inequalities are strong predictors of Interventions should be tailored to patients socioeconomic and educational status, as well as cultural, work, and home environments.19,875 Examples of upstream social determinants of health that affect treatment adherence and ASCVD health outcomes include comorbid mental illness, lack of health literacy, exposure to adversity (eg, home/com- munity violence, trauma exposures, safety concerns), financial strain, inadequate housing conditions, lack of food security (ie, access to affordable and nutritious food), structural and individual discrimination, and inad- equate social support.876 The Centers for Medicare & Medicaid Services has developed a screening tool to assess 5 domains of non health-related measures that affect health outcomes: housing instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety.877 and Stroke convened an expert panel to provide rec- ommendations on key priorities for health disparities research in stroke. One recommendation was to use population-based surveillance to assess achievement of evidence-based guidelines.878 Alliances with the federal government through the National Institute of Neurological Disease and Stroke, Centers for Disease Control and Prevention, nonprofit organiza- tions such as the AHA/ASA, and medical specialty groups such as the American Academy of Neurology and the Brain Attack Coalition are needed to coor- dinate, develop, and optimize implementation of evi- dence-based stroke prevention recommendations.9 3. 