Oct. 26, 2010 Neighborhood barbers, by conducting a monitoring, education and physician-referral program, can help their African-American customers better control high blood pressure problems that pose special health risks for them, a new study from the Cedars-Sinai Heart Institute shows.
The study -- the first to subject increasingly popular barbershop-based health programs to a scientific scrutiny with randomized, controlled testing -- demonstrates the haircutters' heart health efforts work well enough that they could save hundreds of lives annually, according to results to be published online in Archives of Internal Medicine in the peer-reviewed medical journal's Feb. 28, 2011, print issue.
In the research -- led by Ronald G. Victor, MD, a hypertension expert and associate director of the Cedars-Sinai Heart Institute -- barbers for 10 months offered blood pressure checks during men's haircuts and promoted physician follow-up with personalized health education for customers with high blood pressure. This enhanced screening program markedly improved blood pressure levels among the barbershops' patrons. Although blood pressure levels also fell in a comparison group whose members received only educational brochures about high blood pressure, the improvement was greater in the barber-assisted group.
Uncontrolled hypertension is one of the most prevalent causes of premature disability and death among African-Americans. African-American men have the highest death rate from hypertension of any race, ethnic and gender group in the United States -- three times higher than white men.
"What we learned from this trial is that the benefits of intensive blood pressure screening are enhanced when barbers are empowered to become healthcare extenders to help combat this epidemic of the silent killer in their community"," said Victor, the Burns and Allen Chair in Cardiology Research. "Barbers, whose historical predecessors were barber-surgeons, are a unique work force of potential community health advocates because of their loyal clientele."
Since the 1980s, African-American-owned barbershops and hair salons have hosted screening programs for medical conditions that disproportionately affect African-Americans. Victor's study concludes that if hypertension intervention programs were put in place in the estimated 18,000 African-American barbershops in the U.S., it would result in the first year in about 800 fewer heart attacks, 550 fewer strokes and 900 fewer deaths.
Seventeen African-American-owned barbershops in Dallas and approximately 1,300 male patrons with confirmed hypertension participated in this study, which ran from March, 2006, to December, 2008, when Victor was professor of medicine at the University of Texas Southwestern Medical Center in Dallas.
All African-American men patronizing the participating shops were offered baseline blood pressure screenings for hypertension. The shops then were assigned randomly to the intervention or comparison group.
Barbers at the nine shops in the intervention group were trained to measure blood pressure properly and they offered free checks with every cut. If a customer's reading was high, the barber encouraged him to see his doctor, and, if he did not, the barber called the study's nursing staff to arrange a physician visit. The customer, in turn, got a free haircut if he returned to the shop with a doctor-signed referral card.
In the eight shops in the comparison group, customers received a blood pressure check at the study's outset, and then were offered standard educational pamphlets about hypertension.
At the study's conclusion, 20 percent more hypertensive patrons in the intervention group had their blood pressure controlled with medication compared to 10 percent in the control group.
"We need further exploration to make this kind of program scalable and sustainable," said Victor, who is launching a new study with African-American barbershops in Southern California. "If this kind of program could be applied to large numbers of African-American men, that would be an enormous asset in preventing heart attacks, strokes, kidney failure and other serious complications of hypertension,"
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- Ronald G. Victor; Joseph E. Ravenell; Anne Freeman; David Leonard; Deepa G. Bhat; Moiz Shafiq; Patricia Knowles; Joy S. Storm; Emily Adhikari; Kirsten Bibbins-Domingo; Pamela G. Coxson; Mark J. Pletcher; Peter Hannan; Robert W. Haley. Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men: The BARBER-1 Study: A Cluster Randomized Trial. Archives of Internal Medicine, 2010; DOI: 10.1001/archinternmed.2010.390
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