Neighborhood barbers can influence black men to seek blood-pressure treatment

"The barber and beauty shops for men and women are kind of their own private escapes," Mr. Marshall said. "Every conversation you can imagine goes on in the barbershop. I wouldn't have put the barbershop and blood pressure together -- but that visit to my physician for my blood pressure saved my life."

Mr. Marshall now has a healthy blood pressure thanks to lifestyle and dietary changes.

He is one of about 1,300 participants in a study described online and in the Feb. 28 print issue of the Archives of Internal Medicine. The study was designed to ascertain if barbers could influence African-American men to consult a physician about elevated blood pressure, or hypertension.

"Black men tend to suffer the complications of uncontrolled hypertension -- heart disease and kidney failure -- more than black women and other ethnic groups, and they tend to be affected at younger ages. No one has addressed this issue well, so we went to a social setting where you find black men to see if we could improve things," said Dr. Robert Haley, chief of epidemiology at UT Southwestern Medical Center and senior author of the study, designated Barber-Assisted Reduction in Blood Pressure in Ethnic Residents (BARBER-1).

UT Southwestern investigators found that patrons of black-owned barbershops who had their blood pressure regularly measured there and who were encouraged to follow up with their physicians were nearly nine times more likely to see a physician than patrons who were simply given hypertension literature.

"There is a long tradition of barbers taking part in medical care," Dr. Haley said. "Barbers were the original surgeons. They have the confidence of their customers and other characteristics of health care providers.

"In this study, they only did blood pressure measuring and referring, so the barbers didn't take on the part of medicine that carries the risk."

The study participants were patrons of 17 black-owned barbershops throughout Dallas County between March 2006 and December 2008 and tracked since. Eight shops gave customers traditional pamphlets about hypertension. Nine shops put up posters with messages from other male clients about hypertension, checked patrons' blood pressure and encouraged the men to see a physician if their numbers were elevated.

Researchers in the study found that the men in the intervention group who controlled their hypertension increased from 33.8 percent at the start of the study to 53.7 percent at follow-up. In the group that received pamphlets, the number increased from 40 percent at the start of the study to 51 percent at follow-up.

"The barbers were the heroes of this story. They really stood forward and made it part of their barber practice," said Dr. Haley. "They helped us show that social settings can be an integral part of health care in the black male population."

Dr. Haley said the next step is to expand the work to reach more men with hypertension and to develop incentives for barbers to continue encouraging men to get their blood pressure under control.

Other UT Southwestern researchers involved in the study were Anne Freeman, assistant professor of health care sciences; Dr. David Leonard, assistant professor of clinical sciences; Deepa Bhat, senior Qi analyst in internal medicine; Patricia Knowles, research study coordinator in internal medicine; and Emily Adhikari, medical student.

Dr. Ronald Victor, formerly of UT Southwestern, led the study. Dr. Joseph Ravenell, Dr. Moiz Shafiq and Joy Storm, all formerly from UT Southwestern, participated, along with researchers from the University of California, San Francisco, and University of Minnesota, Minneapolis.

The study was funded by the National Heart, Lung and Blood Institute; the Donald W. Reynolds Foundation; the Aetna Foundation Regional Community Health Grants program; Pfizer Inc.; Biovail Corp, now Valeant Pharmaceuticals International; the Lincy Foundation; and the Robert Wood Johnson Foundation.