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Our Health

Barbershop Interventions Improve Health Outcomes

A safe haven. A country club. A place where people can be themselves: That is how patrons and shop owners describe U.S. barbershops in black neighborhoods.

“The barber-client relationship is a very special one,” Herman Muhammad, owner of Supreme Style Barbershop in Denver, said. “The guys sitting in your chair usually have done so for years. There is a sense of trust there.”

For decades, health professionals have leveraged this relationship to bring care to a hard-to-reach demographic: black men. With barbers as advocates, health workers visit shops to educate and perform screenings, usually for high blood pressure. Women’s hair salons have also been included in intervention programs.

Intervention is critical because blacks, especially black men, are less likely to get regular health checkups than whites. And high blood pressure disproportionately affects black people, who are also more likely to develop complications of stroke and heart conditions than other races and ethnicities, according to the Centers for Disease Control and Prevention. Among men, 43 percent of blacks have high blood pressure, compared to 34 percent of whites and 28 percent of Hispanics.

Barbershop interventions have plenty of advocates, but evidence-based studies have lagged. That changed last year when the New England Journal of Medicine published a study showing that barbershop interventions improved the health of participants. Over 300 customers at 52 Los Angeles black barbershops took part in a randomized study. About one-third of them with high blood pressure were assigned to an intervention group that prescribed a drug therapy by a pharmacist at a shop. Over 60 percent of participants lowered their blood pressure to healthy levels and sustained them for a year.

Then in August, HIV education in barbershops got a boost. APHA’s American Journal of Public Health shared results of an HIV program at dozens of black barbershops in Brooklyn, New York.

The program improved responsible sexual behavior among low-income black men, a demographic at heightened risk for HIV. Sixty-four percent of over 350 men in the intervention group reported no sex without a condom.

“This represents a new way to think about certain diseases and conditions, which, perhaps because of stigma and fears, have not been addressed in this way before,” Tracey Wilson, a professor at the SUNY Downstate Medical Center School of Public Health and lead author of the Brooklyn study, said. “It shows it can be done effectively.”

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A problem, though, is that efficacy trials can be expensive—federal grants for the Los Angeles barbershop trial hit $8.5 million. But that should not stop health groups from partnering with barbershops, especially now that trials are showing health and behavioral improvements, Terri Richardson, M.D., saidA basic barbershop program is simple and low cost.

“If you have a dime and the time, you can make this happen,” said Richardson, a leader of the Colorado Black Health Collaborative, which Muhammad’s barbershop is part of.

Since 2012, the nonprofit collaborative has grown to 14 barbershops in the Denver area, said Richardson, an internal medicine physician at Kaiser Permanente in Denver, and has screened more than 8,600 blacks for high blood pressure.

Barbers encourage customers to attend a four-hour monthly screening held at the shops. Some clients tested have had dangerously high blood pressure and were immediately sent to a hospital.

“We are not trying to be their doctors, their providers, but we are trying to empower them to ask their doctor about what their health goals should be,” Richardson said.

Students at local medical universities can conduct blood pressure screenings at barbershops, or volunteers can be trained how to do it, Richardson said. A table, two chairs, a blood pressure monitor and a screener are all that is required.

Though distrust about health screenings and studies remain in black communities, Muhammad’s customers trust him and his recommendations. He estimates that 85 percent of his customers get screened.

“It’s about education that is not preachy, just practical,” Muhammad said. “I tell them high blood pressure is a silent killer among black men. Get tested.”

Another shop within the Denver collaboration is the Winning Coiffures Salon, which like black barbershops has an open, friendly atmosphere. Shop owner Rosalyn Redwine sat for a screening in 2013 and discovered she had high blood pressure that was a symptom of a rare kidney disease, for which she got treatment.

“Had they not been coming on a regular basis, I would not have caught it, because I go for my checkup once a year,” Redwine said.

As intervention success stories pile up, startup programs are launching. One is the Shop Docs, begun two years ago by medical students at the University of Miami’s School of Medicine. Shop Docs has partnered with several barbershops to conduct blood pressure screenings, and plans to begin education on safe sex and HIV prevention in coming months. Glucose testing for diabetes is also in the works.

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Important for success is a consistent presence at the shops, which helps overcome suspicion of the health care system, said Annette Grotheer, a fourth-year medical student at the University of Miami and founder of Shop Docs.

“One of my main goals is encouraging that positive relationship, showing that we really do care about their health and we aren’t trying to take advantage of them, which is a historically embedded perception in the minority community,” Grotheer said.

Barbershops are also promoting mental wellness. Black Americans are more likely to experience post-traumatic stress disorder than other races and ethnicities, according to CDC. Yet, because of social determinants, they are also less likely to receive treatment for PTSD and other mental health conditions.

Lorenzo Lewis wanted to do something for the black community to improve mental wellness. In 2016, he founded the Confess Project in Little Rock, Arkansas, which trains barbers to advocate to men of color about mental health. Grants have enabled the project to enlist 15 barbershops in seven Southern states.

Barbers are trained to spot customers who are struggling and invite them to attend a mental wellness presentation at the shop.

Besides staying in contact with Confess Project leaders, the some 50 barbers involved have access to a private social media discussion group, which has helped bond them to the larger cause, Lewis said. He also emphasized the importance of building long-term relationships to build trust.

Lewis said the project’s quick success could not have happened without partnering with black barbershops.

“They are one of the most trusted spaces beyond your home,” Lewis said.

From The Nation’s Health

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