A brief history of ABC’s early outreach in churches, barbershops and beauty salons

The idea of getting a haircut and having your blood pressure (BP) checked has garnered many conversations and the recent debates in both the Twittersphere and the media since its presentation at the ACC.18 Scientific Session in Orlando last month. As indicated in the study’s abstract, “A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops,” showed that “among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists.” The late Dr. Anthony Reid, a cardiologist and long time member of the ABC, was a co-investigator on this trial. But he is not the only ABC member to explore the viability of Black barbershops as “community-based hypertension control” centers. The ABC’s history of utilizing these much-beloved sites to reach African American men and address health disparities dates back almost forty years.

“Team-based treatment of hypertension gives barbershops a pivotal role in blood pressure control,” says ABC President John Fontaine MD, MBA, FACC, FHRS. “In this era, where cardiovascular disease and hypertension is the most common cause of death and debilitating stroke in this country, and more so in the African American community, an aggressive approach to managing risk factors is critical. This study, although not novel, highlights the health benefit that can be derived from a collaborative agreement between physicians and health advocates in the community.”

For this first phase of the trial, researchers selected 52 local barbershops and recruited 319 of their patrons – African American men – who had high blood pressure (registering above 130/mm) and randomly assigned them to one of two groups. In one group, the program trained barbers to take their customers’ blood pressure and refer those with elevated readings to a primary care physician for treatment and to make lifestyle improvements, such as increasing exercise and decreasing salt consumption. In the other group, the trained barbers encouraged patrons with elevated pressure to meet with pharmacists, who visited the barbershops on a monthly basis and when necessary prescribed BP medication, monitored blood tests, and worked with each patron’s primary care provider. After six months, both groups experienced reductions in blood pressure. However, almost two-thirds of participants in the group working with pharmacists brought their blood pressure into the healthy range – with as much as a 27-point drop, whereas only about one-eighth or 12 percent of the second group had similar results.

“Although the concept of utilizing barbershops to screen unsuspecting people for hypertension was first introduced by the late Dr. Elijah Saunders and Dr. B. Waine Kong many years ago, it has finally been scientifically tested in the African American population, using an innovative design,” Dr. Fontaine adds. “The results supersede those observed in larger studies and are encouraging. The sustainability of the results observed over the six-month period will have to be evaluated in a longer-term investigation.”

Since its inception, the ABC has sought to reduce incidences of cardiovascular disease (CVD) and eliminate the disparity in healthcare among people of color. In its efforts to realize these goals, particularly with hypertension, the organization developed community programs that began with the church but expanded to other areas, including barbershops and beauty salons. A founding member and past president, Dr. Saunders pioneered ABC’s community health programs, along with Dr. Kong, beginning in the late seventies. With a five-year grant from the NHLBI in 1979 called CHAMP, they trained 500 church volunteers from 100 churches in Maryland to monitor blood pressure of the churches’ members and make appropriate referrals. In 1980, as a way to more directly reach African American men, they used leftover equipment and literature to organize 20 barbers in six barbershops as high blood pressure control centers as well. Over a period of more than two decades, Dr. Saunders and Dr. Kong worked as a team to further develop and expand the reach of ABC’s church and barbershop programs and establish scholarship around their efforts. In 2006, during Dr. Saunders’ time at the University of Maryland, he is credited with launching a “Hair, Heart and Health” initiative in Maryland that later expanded to D.C. (funded by CareFirst Blue Cross Blue Shield), about two years later.

Prior to this most recent barbershop study, ABC former Chief Science Officer (CSO) and past Chair Keith Ferdinand MD, FACC, FAHA, FASH, worked with Paul L. Hess, MD, MHS, Ronald G. Victor, MD, and Joseph Ravenell, MD on a hypertension study using barbershops. But as early as 1994, Dr. Ferdinand served as principal investigator on the Healthy Heart Community Prevention Project (HHCPP) – partially funded by NHLBI – that included a component called “Cut Your Pressure,” where medical volunteers taught Black beauticians and barbers in New Orleans how to check blood pressure based on American Red Cross and American Heart Association guidelines and gave them various NIH publications about hypertension and other CVDs to review and distribute. Later, as CSO in 2009, Dr. Ferdinand worked with the REACH for Wellness Project, a program started and funded by the CDC in 1999 and which continued to provide, among other things, instruction on blood pressure screening to lay members at barbershops and beauty salons. These are but a few of the early examples of the hypertension outreach by the ABC and its members.

The ABC continues to take a leadership role in finding workable solutions to the issues of health care disparities in regards to cardiovascular diseases (CVD) such as hypertension. The organization conducts roundtables on issues of access to new therapeutics, collaborates with other NGOs as well as local, state and federal government agencies, and seeks to increase minority participation in clinical trials – the recent barbershop trial is a testament to the importance of this. The association also frequently partners with other membership organizations including the NMA (“Joint Symposium on the current state of CVD”), the AMA and AHA (with the national hypertension program, Target:BP) and with the ACC and AHA as part of the writing committee of the task force for the new blood pressure guideline (represented on the writing committee by Kenneth A. Jamerson, MD, and as a reviewer by Carlos Rodriguez, MD).

The legacy of Dr. Saunders and Dr. Kong’s pioneering work with community-based wellness outreach continues as many different programs in the U.S. have modeled and duplicated these kinds of efforts over the last four decades, such as the barbershop initiative launched last year by Kaiser Permanente of the Mid-Atlantic States, which was inspired by Dr. Saunders’ “Hair, Heart and Health” program. Additionally, the impact of their contributions to the ABC remain a part of its DNA and can be seen in the organization’s signature “Spirit of the Heart” community program. Held in cities across the country, the program often brings together local businesses along with faith, legislative, and community leaders for a three-day education and health-screening event.

The impressive results of the recent Barbershop study, which brought pharmacists directly to an at-risk population and offered coordinated, customized care, further demonstrates, what the ABC has always believed is critical in the effort to eliminate health disparities and save lives: a community-centered approach that engages directly with underserved populations.