Can Barbershops Help Trim Elevated Blood Pressure in African American Men?

Guest Commentary

A critique of the movie Barbershop was right on target. Calvin, the African American protagonist in the film, learns that the Chicago barbershop he has inherited from his family “is more than a place to get a haircut—it’s a meeting place for the neighborhood, a place where folks can speak their minds and find out what’s happening . . . and (he) starts to understand the importance of the legacy his grandfather and father have left him.”¹ But what does this observation have to do with quality medical care? A recent study makes a most unusual cultural connection between neighborhood barbershops and hypertension in African Americans.²

Hypertension is a devastating disease in the African American community. Black men have the highest death rate from hypertension of any race. In fact, African American men die of hypertension at a rate 3 times higher than that of white men.

BENEFITS OF BARBERSHOP
INTERVENTIONS
So enter the BARBER-1 (Barber-Assisted Reduction in Blood Pressure in Ethnic Residents) Study. From 2006 through 2008, black male patrons of 17 African American–owned barber shops were randomized into 2 groups: a standard group that received instructional pamphlets (8 shops with 77 hypertensive men per shop) and an intervention group in which the barbers continually offered blood pressure checks with haircuts and also promoted physician follow-up coupled with male-specific peer-based health messaging (9 shops with 75 hypertensive men per shop). The primary outcome measure was improvement in blood pressure control.

The hypertension control rate was better in intervention barbershops (8.8%, P = 0.4). The intervention persisted after adjustment for variables as well. It is worthwhile mentioning that blood pressure control was also better in the standard care group. In the discussion, the investigators review other diseases that affect African American men disproportionately, such as diabetes and prostate cancer, which are also being addressed in studies that use barbershops for community health programs.

IMPLICATIONS FOR PATIENT CARE
The commentary/editorial was informative. The author is an African American physician in Texas, where the study took place, and he describes his barbershop experience as “a remarkable social barometer that provides gut-check social commentary, defines a ‘captive audience,’ and represents a ‘teachable moment.’”³ He observes further that the barber is a “trusted partner” who possesses a cultural competency we as physicians may be lacking. But the closing quote of the commentary made me pause: “I will also wonder why it is they, the barbers, and not we, the physicians, who are providing the care.” Specialized, culturally sensitive community screening and greater physician sensitivity and awareness of what makes each of us unique seem to make for powerful messages. ■