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Update: Cedars-Sinai Study of LA Hair Salons

Los Angeles Barbershop Blood Pressure Study Provides Cutting-Edge Information More Than Four Years After Study Findings were Published in The New England Journal of Medicine.

With the help of participants in this landmark study, researchers at Cedars-Sinai’s Smidt Heart Institute are digging deeper to uncover how community health interventions might be best implemented at scale. They presented the rest of their findings today at the American College of Cardiology (ACC) Scientific Session taking place in Washington, D.C.

Hypertension, also known as high blood pressure, is reaching epidemic levels in the black community. A 2018 study in the Journal of the American Heart Association found that among its participants, 75.5% of black men and 75.7% of black women developed hypertension by age 55.and birthday.

The original Cedars-Sinai hair salon studies, the results of which were published in 2010 and 2018, were led by the late Ronald G. Victor, MD, and were the first to scientifically prove the effectiveness of bringing medical treatment directly to customers of black hair salons. The goal: to control blood pressure to help prevent heart attacks and strokes.

Barbers at 52 Los Angeles stores enrolled customers with high blood pressure, and clinical pharmacists visited the stores to prescribe and monitor medications for about half of those customers. Clients who worked with pharmacists showed a marked reduction in blood pressure – for a full 12 months – compared to other clients, who were referred to their primary care providers.

“After the publication of the results of the study on hair salons in 2018 in the New England Journal of Medicine, many groups have been interested in trying to replicate the program,” said Christine M. Albert, MD, MPH, chair of the Department of Cardiology and principal investigator of the study after Victor died. “We wanted to understand, from the perspective of the participants, the elements that made the barber model successful.”

That led to follow-up research – presented today at ACC Scientific Sessions by medical student and first author Nathan Kohrman – where investigators interviewed 20 hair salon customers, 10 barbers and the one of two pharmacists who participated in the hair salon study. The follow-up interviews were designed to determine the key elements that would be needed to successfully replicate or scale up the intervention.

The new analysis was conducted in partnership with the Los Angeles County Department of Public Health, which helped structure the interview questions for the study.

In their phone interviews, participants in the hair salon study said they had struggled to adopt healthy habits – especially proper diet, exercise and taking medications as directed. – and said the program helped them recognize the importance of keeping their blood pressure at a healthy level.

“The community context of the program and the support network in hair salons really underscored that for them,” said Joseph Ebinger, MD, director of Clinical Analytics and lead author of the program’s new analysis. “Having direct contact with the pharmacists in such a place of trust gave them a sense of agency that they did not feel in a clinical setting, and the fact that they discussed the study with barbers, their families and their friends made them feel more committed to improving their health.”

Participating barbers said the study strengthened their role as community leaders and felt it was a positive new way to serve their community.

“Some of these barbers have seen these clients every other week for decades,” Ebinger said. “They have built strong relationships and they know their customers will listen to what they have to say.”

These cultural and social factors were key to the program’s success, said C. Adair Blyler, PharmD, clinical pharmacist at Smidt

“For those creating similar programs, I think it’s important to first understand the origins of the health issue in question, the ‘players,’ and how the issue affects them,” Blyler said. “But the most important thing is to understand how the players themselves would like to see the problem solved. For me, the main takeaway from the hair salon study is that health care is most effective when it is dynamic and flexible enough to meet patient needs.

The team’s future research goals include following hair salon clients to see if their success in keeping high blood pressure at bay translates to fewer heart attacks and strokes, Ebinger said.

The team would also like to understand how public health measures implemented during the COVID-19 pandemic may have disrupted or altered opportunities for community health interventions.

“During the pandemic, several hair salons have closed or significantly changed the way they operate,” Ebinger said. “Many now require customers to meet rather than just stop by, which means fewer opportunities for them to congregate and interact.”

Blyler said she believes these challenges can be overcome.

“The pandemic has certainly changed the way we come together, but it hasn’t changed our desire to connect with others and be part of a larger community,” Blyler said. “That means community-based research always has the ability to reach people. We may have to adapt our approach to take into account the new standards, but I believe we can still succeed.

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