Friday, March 24, 2023
| Characteristic | No. (%) |
|---|---|
| Age, y | |
| 18–24 | 284 (15.5) |
| 25–34 | 371 (20.2) |
| 35–44 | 346 (18.9) |
| 45–54 | 270 (14.7) |
| 55–64 | 312 (17.0) |
| ≥65 | 212 (11.6) |
| Unknown/missing | 38 (2.1) |
| Sex | |
| Male | 707 (38.6) |
| Female | 1,116 (60.9) |
| Unknown/missing | 10 (0.5) |
| Race/ethnicity | |
| White | 305 (16.6) |
| Black | 1,150 (62.7) |
| Hispanic | 311 (17.0) |
| Other | 40 (2.2) |
| Unknown/missing | 27 (1.5) |
| Education | |
| <High school graduate | 262 (14.3) |
| High school graduate | 478 (26.1) |
| Some college | 501 (27.3) |
| College graduate | 504 (27.5) |
| Unknown/missing | 88 (4.8) |
| Has health insurance | |
| Yes | 1,440 (78.6) |
| No | 363 (19.8) |
| Unknown/missing | 30 (1.6) |
| Has a personal physician | |
| Yes | 1,259 (68.7) |
| No | 473 (25.8) |
| Not sure/refused | 2 (0.1) |
| Unknown/missing | 99 (5.4) |
Table 1. Demographic Characteristics of Adults Participating in the Arkansas Minority Barber & Beauty Shop Health Initiative (N = 1,833), Arkansas, 2016–2019
| Result | No. (%) |
|---|---|
| Blood pressure | |
| Hypotension (90 mm Hg/<60 mm Hg) | 5 (0.3) |
| Normal (91–120 mm Hg/61–80 mm Hg) | 524 (28.6) |
| Prehypertension (121–139 mm Hg/81–89 mm Hg) | 643 (35.1) |
| Stage 1 hypertension (140–159 mm Hg/90–99 mm Hg) | 405 (22.1) |
| Stage 2 hypertension (160–179 mm Hg/100–109 mm Hg) | 173 (9.4) |
| Critical hypertension (≥180 mm Hg/≥110 mm Hg) | 61 (3.3) |
| Unknown/missing | 22 (1.2) |
| Cholesterol | |
| Hypocholesterolemia (0–49 mg/dL) | 0 |
| Normal (50–200 mg/dL) | 1,324 (72.2) |
| Borderline (201–239 mg/dL) | 238 (13.0) |
| High (≥240 mg/dL) | 118 (6.4) |
| Unknown/missing | 153 (8.3) |
| Blood glucose | |
| Low (0–70 mg/dL) | 69 (3.8) |
| Normal (71–140 mg/dL) | 1,470 (80.2) |
| Prediabetes (141–200 mg/dL) | 113 (6.2) |
| Diabetes (≥201 mg/dL) | 100 (5.5) |
| Unknown/missing | 81 (4.4) |
| Body mass index, kg/m2 | |
| Underweight (<18.5) | 0 |
| Normal (18.5-24.9) | 352 (19.2) |
| Overweight (25.0–29.9) | 497 (27.1) |
| Obese (≥30.0) | 901 (49.2) |
| Unknown/missing | 83 (4.5) |
Table 2. Screening and Referral Results of Adults Participating in the Arkansas Minority Barber & Beauty Shop Health Initiative (N = 1,833), Arkansas, 2016–2019
| Question | Correct Answer | Pretest, % Correct | Posttest, % Correct | P Valuea | Percentage-Point Difference |
|---|---|---|---|---|---|
| Multiple Choice | |||||
| What should a normal blood pressure level be? | Top number <120 | 55.0 | 86.6 | <.001 | 31.5 |
| What should a normal blood pressure level be? | Bottom number <80 | 50.7 | 77.7 | <.001 | 27.0 |
| What is a normal total cholesterol level? | <200 | 44.6 | 87.9 | <.001 | 43.3 |
| If you thought someone was having a stroke or heart attack, what would be the first thing you should do? | Call 911 | 92.7 | 98.2 | <.001 | 5.6 |
| Average correct | — | 60.8 | 87.6 | — | 26.8 |
| True or False | |||||
| The following are some symptoms of a stroke | |||||
| Facial droop | True | 90.4 | 98.5 | <.001 | 8.1 |
| Slurred speech | True | 90.6 | 98.1 | <.001 | 7.5 |
| Weakness in arm or leg | True | 89.9 | 95.1 | <.001 | 5.2 |
| The following are some symptoms of a heart attack | |||||
| Chest pain | True | 94.1 | 97.4 | <.001 | 3.3 |
| Nausea/flu-like symptoms | True | 70.4 | 90.0 | <.001 | 19.6 |
| Neck, back, and jaw pain | True | 74.6 | 90.0 | <.001 | 15.5 |
| Shortness of breath | True | 93.4 | 95.9 | <.001 | 2.5 |
| Average correct | — | 86.2 | 95.0 | — | 8.8 |
| All | |||||
| Overall average correct | — | 76.9 | 92.3 | — | 15.4 |
Table 3. Knowledge Assessment Results of Adults Participating in the Arkansas Minority Barber & Beauty Shop Health Initiative (N = 1,833), Arkansas, 2016–2019
a Differences between pretest and posttest determined by χ2 test.
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Introduction The Office of Health Equity at the Arkansas Department of Health created the Arkansas Minority Barber & Beauty Shop Health Initiative (ARBBS) to address cardiovascular disease (CVD) among racial/ethnic minority populations. The objective of this study was to describe CVD-related screening results for ARBBS participants and their knowledge of CVD-related risk factors, signs, and symptoms before and immediately after participation in a screening event.
Methods ARBBS screening events were held from February 2016 through June 2019 at barber and beauty shops in 14 counties in Arkansas. During each event, participants were screened for hypertension, high cholesterol, and diabetes; surveys on CVD-related knowledge were administered before (pretest) and after (posttest) screening. Onsite public health practitioners reviewed surveys and identified abnormal screening results. Participants with abnormal screening results were counseled and given a referral to follow up with a primary care physician, wellness center, or charitable clinic. The nurse coordinator followed up to confirm that a visit or appointment had been made and provide case-management services.
Results During the study period, 1,833 people were screened. The nurse coordinator followed up with 320 (55.7%) of 574 unique referrals. Of the 574 referrals, 418 (72.8%) were for hypertension, 156 (27.2%) for high cholesterol, and 120 (20.9%) for diabetes. The overall knowledge of risk factors and symptoms of heart attack and stroke increased significantly by 15.4 percentage points from pretest to posttest (from 76.9% to 92.3%; P < .001). The follow-up approach provided anecdotal information indicating that several participants discovered they had underlying medical conditions and were given medical or surgical interventions.
Conclusion Through referrals and follow-ups, ARBBS participants gained greater knowledge of chronic disease prevention and risk factors. Additionally, this program screened for and identified people at risk for CVD.
Cardiovascular disease (CVD), the leading cause of mortality globally, represented 31.0% of all global deaths in 2017.[1] Of 17.9 million deaths worldwide from CVD in 2017, 85.0% were attributed to myocardial infarctions and stroke.[2] In the United States, heart disease and stroke are the first and fifth leading causes of death, respectively.[3] In 2018, 1 in every 4 deaths was associated with heart disease, and 1 in 20 deaths was associated with stroke.[4]
In the United States, disparities in CVD outcomes are exacerbated by the social constructs and inequalities that disproportionately affect racial/ethnic minority populations.[5] Compared with other racial/ethnic populations, Black people have the highest risk for both heart disease and stroke.[5] Black people develop CVD risk factors (eg, hypertension, obesity, diabetes) at an earlier age and have a higher CVD morbidity and mortality rate compared with their White counterparts.[6,7] Despite the underreporting of data among Hispanic people, heart disease accounts for 20.1% of their deaths, which is comparable to rates among Black people, at 23.7%.[6]
Black people have more than twice the incidence of stroke and are twice as likely to die of a stroke compared with their White counterparts.[4,8] In the United States, stroke is the third leading cause of death among Black people, fourth among Hispanic people, and fifth among White people.[6] Hispanic people are more likely than non-Hispanic White people to be unaware of their risks for CVD.[9]
The trends in heart disease and stroke in Arkansas are similar to national trends: they are the first and fifth causes of death, respectively.[10] Of the 50 states, Arkansas ranks third highest in heart disease deaths and seventh in stroke deaths.[10] The state faces significant challenges: 35.0% of adults are obese, 32.5% are physically inactive, and 22.3% are tobacco users.[11] According to the US Census Bureau, Arkansas had a population of 3,017,804 people in 2019, with White people representing 79.0% of the population, Black people representing 15.7%, and other races representing the remaining 5.3%.[12] Race/ethnicity plays an important role in the prevalence of CVD in the state; Black and Hispanic people have higher rates than White people of heart disease and stroke.[10,13] Also, the prevalence of hypertension is higher among Black people (46.0%) than among White people (39.0%).[14] The Arkansas Red County Life Expectancy Profile shows that Black people have a lower life expectancy than their White counterparts: 68.6 years for Black men, compared with 71.1 years for White men, and 75.8 years for Black women, compared with 76.0 years for White women.[15]
Barbershops and beauty shops have historically served as places where people not only get hair services but also can openly and honestly talk about issues of importance in their community.[16,17] Barbershops and beauty shops are conveniently located and are frequently visited by community patrons of all ages; these locations are important and culturally appropriate avenues for addressing health and social issues.[16] Health promotion programs that target Black people, particularly Black men, have partnered with barbershop owners who are trusted members of their communities to help deliver health messages and help address health issues that disproportionately affect Black communities.[18] Studies have described these partnerships, demonstrated an increase in knowledge and positive changes in health behaviors among clients, and emphasized the need for community health education–based programs to increase their outreach efforts to at-risk populations through barber and beauty shop health intervention initiatives.[16,18,19]
In 2013, the Office of Health Equity, formerly known as the Office of Minority Health & Health Disparities, at the Arkansas Department of Health, created the Arkansas Minority Barber & Beauty Shop Health Initiative (ARBBS) to address CVD and its risk factors among racial/ethnic minority populations. The mission of the initiative was to increase public awareness about heart disease and stroke and empower racial/ethnic minority communities to better understand hypertension prevention and management. This initiative differed from other barbershop health promotion programs in that, in addition to outreach at barbershops, it included beauty shops and barber/beauty colleges and added a program component for the Hispanic population. The initiative also included follow-up on participants who had abnormal screening results. These participants were referred to their family physician or a charitable clinic for treatment. The primary objective of this study was to describe CVD-related screening results of ARBBS participants and knowledge of CVD-related risk factors, signs, and symptoms before and immediately after participation in a screening event.
