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Table 1.  

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)
Male 707 (38.6)
Female 1,116 (60.9)
Unknown/missing 10 (0.5)
White 305 (16.6)
Black 1,150 (62.7)
Hispanic 311 (17.0)
Other 40 (2.2)
Unknown/missing 27 (1.5)
<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

Table 2.  

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)
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

Table 3.  

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
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.


The Arkansas Minority Barber and Beauty Shop Health Initiative: Meeting People Where They Are

  • Authors: Chimfumnanya Smith, MPH, CHES; Austin Porter III, DrPH, MPH; Joyce Biddle, MPA, MPH; Appathurai Balamurugan, MD, DrPH; Michelle R. Smith, PhD, MPH
  • CME / ABIM MOC Released: 12/3/2020
  • Valid for credit through: 12/3/2021
Start Activity

Target Audience and Goal Statement

This activity is intended for primary care physicians and other physicians who provide health screenings and preventive care.

The goal of this activity is to assess the impact of community-based health screenings for Black and Latinx adults.

Upon completion of this activity, participants will be able to:

  • Assess racial and ethnic disparities in cardiovascular health in the United States
  • Distinguish the most common cardiovascular risk factors identified in the current study
  • Evaluate follow-up among adults who received abnormal results during health screenings in the current study
  • Identify which health topic was associated with the greatest gain in patient knowledge in the current study


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  • Chimfumnanya Smith, MPH, CHES

    Arkansas Department of Health
    Little Rock, Arkansas


    Disclosure: Chimfumnanya Smith, MPH, CHES, has disclosed no relevant financial relationships.

  • Austin Porter III, DrPH, MPH

    Arkansas Department of Health
    Fay W. Boozman College of Public Health
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas


    Disclosure: Austin Porter III, DrPH, MPH, has disclosed no relevant financial relationships.

  • Joyce Biddle, MPA, MPH

    Arkansas Department of Health
    Little Rock, Arkansas


    Disclosure: Joyce Biddle, MPA, MPH, has disclosed no relevant financial relationships.

  • Appathurai Balamurugan, MD, DrPH

    Arkansas Department of Health
    Fay W. Boozman College of Public Health
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas


    Disclosure: Appathurai Balamurugan, MD, DrPH, has disclosed no relevant financial relationships.

  • Michelle R. Smith, PhD, MPH

    Arkansas Department of Health
    Little Rock, Arkansas


    Disclosure: Michelle R. Smith, PhD, MPH, has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California


    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: GlaxoSmithKline


  • Ellen Taratus

    Editor, Preventing Chronic Disease


    Disclosure: Ellen Taratus has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director
    Accreditation and Compliance
    Medscape, LLC


    Disclosure: Stephanie Corder, ND, RN, CHCP, has disclosed no relevant financial relationships.

CE Reviewer

  • Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE

    Associate Director
    Accreditation and Compliance
    Medscape, LLC


    Disclosure: Hazel Dennison, DNP, RN, FNP-BC, CHCP, CPHQ, CNE, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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The Arkansas Minority Barber and Beauty Shop Health Initiative: Meeting People Where They Are: Discussion



The results of this study highlight the efforts of a screening program designed to reach a population with a disproportionate share of many chronic diseases. The literature is rich in highlighting innovative ways to reach racial/ethnic minority populations, particularly Black people, to screen for specific chronic diseases.[22–24] Many of these screening activities stress the importance of meeting people where they live and work and have been held in churches, barber/beauty shops, community centers, and other nontraditional locations. The ARBBS initiative sought not only to screen for chronic diseases among a high-risk population but also to provide education and refer people who required follow-up care to a health care provider.

The initial referral and nurse coordinator follow-up were unique aspects of this screening program. The program sought to identify and refer participants with abnormal screening results to an appropriate health care provider and to follow up on treatment outcomes. Using a point of contact after the initial abnormal screening results has been shown to be effective in increasing compliance.[25] A study by Rorie et al used resident housing advocates (RHAs) to follow up with residents of public housing who had abnormal screening results.[25] The RHA offered to help make appointments for residents and accompany residents to their follow-up appointment; the proportion of participants who completed a follow-up appointment increased from 15.0% to 55.0%.[25] Although our program attempted to contact all participants with abnormal screening results, we made contact with 55.7%, and 28.0% kept their follow-up appointments within 30 days of the screening event. Nevertheless, we received anecdotal information that at least 10 participants with abnormal screening results subsequently obtained potentially life-saving surgeries.

Barber and beauty shops have been used as avenues to promote health in the Black community.[16,26] Many promotion activities were associated with an increase in health knowledge. A study conducted by Luque et al administered a health education intervention in barbershops that aimed to increase the knowledge and awareness of prostate cancer and screening in the African American community.[26] These researchers found a significant increase in knowledge among clients given educational materials on prostate cancer.[26] Similarly, the results of our study indicated that the knowledge of chronic diseases and risk factors among participants increased significantly after the intervention.

Modifiable risk factors such as high blood pressure, obesity, diabetes, physical inactivity, and tobacco use increase CVD disparities between non-Hispanic White people and Black and Hispanic people.[7,27] About 46.8% of Black people and 47.0% of Hispanic people are obese, and both populations are more likely than non-Hispanic White people to be diagnosed with hypertension and diabetes and be physically inactive.[8,28] Systematic, environmental, and structural factors also contribute to the high risk and mortality rates of CVD among Black and Hispanic people.[29] Racism, poverty, and low socioeconomic status are associated with increased CVD risk and mortality rates among Black people and Hispanic people.[5,30] Because of inequities worsened by the social determinants of health among many members of racial/ethnic minority populations, it is essential to provide targeted educational and health-promoting interventions to these populations.

Our initiative had several strengths, including the follow-up of participants with abnormal screening results, the inclusion of Black women and Hispanic populations, and the use of nontraditional locations. In addition, more than half of participants were aged 45 or younger; information obtained by people at these younger ages may help to reduce the risk for chronic diseases later in life. Other health promotion activities, such as screening for HIV and sexually transmitted infections, breast cancer, prostate cancer, and mental health, can easily be incorporated into the structure of our initiative. Programs such as ours can be sustained through in-kind contributions and collaboration with various partner organizations, such as hospitals, universities or colleges, and other local community organizations.

Our study has several limitations. First, we used a convenience sample. Barbershop and beauty shop clientele who self-selected to participate in the program may have been different from those who elected not to participate. Second, we did not measure the long-term effect of knowledge gained during the intervention. We assessed knowledge gained immediately after the intervention. Future studies should be designed to measure the long-term effects of the program on participants’ knowledge and changes in health outcomes. Third, we did not conduct regression analyses to identify variables such as health insurance status, ethnicity, and sex that may be associated with keeping follow-up appointments. Fourth, we did not collect data on people lost to follow-up; this information could have provided additional insight into the effect of our intervention. Future research should explore other types of follow-up interventions, such as medication therapy programs for populations with limited access to these programs. Additionally, a cost-benefit analysis of the initiative should be conducted.

Notwithstanding these limitations, the results of our study add to the evidence that barber and beauty shops are viable options for promoting healthy behaviors and conducting screening programs in racial/ethnic minority communities. To the best of our knowledge, our program was the first to incorporate Black women and Hispanic participants. Participants were screened for chronic health conditions and received education on how to reduce their risk for these conditions. Follow-up on abnormal screening results was a critical element of our program: it sought to ensure that patients were further tested and treated by a medical provider. Screening programs must be intentional in screening, educating, and intervening with populations at risk of chronic diseases. Public health programs that seek to target racial/ethnic minority populations should meet people where they are in the community. Community-based health education and behavior modification can be effective measures to decrease CVD risk factors in racial/ethnic minority populations.