1. Can barbers cut BP too? the BARBER-1 trial… Ron Victor, M.D. Burns & Allen Chair in Cardiology Research Professor of Medicine, UCLA Director, Hypertension Center Associate Director, Cedars-Sinai Heart Institute

2. Can barbers cut BP too? Mr. James Smith, President Our innovators’ story…  Community needs assessment  Intervention development & feasibility studies  BARBER-1: 1 st RCT (Dallas)  BARBER-2: Coming to LA…

3. Dallas Population Sample (adults < 65Y, 50% Blacks) Barber-Based Intervention SOUTHWESTERN BP less controlled in black men than women More black men had a barber than a doctor RG Victor et al., Arm J Cardiol. 2004; Arch Intern Med. 2008 Community-Level Needs Assessment The Dallas Heart Study

4. Feasibility studies: Study 1–Medical students and staff Study 2–Barbers as BP “specialists”

5. On-Line: Oct 25, 2010 Print: Feb 28, 2011 BARBER-1 Barber-Assisted Reduction of Blood Pressure in Ethnic Residents

6. Study Shops Other Shops African American-owned barbershops in Dallas County, TX: 2006-2008 225 barbershops  17 study sites ● 10+ years in business ● 4 barbers / shop ● 75 men with HTN / shop

7. Comparison Group (9 shops, 695 patrons with HTN)  AHA pamphlet (HTN in Blacks) Intervention Group (8 shops, 606 patrons with HTN)  No pamphlets  Barbers monitored BP and promoted MD follow- up X 10 months  Barbers discussed role model posters (personalized peer health messaging)

8. Baseline Characteristics — of male patrons with HTN Intervention (695 men w. HTN) Comparison (606 men w. HTN) Age (y)4951 Patronage (y)710 % w. Income >3X poverty level 5462 % Insured85 % Married5767

9. Barbers as healthcare partners

10. Role Model Poster

11. Intervention Fidelity 539 patrons with HTN completed the exit survey in the intervention barbershops:  410 patrons (76%) reported that their barber discussed model stories.  Barbers recorded 3375 sets of BPs (6 sets/patron=~60% of haircuts).  Barbers gave high BP referral cards to 288 patrons and 176 (66%) returned a signed card (MD-patient interaction).

12. Patrons free haircuts ($12 ea.) Barbers $3 per valid BP check $10 per phone call to study staff $ 50 per referral card signed by MD Research staff & contracts  Scientific evaluation  $ 5+ million in research grants (NIH+) Paid for performance…

13. Cost-Benefit 3 mmHg greater fall in systolic BP if applied to the 50% of AA men with HTN in 18,000 barbershops  Barber incentives  Patron incentives  Rx costs $200 M in Year 1 Benefit  800 fewer heart attacks  500 fewer strokes  900 fewer deaths $110 M in Year 1 Cost

14. Pharmacists? Under-treatment of HTN Physician inertia Barber fidelity Patron acceptance Non- Adherence Better medical treatment BARBER-2 Trial (in Los Angeles): How to ehance intervention potency?

15. Team Science! Premere Knowles, Anne Feng, Julie Groth, Andre Rogatko, et al. Cedars-USC Pharmacy Rita Shane, Steven Chen, Alison Reta, Sara Niknezhad UT Southwestern Robert Haley, Anne Freeman, David Leonard, Paul Hess, Deepa Bhat, Patricia Knowles, and many more… Xavier Univ. & ABC Keith Ferdinand Univ. of Minnesota Peter Hannan UCSF Mark Pletcher, Kirsten Bibbins- Domingo, Pam Coxson UCLA CTSI Martin Shapiro, Suzanne Shu, Robert Elashoff, Kate Crespi Charles Drew Univ. Keith Norris Healthy AA Families Loretta Jones PAST FUNDING Reynolds Foundation Texas Education Board, AHA CURRENT FUNDING NHLBI (RO-1 HL080582) Lincy Foundation, UCLA-CTSI

16. Questions (Barber Intervention) Reach Issue:  How to reach the patrons’ physicians in our fragmented healthcare system? Policy Issue:  How to make barbers’ blood pressure monitoring/referral reimbursable care? Disparity Issues:  How to scale up the barber-based program?  How to benefit more low-income men?