Finding Optimal Locations for Implementing Innovative Hypertension Management Approaches Among African American Populations: Mapping Barbershops, Hair Salons, and Community Health Centers
GIS SNAPSHOTS — Volume 21 — February 15, 2024
Yui Fujii, MPH1,2; Taylor E. Streeter, MPH1; Linda Schieb, MPH1; Michele Casper, PhD1; Hilary K. Wall, MPH1 (View author affiliations)
Suggested citation for this article: Fujii Y, Streeter TE, Schieb L, Casper M, Wall HK. Finding Optimal Locations for Implementing Innovative Hypertension Management Approaches Among African American Populations: Mapping Barbershops, Hair Salons, and Community Health Centers. Prev Chronic Dis 2024;21:230329. DOI: http://dx.doi.org/10.5888/pcd21.230329.
PEER REVIEWED
High-resolution JPG for printimage iconimage iconimage icon
Within a 2-mile radius of the East Oakland Health Center and the West Oakland Health Center, in Oakland, California, numerous barbershops and hair salons are located in census tracts where more than 14.7% of the population is Black or African American. This map provides information for implementing innovative blood pressure management approaches that extend the evidence-based LA barbershop model in African American communities. Sources: US Census Bureau (1), Esri Business Analyst (2). [A text version of this figure is available.]
Background
An estimated 120 million US adults have hypertension, a leading cause of heart disease, stroke, and kidney disease, and about 93 million of those adults have uncontrolled hypertension (3,4). Black or African American (hereinafter, African American) populations have a disproportionate burden of hypertension and hypertension-related mortality compared with White populations (5,6). The Los Angeles Barbershop Blood Pressure Study, a novel approach to improve hypertension control among African American adults, involved partnerships between local barbershops and pharmacists. Barbers screened African American men for hypertension, and pharmacists provided hypertension medication management. This intervention significantly reduced systolic blood pressure by an average of 21.6 mm Hg among African American men enrolled in the study (7).
The LA barbershop model demonstrated that trusted spaces, like barbershops, can facilitate evidence-based care and contribute to reductions in blood pressure in African American communities (8,9). Although recognized for its impact on hypertension control, this model has not been scaled to real-world settings, nor has it been expanded to include other trusted spaces. Million Hearts, a national initiative to prevent myocardial infarctions, strokes, and other cardiovascular events, is mapping selected communities as part of a feasibility demonstration project to identify patterns of 3 core components needed for large-scale implementation of the LA barbershop model: 1) percentage of the population that is African American, 2) location of community health centers, and 3) location of barbershops and hair salons within a 2-mile radius of community health centers. In this GIS Snapshot, we expand on the LA barbershop model by including hair salons as trusted spaces and focus on these 3 core components in Oakland, California.
Data and Methods
We obtained data on the percentage of the population that is African American in each census tract in Oakland, California, from the US Census Bureau American Community Survey (2016–2020) (1). We selected the East Oakland Health Center and the West Oakland Health Center because of their interest in partnering in Million Hearts. We used the North American Industry Classification System codes 812111 (barber shops) and 812112 (hair salons) from Esri Business Analyst to obtain geocoded data on barbershops and hair salons, along with their sales volumes (2). We categorized barbershops and hair salons according to tertiles of sales volume.
We created a choropleth map that shows tertiles of the percentage of population that is African American in Oakland (N = 116 census tracts) and drew a 2-mile radius around each health center to capture core components nearby. We included in the map all barbershops (N = 25) and hair salons (N = 112) within a 2-mile radius of each health center; the map also shows these businesses by tertile of sales volume. We used ArcGIS Pro 2.9.2 (Esri) to create the map.
Highlights
Within a 2-mile radius of both the East Oakland Health Center and the West Oakland Health Center, numerous barbershops and hair salons are located in census tracts in the middle tertile (14.7%–24.9%) and top tertile (25.0%–52.3%) of percentage African American population. More barbershops and hair salons are within a 2-mile radius of the West Oakland Health Center (n = 88) than the East Oakland Health Center (n = 49). However, the East Oakland Health Center has a greater percentage (43%) of shops and salons located in the top tertile of percentage of African American population, compared with those near the West Oakland Health Center (16%). In both locations, there are barbershops and salons in all 3 categories of sales volume. These locations are potential settings for implementing the LA barbershop model of hypertension medication management in real-world settings.
Action
Million Hearts addresses inequities in health care among racial and ethnic minority populations, including hypertension medication management in trusted spaces for African American people with hypertension. Our map provides valuable information for implementing innovative hypertension management approaches that extend the evidence-based LA barbershop model. Community health centers in Oakland can use this map to identify barbershops and hair salons — trusted spaces in African American communities — to initiate discussions for enhancing community–clinical linkages for hypertension management that are tailored to the needs of African American communities. This asset mapping of 3 core components (percentage African American population, presence of health centers, and nearby barbershops and hair salons) can serve as a model for other communities interested in extending the LA barbershop model of hypertension medication management.
A recent statement from the American Heart Association/American Medical Association (AHA/AMA) indicates that “large-scale implementation and dissemination [of high blood pressure management and control strategies] would help accelerate the translation of evidence-based best practices into care” (10). The AHA/AMA statement is an urgent call for multipronged approaches to optimize blood pressure management in light of the recent national declines in blood pressure control (10). These organizations also recognized the need to increase access to care for populations that have been historically excluded from traditional health care settings and have a disproportionately high burden of hypertension.
Acknowledgments
This work was supported by the Division for Heart Disease and Stroke Prevention. The authors declared no potential conflicts of interest with respect to the research, authorship, or publication of this article. No copyrighted materials were used in this article. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Author Information
Corresponding Author: Yui Fujii, MPH, Centers for Disease Control and Prevention, 4770 Buford Hwy, Bldg 107, Mailstop S107-1, Atlanta, GA 30341 (Tzf2@cdc.gov).
Author Affiliations: 1Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. 2Bizzell US, New Carrollton, Maryland.
References
- US Census Bureau. Decennial census of population and housing. Page last revised August 18, 2022. Accessed September 20, 2022. https://www.census.gov/programs-surveys/decennial-census.html
- Esri Business Analyst. North American Industry Classification System code 812111 and 812112. Last revised January 4, 2024. Accessed September 20, 2022. https://www.census.gov/naics/?input=812111&year=2022&details=812111
- Centers for Disease Control and Prevention (CDC). Estimated hypertension prevalence, treatment, and control among U.S. adults. US Department of Health and Human Services: Atlanta, GA, 2019. Last reviewed May 12, 2023. Accessed March 10, 2023. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html
- Centers for Disease Control and Prevention. Blood pressure control. Last reviewed July 5, 2022. Accessed March 10, 2023. https://millionhearts.hhs.gov/about-million-hearts/optimizing-care/bp-control.html
- Goff DC Jr, Khan SS, Lloyd-Jones D, Arnett DK, Carnethon MR, Labarthe DR, et al. . Bending the curve in cardiovascular disease mortality: Bethesda + 40 and beyond. Circulation. 2021;143(8):837–851. PubMed doi:10.1161/CIRCULATIONAHA.120.046501
- Kochanek KD, Arias E, Anderson RN. How did cause of death contribute to racial differences in life expectancy in the United States in 2010? NCHS Data Brief. 2013; (125):1–8. PubMed
- Victor RG, Lynch K, Li N, Blyler C, Muhammad E, Handler J, et al. . A cluster-randomized trial of blood-pressure reduction in Black barbershops. N Engl J Med. 2018;378(14):1291–1301. PubMed doi:10.1056/NEJMoa1717250
- Ogunniyi MO, Commodore-Mensah Y, Ferdinand KC. Race, ethnicity, hypertension, and heart disease: JACC focus seminar 1/9. J Am Coll Cardiol. 2021;78(24):2460–2470. PubMed doi:10.1016/j.jacc.2021.06.017
- Zheutlin AR, Caldwell D, Anstey DE, Conroy MB, Ogedegbe O, Bress AP. Trends in hypertension clinical trials focused on interventions specific for Black adults: an analysis of ClinicalTrials.gov. J Am Heart Assoc. 2020;9(24):e018512. PubMed doi:10.1161/JAHA.120.018512
- Abdalla M, Bolen SD, Brettler J, Egan BM, Ferdinand KC, Ford CD, et al. ; American Heart Association and American Medical Association. Implementation strategies to improve blood pressure control in the United States: a scientific statement from the American Heart Association and American Medical Association. Hypertension. 2023;80(10):e143–e157. PubMed doi:10.1161/HYP.0000000000000232
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.