Christina Boyd is a stylist, and something of a psychiatrist. When women sit down in her chair, she hears stories they might never tell anyone else.

“They feel comfortable talking to me, and I think it’s because I don’t know anyone who knows them,” says Boyd, who owns the Hair Estate in Durham, a beauty salon popular among black women. “They tell me things they don’t even tell their husbands or doctors or best friends.”

It’s also because, like many stylists, Christina’s a good conversationalist, says Veronica Carlisle of UNC’s Lineberger Comprehensive Cancer Center. “Customers have developed a relationship with their stylists such that they feel comfortable sharing information with them, and also trust what their stylists share with them,” she says.

In 2002, researchers at Lineberger surveyed forty local salons frequented by black women. They found that about 75 percent of salon customers visit their stylist once every four weeks, and about 17 percent visit at least once a week. Many spend more than two hours per visit — partly to have their hair done, and partly to chat with their stylists.

One in every five of these conversations was health-related, Carlisle says.

Building on their findings, researchers asked these salons to participate in the North Carolina BEAUTY (Bringing Education And Understanding To You) Project, a four-year health and cancer intervention study in salons in eight North Carolina counties.

Cancer incidence and death rates in the United States are disproportionately higher among black women, says Laura Linnan, who leads the BEAUTY Project.

The research study expands on work Linnan’s group completed in 2002, when they first partnered with cosmetologists, beauty school directors, a beauty product distributor, a local health department representative, community residents, and a community outreach worker from the Cancer Information Service to find out what kinds of health messages would work best in beauty salons, and how to most effectively deliver them.

“We told the researchers that they had to get the stylists involved, because the stylists are the ones dealing with the customers,” says Morris Boswell, chairman of the cosmetology department at Guilford Technical Community College and a member of the BEAUTY advisory board. “If they can get the stylists to buy into the concept, then it can work.”

It turned out that most of the stylists were excited about the project, Linnan says. They also preferred messages that were easy to communicate.

So researchers kept the messages simple: eat three to five servings of fruits and vegetables a day, engage in physical activity for at least thirty minutes most days of the week, talk with your doctor about personal risks for cancer and recommended cancer-screening tests, and dial 1-800-4-CANCER to get more information.

They put these messages on interactive display boards in each salon, changing the displays once every three months. Each board had a picture of the stylist and a quote, such as, “Ask me how you can maintain a healthy weight!”

A few of the displays had pictures of large food portions on flaps that customers could lift to see how much a single serving of that food actually is; a “rate your plate” section; quick tips on lowering fat intake; and a scale that customers could use to estimate their body mass index. Small pockets attached to the boards also contained brochures, activity calendars, and other materials customers could take home with them.

“The displays were there so customers would get curious and start asking their stylists about what they saw,” Carlisle says. “We’ve trained the stylists on these health messages, so they can share them with their customers.”

Linnan’s group also trained the stylists to latch on to a comment a customer might make any time during a visit, even if the comment wasn’t related to the displays. Because many salon conversations were already health-related, Carlisle says, it was easier to introduce topics related to reducing cancer risk.

“We encouraged stylists to use their natural skills to weave the health messages into a typical conversation, and to encourage their customers,” Carlisle says. “If the customer says, ‘I want to walk but I can’t stick with it,’ then the stylist can say something about walking with a friend.”

But the researchers don’t expect the stylists to be nutritionists, physicians, or physical therapists. “If they don’t know the answer to a question, they recommend that the customer speak with their doctor or dial 1-800-4-CANCER,” Carlisle says.

Researchers used three groups of stylists for the study: the first received health magazines in the mail for their customers, the second received four-hour health training sessions every three months, and the third received both magazines and training. All three groups received displays. The magazines, training, and displays contained similar messages. Meanwhile, a comparison group received unrelated health messages.

The research team compared surveys completed by customers at the beginning and end of the four-year study to assess if BEAUTY resulted in changes in health behavior among customers, stylists, or the salon environment.

They are still finalizing the results, Linnan says, but preliminary data indicate that in all of the salons, there was a modest increase in the number of health conversations customers had with their stylists, in self-reported physical activity, and in self-reported cancer screening tests such as mammograms, Pap tests, and colonoscopies. Almost all of the salon owners said that all salons should offer programs such as BEAUTY.

There are over twelve thousand licensed salons in North Carolina alone, Linnan says. If BEAUTY succeeds, stylists could become health promoters, communicating messages of health in salons all over the state.

“Now we need to find the right methods and the right amount of information to ensure these efforts are effective in producing health behavior changes,” Linnan says. “Once we identify highly effective programs, we can disseminate them widely here in North Carolina and beyond.”

Boswell adds that it’s difficult to estimate the project’s benefits, since health messages could travel far beyond the salons. “Customers who learned something from their stylist might talk about it with family and friends and other people,” he says. “It might even have a bigger effect than what we intended, but we can’t measure that.”

All salons that participated in BEAUTY were privately owned. Linnan says the researchers will look at franchises next. They’re also examining ways to deliver health messages in barbershops visited by black men.