Two women in Cincinnati had better leave big tips the next time they get their hair done.

They survived strokes thanks to fast action by their beauticians, who were taking part in a novel program to raise stroke awareness as they clipped, straightened and braided their customers' hair.

One stylist noticed that a woman's speech was slurred, and called for help. Another woman called her hairdresser weeks after having been in the shop, describing symptoms she was having.

"The beautician recognized it as signs of a stroke, called 911, walked to the woman's apartment and waited with her until an ambulance arrived," said Dr. Dawn Kleindorfer, a University of Cincinnati neurologist who led the project and reported results Wednesday at an American Stroke Association conference in San Francisco.

Beauticians and barbers increasingly are being used like churches to spread the word about stroke, cancer and other diseases. What they can do may be as important as any doctor, drug or diagnostic test.

That is because the key factor to surviving a stroke and limiting its damage is time. The main treatment -- a clot-busting medicine called tPA -- must be given within three hours of the start of symptoms to do any good. But fewer than 5 percent of stroke sufferers wind up getting it.

"By far the biggest reason is people delay going into the hospital because they don't know the signs or realize it's an emergency," Kleindorfer said.

She signed up dozens of stylists in Cincinnati and Atlanta in 2005 for a pilot project to teach customers the warning signs.

Why beauty shops?

"This is a great captive audience," she said. "African-American hairstyles can take a long time. They're there for a long time with someone they know and trust."

Doctors trained the stylists, who then quizzed nearly 400 of their customers on stroke knowledge, talked with them as they did their hair, and sent them home with wallet cards with the stroke warning signs.

They used a simple memory device -- FAST, which stands for face, arm, speech, time. Numbness or weakness of the face or arm, especially on one side, and slurred speech are warning signs. Time refers to the window of opportunity for help.

Customers were surveyed again at follow-up appointments roughly six weeks and five months later.

At the start of the program, only 41 percent could name three warning signs. By the end, 51 percent could. The number who knew no stroke symptoms also declined.

Awareness of the need to immediately call 911 improved. But knowledge of stroke risk factors -- high blood pressure, high cholesterol, diabetes and smoking -- did not.

The detection of two strokes by stylists was an unexpected benefit. The women involved did not want to be identified or discuss it.

The Hazel K. Goddess Fund for Stroke Research in Women paid for the program.

"I felt that it was much needed in an ethnic salon and the black community," said Dorothea Jones, owner of DJ's Image, a Cincinnati salon that participated.

"We come in contact with so many people and they can take it back to their families," said Jones, who also was motivated because her nephew suffered a stroke and had to go through rehabilitation.

"It's very promising," said Dr. Michael Sloan, a stroke specialist at Carolinas Medical Center in Charlotte who had no role in the study.

"We're trying to find ways to get the word out," and targeting beauty shop customers and workers seems ideal, he said. "They tell them gossip, their personal lives, their secrets. That type of rapport gives an opportunity" to share health tips, Sloan said.

Virgil Simons, head of the advocacy group Prostate Net, thought the same thing when he signed up hundreds of barbers to talk to customers about prostate cancer in 2004, to coincide with release of the movie "BarberShop 2." Its maker, MGM, helped finance the campaign.

"Not everybody goes to the doctor," Simons said in an interview last week. "The barber is someone they've seen, in many cases, since they were a kid. He's a pillar of the community, a business leader, a culturally credible communicator. While he's cutting hair, he can say, "Hey, when is the last time you had your PSA checked?"'

His project reached more than 10,000 men in its first year and now includes more than 800 barbers around the country. Other groups have used beauticians to raise awareness of breast cancer and mammograms.