Hair Product Use Research Articles

Abstract A077: Chemical hair relaxer use and chemicals of concern in select hair relaxer products in two counties in Kenya: An analysis of inequities in environmental exposures from personal care products

Abstract Despite the widespread use of hair products, including chemical relaxers, little is known about the prevalence and patterns of use in populations outside the United States. Furthermore, there is emerging interest in the investigation of these products as key sources of exposure to chemicals of concern (CoCs), some of which may be associated with breast cancer. This study aimed to examine the prevalence and patterns of use of chemical relaxers among women in Embu and Nakuru Counties in Kenya, along with addressing key knowledge gaps about hair product use, practices, and perceptions of use. Additionally, we aimed to assess the presence of CoCs by examining product labels of selected relaxers widely used by women in these counties, where breast cancer incidence rates are increasing and concern about exposure to toxic chemicals in hair products is high. A total of 746 women aged 15-50 years enrolled in a questionnaire-based study, which ascertained sociodemographics, ever and current use of chemical relaxers, and perceptions of harm around hair product use. Multivariable-adjusted regression models were used to evaluate associations between participants’ sociodemographic characteristics and perceptions of hair product use in relation to the use of relaxers. Based on respondents’ responses, we purchased 22 commonly used hair relaxers in the target counties and recorded label information (including the ingredient lists). To identify CoCs, we cross-checked the lists of ingredients against the Campaign for Safe Cosmetics (CSC) Red List and European Union (EU) Prohibited/Restricted Substances Annex II and III, Regulation 1223/2009. Nearly 60% of participants reported ever use of chemical relaxers, with a little over one-third (35.7%) reporting current use of these products. On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to product use. We found that all 22 relaxers evaluated listed ≥1 CoCs in the products’ ingredients list. We documented 27 CoCs in total: 6 (23.08%) are categorized as Tier 1 (do not use CoCs for everyone) per the CSC Red List and 4 (14.81%) are prohibited substances per the EU Annex II of Regulation. This study contributes to a growing body of literature documenting CoCs listed on cosmetics labels, particularly products that are disproportionately used among Black and African ancestry populations globally. Further, this study justifies the need for increased public awareness of potentially harmful chemicals in hair products marketed and sold in Kenya. Improving the understanding of patterns of use of specific products and their chemical ingredients – which may be hormone disruptors and/or carcinogens – and exploring the role of environmental health literacy on product use is critical for developing interventions to reduce potentially harmful exposures found in these products. Citation Format: Nia C. Jenkins, Amber Rockson, Alexis Schaefer, Dustin T. Dunkin, Dede K. Teteh-Brooks, Mary Beth Terry, Jasmine A. McDonald, Beatrice Irungu, Esther Matu, Cecilia Kimani, Teresa Olisa, Adiba Ashrafi, Adana A.M. Llanos. Chemical hair relaxer use and chemicals of concern in select hair relaxer products in two counties in Kenya: An analysis of inequities in environmental exposures from personal care products [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A077.

Hair Dye and Relaxer Use among Cisgender Women in Embu and Nakuru Counties, Kenya: Associations with Perceived Risk of Breast Cancer and Other Health Effects.

Despite widespread use of hair products globally, little is known about the prevalence and patterns of use in populations outside the United States. As some hair products contain endocrine-disrupting chemicals (EDCs) and EDCs have been linked to breast cancer, which is increasing globally, in this study, we addressed key knowledge gaps about hair product use and practices, and perceptions of use among women in two counties in Kenya. Using community-engaged approaches in Embu and Nakuru, Kenya, we recruited women aged 15-50 years to complete a questionnaire that ascertained hair product use in the last 7-14 days, ever using hair dyes and chemical relaxers, and participants' perceptions or harm around hair product use. In multivariable-adjusted regression models, we evaluated associations between participants' sociodemographic characteristics and perceptions of hair product use in relation to if they have ever used hair dyes and relaxers. In our sample of 746 women (mean age, 30.4 ± 8.1 years), approximately one-third of participants reported ever using permanent and/or semi-permanent hair dyes, with approximately one-fifth reporting current use. Almost 60% reported ever using chemical relaxers, with a little over one-third reporting current use. Increasing age and having an occupation in the sales and service industry were statistically significant predictors of hair dye use (OR 1.04, 95% CI: 1.02-1.06 and OR 2.05, 95% CI: 1.38-3.03, respectively) and relaxer use (OR 1.03, 95% CI: 1.01-1.06 and OR 1.93, 95% CI: 1.30-2.87). On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to hair product use. However, in contrast to our hypotheses, we observed mixed evidence regarding whether higher levels of perceived risk were associated with lower odds of ever using hair dyes and relaxers. These findings add new knowledge to the extant literature on hair product use among women in Kenya, where breast cancer incidence rates are increasing. Improving the understanding of patterns of use of specific products and their chemical ingredients-which may be hormone disruptors or carcinogens-and exploring the role of environmental health literacy are critical for developing interventions to reduce potentially harmful exposures found in these products.

Herbal Extracts for Hair Growth and Skin Rejuvenation: A Potential Solution for Hair Fall and Enhancing Skin Glow

Hair loss can have significant psychological and sociological impacts on individuals, affecting how they perceive themselves and are perceived by others. Globally, there has been a rise in the proportion of both men and women experiencing hair loss or thinning hair. Dermatological disorders, including alopecia, are common causes of hair loss, leading to a constant search for natural products that may promote hair growth. Several factors contribute to hair loss, including stress, major illnesses, medication use, depression, autoimmune diseases, family history, hormonal imbalances, and nutritional deficiencies. In India, approximately 50% of the population is experiencing hair loss at an accelerated rate, partly due to the use of inferior hair products in the beauty industry. Various herbs have been identified for their potential to promote skin renewal and hair development. These include Ficus religiosa, Ficus bengalensis, coriander seeds, rock sugar, and Chlorophytum borivilianum. These herbs contain nutritional components that can help manage hormonal imbalances and stimulate hair growth. Herbal formulations offer a natural and potentially effective solution for hair loss management. They can be tested for quality control and evaluation to ensure their safety and efficacy. These formulations may serve as immunoboosters or highly nutritious compositions, providing additional health benefits beyond hair care. Importantly, such remedies are typically associated with minimal or no negative side effects, making them a preferred option for individuals seeking natural approaches to address hair loss and related concerns.

Associations between use of chemical hair products and epigenetic age: Findings from the Sister Study

Background: Hair products may be a source of harmful chemicals and have been linked to age-related health outcomes. We investigated whether the use of hair products is related to epigenetic age in a sample of Black (both Hispanic and non-Hispanic) and non-Hispanic White women. Methods: In a subset of 4358 participants aged 35–74 years from the Sister Study, we estimated cross-sectional associations between self-reported use of four chemical hair products (permanent dye, semipermanent dye, straighteners/relaxers, and hair permanents/body waves) in the year before enrollment (2003–2009) and three DNA methylation-based measures of epigenetic age (DunedinPACE, GrimAge age acceleration [GrimAgeAccel], and PhenoAge age acceleration [PhenoAgeAccel]) using survey-weighted multivariable linear regressions. Associations were estimated both overall and by self-identified race and ethnicity, adjusting for chronological age, socioeconomic and lifestyle factors, body mass index, menopausal status, and DNA methylation platform. Results: Associations between the use of hair products and the three epigenetic age measures were largely null. Use of hair permanents/body waves was modestly associated with higher DunedinPACE among all participants (β ever-never = 0.010; 95% confidence interval [CI] = 0.001, 0.019) and with lower PhenoAgeAccel among Black women (β ever-never = −1.53; 95% CI = −2.84, −0.21). Conclusion: In this US-based study, we found little evidence of associations between chemical hair product use and epigenetic age in Black and non-Hispanic White women. Observed associations were modest and largely not supported by dose–response relationships or were inconsistent across epigenetic age measures. Previously observed associations between chemical hair product use and aging-related health outcomes may not be explained by the biological aging pathways captured by DunedinPACE, GrimAgeAccel, or PhenoAgeAccel. Alternative biological pathways are worth investigating in racially diverse samples.

Hair product use and urinary biomarker concentrations of non-persistent endocrine disrupting chemicals among reproductive-aged Black women

BackgroundStudies have shown an association between hair product use and adverse health outcomes. Scientists have hypothesized that exposure to endocrine-disrupting chemicals (EDCs) drives these associations, but few studies have directly evaluated associations between hair product use and biomarkers of EDCs. Even more limited are studies of Black women, who frequently use EDC-containing products (e.g., hair relaxers). ObjectiveWe estimated associations between hair product use and EDC biomarker concentrations. MethodsWe leveraged cross-sectional data from the Study of Environment, Lifestyle, and Fibroids, a cohort of females aged 23–34 years who self-identified as Black/African American from the Detroit-metropolitan area (USA; n = 425). On structured questionnaires, participants reported their past 24-h and past 12-month use of hair products, including relaxers/straighteners/perms, styling products, moisturizers, oils, and hair food. We quantified urinary concentrations of 19 phthalate/phthalate alternative metabolites, 7 phenols, and 4 parabens using high performance liquid chromatography isotope dilution tandem mass spectrometry. EDC biomarker concentrations were creatinine-adjusted and natural log-transformed. We used multivariable linear regression to estimate mean percent differences in EDC biomarker concentrations and 95% confidence intervals (CIs) associated with hair product use, adjusting for sociodemographic confounders. ResultsHair product use was associated with greater concentrations of multiple EDC biomarkers. Notably, use of hair products in the previous 24 h (compared with non-use) was associated with 16.2% (95% CI = 0.7%, 35.9%), 35.0% (95% CI = 2.6%, 77.6%), and 32.3% (95% CI = 8.8%, 92.0%) higher concentrations of mono-isobutyl phthalate, methyl paraben, and ethyl paraben, respectively. Use of hair relaxers/straighteners/perms, styling products, moisturizers, oils, and hair food in the past 12 months was also associated with higher concentrations of multiple phthalate, phenol, and paraben biomarkers. ConclusionHair product use was associated with higher biomarker concentrations of multiple phthalates, phenols, and parabens. These findings suggest that hair products are potentially important exposure sources for hormonally-active chemicals among Black women.

Abstract PO2-25-09: The hidden costs of beauty: An evaluation of breast cancer risk for Black women

Abstract The Black identity, hair product use, and breast cancer scale (BHBS) was developed and previously validated to evaluate the relationship between identity, hair product use, and breast cancer risk for Black women. Black women are disproportionately affected by breast cancer compared to other racial/ethnic groups, with a mortality rate of 40% higher than all other groups. Endocrine Disrupting Chemicals (EDCs) are present in many hair care products and have been linked to several health issues including breast cancer. Due to these health inequities and the complexity of how cultural norms shape Black women’s hair product usage, the purpose of this study was to assess the reliability of the BHBS for intervention planning and evaluate the hazard scores of hair products used by Black women. Methods: Participants were recruited using purposive convenience sampling techniques. The 11-item BHBS includes two subscales: five items measuring sociocultural perspectives about hair and identity (S1) and six items assessing perceived breast cancer risk related to hair product use (S2). To determine reliability, the BHBS was administered twice over a three-week period with sociodemographic factors obtained in the initial data collection phase. All statistical analyses, including descriptive statistics and test-retest reliability (Pearson correlations) were conducted using SPSS version 26. The Environmental Working Group's (EWG's) Skin Deep® database was used to determine hazard scores of hair products used by participants. Products are rated on a 10-point scale with low (0-2), moderate (3-6), and high hazard (7-10) scores. Results: Twenty-three (86.9% African, African American & Caribbean; 13% multiracial) female participants completed the study. Their age ranged from 18-63 years (30.78, SD= 15.40), 47.8% reported an income of less than $25,000, and 34.8% completed some college education. Both subscales demonstrated highly significant and strong reliability (S1: r=.82, p< .001; S2: r=.88, p< .001). Participants primarily used conditioners (91.3% used wash out and 60.9% used leave-in), and professional hair dyes (34.8%). There was also a high frequency of non-use (91.3%) of do-it-yourself relaxers and hair dye kits. We evaluated 40 products across three categories including wash out conditioners, leave-in conditioners and other hair products (e.g., styling gels, shampoo, and hair oils), of which most had a moderate hazard rating of 5 denoting ingredients of health concerns (e.g., parabens, fragrance, and phenoxyethanol). Additionally, of the 22 company brands analyzed, only 10 (45%) are Black owned or founded. Conclusions: The BHBS is a valid and reliable instrument to assess sociocultural perspectives about hair, identity and perceived breast cancer risk. Black women use hair products including relaxers, hair dyes, and conditioners that contain EDCs that may be harmful to their health including risk for breast cancer. The BHBS will be used to evaluate psychosocial interventions that address the unique needs of Black women including exposure to EDCs from hair product use and breast cancer risk. Citation Format: Nicole Sarkaria, Marissa Ericson, Abigail Lopez, Dede Teteh. The hidden costs of beauty: An evaluation of breast cancer risk for Black women [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-25-09.

Abstract IA005: New directions in prevention and early detection of endometrial cancers

Abstract Most endometrial cancers and precursor lesions are preceded by postmenopausal bleeding (PMB), offering a window of opportunity for early detection and improved survival. Clinical guidelines recommend prompt evaluation of PMB to rule out endometrial cancer. Current diagnostic approaches including transvaginal ultrasound and endometrial biopsy are invasive and can be associated with discomfort and procedural pain, and we have shown that recommendations may not be consistent with underlying risk of endometrial cancer. Access to these procedures may be challenging for patients who live in rural areas or who experience other barriers to care. Current strategies may also have limited accuracy for detecting non-endometrioid cancers which are clinically aggressive, more common in Black women, and increasing in incidence and mortality in the U.S. Black women experience significant racial disparities in endometrial cancer survival and are more likely to experience diagnostic delays compared to their White counterparts. Because of the anatomical continuity of the lower genital tract, we and others have demonstrated the feasibility of pairing molecular assays with minimally invasive self-sampling approaches, such as vaginal tampons, for the detection of tumor DNA. In a recent study led by our colleagues at the Mayo Clinic, we identified over 28 methylation markers that were tested in self-collected tampon samples that showed good clinical performance for endometrial cancer detection. Such approaches can mitigate cancer disparities by offering an at-home early detection strategy to increase coverage and expand access to care. To date, few endometrial cancer studies have been conducted within diverse clinical populations. To address this gap, we designed the Discovery and Evaluation of Tests for Endometrial Cancer in Tampons (DETECT) study. DETECT is a case control study that includes patients undergoing hysterectomy for endometrial cancer and benign conditions at the University of Alabama at Birmingham (UAB). DETECT has enrolled over 700 patients to date, including over 360 with endometrial cancer (approximately 30% with non-endometrioid tumors). In this study, we collect extensive questionnaire data including information about symptoms, and novel risk factors such as feminine hygiene and hair product use. We obtain clinical information on diagnostic procedures, surgery, and treatment information from electronic medical records, and collect tampon, tissue, and blood samples from enrolled patients. In preliminary analyses, over two-thirds of participants self-collected a vaginal tampon sample, with collection varying by race (57% in Black vs. 76% in White patients). Next steps include pilot testing to compare the performance of biomarkers (somatic mutations and methylation markers) measured from tampon samples to tissue for endometrial cancer detection. Future goals of DETECT include the evaluation of endometrial cancer risk factors, biomarkers, outcomes, and disparities across the cancer continuum. Citation Format: Megan A. Clarke. New directions in prevention and early detection of endometrial cancers [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr IA005.

Personal Care Product Use during Puberty and Incident Breast Cancer among Black, Hispanic/Latina, and White Women in a Prospective US-Wide Cohort.

Some personal care products (PCPs) contain endocrine-disrupting chemicals that may affect breast cancer (BC) risk. Patterns of use vary by race and ethnicity. Use often starts in adolescence, when rapidly developing breast tissue may be more susceptible to environmental carcinogens. Few studies have examined associations of BC with PCP use during this susceptible window. We characterized race and ethnicity-specific patterns of PCP use at 10-13 years of age and estimated associations of use with incident BC. At enrollment (2003-2009), Sister Study participants ( Black, 2,104 Latina, and 39,312 White women) 35-74 years of age reported use of 37 "everyday" PCPs during the ages of 10-13 y (did not use, sometimes, or frequently used). We conducted race and ethnicity-specific latent class analyses to separately identify groups of women with similar patterns of beauty, hair, and skincare/hygiene product use. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of identified PCP classes and single products with incident BC using Cox proportional hazards regression. During a mean follow-up time of 10.8 y, 280 Black, 128 Latina, and 3,137 White women were diagnosed with BC. Classes of adolescent PCP use were not clearly associated with BC diagnosis among Black, Latina, or White women. HRs were elevated but imprecise for frequent nail product and perfume use in Black women (1.34; 95% CI: 0.85, 2.12) and greater hair product use in Black (1.28; 95% CI: 0.91, 1.80) and Latina (1.42; 95% CI: 0.81, 2.48) women compared with lighter use. In single-product models, we observed higher BC incidence associated with frequent use of lipstick, nail products, pomade, perfume, makeup remover, and acne/blemish products in at least one group. This work provides some support for the hypothesis that PCP use during puberty is associated with BC risk. More research is needed to confirm these novel findings. https://doi.org/10.1289/EHP13882.

Relationship between the use of hair products and urine benzophenone-3: the Korean National Environmental Health Survey (KoNEHS) cycle 4.

Benzophenone-3 is a type of ketone with 2 benzene rings attached to a carbonyl group (C=O) and one benzene ring attached to a hydroxyl group (-OH). As an endocrine-disrupting chemical, benzophenone-3 is known to be associated with reproductive, developmental, thyroid, and endocrine toxicities. Benzophenone-3 is commonly used in hair products, cosmetics, and ultraviolet (UV) filters because of its characteristic property to absorb UV light. This study aims to investigate the association between the use of hair products and urine benzophenone-3 using the data from the Korean National Environmental Health Survey (KoNEHS) cycle 4 (2018-2020), which represents the Korean population. Using the KoNEHS cycle 4 survey, the data of 3,796 adults aged ≥ 19 years were analyzed. Based on the 75th percentile concentration of urine benzophenone-3, the participants were divided into the low- and high-concentration groups. Chi-square test was conducted to analyze the association of urine benzophenone-3 with distribution of general characteristics, use of personal care products, consumption of marine foods, and use of plastic products as the variable. Logistic regression analysis was conducted to calculate odds ratios (ORs) for the high-concentration group of urine benzophenone-3 based on the use of hair products. Women with < 6 times or ≥ 6 times of hair product usage had significantly higher adjusted ORs compared to those who did not use hair products. The calculated ORs were 1.24 (95% confidence interval [CI]: 1.12-1.38) for women with < 6 times of usage and 1.54 (95% CI: 1.33-1.79) for women with ≥ 6 times of usage. This study revealed the association between the use of hair products and the concentration of urine benzophenone-3 in the general Korean population.

Beauty Beware: Associations between Perceptions of Harm and Safer Hair-Product-Purchasing Behaviors in a Cross-Sectional Study of Adults Affiliated with a University in the Northeast.

(1) Background: Widespread personal care product (PCP) use can expose individuals to endocrine-disrupting chemicals (EDCs) associated with adverse health outcomes. This study investigated the association between harm perceptions and hair-product-purchasing behaviors in adults enrolled in a cross-sectional study. (2) Methods: Respondents rated their agreement with five PCP-related harm statements using a five-point Likert scale. Multivariable-adjusted logistic regression models were used to examine the associations between harm perceptions with hair-product-purchasing behaviors and hair product use (i.e., number of products used). (3) Results: Among 567 respondents (non-Hispanic White, 54.9%; non-Hispanic Black, 9.5%; Hispanic/Latinx, 10.1%; Asian American/Pacific Islander, 20.1%; and multiracial/other, 5.5%), stronger harm perceptions around PCP use were associated with potentially "safer" hair-product-purchasing behaviors. Respondents who strongly agreed that consumers should be concerned about the health effects of PCPs had more than fourfold increased odds of always/usually using healthy product apps (OR 4.10, 95% CI: 2.04-8.26); reading ingredient labels (OR 4.53, 95% CI: 2.99-6.87); and looking for natural, non-toxic, or eco-friendly product labels (OR 4.53, 95% CI: 2.99-6.88) when buying hair products. (4) Conclusions: Promoting environmental health literacy and raising awareness of potential PCP use-related harms might encourage healthier hair product use behaviors.

Evaluating Neighborhood-Level Differences in Hair Product Safety by Environmental Working Group Ratings among Retailers in Boston, Massachusetts.

Personal care products are a notable source of exposure to endocrine-disrupting chemicals (EDCs). Racial/ethnic differences in the use of hair products containing EDCs are reported, with women and children of color more commonly using hair products that are hormonally active and contain EDCs than other racial/ethnic groups. There is limited research examining the neighborhood-level social and economic factors that may contribute to these reported disparities. We aimed to examine the safety of hair products across sociodemographically diverse neighborhoods in Boston, Massachusetts. Eight neighborhoods were identified based on indicators of race/ethnicity and socioeconomic status (SES). We randomly selected 50 stores and collected data on the hair products for sale and their corresponding Environmental Working Group (EWG) Skin Deep hazard score. The association between neighborhood and EWG hazard category (low, moderate, high) was examined using a multinomial logistic regression. A total of 14,019 hair products were identified in the eight neighborhoods. When considering products with EWG hazard scores, Roxbury, a lower income community of color, and Mission Hill, a lower income community, were reported to have a higher percentage of high-hazard hair products in comparison with Beacon Hill [12.2% (163/1,332), 11.4% (65/571) vs. 7.9% (30/382), respectively]. Differences between the safety of hair products were observed, with Roxbury and Mission Hill reporting more than a 2-fold higher risk ratio (RR) of finding hair products with high vs. low EWG scores in comparison with that of Beacon Hill [RR for Roxbury: 2.3, 95% confidence interval (CI): 1.1, 4.6; RR for Mission Hill: 2.3, 95% CI: 1.0, 5.4]. Other neighborhoods were also observed to have an increased RR in comparison with Beacon Hill, however, with 95% CIs that extended beyond the null. Retail stores in neighborhoods with a higher percentage of residents of color and lower SES were found to be more likely to sell products with high hazard scores than stores in a higher SES and predominately non-Hispanic White neighborhood. https://doi.org/10.1289/EHP10653.

Abstract P6-05-39: Black Breast Cancer Survivors’ Sociocultural Perspectives of Beauty, and Use of Personal Care Products Containing Endocrine Disrupting Chemicals

Abstract The passage of H.R. 2116 (CROWN Act) prohibits hair texture and style discrimination based on race or national origin, thus, theoretically reducing structural barriers to economic mobility. Regardless, hair is synonymous with Black women’s identities. Possibly due to society’s afro-political ideologies of beauty, Black women tend to use more hair products compared to other racial groups. These standards include social structures that affect self-mediated worth, as well as structural and interpersonal racism based on appearance and societal status. The use of personal care products containing endocrine disrupting chemicals (EDCs) has been shown to increase Black women’s breast cancer risk. The Black identity, hair product use, and breast cancer scale (BHBS) was developed to measure the sociocultural constructs associated with Black women’s hair product use and perceived breast cancer risk. The purpose of this study was to validate the BHBS and examine hair product use among Black breast cancer survivors. Methods: Participants (N=162) completed a 27-item survey between 2020 and 2022 via a community-based participatory research project—Bench to Community Initiative. Principal component analyses (PCA) and confirmatory factor analysis (CFA) were used to establish the underlying component structures and determine the model fit. Chi-square tests were used to determine associations between BHBS subscales and product use, with a p-value &amp;lt; 0.05 defined as statistically significant. Products evaluated included washout and leave-in conditioners, salon, and do-it-yourself (DIY) relaxers, and salon and DIY hair dyes. Response options were used daily through several times a year (daily–yearly), used but stopped, and never used. Results: Participants were African American (90%) and African or Caribbean (10%) Black breast cancer survivors. The mean age (standard deviation [SD]) and stage of diagnosis (SD) was 37.4 ± 8.8 and 1.9 ± 0.97, respectively. PCA yielded two components that accounted for 63% of the total variance in the model. Five items measuring sociocultural perspectives about hair and identity (subscale 1 [S1]) accounted for 28% of the total variance (α = 0.73, 95% CI 0.71, 0.82). Six items assessing perceived breast cancer risk related to hair product use (subscale 2 [S2]) accounted for 35% of the total variance (α=0.86, 95% CI= 0.81, 0.94). CFA confirmed the two-component structure (Root Mean Square Error of Approximation = 0.034; Comparative Fit Index = 0.93; Tucker Lewis Index = 0.89). On average, participants used hair products daily–yearly, including conditioners (64%), relaxers (32%), and hair dyes (33%). The use of salon relaxers was significantly associated with BHBS subscales (S1and S2). Similarly, salon hair dye was significantly associated with S2 of the BHBS. Discussion: The BHBS is a valid measure of sociocultural perspectives associated with hair product use and perceived risk for Black breast cancer survivors. Given that hair remains an important cultural expression within the afro-political confines of identity, the health impacts of hair products containing EDCs used to craft these identities should be considered in intervention planning. Citation Format: Jared Bailey, Marissa Ericson, Tiah Tomlin-Harris, Dorothy Galloway, Lenna Dawkins-Moultin, Adana Llanos, Lindsey Treviño, Susanne B. Montgomery, Dede Teteh. Black Breast Cancer Survivors’ Sociocultural Perspectives of Beauty, and Use of Personal Care Products Containing Endocrine Disrupting Chemicals [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-39.

Use of personal care products during pregnancy and birth outcomes – A pilot study

Prenatal exposure to endocrine disrupting chemicals (EDCs) from personal care products may be associated with birth outcomes including preterm birth and low birth weight. There is limited research examining the role of personal care product use during pregnancy on birth outcomes. Our pilot study consisted of 164 participants in the Environmental Reproductive and Glucose Outcomes (ERGO) study (Boston, MA), with data on self-reported personal care product use at four study visits throughout pregnancy (product use in the 48 h before a study visit and hair product use in the month before a study visit). We used covariate-adjusted linear regression models to estimate differences in mean gestational age at delivery, birth length, and sex-specific birth weight-for-gestational age (BW-for-GA) Z-score based on personal care product use. Hair product use in the past month prior to certain study visits was associated with decreased mean sex-specific BW-for-GA Z-scores. Notably, hair oil use in the month prior to study visit 1 was associated with a lower mean BW-for-GA Z-score (V1: −0.71, 95% confidence interval: −1.12, −0.29) compared to non-use. Across all study visits (V1–V4), increased mean birth length was observed among nail polish users vs. non-users. In comparison, decreased mean birth length was observed among shave cream users vs. non-users. Liquid soap, shampoo, and conditioner use at certain study visits were significantly associated with higher mean birth length. Suggestive associations were observed across study visits for other products including hair gel/spray with BW-for-GA Z-score and liquid/bar soap with gestational age. Overall, use of a variety of personal care products throughout pregnancy was observed to be associated with our birth outcomes of interest, notably hair oil use during early pregnancy. These findings may help inform future interventions/clinical recommendations to reduce exposures linked to adverse pregnancy outcomes.

Use of Straighteners and Other Hair Products and Incident UterineCancer.

Hair products may contain hazardous chemicals with endocrine-disrupting and carcinogenic properties. Previous studies have found hair product use to be associated with a higher risk of hormone-sensitive cancers including breast and ovarian cancer; however, to our knowledge, no previous study has investigated the relationship with uterine cancer. We examined associations between hair product use and incident uterine cancer among 33 947 Sister Study participants aged 35-74 years who had a uterus at enrollment (2003-2009). In baseline questionnaires, participants in this large, racially and ethnically diverse prospective cohort self-reported their use of hair products in the prior 12 months, including hair dyes; straighteners, relaxers, or pressing products; and permanents or body waves. We estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) to quantify associations between hair product use and uterine cancer using Cox proportional hazard models. All statistical tests were 2-sided. Over an average of 10.9 years of follow-up, 378 uterine cancer cases were identified. Ever vs never use of straightening products in the previous 12 months was associated with higher incident uterine cancer rates (HR = 1.80, 95% CI = 1.12 to 2.88). The association was stronger when comparing frequent use (>4 times in the past 12 months) vs never use (HR = 2.55, 95% CI = 1.46 to 4.45; Ptrend = .002). Use of other hair products, including dyes and permanents or body waves, was not associated with incident uterine cancer. These findings are the first epidemiologic evidence of association between use of straightening products and uterine cancer. More research is warranted to replicate our findings in other settings and to identify specific chemicals driving this observed association.

Patterns of personal care product use and their association with sociodemographic characteristics along with endocrine disrupting chemicals among reproductive-aged Black women

BACKGROUND: Compared to White women, Black women in the United States are exposed to higher, more hazardous concentrations of endocrine disrupting chemicals (EDCs), which are found in personal care products. Personal care product use differs by race/ethnicity across multiple product categories such as hair care, skin care, and feminine hygiene products. These differential patterns of exposure are important as they may contribute to environmental health disparities including increased risk of breast cancer, cardiometabolic outcomes, adverse birth outcomes, and uterine fibroids. We previously examined hair product use patterns among reproductive-aged Black women and found that women with higher socio-economic status were more likely to use more products. Our objective was to expand that work to include a wider range of product types including cosmetics, skin care products, nail care products, and feminine hygiene products. AIM: Identify and describe distinct personal care product use patterns and their correlates among a cohort of reproductive-aged Black women living in Detroit, Michigan. METHODS: Using self-reported data, we employed latent class analysis to determine distinct personal care product use patterns among women enrolled in the Study of Environment, Lifestyle and Fibroids. We compared self-reported sociodemographic characteristics across latent classes and examined whether classes were associated with urinary concentrations of EDCs. RESULTS: We will describe the latent classes and report their association with (1) sociodemographic characteristics, and (2) urinary concentrations of EDCs. CONCLUSIONS: The results of this work may be used to address whether product use patterns and related chemical exposures are associated with health outcomes that disproportionately impact Black women. Such information would help identify subgroups of women who may particularly benefit from intervention and potentially modifiable exposures that may be amenable to targeted public health interventions. KEYWORDS: personal care products; Black women; exposure; endocrine disrupting chemicals; latent class analysis

Urinary phthalate metabolite concentrations and personal care product use during pregnancy – Results of a pilot study

IntroductionPhthalates are reproductive toxicants commonly found in personal care products (PCPs). These endocrine disrupting chemicals are associated with pregnancy complications, including gestational diabetes. Yet, little is known about PCP use as a contributor to urinary phthalate metabolite concentrations in pregnancy. MethodsWe conducted a pilot study among 108 pregnant participants to examine the associations of self-reported PCP use with 14 phthalate and 2 DINCH (di(isononyl) cyclohexane-1,2-dicarboxylate) metabolite concentrations measured in single spot urine samples during pregnancy (median: 36 weeks of gestation). At the time of urine collection, participants self-reported use of hair products (within the last month) and other PCPs (within the last 48 h). We used linear regression to estimate associations for natural log-transformed, specific gravity-corrected concentrations of common PCP-associated phthalate metabolites (monoethyl phthalate [MEP], mono-n-butyl phthalate [MBP], and mono-isobutyl phthalate [MIBP]) in our primary analyses, and additional phthalate metabolites in secondary analyses. ResultsMost urinary metabolites were detected for >90% of participants. Participants who reported using hair oil within the past month had MEP concentrations 125% higher (95% confidence interval [CI]: −0.1, 408) than non-users. For other personal care products, we observed the greatest percent difference in PCP-associated metabolites for MIBP among hair gel users (39.3%, 95% CI: −6.3, 107) and for MEP among conditioner/crème rinse users (−55.4%, 95% CI: −76.4, −15.6) compared to non-users. ConclusionFindings suggest that self-reported use of hair oils during late pregnancy may be associated with higher urinary concentrations of MEP. Hair gel use in late pregnancy may also be associated with higher urinary phthalate metabolite concentrations, while conditioner/crème rinse use may be associated with lower levels if MEP.

Occupational differences in personal care product use and urinary concentration of endocrine disrupting chemicals by gender.

In most societies, women and men systematically differ in consumption of cosmetics and household products, which are interlinked with gendered norms and occupational segregation. We investigated the differences in personal care product (PCP) use and exposure to endocrine disrupting chemicals (EDCs) based on occupation and gender. We utilized data from the first to third Korean National Environmental Health Survey analyzing 9218 participants aged 20-59 years engaged in their current occupation for ≥3 months. Frequent PCP use (≥once/week) and exposure to EDCs were analyzed by gender and occupation. We used least-square geometric means (LSGMs) of urinary concentrations of the five EDCs adjusted for covariates. Manual occupation was most common in men and no paid occupation was most frequent in women. In general, clerical, service, and sales workers showed the highest prevalence of frequent use of hair and body products. Women used body and makeup products more frequently than men. For all five EDCs, similarly, women showed higher urinary levels in all occupation groups. When stratified by gender, the differences in urinary concentration of EDCs across occupation groups were not observed in men. Among women, clerical, service, and sales workers showed higher bisphenol A (BPA) and mono-n-butyl phthalate (MnBP) levels than manual workers. Differentials in exposure to EDCs by occupation groups were not evident for men. Given the higher urinary concentration of EDCs in women compared to men, interventions to reduce the exposure to EDCs would need to focus on women, especially in clerical, service, and sales occupations.

Personal care products: Demographic characteristics and maternal hormones in pregnant women from Puerto Rico

Personal care products (PCPs) refer to a wide variety of items commonly characterized as health or beauty products. PCPs contain a number of ingredients, often including a wide range of endocrine disrupting chemicals such as phthalates and parabens. The present study examines the association between self-reported PCP use and prenatal sex-steroids and thyroid hormones levels in women from Puerto Rico. We recruited pregnant women (n = 1070) through the Puerto Rico PROTECT Cohort and collected blood, demographic and pregnancy-related data at recruitment and subsequent visits. PCP use in the 48-h preceding the blood sample was collected through self-reported questionnaires. Nine hormones (corticotropin-releasing hormone [CRH], sex-hormone binding globulin [SHBG], estriol [E3], progesterone, testosterone, thyroid-stimulating hormone [TSH], total triiodothyronine [T3], total thyroxine [T4], and free thyroxine [fT4]) were measured in maternal serum samples at two points during pregnancy. Linear mixed models with random intercepts were used to examine associations between PCP use and serum hormone levels. Use of cosmetics significantly increased with age, household income and education level (p < 0.01). Use of hair products, such as hair dyes and bleach, relaxers, and mousse, was associated with lower levels of all sex steroid hormones compared to non-use: SHBG (%Δ = −7.1, 95%CI: −12.4,-1.8), E3 (%Δ = −23.2, 95%CI: −32.2,-13.0), progesterone (%Δ = −21.5, 95%CI: −29.4,-12.9) and testosterone (%Δ = −21.5, 95%CI: −33.1,-7.8) adjusted for maternal age, education and pre-pregnancy body mass index. Our findings suggest that household income and education level influence PCP use among pregnant women in this study. Use of certain hair products was associated with lower concentrations of sex steroid hormones. Although there are limitations to questionnaire data, characterizing PCP use is inexpensive and may represent exposure from multiple classes of chemicals, including chemicals that may not specifically appear on product labels and/or have not been tested for endocrine disrupting potential, making it a useful complement to chemical biomarker data.

Invited Perspective: How Can Studies of Chemical Mixtures and Human Health Guide Interventions and Policy?

Invited Perspective: How Can Studies of Chemical Mixtures and Human Health Guide Interventions and Policy?

26574 Acne consultations: Recommendations for optimizing patient-centred care

Despite clinical guidelines, many aspects of acne management are overlooked to the detriment of optimal patient care. The Personalising Acne: Consensus of Experts (PACE) group, comprising 13 European and North American dermatologists, aimed to develop consensus recommendations to support patient-centred acne management. The group used a modified Delphi approach. Blinded questions were administered by e-survey. Consensus was defined as ≥75% voting ‘Agree’/‘Strongly agree’; results are presented in brackets (e.g. 11/13 voted ‘Agree’/‘Strongly agree’). It is of paramount importance to discuss long-term treatment expectations with acne patients (13/13), giving consideration to sequelae (eg, scarring), which can be prevented with early, effective intervention (13/13). Treatment goals should be personalized depending on the specific regional impact of acne (13/13); the impact of truncal acne is distinct vs facial acne, (13/13) and should be assessed independently (13/13). Patient discussions should include use of cosmetics, moisturizers, hair products and sunscreen (12/13), while choice of/transitions between treatments should be influenced by factors including specific burden of disease (13/13) and treatment tolerability (11/13). Patients likely to require additional considerations include children <10 years (12/13), patients with darker skin phototypes (13/13), and women who are pregnant/breastfeeding (11/13). Specific populations may benefit from interdisciplinary management (11/12). To optimize comprehensive, patient-centered acne care, physicians could discuss disease burden, treatment goals, long-term treatment expectations, and specific factors related to the patient and their lifestyle. Practical tools to support this, providing clear guidance on each stage of the patient’s journey and care pathway, would be of great value.