Abstract
The disproportionate use of chemical straighteners and skin lighteners by women of color is a growing public health concern given the link between product use and adverse health effects. Prior studies examined product use as an individual choice but neglected social-structural factors, which influence beauty perceptions and personal decisions around product use. We used a community-based participatory research approach to characterize product use by demographics and investigated how racialized beauty norms impact use among 297 women and femme-identifying individuals in Northern Manhattan and the South Bronx. Product use varied by race/ethnicity, nativity, and messaging from family and peers. Black respondents were more likely to ever use chemical straighteners than non-Black respondents (OR = 2.0; 95% CI = 1.2–3.2), as were respondents who heard that family members express a preference for straight hair compared with respondents whose family members expressed mixed preferences about hairstyles (OR = 2.0; 95% CI = 1.1–3.7). Compared with non-Asian respondents and respondents born in the United States, Asian respondents and respondents born in other countries, respectively, had threefold higher odds of ever using skin lighteners (Asian: OR = 3.2; 95% CI = 1.4–7.0; born in other countries: OR = 3.4; 95% CI = 1.9–6.1). Respondents' perceptions that others believe straight hair or lighter skin confer benefits such as beauty, professionalism, or youth were associated with greater use of chemical straighteners and skin lighteners. These findings highlight the pervasiveness of racialized beauty norms and point to the need to reduce the demand for and sale of these products through community education, market-based strategies, and public policy.
Keywords: beauty products, chemical straighteners, skin lighteners, environmental justice, beauty justice
INTRODUCTION
West Harlem Environmental Action for Environmental Justice (WE ACT) was started in 1988 when three fearless community leaders saw that environmental racism was rampant in their West Harlem neighborhood and demanded community-driven, political change.1 In 1991, a multinational group, including WE ACT, organized The First People of Color Environmental Leadership Summit where the Principles of Environmental Justice were drafted and adopted.
The principles combined multiple movement strands, including farm workers' rights and civil rights to frame environmental activism as inclusive of everyone's concerns, including urban communities, people of color, and workers.2 The environmental justice movement also provided an alternative vision for environmentalism that had not been a part of the mainstream movement. This alternative vision included addressing environmental biases that stemmed from the purposeful exclusion of minoritized racial and class groups from clean and healthful environments and combating the abuses of corporate polluters and regulatory agencies that are complicit in ongoing pollution disparities.3
The principles embraced a far-reaching spatiotemporal scale, inclusive of histories of colonialism, imperialism, and genocide of indigenous cultures, that shaped present-day environments. Today, these principles remain a guiding force for the movement that broadly seeks to call attention to, organize against, and end environmental racism.
In the past 30 years, the environmental justice movement has extended its reach to address emerging issues, including the challenges of unregulated chemicals in consumer products along with the disparate exposures and health impacts of these chemicals experienced by people of color.4,5 In 2019, WE ACT launched the Beauty Inside Out (BIO) campaign to educate their predominately Black and Latina/x/o community members in Northern Manhattan about environmental racism in the beauty industry and to reduce the demand for and sale of harmful products, including skin lighteners and chemical straighteners.
While unregulated toxic chemicals in consumer products is a national problem, exposures can vary by neighborhood, and Northern Manhattan has a high density of independent beauty supply stores and hair salons where these products are purchased and used.
The BIO campaign builds on scholarship by Zota and Shamasunder on the “environmental injustice of beauty,” a conceptual framework linking intersectional systems of oppression (e.g., racism, sexism, and classism) to racialized beauty practices, unequal chemical exposures, and adverse health outcomes.6 This framework builds on scholarship in environmental justice to include beauty product exposures as one form of environmental racism.
Elevated levels of beauty-product related chemicals, such as phthalates and parabens, among women of color, can be linked to entrenched social and economic systems, such as colonialism and slavery, that have codified a hierarchy of beauty norms. These beauty norms create material advantages to people with physical traits associated with white femininity, such as light skin and straight hair.
Products sold and used to lighten skin are one example of environmental injustice of beauty. Colorism is prejudice or discrimination toward individuals with darker skin, with benefits accruing to people with lighter or whiter skin.7 The power and pervasiveness of colorism globally has created an extensive and ongoing market for diverse skin lightening products.8,9,10,11 Skin lighteners can contain hydroquinone, corticosteroids, and mercury.12,13 Mercury exposure can cause kidney and nervous system damage, and overuse of corticosteroids can disrupt cortisol regulation and lead to metabolic problems.14 Use of mercury-containing skin creams has been linked to greater body burden of mercury in both female users and their offspring.15 While population-based data on skin lightener use in the United States are limited, prior studies have documented greater use among Dominican and Caribbean groups in New York City and some Hispanic communities along the Texas-Mexico border.16,17,18
Natural hair discrimination, or prejudice against natural hair styles and textures such as locs, braids, fades, and afros, another form of environmental injustice in beauty, plays out through overt policy and practice.19 In particular, Black women have been pressured to straighten their naturally curly or kinky hair for reasons such as being seen as professional in the workplace, social acceptance, or other norms that have excluded Black bodies.
This has created a market for chemical straighteners, such as relaxers, perms, and texturizers. Chemical straighteners, such as relaxers, can contain harmful chemicals such as phthalates, parabens, and formaldehyde, and their use has been associated with earlier age at menarche and increased risk of uterine fibroids and breast cancer.20,21,22,23,24
Given the diversity of WE ACT's community members and potential for higher exposures from beauty products, the BIO campaign conducted a community-based survey to address data gaps around product use among women of color and femme-identifying individuals in Northern Manhattan and the South Bronx. The objective of our present study is to analyze survey data to characterize chemical straightener and skin lightener use in the study sample and identify socio-demographic factors and social influences associated with use.
We also examine respondents' perceptions about the perceived benefits of straight hair and light skin to understand how racialized beauty norms impact personal beliefs and subsequent product use.
METHODS
This community-based participatory research project was a collaboration between WE ACT, Yale School of Public Health (YSPH), George Washington University Milken Institute School of Public Health (GWSPH), and Columbia University Mailman School of Public Health (MSPH). (The academic Principal Investigator and her team moved from GWSPH to MSPH during the study.)
Survey
The survey was developed by YSPH students and WE ACT staff using examples from prior consumer product studies among women of color and incorporating feedback from GWSPH researchers, community groups, survey administrators, and community informants.25 The survey was created in English and Spanish, using inclusive and non-gendered language that was not specific to a region or country. The final survey included 95 questions that ask respondents how, where, and why they choose to use and buy skin lighteners and chemical straighteners to better understand both use of and sentiments toward these products. We focus on a subset of questions for this analysis.
We asked respondents about their use of chemical straighteners and skin lighteners, both ever and current (i.e., past year) use, types of products used, and personal reasons for using products. We asked respondents about the messages they received about hairstyles and skin tone from their peers and family members to understand how personal networks influence product use and impact beauty norms. Respondents were asked whether family members and peers commented on hairstyles, and separately, skin tone.
We also asked questions to gauge respondents' sentiments toward and perceptions of societal beauty norms. Respondents were asked questions about their personal beliefs and, separately, beliefs respondents think that others carry about the benefits that straight hair and lighter skin confer to women. Respondents were asked to respond using a Likert scale, where 0 indicates a preference for straight hair or lighter skin, 5 indicates no preference, and 10 indicates a preference for curly or coiled hair or darker skin. All materials were reviewed and approved for use with adults by the Yale Human Research Protection Program.
Respondent recruitment and survey administrations
Respondent recruitment and survey administration were performed by trained community survey administrators via Qualtrics in March 2020 and October–November 2020 in the Northern Manhattan neighborhoods of: Morningside Heights/Hamilton Heights (including Manhattanville and West Harlem), Central Harlem, East Harlem, and Washington Heights/Inwood (see Supplementary Data for further details). Some surveys were also administered in the South Bronx. Based on feedback from community focus groups, the teams decided that surveys would be administered by women of color aged 18–30 years old who are familiar with the study area and are fluent in English or Spanish.
Data analysis
All statistical analyses were conducted in SAS 9.4 (SAS Institute, Cary, NC). We limited our analyses to respondents who were at least 18 years old, identified as female or non-binary, gender queer, gender non-conforming, or femme-identifying [femme-identifying], and lived in one of the eligible study areas. After we excluded 41 surveys that only contained responses for a few questions at the beginning of the survey, the final study sample included 297 respondents.
We first characterized ever and current use of chemical straighteners and skin lighteners by gender identity and types of products used in the study sample. Given the small number of femme-identifying respondents, we present the majority of our results without stratifying by gender identity. Respondents were asked if they identify as Hispanic or Latina/x (Hispanic). Separately, respondents were asked to select all the racial groups with which they identify (Black or African-American [Black]; Asian or Asian-American [Asian]; Middle Eastern/North African; American Indian or Alaska Native; Native Hawaiian or Pacific Islander; White; Prefer not to answer; or Other with option to write in a response).
We summarized product use data first by distinguishing between respondents who identified as Hispanic and those who did not (Non-Hispanic). Next, we grouped respondents based on their self-identified race, including a category for respondents who identified as Hispanic ethnicity, without a reported race, as well as a category for respondents who reported more than one race/ethnicity (i.e., Multi-racial). We characterized product use by subgroups of Black/African descent (African-American, African, or Afro-Caribbean or Afro-Latina/x), for respondents who identified as Black, and by nativity within Asian and Hispanic subgroups. We also report respondents' personal reasons for using products.
We used bivariate logistic regression models to identify determinants of current and ever use of chemical straighteners and skin lighteners. Our logistic models considered the following covariates: age (35–54, 55 years or older vs. 18–34 years), being in a relationship (yes, no), education (more than equal to Associate's degree vs. less than Associate's degree), and nativity (born in the United States vs. born outside of the United States). Three self-reported race and ethnicity covariates were included because they were the largest and of interest based on the literature (Black, Asian, or Hispanic individuals vs. non-Black, non-Asian, and non-Hispanic individuals, respectively).26,27
We also included messaging about hairstyles from family or, separately, peers (curly/coiled hair is preferable, straight hair is preferable, don't remember them making any comments about hairstyles vs. some said curly/coiled hair is preferable and some said straight hair is preferable), or messaging about skin tones from family or peers (darker skin is preferable, lighter skin is preferable, don't recall them making comments about skin tones vs. some said dark skin is preferable, and some said lighter skin is preferable).
To understand how racialized beauty norms impact personal beliefs and product use, we also investigated respondents' personal beliefs and the beliefs they think others have about the benefits of straight hair and lighter skin for women. We categorized responses, originally captured on a Likert scale, into two groups, 0 to 4 as a preference for straight hair (or lighter skin) and 5 to 10 as a preference for curly hair (or darker skin) or no preference. We used Chi-square tests to assess the difference between respondents' personal beliefs and the beliefs they perceive others have and to investigate whether there is a relationship between other people's beliefs and ever and current use of products.
RESULTS
Respondents' characteristics
The surveys were primarily completed in English (77%) by respondents who were within the 25–34 years or 35–44 years age groups (30% and 22%, respectively) and identified as female (92%) (Table 1). More than half (55%) identified as Hispanic (Table 1). Within the Hispanic group, 31% identified as Hispanic, with no reported race, and 23% identified as Black. Among the respondents who identified as Non-Hispanic, almost two-thirds identified as Black (63%), followed by Asian (14%). Seven percent of all respondents identified as multi-racial, with a majority identifying as Black and Asian or Black plus another group. About half (52%) of respondents were born in the United States. Half of respondents had a college degree or higher, and half of respondents were single or not in a relationship.
Table 1.
Characteristics of Study Respondents in Northern Manhattan and the South Bronx Areas (N = 297)
| Characteristics | % (n) |
|---|---|
| Survey language | |
| English | 77 (230) |
| Spanish | 23 (67) |
| Preferred gender | |
| Female | 92 (274) |
| Femme-identifying individualsa | 8 (23) |
| Age (years) | |
| 18–24 | 13 (39) |
| 25–34 | 30 (90) |
| 35–44 | 22 (65) |
| 45–54 | 12 (37) |
| 55–64 | 15 (44) |
| 65 or older | 7 (22) |
| Hispanic or Latina/x Ethnicity | |
| Non-Hispanic | 45 (134) |
| Hispanic or Latina/x | 55 (163) |
| Race among Hispanic or Latina/x Respondentsb,c | |
| Hispanic or Latina/xd | 31 (50) |
| Black or African-American | 23 (37) |
| Middle Eastern or North African | 1 (2) |
| American Indian or Alaskan Native | 8 (13) |
| Native Hawaiian or Pacific Islander | <1 (1) |
| White | 7 (12) |
| Multi-racial (two or more groups) | 6 (10) |
| Prefer not to respond or missing | 23 (38) |
| Race among non-Hispanic respondentsb | |
| Black or African-American | 63 (84) |
| Middle Eastern or North African | 4 (5) |
| Asian or Asian-American | 14 (19) |
| American Indian or Alaska Native | 3 (4) |
| Native Hawaiian or Pacific Islander | 3 (4) |
| White | <1 (1) |
| Other | 2 (3) |
| Multi-racial (two or more groups) | 8 (11) |
| Prefer not to respond or missing | 2 (3) |
| Birthplace | |
| Born in the United States | 52 (154) |
| Born in other countries | 40 (118) |
| Missing | 8 (25) |
| Education | |
| Less than high school | 16 (48) |
| High school graduate or equivalent | 15 (44) |
| Some college credit, no degree | 14 (42) |
| College degree (at least an associate's degree) | 35 (104) |
| Professional or other graduate degree | 15 (44) |
| Other or missing or prefer not to respond | 5 (15) |
| Relationship status | |
| In a relationship | 22 (65) |
| Married | 24 (72) |
| Single or not in a relationship | 50 (148) |
| Missing or prefer not to answer | 4 (12) |
Including non-binary, genderqueer, and gender non-conforming.
Respondents can identify as a member of more than one racial group.
Respondents were asked about Hispanic or Latinx ethnicity separately from the question about race.
No reported race. Respondents indicated “Other” as their racial group and wrote in one of several responses such as “Hispanic,” “Latino/a,” “Puerto Rican,” “Spanish/Espana” “Brazilian,” or “Dominican.” Category also includes respondents who indicated “Other” and did not write it a response.
Chemical straightener use and associations with use
Forty-four percent of female respondents reported ever use of chemical straighteners, and 34% of femme-identifying respondents reported ever using them. Current use of products was lower at 15% and 13% for female and femme-identifying respondents, respectively (Fig. 1a). Relaxers were the most common type of product used among all ever users (Fig. 1b). Product use varied by race/ethnicity. Black respondents reported the highest frequency of use, regardless of Hispanic ethnicity (Non-Hispanic Black: ever use = 60%; current use = 19%; Hispanic Black: ever use = 48%; current use = 24%) (Fig. 2a). There were similar frequencies of use across Black subgroups (Supplementary Fig. S1a).
FIG. 1.
Chemical straightener (a) and skin lightener (c) use for respondents by gender identity defined as female or non-binary, gender queer, gender non-conforming, or femme-identifying [femme-identifying]. Types of products used across all respondents who have ever used chemical straighteners (b) or skin lighteners (d). Respondents could choose more than one product type. Respondents who responded as “unsure” about product use or did not respond to the question are not shown.
FIG. 2.
Ever and current use of chemical straighteners (a) and skin lighteners (b) by race and ethnicity. We reported racial groups stratified by Hispanic ethnicity. We characterized respondents as “Black,” “Asian,” or “Other,” which includes respondents who identify as being a member of one of the other smaller groups. “Multi-racial” means a respondent reported more than one race/ethnicity.
Among current users of chemical straighteners (n = 44), a majority (61%) reported that they used chemical straighteners because they felt “more beautiful with straight hair.” Other common reasons for use were “straight hair is easier to manage than curly/coiled hair” (45%); “straight hair makes me feel more comfortable in social situations than curly/coiled hair” (39%); and “I feel freer with straight hair” (32%) (respondents were able to select more than one reason) (Supplementary Table S1).
In bivariate regressions, Black respondents were more likely than non-Black respondents to ever use chemical straighteners (OR = 2.0; 95% CI = 1.2–3.2) (Table 2). Compared with respondents aged 18–34 years, respondents aged 35–54 and 55 years or older both each had a 2.7-fold increased odds of ever using chemical straighteners (35–54 years: 95% CI = 1.6–4.7; 55 years or older: 95% CI = 1.4–6.8). Respondents in a relationship were less likely than respondents not in a relationship to ever use chemical straighteners (OR = 0.6; 95% CI = 0.4–1.0), as were respondents born in other countries compared with respondents born in the United States (OR = 0.6; 95% CI = 0.3–0.9) and Asian respondents compared with non-Asian respondents (OR = 0.4; 95% CI = 0.1–0.9).
Table 2.
Bivariate Associations Between Socio-Demographic Characteristics, Messaging from Family and Peers, and Ever and Current Use of Chemical Straighteners
| Predictora | Ever use of Chemical Straighteners OR (95% CI)b | Current use of Chemical Straighteners OR (95% CI)b |
|---|---|---|
| Age group | N = 288 | N = 285 |
| 18–34 years | Ref. | Ref. |
| 35–54 years | 2.7 (1.6–4.7) | 1.7 (0.8–3.9) |
| 55 years or older | 2.7 (1.4–4.8) | 1.8 (0.8–4.2) |
| Being in a relationship |
N = 285 0.6 (0.4–1.0) |
N = 282 1.1 (0.6–2.1) |
| College educated |
N = 288 1.0 (0.6–1.6) |
N = 285 0.7 (0.4–1.4) |
| Born in other countries |
N = 263 0.6 (0.3–0.9) |
N = 261 1.0 (0.5–2.0) |
| Hispanic or Latina/x |
N = 281 0.7 (0.4–1.1) |
N = 279 1.1 (0.5–2.1) |
| Black or African-American |
N = 288 2.0 (1.2–3.2) |
N = 285 1.6 (0.8–3.0) |
| Asian or Asian-American |
N = 288 0.4 (0.1–0.9) |
N = 285 0.4 (0.1–1.7) |
| Messaging about hair types from family | N = 279 | N = 276 |
| They said curly/colied hair is preferable | 0.7 (0.3–1.6) | 0.9 (0.3–2.7) |
| They said straight hair is preferable | 2.0 (1.1–3.7) | 1.3 (0.6–2.9) |
| Some said straight hair is better, some said curly hair is better | Ref. | Ref. |
| I don't remember my family making comments about hair types | 2.1 (1.0–4.5) | 1.4 (0.5–3.8) |
| Messaging about hair types from peersc | N = 281 | N = 279 |
| They said curly/colied hair is preferable | 0.9 (0.4–1.8) | 1.4 (0.5–3.9) |
| They said straight hair is preferable | 2.0 (1.1–3.4) | 1.3 (0.8–3.9) |
| Some said straight hair is better, some said curly hair is better | Ref. | Ref. |
| I don't remember my peers making comments about hair types | 2.3 (1.0–5.1) | 1.3 (0.4–4.2) |
For dichotomous variables, odds ratios are interpreted in comparison to other option (e.g., Respondents born outside the United States vs. respondents born in the United States). For variables with more than two categories, the reference group is noted.
Estimated using bivariate logistic regression. Current users compared to respondents who said no to current and ever use of products.
Peers were defined as sibling, cousins, friends, or classmates.
Ref, reference group.
Messaging was also associated with ever use of chemical straighteners. Respondents who heard peers or family members express a preference for straight hair were more likely to ever use chemical straighteners than respondents who recalled that family and peers had mixed preferences about hair type (family: OR = 2.0; 95% CI = 1.1–3.7; peers: OR = 2.0; 95% CI = 1.1–3.4). None of these variables were associated with current use of chemical straighteners (Table 2).
Beauty perceptions and chemical straightener use
Respondents believed that others attribute certain advantages to women with straight hair; yet, in comparison, fewer respondents personally felt this way (Supplementary Fig. S3a). Half of all respondents indicated that they think others believe that straight hair makes women more beautiful, whereas only 36% of respondents personally felt this way (p ≤ 0.0001). We found similar differences between participants' personal beliefs and their perception of others' beliefs when respondents were asked about straight hair making women look younger, wealthier, or more professional (p < 0.05) (Supplementary Fig. S3a).
Respondents' perceptions of others' beliefs were associated with ever use (Supplementary Table S2), but not current use of chemical straighteners (Table 4). Respondents who thought that other people believe that straight hair makes women look wealthier (p = 0.01) or more professional (p = 0.03), respectively, were more likely than women who did not have these beliefs to ever use chemical straighteners.
Table 4.
Relationship Between Current Use of Chemical Straighteners and Skin Lighteners and the Beliefs Respondents Attribute to Others About the Perceived Benefits of Straight Hair or Light Skin, Respectively
| Current use of chemical straighteners |
Current use of skin lighteners |
||||||
|---|---|---|---|---|---|---|---|
| Perceived benefitb | Yes (N) | No (N) | p a | Perceived benefitb | Yes (N) | No (N) | p a |
| Beautyc | Beautyd | ||||||
| Favor curly hair or no preference | 23 | 110 | 0.55 | Favor dark skin tone or no preference | 13 | 106 | 0.01 |
| Favor straight hair | 19 | 111 | Favor lighter skin tone | 29 | 96 | ||
| Wealth | Wealth | ||||||
| Favor curly hair or no preference | 24 | 119 | 0.61 | Favor dark skin tone or no preference | 18 | 104 | 0.29 |
| Favor straight hair | 16 | 95 | Favor lighter skin tone | 23 | 92 | ||
| Youth | Youth | ||||||
| Favor curly hair or no preference | 20 | 113 | 0.64 | Favor dark skin tone or no preference | 20 | 128 | 0.02 |
| Favor straight hair | 19 | 91 | Favor lighter skin tone | 22 | 62 | ||
| Professionalism | Professionalism | ||||||
| Favor curly hair or no preference | 23 | 102 | 0.35 | Favor dark skin tone or no preference | 22 | 112 | 0.76 |
| Favor straight hair | 18 | 110 | Favor lighter skin tone | 19 | 87 | ||
Respondents were asked which hairstyle or skin tone makes women look more beautiful, wealthier, younger, or more professional. Respondents were asked to respond using a Likert scale, with 0 indicating straight hair, 5 indicating no preference, or 10 indicating curly/coiled hair or 0 indicating light skin, 5 indicating no preference, or 10 indicating dark skin.
Chi-square test of independence used to generate p-values.
Likert scale responses categorized for analyses, 0 to 4 as preference for straight hair or lighter skin and 5 to 10 as preference for curly hair or no preference or a preference for darker skin or no preference.
Questions: Which hairstyle do people generally find more beautiful? Which hairstyle makes a woman look wealthier in most people's opinion? Which hairstyle makes a woman look more professional in most people's opinion? Which hairstyle makes a woman look younger in most people's opinion?
Questions: Which skin tone do people generally find more beautiful? Which skin tone makes a woman look wealthier in most people's opinion? Which skin tone makes a woman look more professional in most people's opinion? Which skin tone makes a woman look younger in most people's opinion?
Skin lightener use and associations with use
Twenty-five percent of female respondents reported ever using skin lighteners, and 22% of femme-identifying respondents reported ever using. Current use of products was lower at 16% and 9% for female and femme-identifying respondents, respectively (Fig. 1c). Among all ever users of skin lighteners, creams were the most commonly reported product use (Fig. 1d). Product use varied by race/ethnicity and nativity. Asian respondents reported the highest frequency of skin lightener use (ever users = 57%; current users = 57%) (Fig. 2b). Skin lightener use among Asian and Hispanic respondents was higher for respondents born in other countries versus the United States (p < 0.05) (Supplementary Fig. S2b).
Beauty was the leading reason for using skin lighteners; 57% of current users (n = 46) responded that they “feel more beautiful with lighter skin” (Supplementary Table S1). The next most common reasons for using skin lighteners were “I want to achieve a uniform body skin tone” (28%) and “lighter skin makes me feel more comfortable in social situations than darker skin” (28%) (respondents could select more than one).
In bivariate analyses, respondents born in other countries were more likely than respondents born in the United States to ever use skin lighteners (OR = 3.4; 95% CI = 1.9–6.1) (Table 3), as were Asian respondents compared with non-Asian respondents (OR = 3.2; 95% CI = 1.4–7.0). Black respondents were less likely than non-Black respondents to ever use skin lighteners, although this finding was only marginally significant (OR = 0.6; 95% CI = 0.3–1.0). We found similar associations with current use of skin lighteners (Table 3).
Table 3.
Bivariate Associations Between Socio-Demographic Characteristics, Messaging from Family and Peers, and Ever and Current Use of Skin Lighteners
| Predictora | Ever use of Skin Lighteners OR (95% CI)b | Current use of Skin Lighteners OR (95% CI)b |
|---|---|---|
| Age group | N = 282 | N = 279 |
| 18–34 years | Ref. | Ref. |
| 35–54 years | 1.0 (0.5–1.9) | 0.5 (0.2–1.0) |
| 55 years or older | 1.4 (0.7–2.8) | 0.8 (0.4–1.8) |
| Being in a relationship | N = 279 | N = 276 |
| 1.0 (0.6–1.7) | 0.8 (0.4–1.5) | |
| College educated | N = 282 | N = 279 |
| 1.1 (0.6–1.8) | 1.1 (0.6–2.1) | |
| Born in other countries | N = 257 | N = 254 |
| 3.4 (1.9–6.1) | 3.7 (1.8–7.5) | |
| Hispanic or Latina/x | N = 276 | N = 273 |
| 1.2 (0.7–2.1) | 1.1 (0.6–2.2) | |
| Black or African-American | N = 282 | N = 279 |
| 0.6 (0.3–1.0) | 0.5 (0.2–0.9) | |
| Asian or Asian-American | N = 282 | N = 279 |
| 3.2 (1.4–7.0) | 6.2 (2.7–14.3) | |
| Messaging from family | N = 271 | N = 268 |
| They said darker skin is preferable | 2.0 (0.7–5.5) | 2.2 (0.7–6.6) |
| They said lighter skin is preferable | 1.6 (0.8–3.2) | 1.2 (0.5–2.8) |
| Some said lighter skin is better, some said darker skin is better | Ref. | Ref. |
| I don't remember my family making comments about skin tone | 0.9 (0.4–2.1) | 0.5 (0.1–1.5) |
| Messaging from peersc | N = 268 | N = 266 |
| They said darker skin is preferable | 2.0 (0.8–5.2) | 1.2 (0.4–3.8) |
| They said lighter skin is preferable | 1.8 (0.9–3.6) | 1.5 (0.7–3.4) |
| Some said lighter skin is better, some said darker skin is better | Ref. | Ref. |
| I don't remember my peers making comments about skin tone | 0.8 (0.3–2.0) | 0.4 (0.1–1.5) |
For dichotomous variables, odds ratios are interpreted in comparison to other option (e.g., Respondents born outside the United States vs. respondents born in the United States). For variables with more than two categories, the reference group is noted.
Estimated using bivariate logistic regression. Current users compared to respondents who said no to current and ever use of products.
Peers were defined as sibling, cousins, friends, or classmates.
Beauty perceptions and skin lightener use
Similar to our findings for straight hair, respondents believed that others attribute certain advantages to women with light skin; yet, in comparison, fewer respondents personally felt this way (Supplementary Fig. S3b). Fifty percent of respondents thought that others find light skin more beautiful, whereas only 33% of respondents reported personally feeling this way (p < 0.0001). We found similar results when respondents were asked about lighter skin making women look younger, wealthier, or more professional (p < 0.05) (Supplementary Fig. S3b).
Respondents' perceptions of others' beliefs were associated with current use (Table 4), and to some extent, ever use of skin lighteners (Supplementary Table S2). Respondents who thought other people believe that lighter skin makes women look more beautiful (p = 0.01) or younger (p = 0.02), respectively, were more likely to currently use skin lighteners than women who did not have these beliefs. Among ever users of skin lighteners, beauty was the only perceived advantage that was statistically significant (p = 0.003).
DISCUSSION
In this community-based participatory study, we documented historical and contemporary use of chemical straighteners and skin lighteners among a diverse sample of women and femme-identifying individuals in Northern Manhattan and the South Bronx. Product use varied by race/ethnicity, nativity, and messaging from family and peers. The common use of chemical straighteners and skin lighteners among self-identified Black and Asian respondents, respectively, is consistent with prior literature, and it points to the need to assess health risks of these products in communities of color.
We found evidence that racialized beauty norms can impact personal product use decisions. Achieving a certain standard of beauty was the top reason for using products. Respondents' perceptions that others believe straight hair and/or lighter skin confer benefits were associated with greater product use. These findings have the potential to inform prevention and intervention strategies locally in New York City as well as more broadly.
Our results for product use differences by race/ethnicity and nativity shared some similarities to prior studies. For example, prior studies have reported a high prevalence (range: 52%–94%) of lifetime use of chemical straighteners among U.S. Black women with no stratification by Hispanic ethnicity.28,29,30 We reported 57% and 48% ever use of chemical straighteners among Non-Hispanic Blacks and Hispanic Blacks, respectively, and similar frequencies among different Black subgroups. To our knowledge, we are one of the first studies to examine chemical straightener use among Black subgroups.
There is a lack of comparable data characterizing skin lightener use among U.S. racial/ethnic subgroups. Yet, our findings of high ever and current use of skin lighteners, 57% respectively, among Non-Hispanic Asians are consistent with many studies showing a high prevalence of skin lightening product use in Asian countries.31,32,33 Indeed, the Asia-Pacific market accounted for over half of the global skin lightener market in 2018.34 Consistent with a prior study, respondents in our study who were born outside of the United States reported greater skin lightener use.35 While two prior studies reported a high prevalence of skin lightener use among women of African descent globally and in New York, NY, we did not observe a similar finding among Black or African respondents.36,37
We report similarities in product use between femme-identifying and female respondents, although femme-identifying individuals reported a lower current use of skin lighteners than females (9% vs. 16%, respectively). To our knowledge, we are one of the first to report product use by gender identity, which is an area of research that has yet to catch up to societal shifts where more personal care and beauty product companies are moving toward gender-inclusive marketing or selling gender-neutral products.38
Our results suggest that product use decisions are influenced by respondents' social environments, including their immediate and more distant networks. For example, respondents who received messages from their families and peers about preferences for straight hair reported greater ever use of chemical straighteners. People within respondents' personal networks may have internalized racialized beauty norms and unconsciously or consciously perpetuate these messages.39,40 In addition, respondents' own perceptions of others' beauty preferences about straighter hair or lighter skin may drive product use. Thus, our findings help discern how purchasing can reinscribe beauty norms, even if these preferences are not self-held.
Racialized beauty ideals can be traced back to slavery and colonialism, and still linger today.41,42,43 Hair relaxers or other chemical straighteners have been used over decades by Black women to achieve straighter hairstyles, and thus, more easily assimilate.44 For example, a recent study found that Black women with natural hairstyles were considered less professional and competent and received fewer recommendations for job interviews compared with Black women with straightened hair and white women with straight or curly hair.45
Globally, light skin is perceived as a sign of cultural capital, which extends social desirability and economic and career opportunities.46,47 A 2021 survey of 3375 U.S. Hispanic adults reported that 59% believed that having light skin helps them get ahead in the United States.48 Individuals with darker skin are subject to more prejudicial treatment that has documented ramifications, including adverse health outcomes.49,50
Understanding how social-structural factors converge to impact product use can help reduce existing health inequities. Our findings point to potential areas for intervention such as education and advocacy directed to consumers and retailers about health concerns linked to product use. For the Harlem/Northern Manhattan area specifically, our informal research found that independent, local beauty supply stores are more likely to sell skin lighteners, so education efforts starting with those retailers could be particularly impactful.
Simultaneously, campaigns to teach consumers how to read and interpret product labels are sorely needed, even for women who choose to wear natural hairstyles. The notion that people who wear their hair naturally are avoiding toxic beauty products is unsubstantiated, since there is a lack of data on the chemical content of hair styling products sold to facilitate natural hairstyles. Lastly, educating consumers about the environmental injustice of beauty could motivate them to advocate for legislation, such as the Safer Beauty Bill package, which ensures safer products for all.51
Programs and policies are needed to counteract natural hair discrimination and colorism and transform the markets that depend on racist beauty norms. Qualitatively, our data suggest that respondents in our study are moving away from chemical straighteners since the percentage of current users was much lower than ever users. This observation aligns with the rise of the natural hair movement, which encourages Black women to embrace their natural hair.52,53
Moreover, the passage of the CROWN (Create a Respectful and Open World for Natural Hair) Act in multiple states seeks to prohibit race-based hair discrimination in the workplace and in public schools. It, or inspired legislation, has passed in 17 states as of August 2022, which has both amplified the problem of hair-based discrimination and created more opportunities for dialogue.54,55 In contrast, there has been less progress on skin lighteners. In our study, the percentages of current and ever use of skin lighteners were equivalent for self-identified Asians and Asian-Americans.
Further, gaps in the regulations of skin lighteners and their constituent chemicals have created a market where products are easily accessible and detrimental to public health. For example, skin lighteners that are prohibited from being sold in stores are allowed to be sold online without the same level of oversight.56 Greater efforts are needed both in the United States and abroad to address colorism and end skin lightening practices.
Our findings must be considered in light of the strengths and limitations. In alignment with environmental justice principles, this community-based project was led by WE ACT, with substantial input from its membership.57 We are among the first exposure assessment study of beauty product use to quantify the impact of racialized beauty norms on product use. Our sample was predominantly Black and Hispanic/Latina/x women and femme-identifying individuals, which reflects key organizing populations for WE ACT's BIO Campaign. Although our results may have limited generalizability, the results are instrumental for informing intervention actions for communities that WE ACT serves and also adds to the literature about product use in understudied communities such as those from the Asian diaspora.
Our study includes some femme-identifying individuals, an understudied group in this body of literature.58 Future studies should prioritize understudied and multiply marginalized communities. The survey was only available in English and Spanish, which also limits our generalizability. Although both languages are predominantly spoken in the study areas, we may have excluded high-risk populations who speak other languages in the diverse Northern Manhattan and South Bronx areas. Finally, the data we collected were self-reported information and may suffer from inaccurate recall or recall bias.
CONCLUSION
The fight for environmental equity includes the right to clean air, land, water, and food as well as safe and healthy cosmetics and personal care products. The failure of companies to disclose the harmful chemicals in their beauty products, along with the targeted marketing of these products to women of color, raises environmental justice concerns. Adoption of environmental justice principles to protect vulnerable communities from consumer product exposures, in addition to place-based exposures, is necessary.
Specifically, principles that call for stricter regulations to hold manufacturers accountable and education of present and future generations on these issues in a manner that upholds diverse cultural perspectives are critical steps for promoting beauty justice.
ACKNOWLEDGMENTS
The authors thank Samar Ahmad, Rena Miu, and Marissa Chan for their excellent work on data quality assurance and data control. We also thank Deanna Johnson, Francesca Maviglia, Victoria Lim, Gabi Rivera, and Liam Comer-Weaver for their contributions to the study design; recruitment plan; drafting of the survey instrument, survey administrator training materials, recruitment materials, and human subjects research protocol; training of the survey administrators; and survey administration.
Supplementary Material
AUTHORs' CONTRIBUTIONS
L.E. helped clean the data, performed the statistical analyses, created the tables and figures, and led the writing of the paper for publication. L.A., L.M., S.H., and B.M. were part of the team that conceptualized and led the community-based campaign that this study is based on. L.A., L.M., S.H., B.M., R.D., and A.R.Z. contributed to the study design. A.R.Z., B.S., and R.D. contributed to the statistical analyses and development of the final results. A.R.Z. and L.A. secured funding for the research study. All authors contributed to the writing and editing of the paper and read and approved the final paper.
AUTHOR DISCLOSURE STATEMENT
No competing financial interests exist.
FUNDING INFORMATION
This work was supported by the Passport Foundation and the National Institute of Environmental Health Sciences Center for Environmental Health in Northern Manhattan (P30ES009089).
Supplementary Material
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