Is cost of beauty putting Black women at risk? IEAAWC Study

Institution: Healthy Heritage Movement
Investigator(s): Phyllis Clark,  - Eudora Mitchell, MA - Susanne Montgomery, Ph.D., M.P.H. -
Award Cycle: 2014 (Cycle 20) Grant #: 19AB-2102 Award: $19,076
Award Type: CRC Pilot Award
Research Priorities
Etiology and Prevention>Etiology: the role of environment and lifestyle

This is a collaboration with: 19AB-2101 - 19AB-2100 -

Initial Award Abstract (2013)

The Inland Empire African American Wellness Collaborative (IEAAWC) group is located in the Inland Empire (IE) region of Sothern California. The IE has been called the Third California by the Brookings Institution to describe its staggering disparities in socio-economic and health indicators. One of the many health disparities in our region is found in breast cancer (BC): Compared to other racial/ethnic groups, African American/Black (AA/B) women are more likely to get BC, die from BC, be diagnosed with an advanced stage of BC, and get BC when they are younger. At the same time, emerging evidence suggests that toxins in hair products may contribute to BC risk [17,18]. AA/B women use hair products such as relaxers at higher rates, use products that contain more hormones and placenta than white women, are often exposed in utero through their pregnant mothers, and many begin a lifelong hair regimen of straightening product use as toddlers. Thus, at least some of the observed increased risk may be due to differences in exposure to these products. The goal for our pilot study came from the local women themselves: they wish for us to explore the potential role of hair product use in causing BC in local AA/B women. In response, our partnership proposes using a Community-Based Participatory Research (CBPR) approach of true collaboration and empowerment to engage local AA/B women in exploring our research questions with an eye to helping us prepare for prevention and outreach.

We will train local AA/B community women volunteers to engage other AA/B women with and without BC, their beauticians, salon owners, and AA/B men by conducting 30 personal interviews and seven group discussions to explore risks from a personal, cultural/social norms, and policy perspective. We will also identify and analyze the labels of hair products used locally and explore ingredients for potential risks using the “Skin Deep” cosmetics database. We will further explore our findings by developing surveys that we will pilot test with 140+ persons across our target groups. Throughout, we will be in partnership with the women and our Community Advisory Board to discuss and contextualize what we learned, use it for designing good questions and plan for how we will share results locally and to design a rigorous larger study.

Innovative elements
While there is increasing research linking hair products to the development of BC in AA/B women, this work is new and many traditional researchers are doubtful about it. At the same time, many in the AA/B community worry about widening disparities in BC incidence and mortality and fear that hair products may be involved. IE AA/B women learned about this and wanted to study this issue locally, believing in the power of capacity building, translational research that translates scientific findings into community relevant solutions, as it is only through this type of research that we can hope to develop meaningful and culturally accepted prevention efforts that can help reduce BC disparities.

Our proposed pilot study came about due to increasing community concerns about stubborn BC health disparities and the possibility that they may, at least in part, be explained by the use of the very products AA/B women use to feel more beautiful. In response, we formed our community/academic collaborative and chose to conduct the proposed research using community involved methods and begin a systematic exploration of this issue. In addition to working with community volunteers, our study will be guided by a Community Advisory Board made up of persons who lend meaningful expertise to this challenging work.

The methods and measures developed under this pilot study will inform a full scale rigorous follow-up study. That is, the pilot study will help us to establish appropriate measurement tools, refine our research questions, develop effective participant recruitment strategies, data analysis approaches, and community outreach strategies that will be part of a larger, future study of hair product related BC risk in CA AA/B women.

Final Report (2016)

Background: Our Collaborative, the Inland Empire African American Wellness Collaborative (IEAAWC) set out to investigate the potential role of hair products on breast cancer in African American (AA) Black (B) women in the Inland Empire (IE) region of Southern California. Compared to other racial/ethnic groups, African American/Black (AA/B) women in the Inland Empire are more likely to get BC, die from BC, be diagnosed with an advanced stage of BC, and get BC when they are younger. We also anecdotally know that AA/Black women use such products at younger ages, throughout their lifetime, more, and use different hair products than other race/ethnicities. In this Phase I community collaborative pilot study we are in the process of gaining a better understanding community perception on this issue and explore readiness for potential recommended changes.

Progress: We reached our stated goal to conduct a pilot CBPR study to investigate the potential role of hair products for breast cancer etiology in AA/B women living in the IE Region of Southern California and to use our findings to inform a full-scale follow-up study. Our research questions were answered. We found that women reported using substantial products on their own as well as with professional hairdressers. Indeed women with BC reported significantly higher personal as well as professional use. While we found that men, women (with and without BC), and hairstylists were indeed at least somewhat concerned about the issue, that knowledge levels were quite low, but that our respondents had a stated desire to get clearer guidance based on which to make decisions if it would be best for them to consider not using certain products. We also explored the health risks of products we identified local women used and found mixed results. Of the 52 products we examined, 26 had ingredients reviewed by Skindeep® and most of these had ratings in the moderate to high risk range; only one was rated low risk; many contained endocrine disrupting substances; however epidemiological evidence continues to lack clarity and laboratory studies on this issue present with mixed results. With respect to future outreach modalities we got feedback from all of our respondents as well as our advisory board members. The feedback suggested a combination intervention that involves community-based education that would help women make better decisions about their personal risk. We also learned that while churches continue to be an important outreach venue, many of the younger respondents as well as the men would like to have more secular forums--such as community venues, sororities, and fraternities. In addition, it was suggested that an intervention should use social media as this was seem as a more effective approach to initially reach and engage younger and working audiences. It was stressed that any approach needs to also involve male partners as they’re key to decision making for most women. However, most men (except some young men) stated that they would be supportive if the women in their lives would decide to go “natural”. In addition, many suggested to include local trainings of hairdressers with professionals (i.e. professional from the East Coast who come to hair conventions here, as the field there seems to be further along in the natural hair movement), that know more about alternatives and then these hairdressers could reach out to their clients more effectively (training the trainer).

Barriers/Challenges: As all projects we encountered some challenges, which we have either already overcome or have made much progress in overcoming. Challenges encountered include: 1. Our original subcontracting procedure and disbursement of funding proved to be disruptive due to lack of clarity. With support from the funder we reorganized the contractual structure, with each agency receiving their own award. 2. Communication was affected by this and delayed our progress, requiring us to request and receive a no cost extension. We made up nearly all deliverables, mostly even exceeding the proposed numbers in most target groups except for surveys from women with breast cancer.

Major Accomplishments: Our major accomplishments include successfully obtaining local support for the project; reaching and exceeding our qualitative key informant interview numbers in each proposed strata (N=39) as well as focus group numbers (17 FGs with 86 persons) and 279 completed surveys; in addition, we have a peer review paper in final revisions in Cancer Medicine laying out the premise of our study as well as 11 presentations at national meetings as well as a report on local product use and health risk; all of which were received with much excitement and interest. In addition we used the qualitative data to developed questions around the importance of hair to Black women and men and are in the process to developing a Black culture and hair scale as this is lacking in the literature.

Future plans: In general, the decision was made to go forward with a future application to the California Breast Cancer Research Program this coming (2016) application cycle. We are in the process of figuring out details of the intervention approach aligned with the recommendations of our respondents as well as a final partnership model. We plan to continue meeting and will continue with dissemination of our findings to both professional and local community audiences; and to report our results back to the community that supported us in this important work


A review of hair product use on breast cancer risk in African American women doi: 10.1002/cam4.613
Periodical:Cancer Medicine
Index Medicus:
Authors: Stiel L., Adkins-Jackson P.B., Clark P., Mitchell E., Montgomery S.
Yr: 2016 Vol: 5 Nbr: Abs: Pg:597-604