Effect of body image perception and skin-lightening practices on mental health of Filipino emerging adults: a mixed-methods approach protocol

INTRODUCTION

The rampant distribution of idealised images on the internet may lead the general public to improve their body appearance in a way that is sometimes excessive, compulsive or detrimental to other aspects of their lives. There is a decreasing appreciation of body image among emerging adults and an increasing trend on skin-lightening practices linked with psychological distress. This protocol describes the mixed-method approach to assess the relationships among body image perception, skin-lightening practices and mental well-being of Filipino emerging adults and determine the factors that influence them.

METHODS AND ANALYSIS

An explanatory sequential mixed-method approach will be used. A cross-sectional study design will involve an online self-administered questionnaire of 1258 participants, while a case study design will involve in-depth interviews with 25 participants. Data analysis will use generalised linear models and structural equation modelling with a Bayesian network for the quantitative data. Moreover, the qualitative data will use an inductive approach in thematic analysis. A contiguous narrative approach will integrate the quantitative and qualitative data.

ETHICS AND DISSEMINATION

The University of the Philippines Manila Review Ethics Board has approved this protocol (UPMREB 2022-0407-01). The study results will be disseminated through peer-reviewed articles and conference presentations.

Our evolved understanding of the human health risks of mercury

Mercury (Hg) is a chemical of health concern worldwide that is now being acted upon through the Minamata Convention. Operationalizing the Convention and tracking its effectiveness requires empathy of the diversity and variation of mercury exposure and risk in populations worldwide. As part of the health plenary for the 15th International Conference on Mercury as a Global Pollutant (ICMGP), this review paper details how scientific understandings have evolved over time, from tragic poisoning events in the mid-twentieth century to important epidemiological studies in the late-twentieth century in the Seychelles and Faroe Islands, the Arctic and Amazon. Entering the twenty-first century, studies on diverse source-exposure scenarios (e.g., ASGM, amalgams, contaminated sites, cosmetics, electronic waste) from across global regions have expanded understandings and exemplified the need to consider socio-environmental variables and local contexts when conducting health studies. We conclude with perspectives on next steps for mercury health research in the post-Minamata Convention era.

A Cross-Sectional Study of the Knowledge, Practice, and Attitude Towards Skin-Lightening Products Among the General Population in the Western Region of Saudi Arabia

Introduction Skin bleaching is a growing phenomenon worldwide and is becoming an increasing problem. Several skin-lightening products (SLPs) containing mercury, hydroquinone, and corticosteroids have impacted serious dermatological, nephrological, and neurological side effects. There is relatively little regulation, and the products are easily accessible and inexpensive. Justifications and beliefs for the use of these products vary from culture to culture, and there is little previous research on the use and abuse of skin-lightening cosmetics among Saudi women. This study examines the knowledge, attitudes, and practices of the public in the western region of Saudi Arabia regarding SLPs to understand the situation better. Methodology An observational, cross-sectional, questionnaire-based study was conducted over two months between July and August 2022. A 29-question survey was used to collect data from the general population. The study included all women residing in the western region of Saudi Arabia. Non-Arabic speakers were excluded. RStudio (R version 4.1.1) was used to analyze the data. Results A total of 409 participants were included in this study; In general, 146 (35.7%) of the participants said they had ever used an SLP. More than two-thirds (67.1%) had been using them for less than a year. In terms of the most common site of SLPs application, women reported applying the products to the skin of their face (74.7%), elbows (47.3%), and knees (46.6%). Use of SLPs differed significantly across participants' ages, with the proportion of SLP users in the 20-30 age category significantly higher than non-users (50.7% vs. 36.9%, p=0.017), and non-users were more common than users within the age category >50 years. In addition, the proportion of SLP users relative to educational level was significantly higher among participants with a bachelor's degree than the proportion of non-users (69.2% vs. 54.0%, p = 0.009). Conclusions The results of this research show that Saudi women frequently utilize topical lightening products. Therefore, regulation and controlling the use of bleaching products is essential, as is educating women about the risks involved with this practice. The misuse of bleaching products should decline with greater awareness.

A Systematic Review of Mercury Exposures from Skin-Lightening Products

BACKGROUND

The Minamata Convention on Mercury (Article 4) prohibits the manufacture, import, or export of skin-lightening products containing mercury concentrations above 1 ppm. However, there is a lack of knowledge surrounding the global prevalence of mercury-added skin-lightening products.

OBJECTIVE

The objective of this study was to increase our understanding of worldwide human mercury exposure from skin-lightening products.

METHODS

A systematic search of peer-reviewed scientific literature was performed for relevant articles in four databases (PubMed, Web of Science Core Collection, Scopus, and TOXLINE). The search strategy, eligibility criteria, and data-extraction methods were established a priori. The search identified 2,303 unique scientific articles, of which 41 were ultimately deemed eligible for inclusion after iterative screens at the title, abstract, and whole-text levels. To facilitate data extraction and synthesis, all papers were organized according to four data groups a) "Mercury in products," b) "Usage of products," c) "Human biomarkers of exposure," and d) "Health impacts."

RESULTS

This review was based on data contained in 41 peer-reviewed scientific papers from 22 countries worldwide published between 2000 and 2022. In total, we captured mercury concentration values from 787 skin-lightening product samples [overall pooled central median mercury level was 0.49μg/g; interquartile range (IQR): 0.02-5.9] and 1,042 human biomarker measurements from 863 individuals. We also synthesized usage information from 3,898 individuals and self-reported health impacts associated with using mercury-added products from 832 individuals.

DISCUSSION

This review suggests that mercury widely exists as an active ingredient in many skin-lightening products worldwide and that users are at risk of variable and often high exposures. These synthesized findings identify data gaps and help increase our understanding of the health risks associated with the use of these products. https://doi.org/10.1289/EHP10808.

Formulation and Characterization of Carbopol-934 Based Kojic Acid-Loaded Smart Nanocrystals: A Solubility Enhancement Approach

Kojic acid (KA) is a BCS class II drug having low solubility and high permeability. This study was designed to enhance the aqueous solubility of KA, as well as its dissolution rate and, in turn, bioavailability, by formulating its smart nanocrystals. Nanocrystals of pure KA were formulated by the top-down method under high-pressure homogenization followed by freeze drying. The nanocrystals were evaluated for stability and other physical characteristics, including zeta sizer analysis, DSC, surface morphology, XRD, drug content, solubility, FTIR and in vitro drug release. The KA nanocrystals were found to be stable when kept at exaggerated conditions. The particle size of the nanocrystals was 137.5 ± 1.7, 150 ± 2.8, and 110 ± 3.0 nm for the F1, F2 and F3 formulations, respectively. There was negative zeta potential for all the formulations. The dispersity index was 0.45 ± 0.2, 0.36 ± 0.4 and 0.41 ± 1.5 for the F1, F2 and F3, respectively. The DSC studies showed that there was no interaction between the KA and the excipients of the nanocrystals. The morphological studies confirmed the presence of rough crystalline surfaces on the nanosized particles. XRD studies showed the successful preparation of nanocrystals. The drug content was in the official range of 90 ± 10%. The solubility of KA was significantly (p < 0.05) enhanced in the formulations of its nanocrystals as compared with pure KA powder. The ATR-FTIR studies revealed the presence of functional groups in both KA and KA-loaded nanocrystals, and no interaction was found between them. The nanocrystals released 83.93 ± 1.22% of KA in 24 h. The study concluded that the nanocrystals were successfully formulated using the top-down method followed by high-pressure homogenization. The solubility, as well as the dissolution, of the KA was enhanced, and this could improve the therapeutic effects of KA.

A survey evaluating knowledge, perception, and use of skin lightening products among South African students

Background

In sub-Saharan Africa, the use of skin-lightening products (SLPs) for cosmetic purposes has become common practice among women with dark skin tones. Despite the associated risks, the practice is still significantly increasing in Africa. The objective of this study was to determine the knowledge, perceptions and practice toward skin lightening among young adults.

Methods

A cross-sectional survey among health science students at a tertiary institution in the Western Cape of South Africa was conducted.

Results

A total of 401 participants were included in the sample. There was a low prevalence (12%) of skin-lightening practice among students, which could possibly be a result of students being aware of the associated side effects. Participants believed that family and friends are most likely to influence this behavior (48%) and perceived that individuals who practice skin lightening do so because this provides a more fashionable look (76%). Men and women were found to be equally likely to use SLPs, and those residing in urban settings are 10 times more likely to engage in the practice compared with rural dwellers.

Conclusion

This study contributes valuable information on the phenomenon of skin lightening among a diverse group of young adults. The results highlight the influential role social media platforms and family members play in motivating use of SLPs. Furthermore, the equal likelihood of use among both sexes suggests that the practice is growing among males.

"The unfair drive to be fair": Psychosocial aspects and implications of the use of skin lightening agents

The quest to be fair is not a concept of the new world. For centuries untold, having a lighter skin tone has been considered as a trait of beauty and supremacy. Society implicates fairness as a factor for getting a prospective life partner. Media portrays fair skin tone as a predecessor for success. These subtle influences affect young minds and drive them towards wanting fair skin. Physicians observe that it is one of the most common forms of body dysmorphic disorder. This article aims to highlight the psychosocial factors that mold this mentality and the possible ill effects it can have on a person, both psychologically as well as physically.

A indústria do branqueamento em Lisboa: uma etnografia das práticas e produtos para o branqueamento da pele e seus riscos para a saúde dermatológica

Resumo Por meio de um exercício de walking ethnography, pretendemos apresentar uma etnografia da oferta cosmética destinada à despigmentação da pele no coração de Lisboa, focando num fragmento da cidade que junta diferentes propostas e produtos estéticos: spas chineses, salões de beleza e cabeleireiros africanos, lojas do comércio dito “étnico” ligado a imigrantes e portugueses descendentes de populações asiáticas ou africanas. Definimos esse passeio como “caminho do branqueamento” - parafraseando ironicamente o título de um dos mais famosos livros de Michael Jackson, Paths towards a clearing (1989). Considerando o corpo como um projeto em construção, pretendemos mostrar que os imaginários e os desejos ligados ao consumo desses tratamentos, assim como os padrões de beleza veiculados pelo marketing dos produtos de clareamento da pele, refletem e reproduzem variáveis sociais de género, classe e raça. Queremos também evidenciar como a maior parte dos produtos branqueadores, vendidos no centro da cidade, são proibidos pela legislação europeia de regulamentação de cosméticos, devido às altas concentrações de substâncias tóxicas. Essas substâncias, que circulam livremente nas redes do comercio informal, podem ser muito prejudiciais para a saúde dos consumidores, comportando severos riscos dermatológicos.

Kojic acid applications in cosmetic and pharmaceutical preparations

Skin color disorders can be caused by various factors, such as excessive exposure to sunlight, aging and hormonal imbalance during pregnancy, or taking some medications. Kojic acid (KA) is a natural metabolite produced by fungi that has the ability to inhibit tyrosinase activity in synthesis of melanin. The major applications of KA and its derivatives in medicine are based on their biocompatibility, antimicrobial and antiviral, antitumor, antidiabetic, anticancer, anti-speck, anti-parasitic, and pesticidal and insecticidal properties. In addition, KA and its derivatives are used as anti-oxidant, anti-proliferative, anti-inflammatory, radio protective and skin-lightening agent in skin creams, lotions, soaps, and dental care products. KA has the ability to act as a UV protector, suppressor of hyperpigmentation in human and restrainer of melanin formation, due to its tyrosinase inhibitory activity. Also, KA could be developed as a chemo sensitizer to enhance efficacy of commercial antifungal drugs or fungicides. In general, KA and its derivatives have wide applications in cosmetics and pharmaceutical industries.

Should We Genetically Select for the Beauty Norm of Fair Skin?

Fair skin is often regarded as a beauty ideal in many parts of the world. Genetic selection for non-disease traits may allow reproducers to select fair skin for the purposes of beauty, and may be justified under various procreative principles. In this paper I assess the ethics of genetic selection for fair skin as a beauty feature. In particular, I explore the discriminatory aspects and demands of such selection. Using race and colour hierarchies that many would find objectionable, I argue that selection for beauty that is underpinned by such hierarchies is not a trivial selection. Given this, I claim that we should not make such selections.

The global prevalence and correlates of skin bleaching: a meta-analysis and meta-regression analysis

PURPOSE

To estimate and investigate the global lifetime prevalence and correlates of skin bleaching.

METHODS

A meta-analysis and meta-regression analysis was performed based on a systematic and comprehensive literature search conducted in Google Scholar, ISI Web of Science, ProQuest, PsycNET, PubMed, and other relevant websites and reference lists. A total of 68 studies (67,665 participants) providing original data on the lifetime prevalence of skin bleaching were included. Publication bias was corrected using the trim and fill procedure.

RESULTS

The pooled (imputed) lifetime prevalence of skin bleaching was 27.7% (95% CI: 19.6-37.5, I²  = 99.6, P < 0.01). The highest significant prevalences were associated with: males (28.0%), topical corticosteroid use (51.8%), Africa (27.1%), persons aged ≤30 years (55.9%), individuals with only primary school education (31.6%), urban or semiurban residents (74.9%), patients (21.3%), data from 2010-2017 (26.8%), dermatological evaluation and testing-based assessment (24.9%), random sampling methods (29.2%), and moderate quality studies (32.3%). The proportion of females in study samples was significantly related to skin bleaching prevalence.

CONCLUSION

Despite some limitations, our results indicate that the practice of skin bleaching is a serious global public health issue that should be addressed through appropriate public health interventions.

The Effects of System Justifying Beliefs on Skin-Tone Surveillance, Skin-Color Dissatisfaction, and Skin-Bleaching Behavior

In two studies with women living in India (Study 1, n = 177) and African American women in the United States (Study 2, n = 120), we investigated whether skin-tone surveillance, which theoretically is a manifestation of self-objectification, predicted greater skin-color dissatisfaction and greater skin-bleaching behavior. Given the existence of colorism in Indian and American societies, we expected that ideologies that rationalize and perpetuate the status quo would moderate the proposed relations. Results were consistent with objectification theory and system justification theory. The positive relation between skin-tone surveillance and skin-color dissatisfaction was weaker among women of color who more strongly (vs. weakly) endorsed system justifying ideologies, and the positive relation between skin-tone surveillance and skin-bleaching behavior was stronger among women of color who more strongly (vs. weakly) endorsed system justifying ideologies. Our results suggest that self-objectification theorists and researchers should consider culturally specific manifestations of self-objectification as well as protective and legitimating effects of system justifying ideologies. We encourage clinicians and policy makers to use public campaigns and individual-level interventions to target the norms and motivations underlying skin-bleaching. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 26 countries

BACKGROUND

The aim of this study was to investigate the use of skin lighteners and its social correlates in university students from 26 low, middle income, and emerging economy countries.

METHODS

Using anonymous questionnaires, data were collected from 19,624 undergraduate university students (mean age 20.8, SD 2.8) from 27 universities in 26 countries across Asia, Africa, and the Americas. Multivariate logistic regression analysis was used to identify associations between sociodemographic, social, health risk, mental health and abuse, and the use of skin lighteners.

RESULTS

Overall, the prevalence of previous 12-month skin lightener use was 24.5, and 16.7% in male and 30.0% in female students. The use of skin lighteners varied by country, ranging from 0% in Turkey to 83.8% in Thailand. In multivariate logistic regression analysis among both men and women, social variables (highly-organized religious activity and lack of personal mastery) and health variables (inconsistent condom use) were associated with skin lightening use. In addition, male students from a lower income country, having a lack of social support, and a history of childhood sexual abuse were more likely to use skin lighteners, and women aged 20-21 years old, residing on the university campus, being a student of health and welfare, and having a lack of personal control, inadequate physical activity, and depressive symptoms were more likely users of skin-lightening products.

CONCLUSION

A high prevalence of skin lightener use was found in this large sample of university students, and social and health-related risk factors were identified.

Mixed-Ethnicity Face Shape and Attractiveness in Humans

Many studies show agreement within and between populations and cultures for general judgments of facial attractiveness. Studies that have examined the attractiveness of specific traits have also highlighted cross-cultural differences for factors such as symmetry, averageness, and masculinity. One trait that should be preferred across cultures is heterozygosity. Indeed, several studies suggest that mixed ethnicity, in terms of appearing to possess a mixture of traits from different human population groups, may be found attractive, which could reflect preferences for heterozygosity. We examined preferences for manipulated face shape associated with different populations in both Europeans (Britain) and Africans (Guinea-Bissau). We found that mixed-ethnicity face shapes were more attractive than enhanced single-ethnicity face shape across both populations. These results are consistent with evolutionary theories suggesting individuals should prefer heterozygosity in partners because facial cues to mixed-ethnicity are likely to indicate diverse genes compared to cues that indicate a face belongs to a single particular culture or population.