Hair Care Product Use Among Pregnant Women of Color: Protocol for a Feasibility Educational Intervention

Felice Tsui¹Chrystelle L Vilfranc²Adana A.M. Llanos^1,2Lauren Houghton^1,2Jamirra Franklin^1,2Vaishnavi More^1,2Kurt Pennell³Mary Beth Terry^1,4Peggy Shepherd⁵Emily Barrett⁶Desiree A H Walker⁷Jasmine A McDonald^1,2*

• ¹Department of Epidemiology, Columbia University Mailman School of Public Health, New York, United States
• ²Columbia University Herbert Irving Comprehensive Cancer Center, New York, United States
• ³Brown University School of Engineering, Providence, United States
• ⁴Silent Spring Institute, Newton, United States
• ⁵We ACT for Environmental Justice, New York, United States
• ⁶Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, United States
• ⁷Young Survival Coalition, New York, United States

Background: Endocrine-disrupting chemicals (EDCs) disrupt hormonal regulation and pose health risks. Phthalates, common in personal care products, contribute to disparate chemical exposures among different demographic groups, notably impacting critical life stages like pregnancy and postpartum. Objective: Using an environmental health literacy framework, we designed an educational intervention for pregnant Women of Color to highlight the health risks of phthalates in hair care products. The intervention aimed to measure behavioral changes toward phthalate-free products through self-reporting and urinary phthalate metabolite levels and explore factors influencing hair care practices during pregnancy. Methods: In collaboration with multidisciplinary academicians, environmental health, and breast cancer advocates, we developed a virtual educational intervention during the COVID-19 pandemic. Components included a facilitated presentation, an educational video, and a semi-structured interview guide, refined through feedback. Data collection involved baseline and follow-up sessions, sociodemographic data, hair product usage, behavior related to phthalate-containing products, and urine sample collection. To provide proof of methodological principle, we examined individual change over time from questionnaire data and targeted exposomics analysis of urinary phthalate compounds among women with baseline and follow-up data. Results: Educational materials were developed in English and Spanish. Enrollment occurred from March 2021 to June 2022, involving participants in the second or third trimester of pregnancy. Women enrolled before 31 weeks gestation, completed a baseline assessment and at least one follow-up assessment, while those at ≥31 weeks gestation completed a baseline assessment and one postpartum follow-up assessment. Forty-six participants enrolled, with 31 completing the intervention, and 42 urine samples collected. Women who completed the educational intervention were slightly older than those women who did not attend an intervention session (mean age (SD) 31.0 (5.8) vs. 27.5 (5.4)), respectively. Product and brand use decreased over time, and 27–73% of participants exhibited reductions in low molecular weight phthalate metabolites. Significance: This intervention was shaped by a collaborative effort that ensured its cultural relevance, linguistic inclusivity, and alignment with community needs, amplifying its potential impact on reducing the unequal burden of environmental exposures in marginalized communities.