Why are people cosmetic skin whitening? A systematic review

ImportanceCosmetic skin whitening is a growing practice in a number of countries and long-term use has been shown to have potentially serious health risks. No reviews have documented the behavioral factors that help explain practices related to cosmetic skin whitening. ObjectiveTo explore the main behavioral (psychological and cognitive, social and cultural, and environmental) factors behind the practice of cosmetic skin whitening, and to explore which groups and characteristics are associated with the practice as well as what interventions have been designed to address this practice. Evidence ReviewFive databases (PubMed, Scopus, APA PsychINFO, ASSIA, and Web of Sciences Preprint Citation Index) were searched using adaptations of key search terms (e.g. "skin whitening", "behavior", "risk"). Studies were not restricted by date or country. FindingsFrom 816 candidate studies, 43 studies were included in the final sample. Twelve main factors were identified: beauty; self-esteem; to attract a partner or get married; dissatisfaction with skin tone; low awareness of risks of skin whitening; to look whiter or fairer; for social status; social norms or social influence; for a job or to secure employment; colorism; the influence of advertising; and fashion. Prevalence of use ranged from 2-74%. Use was more common amongst women and younger adults but varied by country or region in terms of whether it was more commonly used by people with high or low formal education. Only one study documented an intervention designed to raise awareness of the harms of cosmetic skin whitening. Conclusions and RelevanceCosmetic skin whitening is a complex practice influenced by multiple behavioral factors. Findings should be used to inform theory-based interventions designed to reduce the prevalence of cosmetic skin whitening practices. Key pointsO_ST_ABSQuestionC_ST_ABSWhat are the main behavioral factors behind the practice of cosmetic skin whitening, what demographic groups and characteristics are most likely to engage in skin whitening, and what interventions exist that are designed to reduce its prevalence. FindingsTwelve main factors were identified: Beauty; self-esteem; to attract a partner or get married; dissatisfaction with skin tone; low awareness of risks of cosmetic skin whitening; to look whiter or fairer; for social status; social norms or social influence; for a job or to secure employment; colorism; the influence of advertising; and fashion. MeaningThe practice of cosmetic skin whitening is a complex combination of psychological and cognitive, social and cultural and environmental factors. Themes identified can be used to inform tools for future research to understand the drivers of cosmetic skin whitening, as well as theory-based interventions designed to understand and address the practice of skin whitening.