Skin-lightening practices among shoppers in select markets in Kumasi, Ghana: A cross-sectional survey

BACKGROUND: Despite warnings about its harmful adverse effects and the implementation of regulatory bans, anecdotal reports suggest high use of skin-lightening agents in Kumasi, Ghana. OBJECTIVE: To estimate the prevalence and motivation for skin-lightening agent use and nonuse among shoppers in Kumasi, Ghana. METHODS: This is a cross-sectional survey of a convenience sample of shoppers in 3 of Kumasi's largest markets. RESULTS: Of the 350 shoppers who were approached, 334 consented, for a response rate of 95%. Data were analyzed on 331 completed surveys. A total of 40.4% of individuals reported current or past use of skin-lightening products, and 26.6% of men reported history of product use compared with 56.5% of women. Female sex was significantly associated with skin-lightening product use (odds ratio 3.59; 95% confidence interval 2.26-5.70). Users of skin-lightening agents were more likely to agree with statements that associated lighter skin with beauty, self-esteem, attractiveness, and wealth. LIMITATIONS: Using a nonrandomized convenience sampling method on a single city limits the generalizability of the results. Response, recall, and social desirability biases may have skewed the results, especially given the stigma associated with skin-lightening agent use. CONCLUSION: The practice of skin lightening among all participants is high and is associated with perceptions of increased beauty, attractiveness, self-esteem, and wealth.