Hair Straightener Use in Relation to Prevalent and Incident Fibroids in the Sister Study with a Focus on Black Women

Abstract

Background: Uterine fibroids disproportionately affect Black women, and exposure to chemicals from hair relaxers or straighteners ("straighteners") may contribute to fibroid development.

Objectives: We examined the association between straightener use and prevalent young-onset uterine fibroids (diagnosed before age 36 y), as well as incident fibroids (diagnosed age 36-60 y), with a focus on Black women. We also examined differences in associations across birth cohorts as proxies for formulation changes.

Methods: Data from 4,162 Black women in the Sister Study, a prospective cohort of women 35-74 y of age (enrolled 2003-2009), were analyzed. We used logistic regression to estimate odds ratios (ORs) for the association of straightener use at 10-13 y of age and self-reported young-onset fibroids. We used Cox regression to assess hazard ratios (HRs) for straightener use (age 10-13 y and in 12 months before enrollment) and incident fibroids among 779 premenopausal Black women. Similar analyses were conducted in 40,782 non-Hispanic White women.

Results: Over 70% of Black women used straighteners. In comparison with no use, any [$\text{OR}=1.15$; 95% confidence interval (CI): 0.96, 1.36] and frequent use ($\text{OR}=1.18$; 95% CI: 0.99, 1.42) of straighteners at 10-13 y of age were associated with young-onset fibroids. This association was most apparent among those born between 1928 and 1945 ($\text{OR}=1.78$; 95% CI: 1.15, 2.74) and 1965-1974 ($\text{OR}=1.64$; 95% CI: 0.82, 3.29). Fibroid incidence from 36 to 60 y of age was modestly associated with use of straighteners at 10-13 y of age [hazard ratio $\left(\text{HR}\right)=1.14$; 95% CI: 0.81, 1.63] and in the 12 months prior to enrollment ($\text{HR}=1.32$; 95% CI: 0.88, 2.00). Among non-Hispanic White women, straightener use at 10-13 y of age was similarly associated with young-onset fibroids ($\text{OR}=1.23$; 95% CI: 1.03, 1.47) despite lower use ($\le 5\%$) of straighteners. Sensitivity analyses indicated a potential for bias due to fibroid misclassification, with an overestimation of the effect likely if nulliparous women or women from households with lower education reported their fibroid status less accurately.

Discussion: Hair straightener use may be positively associated with fibroid risk. https://doi.org/10.1289/EHP14493.

Figure 1.

Flow chart showing Black participants in the Sister Study included in the prevalence and incidence analysis of the association of hair straightener use and fibroids.

Figure 2.

The association of hair straightener use and young-onset fibroids (diagnosed before age 36 y) stratified by birth cohort among Black participants in the Sister Study ($n=\mathrm{4,162}$).