title: The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 26 countries.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: ASEAN Institute for Health Development, Mahidol University, Phutthamonthon, Nakhonpathom, Thailand.|Department of Psychology, University of Limpopo, Sovenga, South Africa.|HIV, AIDS, TB, and STIs (HAST), Human Sciences Research Council (HSRC), Pretoria, South Africa.
authors.forename: Karl
authors.initials: K
authors.lastname: Peltzer
authors.affiliation: ASEAN Institute for Health Development, Mahidol University, Phutthamonthon, Nakhonpathom, Thailand.|Department of Research Development & Innovation, University of Limpopo, Sovenga, South Africa.
authors.forename: Supa
authors.initials: S
authors.lastname: Pengpid
authors.affiliation: Department of Sociology, Psychology and Social Work, The University of the West Indies, Mona, Jamaica.
authors.forename: Caryl
authors.initials: C
authors.lastname: James
mesh_terms: D000293:Adolescent; D000349:Africa; D000569:Americas; D001208:Asia; D002650:Child Abuse, Sexual / Q000523:psychology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D012067:Religion; D020377:Self Efficacy; D012737:Sex Factors; D012725:Sexual Behavior; D062327:Skin Lightening Preparations / Q000627:therapeutic use*; D012944:Social Support; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014495:Universities; D055815:Young Adult
chemical_list: D062327:Skin Lightening Preparations