Validating the Black Identity, Hair Product Use, and Breast Cancer Scale (BHBS) Among Black Breast Cancer Survivors

Abstract

Personal care products containing toxic chemicals (e.g., endocrine-disrupting chemicals) may increase breast cancer risk, especially for Black women who use these products more than other racial groups. There are limited tools that examine the intersections of identity, behaviors, and attitudes surrounding product use, perceived safety, and breast cancer risk; thus, the Black Identity, Hair Product Use, and Breast Cancer Scale (BHBS) was developed to bridge this gap. While initial validations lacked diverse survivor representation, this study seeks to validate the BHBS among Black survivors. Methods: This study is a part of the Bench to Community Initiative (BCI), where respondents (n = 167) completed a 41-item survey including the BHBS between 2020 and 2022. The use of Principal Component Analysis (PCA) and confirmatory factor analysis (CFA) established the underlying component structures and model fit. CFA measures used to confirm component structures included the Root Mean Square Error of Approximation, the Comparative Fit Index, and the Tucker Lewis Index. Results: Black survivors on average were diagnosed with breast cancer before age 40 (37.41 ± 8.8) with Stage 1 (45%) disease. Sixty-three percent of the total variance resulted in a two-component structure. Subscale 1 (S1) measures the sociocultural perspectives about hair and identity (28% of the total variance; α = 0.73; 95% CI = 0.71–0.82). Subscale 2 (S2) can be used to assess perceived breast cancer risk related to hair product use (35% of the total variance; α = 0.86; 95% CI = 0.81–0.94). The two-component structure was confirmed with Root Mean Square Error of Approximation = 0.034, Comparative Fit Index = 0.93, and Tucker Lewis Index = 0.89. Discussion/Conclusions: The BHBS is a valid tool to measure identity, attitudes, and behaviors about product use and breast cancer risk among survivors. Hair is a significant cultural identity expression, and the health effects of styling products should be considered in future interventions.