Knowledge, Attitudes, Practices (KAP) and Sources of ...

Knowledge, Attitudes, Practices (KAP) and Sources of Information on Safe Cosmetics and Personal-care Products Among Journalists in a Major Philippine Newspaper May M. Serrano1

Abstract This study assessed the knowledge, attitudes and practices, as well as the sources of information on cosmetics, of 71 journalists working at a major Philippine daily. The study is informed by the theory of reasoned action and was conducted from Sept. 22 to Nov. 7, 2014 in Manila using questionnaires and e-mail. The respondents’ sources of information on cosmetics/PCPs use and potential hazards were the Internet (87.32%), newspapers (70.42%), magazines (69.01%), friends and colleagues (69.01%), media launches and events (52.11%), and television (50.7%). They exhibited a medium level of awareness (52.39%), which was close to low level (0%-49%). Only 8.45% knew the Philippine Safe Cosmetics Act. Nevertheless, the respondents showed a medium level of favorable attitude (69.67%) toward the use of safe cosmetics and PCPs. They also showed a medium level of favorable practices (64.68%). Only 45.59% regularly read the labels and ingredients of cosmetic products, 25.37% consulted guides for safer cosmetics, and majority were not updated with health-related bills in the Congress (76.81%). However, majority (75.36%) agreed to share information about any cosmetic hazards to others. The respondents’ top reasons for choosing cosmetics/PCPs were availability and safety. However, most of their preferred brands contain harmful cosmetic ingredients. The study recommends health practitioners and advocates of safe cosmetic use to strengthen their awareness campaigns among “secondary stakeholders” such as the government, community leaders and the media. Knowledge gain and attitudinal change are necessary to actualize a behavior change, and The Steps to Behavior Change postulates five major stages of change, namely 1

A research study submitted in partial fulfillment of the requirements for DEVC 290 under Dr. Serlie B. Jamias

knowledge, approval, intention, practice and advocacy. In the case of the journalists, behavior change would benefit themselves on the personal level and, more importantly, their readers. As stated by the CDC, media advocacy “seeks to use the media to change the social environment in which individuals make personal behavior decisions.”

Key words: Safe Cosmetics Act, health journalism, print media, media KAP

INTRODUCTION Rationale of the Study Sen. Miriam Santiago penned Senate Bill 1574, also known as An Act Establishing the Safe Cosmetics Act, with the 14th Congress (2007-2010). On Sept. 11, 2013, the bill was refiled with the 16th Congress and presented to the Committees on Health and Demography; and the Trade, Commerce and Entrepreneurship—the primary and secondary committees, respectively. The bill “seeks to ensure that cosmetic products are free of any ingredients which have been identified as chemicals causing cancer or reproductive toxicity” (SB 1574, Sec. 2, 2013).” The said chemicals include those identified by the authoritative body as substance reported to be human carcinogens by a national toxicology report on carcinogens, the International Agency for Research on Cancer, the US Environmental Protection Agency, and those reported to cause male or female reproductive toxicity by the National Toxicology Program’s Center for the Evaluation of Risks to Human Reproduction of the US. The global cosmetics industry is categorized into six major types: skin care, hair care, makeup, perfumes, toiletries and deodorants, and oral-care cosmetics. In 2010, online shops and mail-order household earned about $7.2 billion dollars from the whole cosmetic industry. Skin care, the largest segment, “accounted for 33.8% of the global market in 2012” (Statista, 2014). In the Philippines, “beauty and personal care increased in value by four percent in 2012 (Euromonitor International, 2014). According to the report, Unilever Philippines, a

multinational brand led the beauty and personal-care industry with a 22% value share. It was followed by Procter & Gamble Philippines, Colgate-Palmolive Philippines and Avon Cosmetics. The Food and Drug Administration (FDA) of the Philippines defines cosmetic as “any substance or preparation that can be applied on the external parts of the body, such as the skin and its appendages, epidermis and hair system, nails, lips, external genital organs, and teeth, that have any of the following functions: a) for cleaning, b) promoting health benefits, c) perfuming, d) modifying one’s appearance, e) correcting body odor, or f) for protecting or keeping any structure of the body in good condition, among others” (FDA Advisory 2013-10, 2013). Statement of the Problem Asian countries tend to be more conscious of using cosmetics and PCPs, particularly for the face. In the study, The construction of beauty: A cross-cultural analysis of women's magazine advertising, it was revealed that Asian ads—based on Singapore and Taiwan magazines—chiefly contained cosmetics and facial beauty products while US ads mostly included clothing (Frith et al., 2005). However, there have been reports on harmful effects of cosmetics. Phthalates is an anti-androgen used as plasticizer in cosmetics. Testosterone produces the masculine brain, thus scientists believe that phthalates affects masculine brain development. In a University of Rochester Medical Center-led study published in the International Journal of Andrology, it was found out that high concentration of phthalates in mothers resulted to their sons’ less interest in male-typical toys and games (Swan et al., 2009).

Mineral oil hydrocarbons are the greatest contaminant of the human body. In a study published by the Journal of Women’s Health, it was revealed that fat and milk samples from women contained mineral oil concentrations, which were strongly correlated with the respondents’ use of sun creams in the present pregnancy and use of hand creams and lipsticks in daily life (Concin et al., 2011). In 2009, the FDA published an analysis of lead levels in lipstick in the Journal of Cosmetic Science. It found lead, a neurotoxin, in all 20 of the lipsticks tested, four times the highest level reported by the Campaign for Safe Cosmetics’ independent study in 2007. One of the tasks of mass media practitioners is to inform the public and fill in the gap in health and safety awareness. Friedman et al. (2014) conducted 15 in-depth telephone interviews with health journalists covering different geographic regions and media market sizes. The respondents stated that they would need more collaboration with public health practitioners to improve their understanding of health information, hence enabling them to develop better health news content for their intended audience. Media practitioners have the ability to inform and educate the public on sustainable practices. Media advocacy is defined as “the strategic use of mass media and community advocacy to advance environmental change or a public policy initiative… [It] is a crucial component of a comprehensive media campaign because it empowers the community and targets policy makers” (Centers for Disease Control and Prevention

(CDC), 2003). A media advocacy on safe cosmetics may reinforce social responsibility as well as help push the Safe Cosmetics Act in the Congress. Hence, there is a need for communication sharing about the hazards of conventional cosmetics and personal-care products (PCPs). The study sought to determine the level of knowledge, attitudes, practices (KAP) and sources on information on safe cosmetics and PCPs of media practitioners at a major broadsheet newspaper in the Philippines. A high degree of KAP among the respondents may encourage an effective media advocacy on the use of safe cosmetics and PCPs, thus informing and educating the readers as well as helping the proponents of the Safe Cosmetics Act push the bill in the Congress. Objective of the Study The study sought to find out the level of knowledge, attitude and practice (KAP) and the sources of information on safe cosmetics and PCPs among selected journalists in the Philippines. Specifically, it sought to: 1. Determine the respondents’ knowledge about cosmetics and PCPs, and their possible hazards; 2. Determine the respondents’ attitude toward cosmetics and PCPs, their use, and their safety;

3. Determine their sources of information about cosmetics and PCPs and potential hazards; and 4. Determine the respondents’ safe practices in using cosmetics and PCPs. Review of Literature ‘Cosmetovigilance’ and regulatory initiatives To establish transparency with the government, health authorities and consumers, some manufacturers and organizations implement a structured cosmetovigilance system in certain countries. Cosmetovigilance is a formal and reliable monitoring system that investigates and prevents risks caused by the use of cosmetics (Sautebin, 2008). Stakeholders such as dermatologists, pharmacists and consumers are generally asked to list down undesirable effects of cosmetics on standard reporting forms, which are then evaluated by appropriate authorities. Cosmetics and household cleaning products brand Unilever established a vigilance system in France in late 2003. From 2005 to 2007, the company’s consumer department received 102,689 reports from consumers, where 842 (0.82%) reported skin reactions. Analysis showed that 0.144 skin reaction cases per million units sold were attributed to cosmetic or household products (Kornfeld-Lecanu et al., 2010). From July 2009 to May 2011, the National Institute for Public Health and the Environment (RIVM) in The Netherlands rolled out a cosmetovigilance system among general practitioners, dermatologists and consumers. It received more than 1,600

reports, with one to four percent claiming severe undesirable effects. Makeup and moisturizers were the most frequently reported cosmetic products while isothiazolinones and fragrance ingredients were the most frequently identified allergens (Salverda et al., 2013). In the 2010 review, Safety assessment of personal care products/cosmetics and their ingredients, Nohynek et al. concluded that, according to current records, PCPs are safe and offer multiple benefits to quality of life and health of the consumer. However, the study also reported that “the potential human systemic exposure to PCP ingredients is increasingly estimated on the basis of in vitro skin penetration data” and because in vitro test is usually done on cadaver skin, the results may be miscalculated. Public understanding of science In this research study, the respondent journalists are considered as (1) media practitioners/information channels and as (2) “highly standardized publics” who get information on safe cosmetics and PCPs from interpersonal, group, mass media and new media. Dodds et al. (2008) studied the views of scientifically aware—but not scientists—British consumers toward scientific and pseudoscientific claims made in advertisements for functional foods and cosmetics. The study proved that scientific awareness helps consumers to critically observe cosmetics that claim to be effective. According to Greco (translated by Caregnato, 2008) and as a common knowledge in science communication, information (knowledge) and judgment elaboration (attitude)

has no linear relationship because “data never are totally ‘bare’ and culturally neutral” and judgment depends on “cultural history and the personal elaboration.” Demonstrating this notion is the study of Kahan et al (2008) on risk perceptions on nanotechnology, an aspect of cosmetic products through engineered inorganic nanoparticles (Wiechers & Musee, 2010). In 2008, the technology was hardly known to the public or non-experts, thus Kahan’s study surveyed two groups: one with no exposure to information on nanotechnology; the other, exposed to substantial amount of information. One thousand six hundred respondents were selected among the adult US population with medium-high income and higher education. Before exposure to information, the risk perception between the two groups were the same. After the experiment, the group exposed to information showed decreased risk perception among the males and white ethnic group, and increased risk perception among the females and non-white ethnic group. The study further concluded that “any type of information may generate different and unpredictable effects even in highly standardized publics.” El-Sharkawy (2011) did a cross-sectional survey was done among 970 high social-class Egyptians aged 20 years and above from nine different Egyptian governorates to know their awareness of sodium lauryl sulfate and sodium laureth sulfate. Results showed very low awareness level and that practice of reading the products’ ingredients was significantly associated with hearing about the substances. The practice of reading ingredients was unsatisfactory.

Respondents who read the ingredients were found to have significantly better knowledge of SLS and SLES. Nevertheless, positive attitude towards readiness for changing products was high. Theoretical and Conceptual Framework of the Study Theoretical Framework "Human development is the key to sustainable development… and human development is a continuous process of improving people's knowledge, attitudes and practices through education, training and communication campaigns in order to increase their productivity and income while protecting the environment” (Mercado, 2000). This study is informed by Fishbein and Azjen’s Theory of Reasoned Action. The authors argue that “the best predictor of a person’s behavior is his intention to perform the behavior, irrespective of the nature of the behavioral criterion (Fishbein & Azjen, 1975).” The theory specifies two major determinants of intentions, i.e., attitudes toward the behavior and subjective norms. The latter, the normative component, “is related to the person’s beliefs that relevant referents think he should or should not perform the behavior and his motivation to comply with the referents.”

Figure 1. Theory of Reasoned Action’s conceptual framework for the prediction of intention and behavior.

Attitude Toward Act or Behavior Behavioral Intention

Behavior

Subjective Norm

Conceptual Framework

Knowledge

Attitude

Practice

Information Sources

Knowledge is defined as “a set of understandings, knowledge and of ‘science’… one’s capacity for imagining, one’s way of perceiving. Knowledge of a health behavior considered to be beneficial, however, does not automatically mean that this behavior will be followed” (Medecins du Monde, 2011). In a typical KAP survey, the level of knowledge helps to “locate areas where information and education efforts remain to be exerted.” In this study, knowledge was measured through a 10-item awareness test. Ivancevich and Matteson (1996) define attitude as “a mental state of readiness learned and organized through experience” while according to Cox & Cox (1991), it is “a

predisposition or readiness to respond in a certain way to a person, object, idea, or situation.” Some attitudes may stay relatively stable over time while others may change with new information and experience. Accordingly, attitude has three components, namely: cognitive component (perceptions, opinions and beliefs), affective component (feelings, emotions toward an object) and behavioral component (the tendency to act in a certain way). In this study, attitude was measured through a Likert scale using 10 attitudinal statements. The study of Dodds et al (2008) proved that scientific awareness helps consumers to critically observe cosmetics that claim to be effective. Mass media are most effective for attention and awareness stages while interpersonal communication is most effective during adoption phase (Rogers, 1971). In this study, sources of information were measured through a 14-item categorical survey covering interpersonal, group, mass media and new media. Practices are the “observable actions of an individual in response to a stimulus. This is something that deals with the concrete, with actions” (Medecins du Monde, 2011). In this study, practice was measured through a Likert scale using 10 behavioral statements.

MATERIALS AND METHODS Research Design The study used a cross-sectional survey research design. A total of 71 journalists, including regular columnists, of the major Philippine broadsheet newspaper were given the research questionnaire. The design is conducted by collecting “data at one point in time from a sample selected to describe a population at that time” (Librero, 2003). Research Locale and Time The study was conducted at the head office of a major Philippine broadsheet newspaper in Metro Manila from Sept. 22 to Nov. 7, 2014. Respondents and Sampling The respondents were reporters and columnists in a major newspaper in Manila. The newspaper has a total of 169 regular writers in all, which made up the sampling population. The Slovin’s formula was used to get the exact value for the target-sample size, i.e., 119 respondents at 5% margin of error. Twenty-six respondents (15.38%) had no available contact information, while the remaining 143 (84.62%) were each sent a survey questionnaire, with an aim of retrieving 119. Data Gathering and Analysis A self-administered questionnaire was used, which was divided into four sections following the specified objectives. Data was analyzed using descriptive statistics.

Overall scores for knowledge, attitude and practice were classified into three levels: less than 50 percent (low), 50 to less than 75 percent (medium) and 75 percent and more (high). Overall awareness/knowledge was based from scores obtained in a 10-point system. For questions 1 to 3, a respondent should answer Yes (Aware) to earn a point. For questions 4 and 5, a respondent should check at least one substance. For questions 6 to 10, all correct answers were given one point each. Overall attitude was measured using a 50-point system, where favorable attitude led to higher points, i.e., strongly disagree = one point, disagree = two points, neutral = three points, agree = four points, and strongly agree = five points. Overall practice was based from scores on a 30-point system, also with favorable practice leading to higher points, thus positive/favorable practice = three points, and negative practice = one point. The respondents also listed down their preferred brands for cosmetics and PCPs and their reasons for choosing/using it, as well as their sources of information about the possible hazards of cosmetics and PCPs. RESULTS AND DISCUSSION The Respondents There were a total of 71 from the original 169 potential respondents. After seven weeks (Sept. 22 – Nov. 7, 2014), 71 (42.01%) completely filled-out questionnaires were retrieved, while 31 (18.34%) did not respond at all. Twenty-seven

journalists (15.98%) refused to answer the questionnaire while 14 (8.28%) expressed willingness to join the survey but were not able to submit answers. Most of the journalists who refused to answer said they were hesitant and uncomfortable to answer surveys on subjects they were not well-versed in, thus referring the author to women journalists and those they thought were fond of using cosmetics. Thirteen out of the 71 respondents (18.31%) were columnists focusing on health, science or beauty topics. Table 1. Respondents of the Study RESPONDENTS NUMBER (N=169) Filled up questionnaire 71 No response 31 Refused to answer 27 No contact information 26 Willing but did not answer 14 TOTAL 169

PERCENTAGE (%) 42.01 18.34 15.98 15.38 8.28 100

Knowledge on Cosmetics and Hazards Overall, the respondent-journalists exhibited a medium level of awareness (52.39%), which was bordering on low level (0%-49%). This showed that the information that the respondents get from various media (Table 6) is not sufficient, particularly on the Safe Cosmetics Act of the Philippines. Information and education need to be exerted to increase the respondents’ knowledge. Meanwhile, they scored high on familiarity with the ill effects of cosmetics (81.69%). According to The Steps to Behavior Change, the five major stages of change are knowledge, approval, intention, practice and advocacy. For a media advocacy to take place, the individuals that compose the sector must display high scores in knowledge, approval, intention and practice.

Table 2. Overall knowledge of the respondents on cosmetics and hazards KNOWLEDGE NUMBER (N=71) PERCENTAGE (%) Low 28 39.44 Medium 30 42.25 High 13 18.31 TOTAL 71 100

As for the individual knowledge, results are shown in Table 3. The respondents knew an average of 4.10 out of 12 cosmetic ingredients (34.17%) in the list provided. Most of the respondents (91.55%) were familiar with at least one of the listed cosmetic ingredients (paraben, lead, UV filters, dimethicone, talc, petrolatum, paraffin, triclosan, phthalates, triethanolamine, sodium lauryl sulfate, and diethanolamine). The low awareness on the names of harmful cosmetic ingredients may be due to the fact that only 18.31% of the respondents regularly write about health, science or beauty. However, more than half were familiar with UV filters (67.64%), which is used in sunscreen products; talc (66.20%); and lead (66.20%). These supported the respondents’ high awareness on the presence of lead in US-made lipsticks (63.38%) and the high level of sunscreen and baby powder usage (Table 8). Asked which of the cosmetic ingredients are harmful to human health, the respondents checked an average of 2.62 out of 12 ingredients (21.83%). Majority (88.73%) perceived at least one of the ingredients as harmful to human health—led by lead (84.51%) and parabens (35.21%). Environmental organizations and safe cosmetics advocates are active in spreading awareness about these two toxic products, hence the increase in products labeled “lead-free” or “paraben-free.”

Interestingly, 40.85% of the respondents were aware of the harm of certain ingredients but did not know that these are mixed in some cosmetics. These include lead (39.44%), triclosan (22.54%) and petrolatum (21.13%). While lead is important in manufacturing batteries and alloys, it is also included in a variety of cosmetics and PCPs such as lipstick and whitening toothpaste. Triclosan is mainly used as preservative and an antimicrobial ingredient, while petrolatum is mineral oil jelly or the common petroleum jelly. Majority of the respondents (81.69%) knew at least one ill effect of cosmetics. Almost half (45.07%) mentioned allergies and 35.21%, other skin problems, which they had personally experienced. Less than a quarter (22.54%) mentioned poisoning due to lead content. One respondent stated the ill effect of cosmetics to the environment. Almost half (45.07%) were aware that not all organic products are chemical-free. The US FDA does not approve all cosmetic products before they are sold in the market. Almost a third of the respondents (33.80%) were aware of this, while the same number (33.80%) believed otherwise. The FDA does not approve cosmetic products or ingredients other than color additives. Almost a third (30.99%) were aware of any bill or law related to safe cosmetics use in other countries, which include the Safe Cosmetics Act in the US and the ban on animal testing in the UK. More than half (56.34%) agreed that even when cosmetics claim to be hypoallergenic, dermatologist-tested or non-irritating, these may still cause allergic reactions, as experienced by most of the respondents. The FDA doesn’t provide standards on the use of “hypoallergenic” thus cosmetic manufacturers need not prove their claims.

A few (16.90%) were aware that an average woman is exposed to more than 100 chemicals in cosmetics on a daily basis. Nearly half (49.30%) believed it was only 20-50 chemicals. Only 15.49% of the respondents were aware of any bill or law related to safe cosmetics use in the Philippines and 8.45% knew the Safe Cosmetics Act. Table 3. Knowledge of respondents on cosmetics and hazards NUMBER KNOWLEDGE ITEMS (N=71) Familiarity with cosmetic ingredients 65 Familiarity with harmful cosmetic ingredients 63 Ill effects of cosmetics 58 Presence of lead in lipsticks made in the US 45 Presence of chemicals in organic products 26 US FDA approval on all cosmetic products before 24 they are sold in the market Bill related to safe cosmetics in other countries 22 Hypoallergenic/ dermatologist-tested/ non-irritating 13 cosmetics vs. allergic reactions Number of chemicals in cosmetics an average 12 woman exposed to Bill related to safe cosmetics in the Philippines 11

PERCENTAGE (%) 91.55 88.73 81.69 63.38 36.62 33.8 30.99 18.31 16.9 15.49

Attitudes Toward Cosmetics and Safety The respondents generally exhibited a favorable attitude (medium level) toward cosmetics/PCPs, their use and their safety. They garnered an average score of 69.67%. Meanwhile, the respondents showed highly favorable attitude toward having a Philippine Safe Cosmetics Act (90.2%), the use of cosmetics as a cause of allergies and other skin reactions (83.4%), the use of cosmetics to improve one’s physical appearance to the public (78.4%) and the use of cosmetics to improve one’s selfconfidence (78.4%).

About half of the respondents answered “neutral” to controversial issues such as whether cosmetics could cause cancer and reproductive health problems. Because of the respondents’ awareness of the profusion of illegal and/or substandard products in the market, there was an unfavorable attitude toward quality control in cosmetic laboratories. Table 4. Overall attitude of the respondents on cosmetics and hazards ATTITUDE NUMBER (N=71) PERCENTAGE (%) Low 0 0 Medium 52 73.24 High 19 26.76 TOTAL 71 100

If we look at the individual attitude statements (Table 5), we can explain the above results. Majority of the respondents (64.79%) strongly agreed that the country should have a Safe Cosmetics Act. It was followed by 28.17% who agreed, thus totaling 92.96% of favorable attitude toward the bill’s enactment. Most of the respondents—36.62% strongly agreed and 50.70% agreed that cosmetics could cause allergies and other skin reactions. The total percentage was higher than the percentage of those who classified allergies (Table 3) as ill effect of cosmetics and PCPs (45.07%). For the statement, “Use of cosmetics improves one’s physical appearance to the public,” 18.31% strongly agreed while the majority (61.97%) agreed.

Majority (59.15%) agreed while 19.72% strongly agreed that use of cosmetics improves one’s self-confidence. Almost half (47.83%) were on neutral position as to whether cosmetics could cause cancer. Meanwhile, 15.94% strongly agreed and 28.99% agreed to the statement—a total of 44.93%. The latter was higher than number of respondents that mentioned cancer as an ill effect of cosmetics and PCPs (18.31%). Nearly half (49.30%) agreed to the statement, “Cosmetics are integral to our lives as even our ancestors have used them” while 7.04% strongly agreed and 21.13% adopted a neutral rating. More than half (52.86%) gave a neutral rating to the statement, “Cosmetics can cause reproductive health problems.” Almost a third of the respondents either strongly agreed (10%) or agreed (22.86%). A large part of the respondents (41.43%) disagreed to the statement that cosmetics are well-tested in laboratories before these are sold in the market, blaming illegally-sold Chinese products. Almost a third (32.86%) rated it as neutral. On the statement that expiration dates are very clear in the packaging of cosmetics, 33.33% disagreed while 30.44% (4.35% strongly agreed, 26.09% agreed) showed a favorable attitude. Similarly, 40.58% disagreed that quality control is ensured in the manufacture of cosmetics in the Philippines; 36.23% gave a neutral rating.

Before a behavioral change can be actualized, knowledge gain and attitudinal change are necessary. When journalists, especially those in the health and science beats, demonstrate high intention to support the Safe Cosmetics Act or safe cosmetics use, an effective and more wide-reaching media advocacy can occur. The questionnaire was intended to elicit answers and indirectly “pitch” the issues on cosmetic hazards and Safe Cosmetics Act among the respondent-journalists. After going through the Awareness section, responses showed an immediate increase in the number of respondents who perceived some harmful effects of cosmetics and PCPs on human health. Indeed, attitudes may change with new information or experience. Table 5. Attitude of the respondents on cosmetics and hazards (N=71) 5 4 3 2 1 ATTITUDE STATEMENTS (%) (%) (%) (%) (%) The Philippines should 64.79 28.17 2.82 1.41 2.82 have a Safe Cosmetics Act. Use of cosmetics can 36.62 50.7 8.45 1.42 2.82 cause allergies. Use of cosmetics improves 18.31 61.97 14.08 4.23 1.41 one’s physical appearance to the public. Use of cosmetics improves 19.72 59.15 14.08 7.04 0 one’s self-confidence. Use of cosmetics can 15.94 28.99 47.83 7.25 0 cause cancer. Cosmetics are integral to 7.04 49.3 21.13 14.08 8.45 our lives. Use of cosmetics can 10 22.86 52.86 8.57 5.71 cause reproductive health problems. Cosmetics are well-tested 2.86 24.29 32.86 41.43 0 in the laboratories before these are sold. Expiration dates are very 4.35 26.09 21.74 33.33 14.49 clear in the packaging. Quality control is ensured in 0 15.94 36.23 40.58 7.25 the Philippines. Scale: 5, strongly agree; 4, agree; 3, neutral; 2, disagree; 1, strongly disagree

MEAN 4.51 4.17 3.92

3.92 3.54 3.32 3.23

2.81

2.72 2.61

Sources of Information on Cosmetics and Hazards A huge number of respondents got information through mass media—newspapers (70.42%), magazines (69.01%)—because most of the respondents also write for magazines, television (50.7%) and radio (23.94%). Most of the respondents (87.32%) got information through the Internet, being the most accessible medium nowadays. In fact, almost all types of mass media now have their own digital edition accessible via the Internet. Around a third of the respondents got information through (33.80%) web logs or, simply, blogs. Public relations organizations, also called media optimizers, consider bloggers as a new element of mainstream mass media. Most of the respondents (81.69%) got information about cosmetics hazards through interpersonal communication—friends and colleagues (69.01%), family (33.8%) and organic/safe cosmetics dealers (32.39%) (Table 6). Majority (59.15%) got information through group communication—media launches and events (52.11%) and group talks (16.9%). Some respondents mentioned getting information through dermatologists and folk medicine experts (interpersonal), school (group), and billboards/displays (mass media). Table 6. Respondents’ sources of information on cosmetics and hazards MEDIA USED NUMBER (N=71) PERCENTAGE (%) Mass media 64 90.14 New media 62 87.32 Interpersonal 58 81.69 Group 42 59.15 Others 4 5.63

Safe Practices in Using Cosmetics Overall, the respondents showed a medium level of practice toward safe cosmetics/PCPs use. The average score was 64.68%. The respondents showed a high level of practice toward sharing information about any cosmetic hazards—which is one of their main tasks as journalists—and reading the labels/ingredients of cosmetic products. Although most of the respondents read labels/ingredients, there was a wide misunderstanding on which products should be considered safe or not, leading to wrong practices such as using skin products with Vitamin A, cosmetics that claim to have medicinal value, petroleum jelly, baby powder and sunscreens with SPF above 50. Most respondents were also unaware of guides for safer cosmetics and health-related bills in the Congress, hence the unsafe practices. Table7. Overall safe practices of the respondents on cosmetics and hazards PRACTICES NUMBER (N=71) PERCENTAGE (%) Low 4 5.63 Medium 54 76.06 High 12 16.90 No answer 1 1.41 TOTAL 71 100 Majority (75.36%) agreed to regularly share information about any cosmetic hazards to others. Additional information on the health topic will help journalists filter the contents of cosmetics-related articles, hence informing the readers accordingly and accurately. According to Friedman’s study, health journalists need more collaboration with public health practitioners to improve their understanding of health information.

Less than half (45.59%) regularly read the labels and ingredients of cosmetic products. The result coincided with the measures of the respondents’ familiarity with harmful cosmetic ingredients. On average, the respondents recognized only 34.17% of the listed cosmetic ingredients and perceived only 21.83% as harmful to human health. More than a quarter of respondents (29.23%) would regularly buy skin/lip products with Vitamin A, such as those with retinol, retinyl palmitate, retinyl acetate. A larger percentage (35.38%) would use the products occasionally. The Norwegian Scientific Committee for Food Safety (VKM) says that retinol concentrations of at least 0.075% leads to local adverse effects on human skin. Before the EU Cosmetics Regulation took effect in 2013, retinol and retinyl esters were restricted in Norwegian cosmetics (McDougall, 2013). There were equal numbers of respondents (36.51% each) who would buy paraben-free cosmetics/PCPs and who wouldn’t. Almost a quarter (26.98%) would buy the products occasionally. More than a third (37.31%) would regularly buy cosmetics that claim to have medicinal value while 29.85% buy sometimes. The FDA classifies a product as either a drug or a cosmetic, and does not recognize a combination of the two. A quarter (25.37%) regularly would consult and a third (35.82) would occasionally consult guides for safer cosmetics such as EWG’s Skin Deep cosmetics database. Almost half of the respondents (48.53%) would regularly use petroleum jelly while 29.41% never use it at all. Petroleum base oils or mineral oils contain aromatics including alkylated polycyclic aromatic compounds (PAC) may cause cancer. According

to Concin et al, mineral oil hydrocarbons are the greatest contaminant of the human body. More than half of the respondents (55.22%) would regularly use baby powder on young children or were all right with the practice. Meanwhile, 32.84% opposed the practice. The American Academy of Pediatrics is against the use of baby powder because it may cause respiratory problems (Lowry, 2014). More than half (53.73%) would regularly use sunscreens with SPF rating of more than 50, while 22.39% either preferred suncreens with lower rating or no sunscreen at all. The US FDA asserts that SPF higher than 50 is “inherently misleading” (FDA in Environmental Working Group); Australia limits it at 30; Europe and Japan at 50 (Osterwalder in EWG); and Canada at “50+”. (EWG, nd) Although 92.96% of the respondents were in favor of having a Safe Cosmetics Act in the country, the study showed that majority (76.81%) were not updated with healthrelated bills in the Congress. Table8. Safe practices of the respondents on cosmetics and hazards (N=71) 3 2 1 SAFE PRACTICES MEAN (%) (%) (%) I will share information about cosmetic hazards. 75.36 20.29 4.35 2.71 I read the labels of cosmetic products. 45.59 41.18 13.24 2.32 I buy skin/lip products with Vitamin A. 29.23 35.38 35.38 2.06 I buy products labeled “paraben-free”. 36.51 26.98 36.51 2 I buy cosmetics that claim to have medicinal 37.31 29.85 32.84 1.96 value. I consult guides for safer cosmetics. 25.37 35.82 38.81 1.87 I use petroleum jelly. 48.53 22.06 29.41 1.81 I use baby powder on young children. 55.22 11.94 32.84 1.78 I use sunscreens with SPF above 50. 53.73 23.88 22.39 1.69 I am updated with health-related bills. 7.25 15.94 76.81 1.30 Scale: 3, yes; 2, sometimes; 1, no

Overall, respondents would use cosmetics/PCPs that were readily available (58.12%) and safe (49.68%). However, most of the respondents’ preferred brands contain harmful cosmetic ingredients. The result supported the almost low score in the knowledge section. More than half of the respondents would use hair-care products such as shampoo and hair-styling treatment based on availability (56.25%). Other reasons for choosing a brand included deemed product safety (46.88%), affordability (26.56%), efficacy (23.44%) and popularity (21.88%). Less than half of the respondents (55.74%) would choose oral-care brand (toothpaste) that was readily available. More than a third (40.98%) based their preference on deemed product safety, while around a quarter looked for brand popularity (34.43%) and affordability (29.51%). Other reasons were efficacy (6.56%) and dental prescription (4.92%). For skin-care (and facial-care) brands, the respondents listed down their preferred brands for soap, deodorant, lotion, sunscreen, lip care and face powder. Majority would choose brands based on availability (64.18%) and deemed product safety (61.19%). More than a third of the respondents based their preference on affordability (37.31%) and popularity (37.31%). Another reason was efficacy (34.33%).

Table 9. Respondents’ reasons for choosing cosmetics HAIR CARE ORAL CARE SKIN CARE REASONS (%) (%) (%) Availability 56.25 55.74 64.18 Safety 46.88 40.98 61.19 Popularity 21.88 34.43 37.31 Affordability 26.56 29.51 37.31 Efficacy 23.44 6.56 34.33 Others 7.81 9.84 14.93

MEAN (%) 58.12 49.68 31.21 31.13 21.44 10.86

CONCLUSION AND RECOMMENDATIONS Given the high market share of local and global cosmetics industry, it shows that a large portion of the society is still unaware of the highly-encompassing problem on harmful cosmetics and PCPs with regard to human health. Results showed that the respondent-journalists exhibited a medium level of awareness (52.39%), which was bordering on low level (0%-49%). Only 8.45% knew the Philippine Safe Cosmetics Act. There was low awareness on the names of harmful cosmetic ingredients but this may be due to the fact that only 18.31% of the respondents regularly write about health, science or beauty. A total of 40.85% were aware of harmful ingredients, such as lead, triclosan and petrolatum, but did not know that these are mixed in some cosmetics. Nevertheless, the respondents showed a medium level of favorable attitude toward the use of safe cosmetics and PCPs. About one-third were skeptical of safety procedures and quality control in the manufacture of cosmetics and PCPs and the majority strongly agreed that the country should have a Safe Cosmetics Act.

When the respondents were asked about their sources of information on cosmetics/PCPs use and potential hazards, the top answers were: the Internet (87.32%), newspapers (70.42%), magazines (69.01%), friends and colleagues (69.01%), media launches and events (52.11%), and television (50.7%). The respondents showed a medium level of favorable practices on safe cosmetic use. Only 45.59% would regularly read the labels and ingredients of cosmetic products, 25.37% consult guides for safer cosmetics, and majority were not updated with healthrelated bills in the Congress. The good news is that majority (75.36%) agreed to share information about any cosmetic hazards to others. The respondents’ top reasons for choosing cosmetics/PCPs were availability and safety. However, most of the respondents’ preferred brands contain harmful cosmetic ingredients. The study recommends that health practitioners and advocates of safe cosmetic use to strengthen their awareness campaigns among “secondary stakeholders” such as the government, community leaders and, especially, the media. The respondent-journalists’ KAP level could be used by the supporters and proponents of the Safe Cosmetics Act and safe cosmetics advocates, in partnership with public relations or media optimization teams, in creating an extensive awareness campaign. The planners can use the KAP results in designing message content and channels, and the respondents’ preferences (sources of information) in choosing the most effective communication strategies.

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