Knowledge about, attitude toward, and practice of skin lightening products use and its social correlates among university students in five Association of Southeast Asian Nations (ASEAN) countries

Background: The aim of this study was to investigate the knowledge about, attitude toward, and use of skin lightening products (SLP) and its social and psychological correlates among university students from five Association of Southeast Asian Nations (ASEAN) countries. Methods: In a cross sectional survey, 3259 undergraduate university students (Mean age = 20.5 years, SD = 1.6) from five ASEAN countries responded to an anonymous questionnaire. Multivariate logistic regression analysis was used to identify associations between sociodemographic characteristics, knowledge, attitude, poor mental health, and SLP use. Results: Overall, 79.1% of the students were aware that the use of SLP can harm the skin, and 30.1% knew the active ingredients of SLP. Most students had a positive perception of having a lighter skin tone and SLP. Overall, the prevalence of SLP use over the past 12 months was 30.7%, 16.7% of male, and 30.0% of female students, ranging from 13.4% in Myanmar to 69.4% in Thailand. In multivariate logistic regression analysis, among women, older age, coming from a poorer family, residing in an upper middle income country, awareness of active skin lightening ingredients, and poor mental health were associated with SLP, while among men, not aware of the negative effects of SLP and awareness of active skin lightening ingredients and poor mental health were associated with SLP use. Conclusion: A high prevalence of SLP use was found in a large sample of ASEAN university students, and several social and mental health-related risk factors were found that may help in guiding interventions.