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. Author manuscript; available in PMC: 2024 Feb 16.
Published in final edited form as: J Racial Ethn Health Disparities. 2023 Jan 17;11(1):226–237. doi: 10.1007/s40615-023-01513-9

Assessing Hair Concerns and Physical Activity Measures Among African American Women: a Mixed-Method Exploratory Study

Marie Aline Sillice 1, Tamara Nelson 2, Ernestine Jennings 3, Curtis C Holland 4, Beth C Bock 3
PMCID: PMC10350471  NIHMSID: NIHMS1872153  PMID: 36648622

Abstract

Objectives

Research on the association between hair concerns and physical activity (PA) constructs among African American (AA) women is lacking. Demographics such as age and income are indicated to influence hair concerns. In this study, quantitative methods were used to assess demographic differences in hair concerns and associations between hair concerns and PA. Qualitative interviewing explored AA women’s views about their hair and engagement in PA.

Methods

Participants (n = 48; M age = 37.57, SD = 13.72) completed a survey that included demographics, hair type and hairstyle management (HTHM), decisional balance (pros, cons), perceived benefits and perceived barriers scale, and level of physical activity. HTHM consists of six items measuring different factors related to hair concerns. 25 completed a qualitative interview. Chi-square or analysis of variance tests were conducted as appropriate. Qualitative data were analyzed using content analysis.

Results

Proportion differences were noted between age groups (≤ 32 vs. ≥ 33) and average cost of haircare per month (p = .048). A statistically significant effect was noted for average monthly haircare cost and pros (p = .05), and for alter behavior due to hair concerns and perceived benefits to physical activity (p = .05). For level of physical activity, proportion differences were noted between exercisers and non-exercisers for average minutes spent on hair care (p = .009). Qualitative results showed few participants view hair concern as an important barrier to PA. Some participants suggested strategies for overcoming hair concerns to exercise (e.g., braids, twists).

Conclusion

Implications of findings including development of PA intervention approaches that may appeal to AA women are discussed.

Keywords: Hair concerns, Physical activity, African American Women, Mixed methods

Introduction

Numerous physical activity interventions have been conducted with African American (AA) women, to date e.g., [1–5]. However, the number of AA women that meet the recommended guidelines for moderate-to-vigorous physical activity shown to be associated with various health benefits accounts for only 36% of this population [6, 7]. Reports on health disparities among US adults continue to show AA women as having disproportionally high prevalence rates of many disease conditions (e.g., cardiovascular diseases, type 2 diabetes) associated with chronic physical inactivity [6–8]. Recommendations for physical activity promotion among AA women emphasize the need for researchers to extend the current knowledge of both barriers and facilitators to physical activity engagement [9–12]. Over the past few years, several studies have indicated hair concerns among AA women as a socio-cultural factor that likely hinders their engagement in physical activity [13–16]. Joseph and colleagues [13] have suggested that intervention strategies with AA women should consider addressing hair concerns given its potentially impeding effect in the acquisition of PA in this population.

Impact of Physical Activity on Hair and Hairstyle

Hair concern as a barrier to physical activity corresponds to the notion that perspiration occurring as a result of engaging in physical activity, particularly at the moderate-to-vigorous level, adversely affects the texture of the hair, causing the hair to “dry out” and making it difficult to maintain some hairstyles [17–19]. The level of impact that perspiration has on hair is noted to vary among AA women with different hair patterns or hair types [16–19]. For example, tightly coiled hair patterns that are also short in length show significantly noticeable shrinkage with substantial sweating in comparison to loose coils and longer hair [18, 20]. Additionally, hair that is chemically altered or straightened with a relaxer tends to be impacted over time by perspiration more so than natural hair that is not chemically altered (e.g., locks1) [20]. While the topic of hair concerns, and related physical activity behaviors among AA women, has been substantially discussed within the communities of AA women and in wellness blogs, magazines [17, 19–21] and documentaries [20, 22], scientific research in this area remains sparse.

Studies on Hair Concerns Among AA Women

Our review of the literature identified six studies that have addressed hair concerns and physical activity in AA women [13–16, 23, 24]. The most well-known study was conducted by Hall and colleagues [15], who surveyed a sample of 103 AA women and noted that 29% of them reported difficulty maintaining their hairstyle post physical activity as a barrier to engaging regularly in this behavior. Barnes et al. [24], in their focus group study of AA women who completed a weight loss intervention, found that participants who maintained their weight loss and were physically active were less likely to report hair concerns as an obstacle to physical activity in comparison to their unsuccessful counterparts. Similarly, Railey [23] found that close to half of their sample of 40 overweight AA women who were enrolled in a physical activity trial reported “cost of haircare” and “hairstyle maintenance” difficulties as factors that explain their physical inactivity. Other researchers have noted a similar trend between the cost of haircare and physical inactivity among AA women [14, 16]. However, Joseph and colleagues [13] indicated that a subset of their sample did not view hair concern as a barrier to physical activity.

Addressing the Gap in the Literature

Overall, current studies indicate that hair concerns among AA women might be an important obstacle to promoting physical activity engagement in this population [13–16, 23, 24]. However, more research is needed to determine the nature of the association between hair concerns and physical activity engagement among this group. Central to developing this knowledge is the assessment of the potential relationship between hair concern and established physical activity constructs used to explain and predict physical activity behaviors (e.g., decisional balance and self-efficacy [25, 26]). Moreover, since haircare or hair-style maintenance costs have been suggested as a likely essential component of hair concerns among AA women [16, 18, 19], income level may influence any potential association between hair concerns and physical activity. Furthermore, perspiration due to physical activity has been suggested to have a differential impact among AA women with different hair types or hair patterns (e.g., tight-coiled hair vs. loose coiled hair). Accordingly, hair concerns may likely differ as a barrier across AA women with different hair patterns. Research in the sociocultural sphere of feminine identity suggests an age effect for greater emphasis on physical appearance as an essential tenet of feminine identity or beauty [27, 28]. Correspondingly, age might be an important factor in hair concerns among AA women. Lastly, in addition to the importance of assessment studies on the relationship between hair concerns and both physical activity and its related constructs, qualitative approaches are also necessary to explore AA women’s views, feelings, and beliefs about their hair and physical activity engagement not previously incorporated into the quantitative constructs applied in previous studies.

This study used mixed-method approaches to explore primarily whether (a) hair concerns are evident among AA women, (b) hair concerns are associated with income and age, and lastly, (c) hair concerns are related to physical activity constructs and physical activity behavior patterns among AA women.

Methods

Procedures and Participants

Participants were recruited primarily from a Listserv of predominantly AA members. The majority of participants (90%) resided in the New England area. Members received an electronic copy of the study flyer from the owner of the Listserv that included the eligibility criteria for participation. Eligible individuals had to identify as AA, female, and be aged 18 or older. A sample of 48 participants completed the full survey as part of an assessment study on barriers to physical activity among AA women. Participants were also asked to participate in a qualitative interview. Details about recruitment and procedures have been published elsewhere [29]. All study methodologies were approved by the Institutional Review Board (IRB # No. 857242–12). Informed consent was obtained from all participants included in the study.

Measures

Demographics

Single item questions were used to collect information about age, marital status, education, employment, and household annual income.

Hair Variables

Hair Type and Hairstyle Management

Hair concerns were measured using the 6-item HTHM survey developed to assess various hair related barriers to PA engagement that have been indicated to be prevalent among AA women. The first three items of the measure assess individuals’ natural hair patterns (“S” pattern/tight coil or “O” pattern of straight/some waves), current hairstyle (e.g., braids or twists), and whether participants’ hair is chemically treated or had a relaxer. Items 4 and 5 of the HTHM scale assess, respectively, average time spent on haircare each day and monthly cost associated with haircare or hairstyle maintenance. Lastly, item 6 measured whether an individual altered their behavior due to hair concerns. Participants were asked to report their responses for items 1–3 and item 6 by circling the answer options most relevant to them. For items 4 and 5, participants were required to write in their responses. The HTHM items were used as individual measures assessing different factors that may hinder PA engagement in AA women. The HTHM scale is found in the Appendix.

Hair Type

Participants were provided with a list of eight natural hair patterns that have been indicated to be prevalent among AA women and were asked to pick the one that most resembles their hair types using the following instruction: “Please review each picture carefully and circle the picture that most resembles your natural hair type. Natural hair type is without any chemical alteration or products.” Moreover, participants were asked to refer to this document during the qualitative interview when discussing their natural hair patterns or hair types.

Physical Activity Measures

Decisional Balance

This scale consists of two subscales that assess an individual’s weighing of pros and cons (i.e., perceived benefits and perceived risks) for engaging in a behavior. Each item is rated using a 5-point Likert scale ranging from 1 “not at all important” to 5 “extremely important” [25]. The 5-item pros scale (α 0.90) and a 5-item cons scale (α 0.67) have been demonstrated to be internally consistent [25]. Decisional balance measure has been used in numerous assessment and intervention studies and with different populations [30, 31].

Self-efficacy

Perceived ability to engage in physical activity was assessed using a 5-item measure (α 0.82) that assesses different factors that may serve to influence an individual’s level of confidence that they could exercise when faced with a variety of situations (e.g., bad weather). Participants’ responses were based on five answer options, from 1 = “not all confident” to “5 = extremely confident” [32, 33]. The measure has strong psychometric properties and has been demonstrated to be invariant across African American subgroups [34]. Similarly, the self-efficacy measurement has been used in both assessment and individualized physical activity interventions [30, 31].

Perceived Benefits and Perceived Barrier Scale

This scale consists of 29 benefits to physical activity and 14 commonly reported barriers [35]. Participants were asked to rate their agreement to perceived benefits and perceived barriers on a Likert scale, ranging from 1 = “strongly agree” to 4 = “strongly disagree” [35]. This scale has demonstrated good reliability (α 0.94 [35]). Similar to the above physical activity measures, this scale has been used in numerous studies and with different populations [36, 37].

Level of Physical Activity

Recommendations for regular physical activity were assessed using the following questions to participants who reported “yes” to whether they currently exercise: (1) “How many days a week do you exercise?” (2) “How many minutes do you exercise each time?” (3) “How long have you been exercising at this level?” These items were informed by the Seven Day Recall measure, as established construct of physical activity [38]. Respondents wrote their response for each question.

Qualitative Interview Guide Approach

A standardized open-ended interview approach was used to explore hair concerns as a barrier to physical activity engagement among AA women. This research method is used extensively in formative research and is beneficial in exploring participants’ opinions, beliefs, and feelings toward a particular topic [39]. A pragmatic approach [40] was used to help cultivate a deeper understanding of AA women’s experience with their hair, haircare, and hairstyle maintenance and whether they view the aforementioned factors as important obstacles to regular physical activity. The interview guide included the following questions that were asked to each participant: (1) Tell me about your hair-style? (2) Describe your hair pattern? (3) Has hair management or hair maintenance ever been a barrier to exercise for you? The following probes were used as appropriate: (2a) Describe your hair type/hair pattern without chemical alteration; (3a) If hair concern is reported as a barrier, When did it become a barrier?, and (3b) if the participant reported that she exercises and reports hair concern as a barrier to exercise, How do you manage it to continue exercising?

Analyses

Quantitative Analysis

Frequency analyses were used to assess the distribution of the sample and develop subgroups as appropriate. Chi-square tests for independence (with Yates Continuity Correction as appropriate [41]) were conducted and compared the demographic variables (age, marital status, and income) by hair variables. Next, a series of chi-square analyses were used to explore proportion differences between the hair variables, natural hair structure, current hairstyle (IVs), average daily minutes spent on hair care, average cost of haircare per month, and altered behavior due to hair concerns (DVs). Post hoc tests following significant Chi-square results were conducted, as appropriate, using adjusted residuals and Bonferroni adjusted p-values. Moreover, several analyses of variance (ANOVAs) tests were conducted to assess any potential relationship between the hair variables and the physical activity measures. Analyses were completed using the SPSS analytical software [42].

Qualitative Analysis

The interviews were audio recorded and transcribed verbatim. Content analyses [43] were used to explore whether hair concerns serve as barriers to PA engagement among participants. Content analysis of the text allows the researcher to annotate or mark sections of text(s) and specific items for analysis. First, the research team developed the preliminary coding scheme based on whether AA women experience or have experienced hair-related barriers to physical activity. The final code model was completed over the course of several meetings. A double coding approach was used for analysis [44]. Two research team members independently reviewed and coded all of the transcripts; the passages coded were compared, discrepancies were noted, and a consensus on the appropriate coding for both transcripts was reached. Analyses were completed using the NVivo software [45].

Results

Quantitative Preliminary Results

Sample Description and Development of Subgroups

The sample was comprised of 48 AA women, M age = 37.57, and SD = 13.72. A little over half of the sample (51.1%) were married or living with a partner and 46.8% reported being single/separated/widowed. Two age groups were developed: age ≤ 32 (n = 24) and age ≥ 33 (n = 22). Most participants were employed (83%) and 15.0% were unemployed/retired/disabled. For education, 25.5% completed 12th grade/had some college, 36.2% had an undergraduate degree, and 38.3% had a graduate/advanced degree. Income was obtained for 34 participants of the total sample (N = 48); the two income groups were < $60 K (63.8%) vs. ≥ $60 K (36.2%), with annual median income of $61,500.

HTHM

The distribution for the 6-item HTHM measure was used to develop the following subgroups: (1) natural hair structure, coded into tight coil/ “O” hair pattern (68.9%) vs. straight hair/hair “S” pattern (31.1%); (2) current hairstyle was developed into two categories: natural/flat-ironed/pressed (39.5%) vs. protective styles (e.g., weave, braids) 60.5%); (3) average daily minutes spent on hair care was categorized into two groups: ≤ 23 daily minutes (52.3%) vs. > 23 daily minutes (47.7%); (4) average cost of haircare per month was categorized into two groups: ≤ $ 40 costs (52.2%) vs. ≥ $40 costs (47.8%); (5) altered behavior due to hair concerns were categorized into groups, rarely/never (66.0%) and occasionally/little of the time (34.0%); lastly, (6) the chemically/non-chemically altered hair was maintained as two groups: Yes (12.8%) and No (87.2%). Potential group differences were not assessed for the last hair variable since the majority of participants (87.2%) reported their hair as being “non-chemically altered.”

Physical Activity

Initial mean differences for the total sample for the physical activity constructs were as follows: pros (M = 7.38, SD = 2.64), cons (M = 18.40, SD = 1.83), self-efficacy (M = 2.60, SD = 0.881), perceived benefits subscale (M = 3.39, SD = 0.354), and perceived barriers (M = 4.86, SD = 1.86). For current physical activity, 33 participants (70.2%) reported that they currently exercise, with a reported average of 3.3 days weekly (SD = 1.48). The average number of minutes per exercise session was 55.08 min (SD = 18.25), and the average length of time exercising at this level was 58.62 months (SD = 156.88).

Primary Results

Demographics and Hair Variables

There were proportion differences for age and average cost of haircare per month, χ2 (1, N = 48) = 3.920, p = 0.048, phi = 0.35. A greater proportion (68.0%) of participants aged ≤ 32 reported spending $40 or less on haircare in comparison to older participants (31.8%). Accordingly, more older participants (66.7%) than their younger counterparts (33.3%) reported higher monthly costs on hair care. As a result, age was added to the analytic model with this hair variable and the physical activity measures. No other statistically significant differences or marginal significant differences were noted between the other demographics and hair variables (p-values > 0.05). See Table 1 for detailed information.

Table 1.

Proportion differences between demographics and hair variables

Age Income
Natural hair structure χ2 (1, N = 44) = 1.388, p = 0.13, phi = − .23 χ2 (1, N = 45) = .275, p = 0.60, phi = − 13
Current hairstyle χ2 (1, N = 42) = .0001, p = 1.00, phi = .0001 χ2 (1, N = 43) = .0001, p = 1.00, phi = .03
Average daily minutes spent on hair care χ2 (1, N = 43) = 3.920, p = 0.048, phi = .35 χ2 (1, N = 44) = .0001, p = 1.00, phi = .01
Average cost of haircare per month χ2 (1, N = 45) = .0001, p = 1.00, phi = .02 χ2 (1, N = 46) = 1.063, p = 0.30, phi = .24
Altered behavior due to hair concerns χ2 (1, N = 46) = 1.779, p = 0.18, phi = − .24 χ2 (1, N = 47) = .0001, p = 1.00, phi = .06
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Physical Activity and the Hair Variables

Decisional Balance (Pros and Cons Subscales)

A statistically significant relationship was noted only between average monthly haircare cost and the pros subscale, F(1,44) = 4.061, p = 0.05, partial eta-squared (η 2p = 0.09). Specifically, individuals who reported, on average, lower haircare cost had greater pros for physical activity (M = 7.96, SD = 2.61) compared to the group with higher haircare cost (M = 6.50, SD = 2.26). There were no statistically significant associations or significant trends between the hair variables and the cons subscale. Detailed results are found in Table 2.

Table 2.

Associations between the hair variables, decisional (pros, cons), and self-efficacy

Pros Cons Self-efficacy
Natural hair structure F(1, 45) = .057; p = 0.81, η2p=.001 F(1, 45) = 1.188; p = 0.28, η2p=.03 F(1,41) = .039; p = 0.84, η2p = .001
Current hairstyle F(1, 43) = .238; p = 0.63, η2p=.006 F(1, 43) = 2.891; p = 0.09, η2p=.07 F(1, 39) = .009; p = 0.92, η2p = .01
Average daily minutes spent on hair care F(1, 44) = 1.624; p = 0.21, η2p=.04 F(1, 44) = .064; p = 0.80, η2p=.002 F(1, 40) = 1.250; p = 0.27, η2p = .03
Average cost of haircare per month F(1, 46) = 4.061; p = 0.05, η2p=.05 F(1, 46) = .240; p = 0.63, η2p=.005 F(1, 42) = .384; p = 0.54, η2p = .01
Altered behavior due to hair concerns F(1, 47) = .110; p = 0.74, η2p=.002 F(1, 46) = .240; p = 0.63, η2p=.005 F(1, 47) = 2.639; p = 0.11, η2p = .06
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Self-efficacy for Exercise

No statistically significant relationships were found between perceived self-efficacy to exercise and the hair variables (p-values > 0.05). See Table 2 for detailed information.

Perceived Benefits and Perceived Barriers to Physical Activity

The hair variable alter behavior due to hair concerns was shown to be associated with the Perceived Benefits to Physical Activity subscale, F(1,45) = 8.249, p = 0.05, η 2p = 0.16. Participants who were in the “rarely/never” group had a greater mean score on this measure (M = 3.49, SD = 0.333) compared to the participant group who reported “little of time/occasionally” (M = 3.20, SD = 0.322) to altering their behaviors due to hair concerns. Moreover, a marginal significance was noted for the natural hair structure and this subscale, F(1,43) = 4.061, p = 0.06, ηp2 = 0.08). Participants in the “straight/some waves” group (M = 3.54, SD = 0.349) reported greater perceived benefits to physical activity versus those in the definite “S” pattern/tight coil or “O” patterns group (M = 3.32, SD = 0.350). Table 3 shows results that were not statistically significant or demonstrated a near significant trend.

Table 3.

Associations between hair variables, perceived benefits, and perceived barriers

Perceived benefits Perceived barriers
Natural hair structure F(1, 45) = 3.836; p = 0.06, η2p = .08 F(1, 45) = 1.035; p = 0.32, η2p = .02
Current hairstyle F(1, 43) = .853; p = 0.36, η2p = .02 F(1, 43) = .080; p = 0.78, η2p = .002
Average daily minutes spent on hair care F(1, 44) = .264; p = 0.61, n2p = .006 F(1, 44) = 2.162; p = 0.15, n2p = .05
Average cost of haircare per month F(1, 45) = 2.983, p = 0.09, η2p = .063 F(1, 46) = .004; p = 0.95, η2p < .001
Altered behavior due to hair concerns F(1, 47) = 8.249; p = 0.006, η2p = .16 F(1, 47) = .903; p = 0.35, η2p = .02
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Current Physical Activity

Thirty-three participants (70.2%) indicated they currently exercise. Among this sample, significant proportion differences were noted for the average daily minutes spent on hair care, χ2 (1, N = 44) = 6.832, p = 0.009, phi = 0.45. Specifically, a higher number of non-exercisers (56.5%) reported spending 23 min or less on haircare daily in comparison to exercisers (43.5%). Exercisers were more likely to spend more than 23 min on their hair (95.2%) than non-exercisers (4.8%).

Moreover, a near significant trend was noted between the alter behavior due to hair concern variable and average number of minutes per exercise session, F(1,33) = 3.647, p = 0.06, ηp2= 0.11. Participants who reported rarely/never altering their behaviors due to hair concerns had a higher mean score on this measure (M = 58.65, SD = 19.01) versus the occasionally/little of the time group (M = 45.56, SD = 12.36), indicating that those who engaged in longer exercise sessions were less likely to alter their behaviors due to hair concerns.

Similarly, the results of the model that included for average cost of haircare per month and average length of time exercising at this level showed a near significant trend, F(1, 32) = 3.462, p = 0.065, ηp2 = 0.10. Participants who reported spending $40 or less a month on haircare reported exercising longer (M = 15.64 months, SD = 15.43) than participants who reportedly spent more than $40 monthly on haircare (M = 117.21 months, SD = 232.05).

There were no statistically significant results or near significant trends noted for the other hair variables and physical activity measures. Detailed results are found in Table 4.

Table 4.

Associations between hair variables and level of physical activity measures

Currently exercising
Natural hair structure χ2 (1, N=43) = .749; p = 0.39, phi = − .19
Current hairstyle χ2 (1, N=45) = .150; p = 0.70, phi = − .11
Average daily minutes spent on hair care χ2 (1, N=44) = 6.832; p = 0.009, phi = .45
Average cost of haircare per month χ 2 (1, N=46) = .266; p = 0.60, phi = − .12
Altered behavior due to hair concerns χ2 (1, N=47) = 1.362; p = 0.24, phi = − .22
Exercise days per week
Natural hair structure F(1, 32) = 1.394; p = 0 .25, η2p = .04
Current hairstyle F(1, 31) = .067; p = 0.80, η2p = 0.002
Average daily minutes spent on hair care F(1, 31) = .373; p = 0.55, η2p = .01
Average cost of haircare per month F(1, 32) = .005; p = 0.94, η2p < .001
Altered behavior due to hair concerns F(1, 33) = .110; p = 0.74, η2p = .004
Exercise minutes per session
Natural hair structure F(1, 32) = 1.844, p = 0.19, η2p = .06
Current hairstyle F(1, 32) = 1.548, p = 0.22, η2p = .05
Average daily minutes spent on hair care F(1, 33) = .420; p = 0.52, n2p = .01
Average cost of haircare per month F(1, 32) = .627; p = 0.43, n2p = .02
Altered behavior due to hair concerns F(1, 33) = 3.647; p = 0.065, n2p = .11
Length of time exercising at this level*
Natural hair structure F(1, 32) = 2.666; p = 0.11, η2p = .08
Current hairstyle F(1, 31) = 1.957; p = 0.17, η2p = .06
Average daily minutes spent on hair care F(1, 33) = 1.947; p = 0.17, n2p = .06
Average cost of haircare per month F(1, 32) = 3.462; p = 0.07, n2p = .10
Altered behavior due to hair concerns F(1, 33) = .124; p = 0.73, η2p = .004
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*

Length of time exercising at this level was reported based on the number of months

Qualitative Results

Twenty-five out of 48 participants completed the interview. There were no statistically significant demographic differences between participants who completed the interview versus participants who did not complete this task. The primary response categories are presented below. Subcategories, which are italicized, are also presented.

Hair Concern or Hair Management a Barrier to Exercise?

Six out of the 25 participants indicated that hair concerns serve as a barrier to regular engagement in physical activity. These concerns include the ability to maintain one’s hair-style after engaging in physical activity due to sweating in the scalp that can immediately lead to significant shrinkage, engaging in certain physical activities and exposing one’s hair to water, and the discomfort of using certain recommended protective styles within a predominantly white environment to facilitate physical activity engagement. Some response exemplars are as follows:

Exercising when you have natural hair sucks…it shrinks. No one wants to have a small little TWA,2 small little afro. I hated it. Sometimes, if my hair was in a twist or something, and I wanted to go out that night, I wouldn’t work out because okay, what am I going to do? I don’t think I can maintain my exercise regimen and look good every day with my natural hair

(ID 1025).

Well, the only barrier I can see with that is swimming. I certainly don’t want to have it straightened and go in the water. Because black hair and water does not mix

(ID 1004).

I’m in a very suburban community, and I tend to feel uncomfortable sometimes, so if I don’t have my hair in braids or something like that, I don’t want to go in there with a scarf or anything

(ID 1015).

Hair Concern or Hair Management Not a Barrier to Exercise?

Thirteen participants stated they did not consider hair or hairstyle maintenance a barrier to physical activity engagement. Some of these participants explained that hair concerns were irrelevant to them since their hair is natural (i.e., without any chemical alteration) and that their hairstyle (e.g., twist, braids) was not significantly impacted with exercise. Some of these responses are:

It doesn’t really have an impact. It’s just if I sweat a lot, it’s not like I’m sweating my hair out or anything. I wouldn’t say it has an impact

(ID 1007).

No. I’d say no. Especially going natural, I don’t have to worry about any, I mean if it’s sweating, my hair is already in a style that it can absorb it

(ID 1013).

Not really, but it does—I feel like I have to retwist it more often when I exercise because the sweat makes it untwist

(ID 1017).

No, because actually, I prefer something that’s low maintenance for me to be able to exercise so that I can wash my hair before or afterwards

(ID 1046).

Hair Concern Had Been a Barrier to Exercise

Among participants who indicated hair is not a current barrier to exercise, five indicated that hair concerns had been a barrier in the past when their hair had a relaxer. Two other participants mentioned avoiding working out regularly to keep from sweating out their hair and maintaining their hairstyle longer. Some of these response exemplars are as follows:

When I did wear my hair straight all the time, that was why I didn’t go to the gym pretty much

(ID 1007).

When I had a perm, I wasn’t so quick to exercise, especially if I had just gotten my hair done.

(ID 1018).

Oh, absolutely. I was having this conversation with my sister, because it’s—when I have your hair relaxed, and then you go to the gym and you sweat it out, it’s kind of counterproductive, so I have for years, sad but true, but I’ve made the decision that I wasn’t gonna work out in order to maintain my hair…

(ID 1012).

Hair Concern Was Never a Barrier to Exercise

Four participants mentioned that they never viewed hair or hairstyle maintenance as an essential obstacle to physical activity. This subgroup included individuals with a relaxer or pressed hair. Two of these responses are as follows:

No, it wasn’t. Back then, let’s see, I was on the track team for a while when my hair was relaxed. I feel like with something with such a set schedule, you don’t really get to think about things like what’s gonna happen to your hair. I feel like with that I was just used to not thinking about my hair in relation to exercise

(ID 1017).

I think it was. I don’t think that exercise was—I never thought about it. I think I was always finding more— other things with physical activity and not liking it. I think that was a big issue

(ID 1034).

Hair Concern or Hair Management Sometimes a Barrier to Exercise

Four participants indicated that hair could “sometimes” or “somewhat” be a barrier to exercise, as the decision to be active also requires that they consider the impact of this behavior on their hair and identify viable strategies to help maintain their hairstyle. Nevertheless, some of the participants stated that the decision to exercise and be healthy serves as an important facilitator against any hair concerns. Some of the response exemplars are as follows:

…It does sometimes get [to be] a barrier with if I’m exercising a lot, I have to think about, “Well, how am I gonna maintain my hairstyle as well? Am I going to moisturize more? Am I gonna change my regimen of dealing with natural hair in that way?” It is a factor, for sure

(ID 1014).

Very slightly. Sometimes, if I went too long without locking my hair, my hair would weaken. Putting it up was not advised just because of thinking you could break it off at the point where your new growth and the lock is starting. Also, always trying to prevent lint was a problem with towels, sand, dirt from just the air. That seemed to be a slight issue

(ID 1036).

Somewhat, but like I said, I have to make the decision. This is what I wanna do. Probably in the summertime when it’s really hot and you’re sweating

(ID 1001).

Yes…I’m an advocate of them taking care of themselves and we’ll figure the hair out

(ID 1005).

Strategies Used or Suggested to Overcoming Hair Concerns and Exercise

Several participants shared various strategies they use for haircare or hairstyle maintenance. Some of these strategies include strategies they have previously used when they had a relaxer to maintain their straightened hair longer (e.g., putting hair in a ponytail or altering their workout schedule) and their choice for current hairstyles (e.g., braids, crochet) that allow easy engagement in regular physical activity. Some of these suggestions are:

…when I had a relaxer, all I ever did was put my hair in a ponytail. Put it back in a ponytail and go. Even if I worked out, it didn’t matter. I would just put my hair in a ponytail and go

(ID 1010).

I would alter my workout schedule because it’s so—I just got my hair done, then I wouldn’t work out until three or four days—it’s just the whole working out thing revolved around what was going on with my hair

(ID 1014).

I would just wrap my hair when I would dance, but when I go to the gym or go take a Zumba class, I would wrap it

(ID 1007).

I find that when I have it braided, it’s so much easier for me to work out. It’s easier for me to wash my hair with braids when I have them. It’s easier for me to get prepared for the gym, and still feel attractive

(ID 1019).

I prefer something that’s low maintenance for me to be able to exercise so that I can wash my hair before or afterwards. I’m considering taking another form of exercise, which is swimming. I pretty much tell everybody, I need this natural look in order if I continue exercising, line dancing, and venture into swimming

(ID 1046).

[When] my hair is in maybe a crochet or a braid or something like that and I feel very comfortable, but when I just have my natural hair, it’s discouraging

(ID 1015).

Discussion

This study investigated the association between hair concerns, demographic variables, and physical activity constructs among AA women. Preliminary quantitative findings indicate overall that hair concerns were not a significant barrier to physical activity in this sample. For example, 66% of the sample rarely altered their behavior due to hair concerns or avoided physical activity. This finding is overall consistent with previous research, where nearly 40% of AA women reported avoiding exercise due to hair concerns [15]. Additionally, the main quantitative findings revealed that participants who spent less on haircare costs endorsed more pros for physical activity as measured by the decisional balance scale. Further, participants who rarely or never altered their behavior due to hair concerns perceived more benefits to physical activity compared to participants who altered their hair behaviors occasionally. There were no statistically significant findings for hair variables and self-efficacy for exercise.

One possible explanation to understand the quantitative findings might be that most participants reported having natural hair or non-chemically treated hair. Similarly, in a recent study of African American women, exercisers were less likely to have chemically straightened hair, compared to non-exercisers [14]. This finding suggests that perhaps chemically straightened or relaxed hair may present a unique barrier to exercise among some AA women. Findings from recent qualitative studies suggest that AA women are embracing a wide variety of protective styles—as a solution to hair concerns—and a facilitator of physical activity engagement [13]. For example, in a qualitative study, one participant noted, “there are more people teaching you how to do things with your hair…if you’re being more physical…that were not available before the Internet” [14, pg. 8]. Accordingly, the pros and cons of exercise measures with this population should assess the relative costs and benefits of exercise versus hairstyle maintenance among AA women with chemically treated hair. Intervention approaches could address the reality that becoming regularly active will require that this subgroup put more effort into haircare while emphasizing the numerous health and mental health benefits of physical activity to help outweigh the con. Moreover, approaches for increasing physical activity among these AA women may include light levels of physical activities, which are associated with less sweating and thus a lower effect on “sweating out” the relaxer.

Qualitative results supported the quantitative findings that hair concerns were a barrier to exercise for relatively few participants in this sample. Among participants who indicated that hair concerns were a barrier, some described their past experiences having relaxed hair and noted that this prevented exercise. Specifically, the desire to maintain hair-styles and prevent sweating were reasons provided among participants with natural hair structures and previously relaxed hair. These findings support results from previous research as “sweating out my hairstyle” was a noted barrier to exercise among AA women [14, 15]. Findings also extend this research as one participant noted discomfort of using protective styles within predominantly white communities. Thus, it is plausible that some AA women may avoid exercise to avoid judgment or potential discrimination in exercise spaces. The extent of this issue should be examined in future research.

Among participants who indicated that hair concerns were not a barrier to exercise, strategies that facilitated engagement in exercise included hair care, hair maintenance, altering work schedules, and utilizing protective and low-maintenance styles. These findings are important and may be useful for providers who hold discussions about exercise with AA women. For example, in a recent study of primary care providers, nearly 95% reported having discussions with AA women about physical activity. However, almost 80% did not discuss hair concerns, and most providers were uncomfortable broaching this topic [46]. Therefore, there is a need for formative work to inform the development of strategies and language that providers (e.g., doctors) can use to explore whether hair concerns are a barrier for their patients and ways to adequately address them in aiding AA women to engage in physical activity. Moreover, other providers (e.g., coaches, personal trainers) who counsel AA women about exercise would benefit from becoming familiar with AA women’s hair concerns as a barrier to exercise and comfortable in engaging in these discussions [47].

Strengths and Limitations

This study explored the relationship between hair concerns and physical activity constructs in a sample of AA women. A strength of this study is the mixed-methods design, which provides context and nuance for exploring hair concerns as a potential barrier to PA among AA women. In addition, this is the first study to our knowledge that examines the association between hair concerns and established physical activity constructs. Further, results highlight strategies used by AA women to engage in exercise that may inform how these barriers are discussed with AA women. This is important as previous studies have suggested that increased education among providers concerning these issues is needed [46, 47].

While this study contributes to the literature by examining the relationship between hair concerns and psychological variables related to physical activity engagement among AA women, there are several limitations worth noting. This sample consists of AA women in the New England area, and therefore, findings may not generalize to AA women living in other geographic locations. Moreover, the study sample was small, which also limits generalizability. The HTMH is not a psychometrically validated scale. The cross-sectional study design is another limitation. As in all cross-sectional studies, the directional relationship of the hair variables in the maintenance of regular physical activity cannot be determined in this sample. Longitudinal studies are required to determine whether hair type and hairstyle management influence the stage of change, motivation, self-efficacy for physical activity, and physical activity behaviors.

Conclusion

This study explored the nature of hair concerns among AA women. Findings offer some preliminary evidence that the cultural norms associated with physical activity engagement and hair concerns are shifting [13]. Moreover, hair concerns among AA women might be less central to physical activity engagement than previously reported. Nonetheless, despite these findings, future research should continue to assess the salience of hair concerns and their relationship with physical activity longitudinally among AA women. Furthermore, physical activity interventions with AA women should actively address and offer strategies for AA women who indicate that hairstyle maintenance is a barrier to physical activity engagement.

Funding

Research reported in this paper was supported by the National Heart, Lung and Blood Institute (award number T32 5T32HL076134-10). While completing this paper, Dr. Sillice was supported by the K23-Mentored Patient-Oriented Research Career Development Award from the National Institute on Minority Health and Health Disparities (award number K23MD014164).

Appendix

Hair Type and Hairstyle Management

  1. Please select the hair type that reflects your natural hair structure (without applying chemicals or styling products)
    1. Hair is straight with no discernible curl pattern.
    2. Hair has some waves but little or no curl pattern.
    3. Hair has definite “S” pattern. Straightens out or forms ringlets when wet, curlier when dry.
    4. Hair forms a tight coil or “O” pattern.
  2. Is your Hair chemically treated or has a relaxer?
    1. Yes
    2. No
  3. Please select the style that best describes how you currently wear your hair (please select one):
    1. Natural hair structure
    2. Flat-ironed, pressed
    3. Weave/wig
    4. Up do (Freeze, French roll, etc.)
    5. Braids/twists
    6. Other

  4. On average, how many minutes per day do you spend on hair care (washing, conditioning, styling attending hair appointments)?

    ___________________

  5. On average, how much money do you spend per month on hair care (products, hair appointments)?

    ____________________

  6. How often to do you alter your behavior due to hair concerns (stay inside to avoid rain)
    1. Rarely/Never
    2. Some or a little of the time
    3. Occasionally
    4. Often

Footnotes

Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Ethics Approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board at The Miriam Hospital (No. 857242–12).

Competing Interests The authors declare no competing interests.

1

The term “locks” is used instead of dreadlocks since the latter is indicated among some African Americans to have a negative connotation—that is, this hairstyle is “dreadful” or “dirty.”.

2

TWA is described as a short natural hairstyle where the hair length is no longer than two inches.

Data Availability

The data can be available with permission consistent with our institution guidelines.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data can be available with permission consistent with our institution guidelines.

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