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. Author manuscript; available in PMC: 2026 Apr 10.
Published in final edited form as: Nurs Res. 2025 Mar 13;74(4):313–317. doi: 10.1097/NNR.0000000000000815

Hair Sampling for Physiological Stress Among Early Childhood Educators

Randi A Bates 1, Walaa R Almallah 2, Bailey E Martin 3, Tharaa I Ananzeh 4, Christopher W Collen 5, Jaclyn M Dynia 6
PMCID: PMC13063155  NIHMSID: NIHMS2156644  PMID: 40088423

Abstract

Background.

Despite expanding investigations of chronic physiological stress as measured by hair cortisol concentration among adults, there is little research examining chronic physiological stress among early childhood educators (hereafter, “educators”). Despite the “calling” of the career, these educators are at a unique increased risk for chronic stress due to earning stagnant, unlivable wages as compared to their K-12 educator colleagues and often being primary care providers to children and families experiencing intergenerational trauma. Because physiological stress may be linked to chronic disease later in life and may present differently than psychological stress, it is important to understand the feasibility of measuring chronic physiological stress, as commonly measured with hair cortisol, in this essential and unique population.

Objectives.

The study's aim was to examine the feasibility of collecting hair to measure cortisol concentration as an estimate of chronic physiological stress among early childhood educators by understanding variations in their participation.

Methods.

Analyses of hair sampling participation of center-based educators by sociodemographic characteristics occurred across two pilot studies: one longitudinal (n = 67) conducted during the COVID-19 pandemic (2021) and one cross-sectional (n = 31) occurring post-pandemic (2024). Educators were asked to provide hair samples for cortisol analysis to measure physiological stress and complete surveys on reasons for non-participation and their sociodemographic characteristics, including age, race, ethnicity, gender, and highest level of education.

Results.

Educators’ sociodemographic characteristics generally reflected nationally representative samples. Across the studies, 75.3% of educators participated in initial hair sampling. Collectively, the most common reason for non-participation was related to hairstyle or hair characteristics. Educators who were Black/African American or had less than a bachelor’s degree in education were least likely to participate in hair sampling.

Discussion.

Collecting hair for cortisol as a measure of physiological stress among early childhood educators is feasible. However, researchers may want to consider alternative measures of chronic physiological stress to promote equitable research practices among educators who are Black/African American or who have lower than a bachelor’s degree in education. Given the importance of chronic physiological stress for health, avenues for future research are discussed.

Keywords: hair cortisol, stress, early childhood educators, sociodemographic

Sampling hair to estimate chronic physiological stress through cortisol has rapidly expanded among many community samples with adults (Abell et al., 2016; Bates et al., 2020; Ford et al., 2023; Manns-James & Neal-Barnett, 2019), in part due to its reliable growth and ease of storage. Across diverse participants, hair grows approximately 1cm each month at the posterior vertex portion of the scalp (Loussouarn et al., 2016) and thus contains the average cortisol output from the previous month (Russell et al., 2012). In contrast to serum and saliva samples, only one sample of hair cortisol is needed to represent a longitudinal period (Short et al., 2016), is not considered a biohazard, and can be stored safely at room temperature until laboratory analysis. To maximize analytic reliability and validity, most researchers limit each cumulative cortisol measurement to 3cm of hair most proximal to the scalp, which estimates chronic physiological stress over the prior three months (Engert et al., 2011).

Most prior research with samples of adults in the United States (U.S.) showed that sampling hair cortisol for estimating physiological chronic stress was feasible (e.g., Bates et al., 2020). However, research involving collecting hair among early childhood educators (hereafter “educators”), an underpaid and underprivileged essential workforce primarily comprised of women (McLean et al., 2021; Paschall et al., 2021), is limited. Educators are at increased risk for adverse mental health and increased stress due to experiencing daily, cumulative stressors (Bates & Dynia, 2023). For example, educators earn wages that are unlivable and are less than 98% of other U.S. occupations, including their K-12 educator colleagues (McLean et al., 2021). While managing the chronic stressor of financial survival, educators report feeling overwhelmed from serving as primary caregivers of children experiencing intergenerational trauma and behavioral issues, a lack of respect, conflicts with families, and frequent physical strains due to lack of occupational equipment for adult bodies (e.g., adult-sized classroom chairs; Bates & Dynia, 2023; Friedman-Krauss et al., 2014). In turn, the most recent prevalence estimates of depression and perceived stress among educators were nearly 50% (Elharake et al., 2022; Swigonski et al., 2021): these levels were 25-50% higher than all United States adults during the same time period (Ettman et al., 2020; Ettman et al., 2022; Rosenberg et al., 2021).

However, feelings of stress, or psychological stress, may differ from physiological stress responses. For example, depression has been linked with both low and high hair cortisol (Ford et al., 2019; Staufenbiel et al., 2013), and physiological stress may be the theoretical mechanism for many adverse health outcomes later in life (McEwen & Wingfield, 2010; Psarraki et al., 2021). Hence, it may be useful to monitor hair cortisol levels when designing workplace wellness programs targeting equity in educators’ mental health and well-being, such as those that are now federally mandated by Head Start (U.S. Department of Health & Human Services, 2021) and may be managed by occupational health nurses.

Yet, educators may not want to provide information on their psychological or physiological stress, including hair cortisol, for research. For example, fierce protection of children and state-mandated educator-child ratios may make it difficult for educators to participate in research, particularly if they must work additional jobs to make ends meet (Roberts et al., 2019). Further, a workforce of mostly women may have unique considerations when sampling hair, which often defines one’s identity (e.g., Nkimbeng et al., 2023). For example, women may have different cultural practices or concerns regarding others viewing (e.g., women in Hijab), touching (e.g., mistrust), or sampling (e.g., women who have in braids or weaves, cultures who typically do not cut) their hair (e.g., Pergament, 1999; Trusty et al., 2022).

There may also be differential participation in hair sampling among educators based on sociodemographic characteristics. For example, previous research has shown that individuals with lower health literacy or women who are Black or may have lower rates of participation as compared to those with higher levels of health literacy or who are White, respectively (Bates et al., 2020; Kripalani et al., 2021). Indeed, many educators in the United States are not required to have college degrees, which may affect health literacy, and 37% are of a minoritized race or ethnicity (Paschall et al., 2021). Additional reasons for nonparticipation in research may be due to decreased trust, for example, due to many historical racial injustices (Scharff et al., 2010), lack of understanding (Kripalani et al., 2021), and structural barriers, particularly for those of low socioeconomic status (Emery et al., 2023). Addressing the gap of limited chronic physiological stress research in educators, this study's aim was to describe the feasibility of collecting hair for cortisol analysis from educators. We describe the number of educators who participated in hair sampling, including demographic characteristics, across two studies. The findings of this study can help inform equitable protocols for sampling hair to estimate stress among center-based educators.

METHODS & MATERIALS

Design, Participants, and Procedure

Two pilot studies comprised this investigation; both studies used hair cortisol to estimate chronic physiological stress in center-based early childhood educators living in the Midwest. Study 1 was a longitudinal, observational design that was conducted in Fall 2021 to examine the relationship between educators’ job characteristics and their stress (n = 67 educators). Hair samples were collected at two time points, at the beginning of the new academic year (~September 2021) and three months later to allow adjustment to the start of the academic year (~December 2021). Study 2 was conducted in late Spring 2024 to examine relationships among early childhood educators, children in their classrooms, and children’s parents (n = 31 educators). Five educators from Study 2 also participated in Study 1, so the final combined sample size for the current investigation was N = 93 unique educators.

For recruitment in both studies, community partners distributed email and flyer advertisements regarding the study to educators. Research personnel also recruited and screened educators in person at participating early educational centers. Educators were eligible to participate if they were at least 18 years old and taught children 0-5 years old at an early educational center. Educators were eligible to provide hair samples if they had at least 1cm of hair length at the posterior vertex portion of the scalp. The research team confirmed participant eligibility and obtained electronic consent before enrollment. Online survey data and hair samples were primarily collected during educators' workplace breaks. We explained the hair sampling process to enrolled participants in person. After agreeing to participate in hair collection, approximately 150 hairs were cut as close as possible to the scalp at the posterior vertex portion of the scalp using professional shears (Bates et al., 2020; Wright et al., 2018). The study received ethical approval from the university institutional review board.

Measures

We measured educators’ participation in hair sampling (recorded yes/no), reasons for nonparticipation (inspired by the lab of Ford et al., 2023), and their sociodemographic characteristics (age, race, ethnicity, gender, and highest level of education). Survey reasons why educators did not want to participate in hair sampling included: (1) I do not want to provide a hair sample; (2) I don’t feel like I have enough hair to give; (3) I’m trying to grow my hair out; (4) My current hairstyle doesn’t allow me to have a sample taken; (4) I am concerned with what you will test my hair for; (5) I am concerned with what you will do with my hair; and (6) Other.

For sociodemographic characteristics, educators could select more than one racial category. However, one or no educators identified as Asian, Native Hawaiian or Other Pacific Islander, or Native American/American Indian or Alaskan Native, so these educators were combined into an “Other” racial category. Educators with more than one race were categorized as “multiracial.” Educators could select from several gender categories; however, all educators selected “female” or “male.” For education, educators selected one of 11 categories to represent their highest level of education, from 8th grade or less to a doctoral degree. Categories were collapsed based on the educators’ characteristics.

Analytical Plan

We examined participation rates, reasons for non-participation, and sociodemographic characteristics by participation versus nonparticipation in hair sampling. Participation rates are emphasized over statistical differences due to underpowered, small group sample sizes.

RESULTS

First, we examined educators’ characteristics across the studies (Table 1). The average age of educators was about 38 years old, and over 95% identified as female. Nearly all educators identified their race as either White (62.1%) or Black/African American (27.6%); 3.4% of educators also identified as Hispanic/Latine. About half of educators had a bachelor’s degree or higher (47.6%), and about half had an associate’s degree or lower in education (51.1%).

Table 1. Characteristics of Full and HCC Participation ECE Subsamples across Time Points.

Both Studies
(N = 93)* 		Study 1
(N = 67)		 Study 2
(N = 31)
Time 1 Time 2
n % n % n % n %
Participated in hair collection
 Yes 70 75.3 50 74.6 41 61.2 23 74.2
 No 23 24.7 17 25.4 26 38.8 8 25.8
Reason for non-participation
 Did not want to 7 30.4 6 35.3 7 26.9 1 12.5
 Not have enough hair 4 17.4 2 11.8 2 7.7 2 25
 Growing hair out 3 13.0 3 17.6 1 3.8 0 0
 Incompatible with hairstyle 3 13.0 2 11.8 1 3.8 1 12.5
 Concerns about testing or other 3 13.0 3 17.6 0 0 0 0
 Other 0 0 1 5.9 1 3.8 0 0
Sex
 Male 4 4.8 3 4.8 2 8
 Female 79 95.2 60 95.2 23 92
Race
 Black/African American 24 27.6 18 26.9 7 28
 White 54 62.1 44 65.7 14 56
 Other 3 3.4 1 1.5 2 8
 Multiracial 3 3.4 2 3.0 1 4
Hispanic/Latine 3 3.4 2 3.0 1 4
Education
 High School diploma 17 20.2 9 13.8 8 33.3
 Some college, no degree 16 19 14 21.5 2 8.3
 Associate’s degree 10 11.9 9 13.8 1 4.2
 Bachelor’s degree 30 35.7 24 36.9 10 41.7
 Master’s degree 9 10.7 7 10.8 3 12.5
 Doctoral degree 1 1.2 1 1.5 0 0
 Other 1 1.2 1 1.5 0 0
 Mean Age (SD) 37.6 (13.4) 39.4 (13.5) 34.1 (11.6)
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Note. Column totals may not add up to total sample size due to missing data and participants could select more than one reason for non-participation.

*

5 participants participated in both studies but were not counted twice

Across the studies, the average participation in hair sampling at enrollment was 75.3%. However, there was some variation in the longitudinal study. At Time 1, hair sampling participation was 74.6%, but at Time 2, participation was lower at 61.2%. Of the 24.7% of participants who did not provide hair samples, the most common reasons were surrounding hairstyle (43.4%), followed by not wanting to (30.4%), and concerns surrounding testing (13%).

Next, we examined the sociodemographic characteristics of early childhood educators by participation, as shown in Table 2. There were few male, other or multiracial, and Hispanic/Latine participants, so herein we focus results on age, education, and Black and White race. Participation based on age was similar, but racial and educational differences were noted. While 85.2% (46/54) of White educators participated, only 54.1% (13/24) of Black educators participated (White compared to Black participation OR = 4.87). About 93% of bachelors-prepared and 80% of master’s degree or higher-prepared educators participated, while 60% of educators with associate degrees, 68.8% of educators with some college education but no degree, and 64.7% of educators with high school diplomas participated (Bachelors degree or higher education compared to lower education participation OR = 4.81). A post hoc analysis showed that there may have been confounding factors between the race and education variables. Black/African American educators were less likely to have a bachelor’s degree or higher than non-Black/African American individuals (χ2 (1) = 14.32, p < .001, OR = .10)

Table 2. Demographic Characteristics of Participants Compared to Nonparticipants in Hair Sampling.

Participants
(n = 70)		 Nonparticipants
(n = 23)
n Mean (SD)
or %		 n Mean (SD)
or %
Age 65 37.8 (12.7) 19 37.1 (15.9)
Sex
 Female 60 75.9 19 24.1
 Male 4 100 0 0
Race
 Black 13 54.1 11 45.9
 White 46 85.2 8 14.8
 Other 2 66.7 1 33.3
 Multiracial 3 100 0 0
Hispanic/Latine 3 100 0 0
Education
 High school diploma or equivalent 11 64.7 6 35.3
 Some college, no degree 11 68.8 5 31.3
 Associates degree 6 60 4 40
 Bachelor’s degree 28 93.3 2 6.7
 Master’s degree or higher 8 80 2 20
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Note. Participants were those who participated at any time, regardless of study or time point. For conciseness, “Other” education was combined into missing.

DISCUSSION

The high participation from the two pilot studies supports the relative feasibility of sampling hair as a measure of chronic physiological stress in a community sample of center-based early childhood educators in the Midwest. However, we found disparities in participation: educators who were the least likely to participate were those who identified as Black/African American or had an education lower than a bachelor’s degree. There may have been confounding in this participation disparity, as in our sample, Black/African American individuals were less likely to have a bachelor’s degree or higher education than those not Black/African American. Notably, the most common reason educators did not participate surrounded hairstyle concerns, which may be an unmodifiable factor in hair sampling among community-based research samples. That is, hair is often tied to one’s culture and identity.

Our primary participation rate of 75% was similar to other community samples of women in the United States, including mothers living with low-income (Bates et al., 2020) and women of color (Manns-James & Neal-Barnett, 2019). While confounded with education disparities, the race-based disparities in hair sampling were similar to previous research (Bates et al., 2020). This may be related to the primary reason for nonparticipation: hairstyle concerns. Wright et al. (2018) also identified hairstyle concerns as a barrier for African American women to participate in hair sampling research, as well as hair-based discrimination and many other historical racially-based research injustices (Scharff et al., 2010).

To overcome race-based disparities in hair sampling research among community samples of early childhood educators, researchers may consider alternative approaches to measuring physiological stress to promote equitable research engagement and more generalizable conclusions. For example, researchers could oversample educators who are Black and then use appropriate statistical weights. Researchers may also consider alternative non-invasive, reliable, and valid measures of physiological stress, such as repeated salivary samples (Short et al., 2016). Finally, researchers should explore ways of increasing trust in the research process among educators who are Black/African American, using some of our research procedures. For example, participants may have had high trust in our procedures as few nonparticipants were concerned about our testing of the hair samples. Our procedures included using registered nurses, the most trusted profession for over two decades (Brenan & Jones, 2024), to collect the hair samples. Further, educational center administrators facilitated introductions of the research staff. Researchers could also follow best practices in community-based participatory research, following the guideline, “Nothing about us without us.”

Another notable factor of our study was the longitudinal nature of sampling hair. Due to some attrition, hair sampling participation decreased from 75% to 61%. Reasons for this attrition may have been related to typical attrition or hair sampling fatigue. Nevertheless, collecting longitudinal measures of hair cortisol over three months may still be more feasible, in terms of participation and budgetary concerns, than collecting multiple measures of salivary cortisol. That is one hair sample is needed as compared to about 270 salivary samples (saliva sampled three times each day for three months; e.g., Short et al., 2016) to estimate cortisol over three months.

Limitations

This observational research had some limitations. For example, we had a non-probability convenience sample in the Midwest, which may only reflect the locale. Next, Study 1 was conducted during COVID-19, which may have affected longitudinal participation. We also did not collect qualitative data detailing reasons for non-participation, which may have illustrated participants’ intersectionality: the combination of characteristics that comprise one’s identity (Crenshaw, 1989). However, a strength is that many sociodemographic characteristics of this sample were similar to those of nationally based or representative samples (Coffey, 2022; Paschall et al., 2021; Zippia, n.d.), and participation rates across the beginning of Study 1 and Study 2 were similar, suggesting that the findings may be generalizable to other educators.

Conclusion

This research provides new knowledge about the feasibility of collecting hair for cortisol concentration to estimate chronic physiological stress in center-based early childhood educators. Sampling biomarkers such as hair cortisol in educators is necessary to begin advancing the science of stress, specifically physiological stress, and the effects of stress on educators’ health and larger ecology – such as on their coworkers, family members, and children in their care.

Acknowledgement:

This work was supported in part by SproutFive, a Rabinowitz Award from the University of Cincinnati College of Nursing, the University of Cincinnati Office of Research, and the Center for Clinical and Translational Science and Training grant (2UL1TR001425-05A1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Footnotes

CONFLICT OF INTEREST

The authors report no competing interests to declare.

The authors have no conflicts of interest to report.

Ethical Conduct of Research: The study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the institutional review board of the University of Cincinnati (#2021-0567).

Contributor Information

Randi A. Bates, University of Cincinnati College of Nursing, Cincinnati, OH.

Walaa R. Almallah, University of Cincinnati College of Nursing, Cincinnati, OH.

Bailey E. Martin, University of Cincinnati College of Nursing.

Tharaa I. Ananzeh, University of Cincinnati College of Nursing.

Christopher W. Collen, University of Cincinnati College of Nursing.

Jaclyn M. Dynia, SproutFive, Columbus, OH.

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