Lead Content of Sindoor, a Hindu Religious Powder and Cosmetic: New Jersey and India, 2014–2015

Abstract

Objectives. To assess the extent of lead content of sindoor, a powder used by Hindus for religious and cultural purposes, which has been linked to childhood lead poisoning when inadvertently ingested.

Methods. We purchased 95 samples of sindoor from 66 South Asian stores in New Jersey and 23 samples from India and analyzed samples with atomic absorption spectrophotometry methods for lead.

Results. Analysis determined that 79 (83.2%) sindoor samples purchased in the United States and 18 (78.3%) samples purchased in India contained 1.0 or more micrograms of lead per gram of powder. For US samples, geometric mean concentration was 5.4 micrograms per gram compared with 28.1 micrograms per gram for India samples. The maximum lead content detected in both US and India samples was more than 300 000 micrograms per gram. Of the examined US sindoor samples, 19% contained more than 20 micrograms per gram of lead (US Food and Drug Administration [FDA] limit); 43% of the India samples exceeded this limit.

Conclusions. Results suggested continued need for lead monitoring in sindoor in the United States and in sindoor carried into the United States by travelers from India, despite FDA warnings.

Sindoor is an orange- or red-colored powder used by Hindus for religious and cultural purposes.¹ Married women may wear sindoor in the part of the hair to indicate marriage status and desire for a long life for their husbands.¹ Women also may wear sindoor as a dot (bindi) on the forehead for cosmetic purposes or, along with men or children, may wear sindoor for religious purposes.¹ To give it its distinctive red color, manufacturers potentially may add lead tetroxide (red lead).¹ In children, lead can cause cognitive deficits and behavioral issues among other health effects; an adult with kidney damage attributable to ingestion of lead-adulterated sindoor was reported in India.^2,3 The US Food and Drug Administration (FDA) limit for lead in color additives in cosmetics is 20 micrograms per gram.⁴

METHODS

We purchased 95 distinct sindoor samples from 66 South Asian markets identified through online directories in New Jersey between March and June 2015, and then analyzed the samples for lead content. We visited markets located within a 15-mile distance of 3 locations to purchase sindoor: Rutgers New Jersey Medical School, Newark, New Jersey; Rutgers School of Public Health, Piscataway, New Jersey; and Rutgers University—Camden, Camden, New Jersey. To represent products potentially brought into the United States by passengers traveling from India, we purchased 23 sindoor samples, via convenience sampling, directly from markets in Mumbai and New Delhi, India, in April 2014. To our knowledge, samples purchased in New Jersey were manufactured in India and subsequently imported into the United States.

To ensure that no brands, colors, or types of sindoor were overlooked during sample collection, sindoor samples were purchased without regard to brand, color, or packaging type, resulting in 2 or more copies of some sindoor samples. Subsequently, to ensure that only distinct sindoor samples were analyzed, multiple purchased samples identical in brand, color, and packaging type, including labeling, were marked with “R” for repeat sample and discarded, leaving only 1 sample with a particular or distinct brand, packaging type, color, and so forth. After we discarded the repeat samples, 145 distinct sindoor samples from the United States and 36 distinct samples from India remained. However, because of resource limitations, 50 additional samples from the United States and 13 additional samples from India were randomly eliminated from analysis. This left 95 distinct powders from the United States and 23 from India to be tested.

Trace Element and Mineral Research Laboratory at Rutgers University conducted analyses of lead in sindoor samples. Samples were considered positive for lead content if they contained 1.0 or more micrograms per gram of lead. The analytical method we used was electrothermal heated graphite atomizer atomic absorption spectrophotometry, summarized in detail elsewhere.¹ Samples were run in duplicate with a lower limit of detection of 0.004 micrograms per gram of lead.

For each sindoor purchase location (United States and India), we tabulated number and percentage of powders containing 1.0 or more micrograms per gram of lead, geometric mean lead levels, median, 25% to 75% quartiles, 95th percentile of lead content, maximum lead concentration, and number of high lead level products (> 10 000 μg/g). We also calculated the proportion of samples containing more than 20 micrograms per gram of lead, the FDA limit. We conducted data analysis with Microsoft Excel 2010 (Redmond, WA).

RESULTS

Laboratory analysis determined that 83.2% of the US samples tested and 78.3% of the India samples tested contained 1.0 or more micrograms per gram of lead. Both the geometric mean lead concentrations and the percentage of samples exceeding 20 micrograms per gram of lead were substantially higher for the India samples (5.4 μg/g of lead and 19% for US samples vs 28.1 μg/g and 43% for India samples). Five samples—3 from the United States and 2 from India—contained more than 10 000 micrograms per gram of lead. Specifically, the 3 US samples contained 50 000, 260 000, and more than 300 000 micrograms per gram of lead, and the 2 samples from India each contained more than 300 000 micrograms per gram of lead. Table 1 has more detailed descriptive statistics; specific brands and associated lead content of US samples can be found in Table A (available as a supplement to the online version of this article at http://www.ajph.org).

TABLE 1—

Descriptive Statistics for Lead Content in US and India Sindoor: 2014–2015

Descriptive Statistic	US Sindoor (n = 95)	India Sindoor (n = 23)
No. with ≥ 1 μg/g of lead (%; 95% CI)	79.0 (83.2; 75.8, 90.6)	18.0 (78.3; 60.5, 96.1)
Geometric mean lead levels, μg/g (SD)	5.4 (1.6)	28.1 (32.4)
Median lead levels, μg/g (SD)	3.0 (0.7)	12.7 (14.2)
SD for samples with lead content < 100 μg/ga	16.6	23.9
25%–75% IQR, μg/g	1.4–11.8	3.4–69.2
95th percentile of lead content, μg/g	266.6	270 511.1
Maximum lead concentration detected, μg/g	> 300 000	> 300 000
No. with > 20 μg/g of lead (%)	18.0 (19)	10.0 (43)

Note. CI = confidence interval; IQR = interquartile range.

^aSD included only lead levels < 100 ppm, which included most samples; if high lead levels (> 300 000) were included, then data would not be normally distributed, precluding use of SD.

No consistent pattern of lead content between distinct sindoor samples of the same brand was observed: we found weak to moderate associations (Pearson product moment correlation coefficient of determination) in lead content between intrabrand samples purchased only in the United States, only in India, and in both the United States and India (r² = 0.03, r² = 0.65, and r² = 0.19, respectively; all P > .05).

DISCUSSION

Results suggested that most tested sindoor samples from both New Jersey and India contained detectable levels of lead. Although most samples tested had lower than the current US FDA limit of 20 micrograms per gram of lead, these products still pose a health hazard, because lead has no known safe exposure level, especially in children.⁵ In addition, although not statistically significant, we found that the lead content may differ even among sindoor samples of the same brand.

The US FDA issued general warnings about sindoor after testing in 2007 by the Illinois Department of Health detected high lead content in one brand, which led to a voluntary recall by the company.⁶ Findings reported in this study indicated that the risk for exposure to lead from sindoor still exists in the United States and India; therefore, at a minimum, a continued need for hazard surveillance is warranted. Other cultural cosmetics, such as kajal and tiro, have been banned by the US FDA because of elevated lead content and classification as illegal color additives.⁷

In a limited number of cases, application of sindoor containing lead to a child’s skin (forehead) by parents and subsequent elevated blood lead levels in the child has been documented.⁸ No other sources of lead were found in these cited cases, and no other means of accidental ingestion were reported.⁸ In one case, a child’s blood lead level declined after parents stopped applying a type of sindoor powder to the child’s forehead.⁸ These cases supported how lead poisoning could be caused by topically applied sindoor, possibly from hand-to-mouth exposure.

This study’s findings are subject to some limitations. Every collected powder sample could not be tested because of resource limitations. Samples collected in New Jersey may not be representative of lead content of sindoor in other states. Sampling in India was guided by convenience rather than being systematic and may not represent the distribution of lead content of sindoor in India. Finally, lot-to-lot variability of lead content of sindoor was not examined.

PUBLIC HEALTH IMPLICATIONS

Public health interventions should focus on primary prevention to ensure that lead-adulterated sindoor is not available for sale. This involves eliminating lead-adulterated sindoor from stores, substituting other ingredients determined to be safe in lieu of lead, and conducting premarket testing of powders.

Secondary prevention (i.e., routine screening for elevated blood lead levels) also plays a role. Although the United States has federal- and state-level requirements for screening children, implementation and compliance are not uniform.^9–12 Physicians who treat patients exposed to sindoor should encourage routine blood lead level screening.

In addition, raising awareness through education is important in reducing risk. For example, health inspectors may educate owners and managers of South Asian stores to limit sales of sindoor to brands found to be lead free and about the importance of placing signs outlining possible risks of sindoor use. Moreover, returning travelers should be advised that sindoor purchased in both India and the United States may contain lead.