Mercury-containing Skin Lightening Cream in the Twin Cities Hmong Community:

An Analysis of Focus Group Findings

Wednesday, November 9th, 2017

Abdullahi Abdulle, Matthew Bjork, Kaele Culver, Mariah Gallagher, Kim Holzer
 Analysis of Focus Group Findings 1

Executive Summary

Background

Skin lightening has been around for many generations. It is influenced by many facets of our

society. Skin lightening products can contain harmful ingredients when applied to the body,

which can damage an individual’s major organ systems. This study focused on one of these

harmful ingredients, Mercury. As part of a Hamline Public Health Sciences Senior Seminar

initiative the University partnered with the Minnesota Department of Health & the Minnesota

Pollution Control Agency to assist with the Minnesota Mercury in Skin Cream Project.

Regulatory efforts have begun, in order to ban the use of mercury in consumer products. Yet,

products containing mercury are still being sold to consumers via Marketplaces and online.

Safer medicines offered by clinicians work slow and are not covered by insurance. Therefore

people affected by this epidemic reach out for more cost effective, fast acting results. There are

generational divides between the type of treatments people choose to use and this is one

aspect we chose to research within our study. This epidemic affects many populations as social

hierarchies have placed larger societal importance on a person’s skin tone. One of the

populations is the Hmong population. Minnesota is one of the few states in America that has a

large Hmong population and we worked with them, in order to form focus groups to investigate

their thoughts on this issue.

Methodology

Students from Hamline University’s Public Health Senior Seminar conducted four focus groups

to look into opinions on community, identity, beauty ideals, and skin lightening among members

of the Hmong-American community of St. Paul, Minnesota. Sixteen questions were asked in

each of the focus groups, and analysis of each question’s responses was conducted to find

common themes among all of the data collected.

 Analysis of Focus Group Findings 2

Results

The qualitative data analysis provided four themes from the four focus groups that were

conducted that address the feelings and opinions that participants had regarding beauty and

skin issues. Some of the participants also emphasized topics that were sub-themes of the major

theme, which will be discussed within each of the major themes.

1. Culture and Individual Perception of Beauty: Respondents talked at length about the

importance of Hmong culture to them, and the security that groups such as HSA

organizations give them to relate with those with similar experiences, allowing them to be

more themselves. Hmong culture played a heavy hand in how participants defined

beauty, citing Korean ideals (such as light, white, clean skin and exaggerating features,

especially eyelids, to be more dramatic) and other Hmong pressure to adhere to theme

as an important standard of beauty. However, almost all participants said a variety of

sources, such as social media, celebrities, and friends, contributed to ideas of beauty.

2. Knowledge and Side Effects of Mercury based Creams: ​Most participants did not think of

mercury toxicity, specifically in skin lightening cream, but some discussed how they have

seen side effects when learning about them. Only a few had learned about the dangers

of this previously, but most agreed that those showing side effects were using skin

lightening creams. Going further, many participants agreed that they often did not check

the ingredients in any skin or beauty products they used- instead, if researching

anything, they cited looking at online reviews or “social media beauty gurus” to look for

advice, positives, and/or mishaps of products before buying them. Additionally, most

products from the Hmongtown Market were written in Korean or other languages,

meaning participants did not bother to check as they knew they would not be able to

learn what was in the products anyways.

 Analysis of Focus Group Findings 3

3. Family and Peer Influence: Participants talked at length about how family and friends

influence many aspects of their lives, especially in selecting beauty and skin products or

seeking advice on health issues. There was especially onus on female family members,

with participants often discussing how they would check with sisters, mothers, aunties,

and more on skin issues before consulting other sources. Some male participants even

said they would go to their sisters or mothers before anything specifically because they

are men, and their female family members would know more. This advice would often

even be unsolicited, with family members and friends noticing a breakout or hair change

and offering advice without being prompted. This is especially compounded when family

members are selling products, as a few participants noted was common. Enough

participants commented on the Hmong idea of older generations pressuring their

children, nieces, nephews, and/or grandchildren to use the products they do (specifically

skin lightening creams) to continue legacies of Hmong beauty.

4. Generational Divide: As all respondents are traditional college students, and therefore in

the younger generation and often more “americanized”, many noted that they are more

accepting and flexible with American beauty ideals and norms, such as cosmetic

surgery, piercings, tattoos, and generally nontraditional looks. However, they made it

clear that older generations did not value this, and it created struggles and conflict

between the generations. Many participants also discussed maintaining Hmong and

Asian beauty standards as to not create tension, and specifically tied back to their

family’s influence on what products they buy and use. It was noted by many that older

Hmong generations have been using products from the Hmongtown Market, such as

skin lightening cream and other medicinal alternatives, and this influenced some and

their friends to use the same, the clear difference was that younger generations are
 Analysis of Focus Group Findings 4

willing to use both these methods and more common western products found in large

stores. Another important generational difference was found when discussing potential

outreach materials. Some participants offered ideas of using the Hmong radio and TV

station, or targeted Facebook ads to potentially change the mind of older generations

(OGs), but a large amount also indicated that many of the OGs would not be open to

changing their products even if they had harmful products, so long as they did not have

to face the consequences. Participants generally agreed that their generation may be

more receptive to outreach materials warning of mercury in skin lightening creams, and

would be more open to switching products than those older. Many also discussed how

the message may be better received coming from within the Hmong community,

indicating that they would talk to their older family members and friends to inform them of

the potential danger.

Conclusion

The Hamline University Public Health Senior Seminar was able to find important and quality

information on the use of skin-lightening creams in the Hmong Community in St. Paul. The

focus groups allowed us to collect outreach materials and multiple potential initiatives to curb

the use of these dangerous products. Participants expressed the desire for further education on

mercury and mercury based skin-lightening creams. This material would be used to educate

their own family and friends.

Due to the generational differences on the perception of beauty and use of skin lightening

creams, different intervention methods are necessary. Older individuals are more likely to be

reached, and listen, to campaigns on radio and television. Popular local Hmong media include

KFAI 106.7 and Hmong TV (Channel 25.3). Younger individuals are effectively reached with

YouTube. Many participants indicated they viewed beauty and product advice on YouTube.
 Analysis of Focus Group Findings 5

Facebook is a platform that can be used to reach both generational groups. Facebook Live is a

popular for product advertisement and product reviews.

Background

Skin lightening has become a worldwide phenomenon used to combat societal

hierarchies which have been influenced by the color of an individual’s skin. Margaret Hunter

stated, “The merging of new technologies with old colonial ideologies has created a context

where consumers can purchase “racial capital” through skin-bleaching creams or cosmetic

surgeries” (Hunter, 2011). The shade of a person’s skin can affect people in the following areas;

jobs and earning potential, social status, perception of beauty, and marriage potential. Skin

lightening is a ten billion dollar industry and it’s forecasted to become a twenty-three billion

dollar industry by 2020 (Global Industry Analysts).

The industry offers different products in order to attain the desired skin tone and effects.

Some products can be applied topically, lasers are sometimes used, some treatments are taken

as dietary supplements, and others can be injected intravenously at clinics. The harmful effects

from these products that have been reported are skin rashes, discoloration, scarring, acne,

bacterial/fungal infections, eye irritation, and increased blood pressure (Mendoza, 2014).

Damage has been reported to people’s adrenal glands, along with kidney failure, liver failure,

and skin cancer (Hunter, 2011). People in the United States will sometimes go to a

Dermatologist, in order look at skin lightening treatments and options. Sometimes this is in an

attempt to even out their skin tone and lighten and dark spots or “blemishes”. According to

Doctor Alexia Knapp, a dermatologist for HealthPartners, skin lightening treatments are slow,

not covered by most insurance, and may cause irritation to the skin. Dr. Knapp also went over

different aspects of Mercury. She stated that mercury is, “present in many cosmetic products,

the inorganic mercury is in skin lighteners. Mercury iodide is in soaps, mercury ammonium is in
 Analysis of Focus Group Findings 6

creams, and it’s organic form is present in cosmetic preservatives.” She also stated that besides

skin problems, the risks of being in contact with mercury can be of a Psychiatric nature.

Including anxiety, depression, and psychosis. The nervous system can also be affected through

peripheral neuropathy and memory problems (Knapp, Alexia).

Mercury is listed as one of the most ten dangerous chemicals in public health by the

WHO. There are other dangerous chemicals used in skin lightening products, such as

Hydroquinone and corticosteroids and both can cause complications with their usage. One of

the researchers we studied stated that, “the use of mercury in cosmetic products should be

strictly prohibited. The public should be warned not to use such products” (Chan 890). We have

seen that just banning these products is not enough to dissuade the public from using them.

This has been seen through the efforts by the MDH and by other countries that have attempted

to cease this epidemic with their Public Health campaigns. Jamaica ran a campaign which was

called, “Don’t Kill the Skin.” Ghana and Kenya are the frontrunner countries and have taken

initiatives in banning Hydroquinone, which surpasses our own success in the fight against the

widespread use of these harmful products.

The Minnesota Hmong population and their knowledge of skin lightening creams is not

well known. Around 200,000 Hmong have immigrated to the US from South China, Laos, and

Thailand. They are dispersed primarily among a few states and Minnesota is one of them. “The

Hmong have a tribal or clan social organization, which is of patrilineal descent and strictly

exogamous, with clan elders and Shamans being important community functionaries”

(Franzen-Castle). These elders and Shamans play an important role in community organization

and health.

Some of the Hmong immigrants practice medical pluralism in order to cure their

maladies. After migrating, it’s important to Hmong families to see that their children succeed in
 Analysis of Focus Group Findings 7

American culture. This has a price all of it’s own, seen through a loss of language and culture

when the younger generations go to American schools and gain American social ties. Through

this acculturation process a change between how the younger generation lives compared to

their elders appears with effects on both of their lives. “Younger participants distrusted

treatments available from medicine women because of unknown ingredients, quantities, and

education level. Younger adults preferred Western over traditional medicines because there is a

supposed reference point and standardization” (Franzen-Castle). This statement referenced

from a focus group study was conducted in Minnesota among younger and older members from

different Hmong communities and it demonstrates the complex situation that envelopes the

Hmong people.

The efforts to lighten a person’s skin is not a new situation. Blemish free white skin in

Korea has been preferred since the first dynasty and has been associated with nobility. ​Fair and

Lovely ​was launched in India in 1978 and targets both men and women. The terms associated

culturally with white in India are; beauty, purity, cleanliness, and happiness and the terms

culturally associated with black are; dark, dirty, wrong, and Hell. In China most goddesses and

buddhas are portrayed as having white skin. Japanese men valued white skin in judging the

beauty of Japanese women and associated it with femininity, chastity, purity, moral virtue and

motherhood (Li et. al, 2008). On the continent of Africa whiter skin is a means to affluence,

respect, and a better lot in life (Souza, 2008).

Data suggests that the group of people that are most affected by this epidemic are highly

paid, educated women, in the urban areas of the Global South. There are safer alternatives on

the market and being developed besides the harmful products that people have been forced to

use. These alternatives obviously don’t discontinue the sociological issues behind racially

biased hierarchies that are prevalent worldwide. However, it does help protect the people that
 Analysis of Focus Group Findings 8

are forced to use these chemicals in the first place, in order to fit in with societal norms and

expectations.

A study in the Saudi Journal of Biological Sciences stated that the active components of

the Persimmon calyx Quercetin (which is typically used as a food supplement for allergies) is

being looked at as an “active ingredient” for skin lightening therapy (Hyun et. al, 2015). Another

study looked at the stem bark of ​Sideroxylon inerme L. and its compounds which were used for

tyrosinase-inhibition activity. “During mechanism studies it was evident that at the transcription

level, ​Sideroxylon inerme (25 μg/ml) was acting as a potent tyrosinase inhibitor compared to

controls” (Momtaz, S., et. al, 2015). These alternatives, while effective, will still carry a cost to

the consumer which some may not be able to afford thereby, leading them to still use the

cheaper more harmful alternatives. Dr. Knapp stated that there are things to look for, in order to

avoid the skin lightening products that contain mercury. The, directions will read that when using

the product a person should: “avoid contact with silver, gold, rubber, aluminum.” She also stated

that consumers should be on the lookout for, “gray or cream colored products” (Knapp, Alexia).

Methodology

Four separate focus groups were held to obtain information pertaining to the Hmong/

Hmong-American community of St. Paul, Minnesota. The first focus group consisted of seven

individuals and took place at Hamline University on Thursday, October 19th. The second focus

group conducted was comprised of six students and also took place at Hamline University on

Thursday, October 19th in a separate room than the first group. The next focus group was

conducted at St. Catherine’s University on Sunday, October 29th and had eight participants.

The fourth and final focus group, which consisted of eleven individuals, was conducted on

Wednesday, November 2nd at Concordia St. Paul. All of the participants were college students

that were recruited through their University’s respective Hmong Student Association. All
 Analysis of Focus Group Findings 9

participation was voluntary and informed consent was obtained prior to participation.

Participants received a $10 Target giftcard for participation. Demographic information can be

found in Index A.

Two designated notetakers were present at each of the four focus groups. Participants

were also audio recorded and consent was gained from each individual in order to record the

conversation. Sixteen questions were asked by two co-facilitators to spark discussion

surrounding the Hmong community, beauty ideals, and skin lightening creams were asked

during the focus groups. The questions included were as follows:

1. What are the benefits about being a part of Hamline’s HSA?

2. What does Hmong culture mean to you? What does Hmong/American culture mean to

you?

3. Are there generational differences in beauty (culture, language) in your household

and/or community? Do you think differently about beauty, culture, language than your

parents? Grandparents? Other family members?

4. What influences your ideas of beauty?E.g. Social media, family/friends, etc.

5. a) How do you see Hmong culture influencing beauty ideals?

b) ​Is there anything that is specifically NOT considered beautiful? According to or in

Hmong culture?

6. Do you have a skin care routine? What products do you use? Types? Brands? b) Have

you ever mixed any products together? What products and where did you learn to do

this?

7. What/Who makes you want to buy or use a certain product?

8. a) Who do you consult with on issues of skin and beauty?

 Analysis of Focus Group Findings 10

b) Would you feel comfortable talking about skin care issues with a primary care provider

if you see one?

9. Are you familiar with or have you heard of skin lightening creams? What do you know

about them? How did you hear about them?

10. a) Do you know anyone who has used skin-lightening creams?

b) Do you notice differences between family/friends who are older younger and their use

of these products? Have you used skin-lightening creams?

11. Have you ever considered what ingredients are in the beauty products you use?

12. (Facilitators show symptoms of mercury toxicity including: irritability, skin rash, weight

loss, metallic taste, nausea, insomnia, fatigue, tremors, mood swings, headaches,

hearing and memory loss, incoordination, hypertension, hypersalivation, hallucinations,

and death.) Have you seen any of these side-effects in someone in your community?

a. What have you noticed?

b. Has anyone in your family experienced these side-effects?

c. Have you experienced these side-effects?

13. Do you have concerns or questions about this information? Are you concerned that the

products you use might not be safe?

14. Knowing this information, what would change your behavior or a family member’s

behavior?

15. What forms of communication would best display the dangers of skin lightening

products?

16. What else do you think we should know about skin lightening issues in the Hmong

community? Is there anything you’d like to discuss on this topic that we haven’t hit on

yet?
 Analysis of Focus Group Findings 11

Results

Theme #1: Culture and Individual Perception of Beauty

Many participants talked about the importance of belonging to this community of people

who can relate to one another and have similar interests with one another. Some participants

talked about the significance behind associating with those of the same culture that speak the

same language and understand where they are coming from, alerting us that these

organizations create a place for them to be able to feel normal and to be themselves.

“For me I just like being a part of HSA cause it is kind of a way where I

can kind of be with people I can kind of feel like I can associate with and

can kind of understand my pain or what I go through my daily life. So it’s

kind of a way where I can just be myself and just be with people I enjoy

being around”

Some participants emphasized that these groups offer them a sense of normality. They

stressed the importance of a safe space in order to find their voice and to share similar ideas

and viewpoints with other people about life and the future. ​Several participants broached the

idea of having split identities between Hmong and American and the importance of finding a

balance between these two worlds, adding that the setting is an appropriate factor.

“Having two identities. In school I am more American when I am at home I

am Hmong. When I was younger I could speak Hmong at home and

school. But now I don’t speak much Hmong. It is difficult to stay in touch

with culture when you don’t speak the language.”

Participants explained that some of them have grown up in traditional families and the

usage of the Hmong language plays an important role in staying in touch with the Hmong
 Analysis of Focus Group Findings 12

culture. Balancing the parents goals, for some of the participants, and their own goals

sometimes becomes problematic in the traditional families because they are supposed to carry

on the traditions and this is a great responsibility within the American culture, yet important to

their elders that have grown up through a different generation. The respondents mentioned that

because the elders have experienced extreme adversity throughout their lives, they expect the

younger kids to jump on the opportunities that America offers such as jobs and they may

sometimes go overboard trying to do this.

In all of the focus groups people discussed a range of influences in regards to their ideas

of beauty. Respondents spoke of peers, friends, and people they were in contact with (including

strangers) that set standards of beauty which helped to mold their own ideas on the topic.

“I think especially for a woman we are influenced by the people we are in

contact with, whether that be family, friends, or strangers. I think

regardless of who we are and how we view beauty we are encountered

with. Without thinking, I judge her or myself if I see someone with good

skin. Not just famous people. That is always something I encounter with

women, especially with teenagers right now, they are going through a

phase in life to be their best.”

One person talked about growing up in a white community and having white beauty

standards because of this influence, while others mentioned the importance of having “good

skin”. Many participants talked about their siblings having an influence over the types of

products they used. They also mentioned Korean celebrities, hollywood and social media
 Analysis of Focus Group Findings 13

displaying images of white teeth and perfect hair which contributes to what the idea of beauty is

within their communities.

Theme #2: Knowledge and Side Effects of Mercury based Creams

Through conducting the focus groups, insightful information surrounding the knowledge

of ingredients in beauty products being used (or lack of knowledge) was gathered. It was found

that many of the participants are not informed about what ingredients are in their products. Most

of them do not attempt to research the items they use, and often base what they use off of

recommendations of people that they know and trust. As one participant explained:

“​If you aren’t educated you wouldn’t look into [ingredients in the beauty

products you use].”

While most participants agreed that they did not look into the substances in the beauty

products they used, a few emphasized that researching the safety of a product was an integral

part of deciding which beauty products they would choose to use. One individual stated:

“For my sisters, they will sometimes buy skin care products and before

they do they usually search out which one is safe, which one is good.

[They] go on Youtube and see which ones the Youtube users are using

and then search those out too to see what’s in those ingredients a​nd then

go see if it’s safe.”

When asked about if individuals have seen the side effects of mercury exposure in the

Hmong community, the response was very mixed. Some of the participants responded saying
 Analysis of Focus Group Findings 14

they had not ever thought about mercury toxicity and thus have not thought about or noticed

symptoms in those around them. However, other participants shared that they had seen

symptoms of mercury exposure in their community. Some of the side effects noticed were skin

rashes, breakouts, dizziness, headaches, and, in one instance, the bleaching of a pillow case.

In most of the examples where individuals have seen signs of potential mercury exposure, the

participants know that skin lightening products were being used by those showing the

symptoms.

Theme #3: Family and Peer Influence

In the focus groups, participants reported that family and friends were the ones they

consulted with on beauty issues. Participants discussed that their mothers, sisters and aunts

were the people to consult with since they were older and may have more knowledge about the

issues that they face. One participant who took part in the Concordia focus group noted:

“​When I was a teenager, I started to break out. My parents have clear

skin. They gave different products to try. One product had alcohol in it

and it wasn’t good for my skin. So I started breaking out. It got kind of

bad but I think we went to go see a doctor and they prescribed medicine

that had to do with hormones and also a cream.”

This also leads into the sub-theme that some participants would only see their primary

care physician (PCP) as a final resort. Many of the participants stated that they would only see a

PCP as a last option because of the costs attached to some of the medications. The focus

groups discussed that they would only see PCP if they had severe acne problems or if some of
 Analysis of Focus Group Findings 15

their alternative medicines did not treat the problem at first. One participant of the St. Kate’s

focus group noted when asked about being comfortable seeing a primary care physician:

“As a last resort. Usually I go into community like Hmong Village”

Many other participants shared this same sentiment and reported that it was common to go to

Hmong village to find alternative medicine to treat their skin.

While respondents from all focus groups listed influence from a variety of sources, family

was a constant for most. Many talked about consulting with family members, specifically female

family members, about beauty products and routines, and when speaking of Hmong culture,

many spoke of the influence of the OG’s- older generation members.

“For me, I don’t really have a particular product. If my sister has a product,

I usually try it.”

“My sister’s influence me as well, we buy products and use them together

and we’ve gotten to the point where we know what we like and who likes

what.”

“My auntie was like I’m ordering some Korean stuff. You want anything?

And I was like just get me something and I’ll try it out.”

“I talk to my cousins. I am uneducated because I am a guy so ask girls.”

An interesting aspect of this theme is that family influence was common even if it was not

solicited:

“If somebody sees you with something they will just come up and be like,

“oh you have that, just try this and this” and you didn’t really ask them for

it…”
 Analysis of Focus Group Findings 16

“I dyed it a lighter color of brown and he constantly, every day was like,

‘dye your hair back to black, dye back to black’.”

Many participants also discussed how sales in family can affect their choices of beauty

products, discussing how friends and family members participating in multi-level marketing try to

sell products to the community.

Participants also easily listed how Hmong culture and families influence perceptions of

beauty, and how that can reflect on personality characteristics such as being nice, clean, or

alternatively being seen as lazy (specifically for males).

“My parents were understanding of [me dying my hair] too but [...] they

didn’t like it as much because it’s just viewed very bad in the Hmong

community for some reason.”

There are numerous pressures to use skin lightening creams. Older generations

pressure younger people to “continue… the culture or legacy…” Parents and elders often

pressure younger people to use the products they use:

“...my mom tried to make me use it. [This] Asian product. It was meant for

when you get marks on your skin.”

‘My dad doesn’t like the mole on my face. And they really dislike it and

[tried’ to get rid of my beauty mark…”

Theme #4: Generational Divide

Many respondents talked about how the younger generations hold modern

Americanized ideals when it comes to beauty. Participants mentioned that this is recognized

through the changing of people’s attire from a more traditional look to a more modern one. They
 Analysis of Focus Group Findings 17

talked about the differing beauty standards of American born Hmong compared to their

grandparents who grew up in different countries. Long hair was considered a sign of wealth by

the participants elders. Tatoos, the cutting and dyeing of one’s hair, meager clothing coverage

or ripped clothing, using bronzers, and getting body piercings creates generational struggles.

While the younger generation appreciates these modern twists on beauty the elders of the

participants do not. Many respondents in all of the groups mentioned the importance of keeping

their hair black and their skin pale for their elders.

“We (younger/American born generation) are willing to accept curly hair

and like dyed hair. So, for example, my grandma she’s traditional. She

doesn’t like, like blonde hair, bleached hair, or like brown hair. She likes

you to have black hair especially for girls. Black hair’s like the standard,

beautiful Hmong woman or girl.”

They said this was important for many reasons; one of which is pride and a need to protect

them from ridicule from others within the community.

Many participants of the focus group talked about the generational divide between the

younger Hmong people and the elders regarding beauty and skin issues. It was discussed that

elder Hmong women were the ones who used these skin-lightening creams and that they were

unaware of some of the side effects. One participant in the St. Kate’s focus group noted:

“A lot of elder women in 40s, 50s and 60s all grew up in Thailand and

Laos. That is what they’re used to and it works for them. They’ve tried

American products...it doesn’t work for their skin types. They go back to
 Analysis of Focus Group Findings 18

those products that they’re used to and it works. They’re more

comfortable with it.”

In all four focus groups, the participants discussed that with some of them being born in

America, they were more likely to use creams they get from convenience stores and big

retailers. They said that the elders were more stubborn, arrogant, and were not comfortable

using American products.

Some members of the focus groups did comment that elders or older people were not

the only people who used the skin-lightening creams. They reported that they do know some

younger people who use these creams. There was even one participant from the St. Kate’s who

noted that she did not have enough money to buy the cream:

“For me I know that there is a Hmong store in St. Paul called Hmong

Village, they do sell a lot of light skin products. Product called “Pop” or

something. I was going to buy it, then I didn’t because I was at the

student at the time and didn’t have money. It has mercury in there.”

Finally, this can be linked back to the other theme that family and friends can influence

your decision on skin issues. Many participants referenced that because they go to their

parents for advice on beauty, they often get recommended skin-lightening creams. One

participants noted that her mother recommended a skin-lightening cream but did not know any

of the ingredients present:

“She got me to use it too but I’m not really sure about it. I don’t know

what’s in there and I don’t know how to feel about it, but she

recommended it”

There was a stark generational divide around stopping the use of skin lightening creams

or using different products. When changing their own behavior, participants said they would be
 Analysis of Focus Group Findings 19

willing or open to change. One participant said, “Yes, definitely,” when asked if they would

change. However, some participants were less open saying they would have to “...see it

firsthand,” or would change only if there were adverse effects of it, “...then I would change, but if

it’s not happening right now, [it won’t] make a difference.”

The opinions of older generations on changing behavior solidified the theme of

generational divide even more. For the older generations, “...it’s a lot harder… because they

don’t want to reject them or get convinced.” for the Hmong community, beauty is “too important.”

One participant labeled the community as “stubborn.”

Each focus group had varying ideas on what communication methods would be most

successful. However, two themes stuck out in particular. The first was using different forms of

media as outreach tools; social media, YouTube, radio, and TV. The second theme was using

other individuals, such as elders and medical professionals, as methods of educating the

Hmong Community.

For the younger members of the community, using platforms such as YouTube is

promising, “For younger generations, YouTube videos and reviews [would help make them

aware].” Older generations do not seem to use YouTube, rather watch Hmong TV and listen

Hmong Radio.

“​…Hmong radio… my parents [and older generations] listen to it a lot.”

“My mom is always on the radio. The radio helps her a lot and it’s the best

way to Communicate.”
 Analysis of Focus Group Findings 20

Using social media seems to be a possible bridge over the generational divide, “a lot of older

hmong people are using Facebook.” Numerous participants stated members of the Hmong

community trust people presenting on Facebook Live.

Conclusion

This report will help the Minnesota Department of Health and the Minnesota Pollution

Control Agency in understanding the perceptions behind the use of skin-lightening creams in the

Hmong community. The focus groups contained a large amount of data which will help them

create a comprehensive plan to tackle such a challenging issue.

Throughout the focus groups, it appeared that skin-lightening is a prevalent issue in the

Hmong community. Participants in the Focus group suggested that more education be provided

so it could help spread the perception that these creams are unsafe. Participants also

expressed initiatives that tackle the issue and that more exposure on the dangerous effects of

mercury will help the community better understand what they are facing. Many of the

participants were concerned about the health of their parents and other relatives and stated that

by targeting them, that they could teach their own family about the harmful effects of mercury.

Finally, based on information collected by the focus groups, it is apparent that different

intervention methods are needed for different generations. Radio and TV should be targeted

towards the older generations while YouTube should be targeted towards younger generations.

Social media platforms, in particular Facebook, has potential to address numerous generations.

Moving forward with this information, a campaign using these platforms should be created in

order to educate the Hmong community about the issue of mercury in skin lightening creams.
 Analysis of Focus Group Findings 21

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 Analysis of Focus Group Findings 23

Index A

Age 19.52 ±1.93 years

Marital Status 27 single 3 attached 1 married

Sex 21 female 10 male

Religion 20 Shamanism 3 Christianity 1 Animaism 1 Other

3 Shamanism/ 1 Shamanism/ 2 None

Animaism Christianity

Immigration 2 immigrant 21 First 7 Second 1 Fourth

Generation Generation Generation

Household Size 3 households with 1 household 2 households 25 households

1 persons with 3 persons with 4 persons with >5 persons

Household 7 households 4 households 2 households 9 households

Income <$10,000/year $15,000 - $20,000 - $30,000 -

$12,000/year $30,000/year $50,000/year

7 households 2 prefer not to

>$50,000/year answer