Don’t Touch My Hair! Acceptability and Feasibility of Hair Collection for Drug Testing among Pregnant Women Victoria H. Coleman-Cowger, PhD1; Emmanuel A. Oga, MD, MPH1; Nikki Weinstein, MSW1; Erica N. Peters, PhD1; Bartosz Koszowski, PharmD, PhD1; Katie Trocin, MPH1; Sage Roth1; Geraldine Baltazar1 & Katrina Mark, MD2 1. Battelle Memorial Institute, Baltimore, MD 21209 2. University of Maryland-Baltimore, Baltimore, MD 21201 ABSTRACT RESULTS The aims of this project are to understand the acceptability and feasibility of collecting hair from pregnant women for drug testing. Pregnant women were recruited from two prenatal clinics for a larger study comparing and validating substance use screeners to assess prescription drug misuse and illicit drug use. Lessons learned from hair collection are described, including participant acceptability of the procedure. This qualitative data was collected from January-May 2017, with preliminary steps taken to increase acceptability from the outset. We concluded that hair collection is acceptable to pregnant women, though themes associated with refusal were identified. Lessons learned from this study can inform hair collection protocols for other drug testing studies with pregnant women. A total of 471 women were eligible to participate in the larger study, and 194 consented and were enrolled. Mean age (SD) of participants was 28.6 (5.42) years. Approximately 68% (131/194) of participants were African American. Of the total eligible, approximately 6% (27/471) declined to participate in the study specifically because hair collection was required. Most other refusals were due to time constraints. Eighty-seven women (58%) provided samples from the crown of the head and 63 (42%) from the nape. About 25% (49/194) of hair samples tested positive for one or more illicit drugs – 45/121 (37%) at clinic A and 4/73 (6%) at clinic B. Of the positive screens, 79% were for marijuana, 35% for cocaine, 6% for oxycodone and 11% for other opiates. Several themes emerge when looking at a sample of participant comments regarding the request for a hair sample. Most participant reactions are related to the removal of their hair and range from willingness to hesitance to flat refusal. Other participants voiced concern about the research process and not wanting a biological sample to be included. Please see table 1 for an analysis of participant responses. INTRODUCTION Self-report of substance use during pregnancy may not be fully accurate due to possible negative consequences of reporting. Maternal hair analysis provides an advantage over other biological markers (e.g., urine) because the window of drug detection is larger;1 however, there may be reluctance to participate in hair collection. Feasibility of collecting hair samples for drug testing in clinical settings is a concern given reports of high refusal rates, ineligibility rates (due to insufficient hair) and demographic patterns associated with these challenges.2 Table 1: Participant Responses to Hair Sample Request Reason/Theme Example Hair Related   Easy Willingness “I have a lot of hair, so that’s fine” Absolute Refusal “My nape hair is my only natural hair, I don’t want to lose it” Hesitance “Can you take the hair first? Or else, I might change my mind” Research Related Negative about research “I don’t want the university keeping my hair samples” Positive about research “It’s good you take hair, because some will lie about drug use” Other Motivation Incentive—Positive or Negative “Yea, I’ll give you hair for $50”; “I don’t care how much money you are offering, you can’t take my hair” Concern about results “I am not comfortable giving my hair sample because results can be positive from 10 years ago” METHODS A total of 194 pregnant women were recruited from two prenatal clinics [one serving Medicaid-eligible patients (clinic A) and one serving privately insured patients (clinic B)] in an urban location for a larger study comparing and validating substance use screeners to assess prescription drug misuse and illicit drug use. Recruitment was conducted between January and May 2017. A $50 incentive was offered for the study visit. The following preliminary steps were taken to increase acceptability from the outset: 1) demonstrate hair collection process on a mannequin during consent; 2) have a sample of hair available to help participants visualize the required 100-120 strands; and 3) allow for the collection of body hair. Hair samples were analyzed for opiates, marijuana, cocaine, amphetamines, and phencyclidine. DISCUSSION AND CONCLUSIONS This study demonstrates that it is feasible and acceptable to collect hair samples for drug testing in clinic settings serving diverse female populations. A sufficiently large proportion of women approached for hair collection agreed, though the incentive may have played a role in acceptance rates. Lessons learned from this study can inform hair collection protocols for other drug testing studies with pregnant women. GRANT SUPPORT The research reported in this poster was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number R01DA041328. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no conflicts of interest to disclose. REFERENCES CITED 1. Maugh TH: Hair: a diagnostic tool to complement blood serum and urine. Science. 1978, 202: 1271-3. 10.1126/science.725602. 2. Fendrich, Michael, et al. "Drug test feasibility in a general population household survey." Drug and alcohol dependence 73.3 (2004): 237-250. Acceptability and feasibility of hair sampling was assessed by overall participation rate and refusal to participate in the larger study specifically for hair sampling reasons. Location of hair collection (e.g., crown of head, nape) was collected for 150 women in the sample.