Imagine every time you handle a receipt, you’re unknowingly transferring toxic chemicals to your skin. It’s a reality cashiers face every day, often without knowing the health risks involved. Research shows that thermal paper receipts commonly contain bisphenol A (BPA) or bisphenol S (BPS), both of which are endocrine-disrupting chemicals with effects that accumulate over time. This article will take you through the science of BPA and BPS, why using hand sanitizer makes it worse, and what research reveals about the elevated health risks faced by cashiers and retail workers.

Thermal Paper Receipts: A Surprising Source of BPA and BPS Exposure

Thermal paper receipts use heat-sensitive coatings, commonly including BPA or BPS, to produce printed text without traditional ink. Unlike BPA in plastics or canned food liners, where it’s more tightly bound, BPA in thermal paper is in a “free” form, transferring easily to the skin. In fact, the Ecology Center found that about 80% of U.S. receipts tested in 2022 contained BPS or similar chemicals, despite bans on BPA in many other products.

The Science of BPA and BPS: Why Are They Problematic?

BPA and BPS are categorized as endocrine disruptors, meaning they interfere with hormone function by mimicking estrogen. The National Institute of Environmental Health Sciences reports that BPA exposure has been linked to issues like reproductive health problems, thyroid dysfunction, obesity, and insulin resistance—all significant concerns for those exposed to BPA or BPS on a daily basis. For instance, cashiers handling hundreds of receipts per shift are at an even higher risk of these health effects.

According to a 2014 study published in JAMA, BPA can be detected in urine within hours after handling thermal paper receipts, confirming rapid absorption through the skin.

Cashiers and the Compounded Risks of Daily Receipt Handling

Research highlights that cashiers, who handle receipts constantly, have measurably higher BPA levels in their bodies than those with less exposure. A 2015 study by the Ohio State University Center for Clinical and Translational Science monitored cashiers over their work shifts and found significantly higher levels of BPA in their urine at the end of a shift compared to the beginning. This routine, daily exposure raises questions about cumulative health effects for workers in high-exposure jobs.

The Environmental Health Perspectives study further emphasized the long-term impact, finding that prolonged, low-dose exposure to BPA from handling receipts could increase cashiers’ risks for hormone-driven diseases, metabolic disorders, and endocrine disruptions. These impacts include increased risks for thyroid issues, weight gain, insulin sensitivity issues, and possibly even hormone-driven cancers like breast cancer.

Hand Sanitizers: Increasing BPA and BPS Absorption Through Skin

Interestingly, the very measures many people take to protect themselves—using hand sanitizer frequently—can make BPA and BPS exposure worse. Alcohol-based sanitizers strip away natural skin barriers, allowing chemicals to be absorbed more easily. A 2014 study demonstrated that people who applied hand sanitizer before handling receipts absorbed up to 185 times more BPA than those with untreated skin.

Dr. Frederick vom Saal, a lead researcher in this study, described it as “opening a chemical gateway,” as sanitizers weaken the skin’s defenses, facilitating faster and more direct entry of BPA and BPS into the bloodstream. For cashiers who sanitize their hands frequently, this combination could mean consistently higher levels of BPA, exacerbating risks.

Broader Health Effects of BPA and BPS Exposure

The health effects of BPA and BPS aren’t limited to hormonal issues. Repeated exposure can contribute to broader health problems, including:

• Obesity and Metabolic Disorders: BPA exposure is linked to insulin resistance and obesity, as it interferes with the body’s ability to regulate glucose. A National Institute of Environmental Health Sciences report notes that endocrine disruptors may play a role in the growing obesity epidemic by altering metabolic function.

• Thyroid and Hormone Imbalance: Endocrine disruptors can throw off thyroid function, leading to symptoms like fatigue, difficulty with weight regulation, and mood changes.

• Reproductive Health: BPA exposure is linked to reproductive disorders and can impact fertility and menstrual regularity in women. Men may also experience hormonal disruptions that can affect reproductive health.

• Cognitive and Behavioral Impacts: Long-term exposure to endocrine disruptors is associated with cognitive and behavioral changes. Some studies suggest that BPA exposure during critical periods of development may even have lasting effects on mental health.

Health Risks for Cashiers and Retail Workers

Because cashiers have such regular exposure to receipts, they’re at an elevated risk of these cumulative effects. The Ohio State University study underscores that cashiers are absorbing BPA on a daily basis, leading to much higher levels than the general public. This exposure could increase their risk of developing endocrine-related diseases over time.

Practical Solutions to Reduce Exposure for Cashiers and Shoppers

While it may seem daunting to avoid receipts, especially for retail workers, practical steps can help reduce BPA and BPS exposure:

1. Promote Digital Receipts
   Many stores now offer digital receipt options. Opting for an emailed receipt, or using app-based receipt storage, can eliminate the need for physical receipts altogether. This is an easy way for shoppers to reduce contact.

2. Use Gloves or Barriers
   For cashiers, wearing disposable gloves or food-grade silicone fingertip protectors can reduce skin contact with receipts. Folding receipts inward, with the coated side facing itself, also reduces the chance of chemicals transferring to the skin.

3. Wash Hands Over Using Sanitizer
   Frequent handwashing with soap and water is less likely to increase BPA absorption than hand sanitizers. Retail workers should avoid sanitizers directly before handling receipts. Washing hands frequently between handling receipts is a safer approach than sanitizing.

4. Encourage Employers to Switch to Bisphenol-Free Receipts
   Employers can take proactive steps by switching to bisphenol-free thermal paper options. Some large retailers, like Trader Joe’s, Target, and Starbucks, have adopted safer alternatives like Pergafast 201 or Appvion Alpha Free, which do not contain BPA or BPS.

5. Policy Advocacy for Safer Receipt Paper
   The European Union has restricted BPA in thermal paper to a concentration of 0.02% or lower, encouraging companies to switch to alternatives. The U.S., however, lacks such stringent regulations. Consumers and advocacy groups can support policies to require safer, bisphenol-free receipt options, which would benefit retail workers and shoppers alike.

A Closer Look at Alternative Receipt Papers

As awareness of BPA and BPS risks has grown, some alternatives have gained popularity among retailers aiming to reduce toxic exposures:

• Pergafast 201: This alternative to BPA and BPS has been classified as a safer option by the GreenScreen for Safer Chemicals, but it isn’t without concerns. Although it has low hormonal activity, some studies suggest it may still pose environmental risks, as it is toxic to aquatic life.

• Appvion Alpha Free: Known as the “vitamin C” thermal paper, Alpha Free theoretically uses ascorbic acid (vitamin C) as a heat-reactive compound. However, some studies indicate it contains pharmaceuticals like dapsone and tolbutamide, raising questions about its long-term safety profile.

While these options may reduce direct exposure to endocrine disruptors, ongoing research is needed to verify their safety fully. Many companies are transitioning to these alternatives, and increasing consumer demand for bisphenol-free receipts could encourage further industry change.

Expanding Awareness: Steps Retailers and Policy Makers Can Take

For significant change to happen, more retailers need to prioritize worker and consumer safety. This may involve:

1. Expanding Digital Options: Some stores offer digital-only receipts to help customers avoid physical copies. Digital solutions not only reduce BPA exposure but are also environmentally friendly, reducing paper waste.

2. Implementing Bisphenol-Free Policies: Policies could support the adoption of safer receipt materials across the board, benefiting cashiers and consumers alike. For instance, policymakers might require stores to disclose the type of thermal paper used or mandate the availability of bisphenol-free options.

3. Training and Educating Retail Workers: Employers can educate cashiers about the risks of BPA and BPS, encouraging safe handling practices and handwashing protocols. Awareness is often the first step toward prevention.

Conclusion: Small Steps for Big Health Impacts

While it might seem like a minor inconvenience, avoiding exposure to BPA and BPS in receipts can have significant health benefits, particularly for those in high-exposure jobs. Cashiers and retail workers, due to their constant contact with thermal paper, face a unique and cumulative risk. For the rest of us, opting out of physical receipts, washing our hands, or handling receipts minimally can reduce our chemical exposure in the long run.

The next time you’re offered a receipt, consider skipping it or opting for a digital copy. And if you’re a retail worker, taking small steps like washing your hands frequently and avoiding sanitizer right before handling receipts could make a meaningful difference. Together, these actions can help reduce the hidden, every day. The next time you’re offered a receipt, consider skipping it or opting for a digital copy. And if you’re a retail worker, taking small steps like washing your hands frequently and avoiding sanitizer right before handling receipts could make a meaningful difference. Together, these actions can help reduce the hidden, everyday health risks associated with BPA and BPS exposure.