Developing an evidence-based intervention

program for Vietnamese nail salon workers

in Philadelphia

Air Pollution Control Board Meeting5/17/2017

Tran Huynh, PhD, CIHDepartment of Environmental and Occupational Health

Dornsife School of Public HealthDrexel University

Some nail industry statistics

• 390,000+ nail technicians nationwide

• 56% are Vietnamese; 36% Caucasian; 8% Other

• 97% female and 3% male

• Age

12% 30 or younger

24% 31- 40

35% 41-50

29% 51 or older

• Highest level of completed school

28% finished high school

44% some college/AA degree

17% finished collegeSource: Nails Magazine: 2016-2017 The Big Book

In Pennsylvania

• 14,244 registered nail technicians – at least 46% are Vietnamese

• There are 396 out of 2386 nail salons in Philadelphia

Source: PA Board of Cosmetology

Exposure Studies

• Area and personal exposure for many solvents are below the permissible exposure limit

• Methyl methacrylate was detected in 58% of the establishments despite having been banned for use in nail products by the state of Utah (Aleves et al, 2012)

• Personal monitoring of solvents at Vietnamese salons in California: ethyl acetate (0.53 ppm), isopropyl acetate (0.4 ppm) and toluene (0.15 ppm) (Quach et al, 2011)

Indoor Air Quality Study

• IAQ conducted in Boston by Goldin et al (2011)

• CO2 in 15 out of 21 salons exceeded 800 ppm (25cfm/person)

• Median Total VOCs = 4,800 ppb (61 - 38,000 ppb)

(typical TVOCs for homes is about 337 ppb)

• Improving ventilation conditions in salons to meet minimum outdoor air delivery requirements can reduce exposures to TVOCs.

Reported Health Effects

• Mostly from cross-sectional studies

• Respiratory irritation (Roelofs et al 2008, Quach et al 2008, Quach et al 2011, NIOSH 1998)

• Dermatitis (Roelofs et al 2008, Quach et al 2011)

• Cognitive symptoms (LoSasso et al, 2001 and 2002)

• Musculoskeletal disorders (Roelofs et al 2008, NIOSH 1998)

• No cancer excess was found in cosmetologists and manicurists in California (Quach et al, 2010)

Tip of the iceberg

• A journalist investigating work conditions in NYC nail salons found:

- Allergy

- Asthma

- Wage issues

- Respiratory and skin irritations

The Price of Nice Nails by Sarah Maslin Nir, May 2015

Ventilation to Be Required in All New York Nail SalonsBy SARAH MASLIN NIRJULY 21, 2016

Health promotion planning tool:Intervention Mapping

Source: Kay Bartholomew Edredge et al. Intervention Mapping book

PUBLIC POLICY

•Self-efficacy

ORGANIZATIONAL

Salons’ practices, policies

COMMUNITY

INTERPERSONAL

INDIVIDUAL

Knowledge attitudes

Adapted from McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion

programs. Health Educ Q. 1988;15(4):351–377. [PubMed]

Social-Ecological Model

Needs assessment phase

• Literature review

• CAB meeting with representatives from the

Philadelphia Department of Public Health, regional

OSHA, nail salon worker.

• CAB meeting with Vietnamese nail salon workers

• Individual interviews and/or focus groups

Personal

determinants

(workers)

Determinants

(environment

al agents)

Behavioral

Risk

(workers)

HealthQuality-

of-Life

Environmen

tal Factors

Phase 1

Quality of life

Phase 2

Health problems

Phase 3

Behavioral and

Environmental Factors

Phase 4

Determinants

Modified Logic Model

Sex

Female 15

Male 2

Marital Status

Married 7

Single 10

Age

18-29 9

30-39 2

40-49 4

50-59 2

>60 0

Birthplace

Vietnam 15

US 2

Employment status

Owner/Manager 3

Worker 14

Years doing nails

0-4 8

5-9 3

>10 5

Years in US

0-4 5

5-9 1

10-19 6

>20 3

Average hours worked* 40+

Demographics of participants

Preliminary analysis – what we’ve learned -

• Most Vietnamese workers got into the business through family/relatives and friends connection.

• Most Vietnamese owners hire Vietnamese workers

• Social media, internet, you tube are major communication outlets for many workers.

• That said, our sample is skewed toward younger people

Preliminary analysis – what we’ve learned -

• Most workers and owners have some awareness

that the potential health effects from chemical

exposures but they don’t exactly know what

specific chemicals they work with. Most know

acetone and acrylic liquid because these

chemicals have strongest odor.

• Many reported wearing gloves and surgical masks

for both chemical protection.

• Barriers for PPE: discomfort and lack of availability of

PPE

• Most workers do not know about ventilation and its

role

• Muscularskeletal diseases (e.g., back pain, shoulder

pain, CTS, eye strain) are prevalent in this industry.

Behavioral outcomes (workers)

• Workers will consistently use gloves when providing nail

services.

• Workers will consistently use safety glasses when providing nail

services.

• Workers will do hand exercises more frequently.

• Workers will do whole body exercises more frequently.

Organizational environmental outcomes • Owners will make gloves available to workers.

• Owners will make safety glasses available to workers.

• Owners will maintain ventilation system annually to make sure

adequate air being circulated.

• Owners will replace methyl methacrylate with less allergic

chemical ethyl methacrylate for acrylic nails.

Selected behavioral and

environmental outcomes for the study

Current work and future directions

• Develop training materials for workers (K-award)

• Develop self-assessment tool to assist owners to

have a healthy salon and corresponding technical

assistance (multilevel interventions)

• Clarify ventilation requirements with engineers and

evaluate cost-benefits

• Work with local policy makers to develop

appropriate guidelines and outreach program

How can the Air Pollution Control Board help?

• Education and outreach • E.g., Boston Safe Shop, Healthy Salons Program in San

Francisco

• Focus on developing partnerships and engaging salon owners

• Work with PA Board of Cosmetology on health and safety training requirements for nail technicians and ventilation requirements for salons.

Acknowledgements

K01 Career Development Award

Natalie Doan Ngan Trinh

Community Advisory

Board:• Dr. Sellassie

• Dr. Komis

• Dr. Palak Raval-Nelson

• Nick DeJesse

• Phuong Nguyen

• Trang Dieu

Extra thanks to the salon owners and technicians who

participated in our study!