National Network on Environments and Women’s Health November 2014 Réseau pancanadien sur la santé des femmes et le milieu by Anne Rochon Ford “Overexposed, Underinformed”1: Nail Salon Workers and Hazards to Their Health / A Review of the Literature INTRODUCTION While some attention has been paid in recent years to the risks of exposures to hazardous chemicals in consumer products, and to the effects of certain chemicals on children’s health, there has been little sustained attention to occupational and environmental sources of exposure, especially among vulnerable populations. Included in those vulnerable populations are women who work in certain service occupations. Workers in nail salons2 — almost exclusively women - are exposed daily to the many hazardous chemicals routinely found in the polishes, removers, gels, shellacs, disinfectants and adhesives that are staples of their work. Some of these chemicals have recognized or probable links to a range of health conditions, both acute and chronic, such as cancer, respiratory, neurological and dermatological problems, as well as reproductive harms and harms to developing foetuses. Some of these chemicals may also alter the body’s normal hormonal functions. Women who receive cosmetic services in nail salons are exposed to under-regulated chemicals on every visit; the women who work there are exposed daily. Given the growth in the nail salon industry in Canada (IBISWorld, 2014), the relative lack of scientific research about this group of workers, as well as the absence of concerted attention by varying levels of government to address the health issues posed 1 This term was used as a sub-heading in the 10-minute video, “Toxic Trio” made by the California Healthy Nail Salon Collaborative (https://www.youtube. com/watch?v=oZqinwSz0Tg). We are grateful to the Collaborative for their guidance and for providing a model for Canadians to consider in making nail salons healthier places in which to work. 2 The terms “nail salon workers”, “nail technicians”, “manicurists” and “cosmetologists” are used interchangeably throughout this review. National Network on Environments and Women’s Health 2 Réseau pancanadien sur la santé des femmes et le milieu by these exposures are of concern. Fortunately, BACKGROUND/CONTEXT (WOMEN AND however, the recent engagement of a number of OCCUPATIONAL HEALTH AND SAFETY) health and research organizations in this issue is Individuals are reported to be more likely to suffer intended to fill some gaps.3 a serious injury or disease from their work than they are from travelling in a car or from a crime of To add to the now growing interest in the study violence (Bohle and Quinlan, 2000). Nevertheless, of this population, the National Network on research on occupational health and safety is a Environments and Women’s Health (NNEWH) comparatively new field of study, and research on examined the existing literature on the health of nail women in occupations even newer. salon workers, with a particular focus on the effects of endocrine-disrupting chemicals. “Occupational health science and interventions have not often been about women. There is legislation This literature review builds on a body of work on the length of the workday, but none for the undertaken by NNEWH in recent years which has combination of paid and unpaid work. There are focused on women’s everyday exposures to toxic standards for how much weight a stevedore can substances in the workplace.4 It is also informed by a lift and how often, but none for how many shirts a community forum held by NNEWH in April 20145 that woman can sew on a shift. There is a threshold limit helped identify where there is consensus – and where value for exposure to asbestos for miners, but no there are gaps — in the literature. The forum also limit to the number of insults a receptionist may hear drew attention to the critical need for policy action per hour without a break.“ (Messing, 1998, p xiv) research and underlined the importance of directly involving the community affected in that research. Women in certain occupations, such as cosmetology, are particularly under-studied even This report comprises a scoping review of available though they may be at special risk of workplace research and includes both academic and “grey” harm. literature. It presents what we found, but does not include an assessment of the quality of this Many nail salon workers in the Greater Toronto evidence. It is intended to contribute to a growing Area (GTA), for example, are recent immigrants base of knowledge that will improve conditions for to Canada, speak limited English and lack an those working in the nail salon industry and those understanding of and access to regulatory and using its services to better protect and promote their health systems that may affect their work and their health and well-being. While our current interest lives6. David (2014) notes that nail technicians in is focused on nail salon workers in the Greater Toronto who emigrated from China have usually Toronto Area (GTA), our review of the literature is not learned how to do nails on the job and without limited to information exclusive to this geographical formal training. Most (in Canada and elsewhere) jurisdiction. 3 Work in recent years in Ontario has been undertaken by Central Toronto Community Health Centres, Environmental Defence, the Ontario Lung Association, the Centre for Research Expertise in Occupational Disease at the Dalla Lana School of Public Health (University of Toronto) , the Occupational Cancer Research Centre at Cancer Care Ontario, and Motherisk. 4 See Brophy, Keith et al (2012), for their work on women’s exposures to EDCs and carcinogens in plastics manufacturing in the automobile sector, putting women at an increased risk for breast cancer: http://www.nnewh.org/overview.php?section=4 5 For a podcast of the event: http://www.cwhn.ca/en/node/46338/ 6 Quach et al (2012-1) notes that Vietnamese make up the majority of nail salon workers in the United States and “are drawn to this profession because it does not require long training or high English proficiency”(p.2). It is assumed – though not confirmed – that this same reasoning accounts for the high proportion of immigrant workers in nail salons in Canada. National Network on Environments and Women’s Health 3 Réseau pancanadien sur la santé des femmes et le milieu earn low incomes and work in non-unionized AN OVERVIEW: HEALTH HAZARDS IN NAIL environments. Market researchers for potential SALONS investors note that, “the level of regulation is low, As with many services and products they purchase, permitting easy entry by new operators.” (IBISWorld, consumers often assume that nail salons and 2014) An investigative journalist with the Globe the products used in nail salons must be safe. and Mail who did research on nail salon workers in Unfortunately, this is not the case. The chemicals 2012 found that women working in this industry in found in most of the products commonly used in Toronto did not want to be interviewed about their nail salons have only begun to be tested in humans7 health for fear of repercussions stemming from their and most products carry no labelling of chemicals immigration status or from their nail salon owners contained within8. Nor are their uses seriously (Balkissoon, 2012). This provides one reason for the monitored or regulated. This is despite a small but many references to these women as “a vulnerable growing body of research that has explored possible group of workers”. links between nail technicians’ work and its effects on their respiratory, dermatological, neurological, Cancers resulting from occupational exposures in and reproductive health. women is an under-studied area in health research. Cancers and occupational exposures have been Tye Arbuckle, an epidemiologist at Health Canada studied more extensively in men (e.g.,Hodgson and with environmental health expertise, has made some Darnton [2000] on lung cancer and mesothelioma observations relevant to nail salon workers in her in asbestos workers, LeMasters et al’s review of research. For example, “most of the research on multiple myeloma, non-Hodgkin lymphoma and chemical absorption has focused on the dermal prostate cancer in male firefighters), as have the route” versus other routes of absorption – GI tract, effects of some lifestyle factors such as tobacco respiratory tract, eyes, urogenital tract, parenteral smoke and diet. But attention to the myriad of and transplacental” (Arbuckle, 2005, p. 199). She environmental and occupational agents that can also points to research that found dermal absorption contribute to new cases of cancer among women of certain chemicals was two-fold greater in female each year is not evident (Clapp, 2013). Any serious than in male rats. Sex hormones can play a role in cancer prevention program must take into account the extent of absorption. the role of hazardous exposures in environmental and occupational settings, and not just focus on Arbuckle has also noted that “either directly or individual-level lifestyle risk factors. indirectly, sex hormones (estradiol in females and testosterone in males) appear to be involved in male:female differences in transport of chemicals” (Arbuckle 2005, p.200). This is worth keeping in mind in view of the fact that the vast majority of nail 7 For example, Health Canada’s Chemicals Management Plan (CMP) website notes: regarding phthalates: “More research is needed into the possible effects that phthalates may have on people. The science