Occupational Exposures Among Hair and Nail Salon Workers: a Scoping Review

Semi-quantitative health risk assessment of heavy metal dust exposure among nail technicians using the SQRA technique and Monte Carlo simulation

Nail technology, including the application of artificial nails and nail care, is a developing sector of the global beauty industry. Nail technicians are exposed to a variety of chemical substances through inhalation, as they spend extended periods of time in close proximity to these materials. This study aimed to evaluate the semi-quantitative health risk of dust-containing heavy metals among nail technicians. This analytical descriptive study employed the risk assessment method provided by the Singapore Occupational Health Department to evaluate the health hazards of lead, cadmium, nickel, chromium, and manganese. Dust samples from nail filing were collected from the respiratory zone of 20 nail technicians following the NIOSH 7300 method. The samples were analyzed using ICP-OES instrumentation. Monte Carlo simulation was utilized to characterize the risk and its uncertainties. Manganese and cadmium had the highest and lowest mean concentrations, respectively. The risk scores of the metals ranked from highest to lowest were as follows: N i > C r > C d > M n > P b . All five metals had risk rankings below 2.8, signifying a minimal risk level. Sensitivity analysis using Spearman's correlation coefficient demonstrated a positive relationship between concentration, daily hours of exposure, and the number of workdays per week with the risk score (RR) and exposure level (ER). Conversely, the variable of weekly working hours (W) showed a negative correlation with these parameters. Despite the low-risk level of the examined metals, continuous exposure and potential long-term effects on nail technicians warrant preventive measures. Recommendations include implementing local exhaust ventilation systems, using table fans, establishing work-rest cycles, wearing N95 dust masks, and using reputable and high-quality nail polishes.

Micronuclei and other nuclear anomalies in exfoliated urothelial cells and urinary 8-hydroxy-deoxyguanosine levels among Turkish hairdressers

Hairdressers are constantly occupationally exposed to many chemicals have the potential to cause allergies and carcinogenic effects, act as skin and eye irritants and induce oxidative stress and DNA damage. This study aimed to evaluate occupation-induced genotoxicity based on the presence of micronucleus (MN) and other nuclear anomalies in urothelial cells and measure oxidative DNA damage based on the 8-hydroxy-2'-deoxyguanosine level in the urine of Turkish hairdressers. Originality of this study comes from that there was no study on MN and other nuclear anomalies frequencies and oxidative DNA damage in urine samples of hairdressers in the literature. The mean±standard deviation frequency (‰) of micronucleated (MNed) cells was higher in the hairdresser group (n=56) (4.81±7.87, p<0.001) than in the control group (n=56) (0.93±1.85). Nuclear buds were not observed in either group. While the frequency of basal cells was higher in the control group (446.6±106.21) than in the hairdresser group (367.78±101.51, p<0.001), the frequency of binuclear, karyolytic, pycnotic and karyorrhectic cells were higher in the hairdresser group (0.41±0.80, p<0.001; 438.02±118.27, p<0.001; 0.43±0.76, p<0.001; and 47.27±28.40, p<0.001) than in the control group (0.04±0.27, 358.57±95.71, 0.05±0.23 and 24.41±14.50). Condensed chromatins were observed only in the hairdresser group. Specific gravity adjusted 8-hydroxy-2'-deoxyguanosine level was statistically lower in the hairdresser group (908.21±403.25 ng/mL-SG) compared to the control group (1003.09±327.09 ng/mL-SG) (p=0.024). No significant correlation was found between the 8-hydroxy-2'-deoxyguanosine level and the frequency MN. The amount of formaldehyde released during Brazilian keratin treatment was higher than the American Conference of Governmental Industrial Hygienists -Threshold Limit Value (ACGIH-TLV; 0.1 ppm). Similarly, the amount of ethyl acetate released in three salons was above the recommended limit (400 ppm). These findings suggest that hairdressers have an increased risk of genotoxicity and cytotoxicity owing to occupational exposure, regardless of age, working hours, smoking and alcohol consumption.

A Gender Hypothesis of sex disparities in adverse drug events

Pharmacovigilance databases contain larger numbers of adverse drug events (ADEs) that occurred in women compared to men. The cause of this disparity is frequently attributed to sex-linked biological factors. We offer an alternative Gender Hypothesis, positing that gendered social factors are central to the production of aggregate sex disparities in ADE reports. We describe four pathways through which gender may influence observed sex disparities in pharmacovigilance databases: healthcare utilization; bias and discrimination in the clinic; experience of a drug event as adverse; and pre-existing social and structural determinants of health. We then use data from the U.S. FDA Adverse Event Reporting System (FAERS) to explore how the Gender Hypothesis might generate novel predictions and explanations of sex disparities in ADEs in existing widely referenced datasets. Analyzing more than 3 million records of ADEs between 2014 and 2022, we find that patient-reported ADEs show a larger female skew than healthcare provider-reported ADEs and that the sex disparity is markedly smaller for outcomes involving death or hospitalization. We also find that the sex disparity varies greatly across types of ADEs, for example, cosmetically salient ADEs are skewed heavily female and sexual dysfunction ADEs are skewed male. Together, we interpret these findings as providing evidence of the promise of the Gender Hypothesis for identifying intervenable mechanisms and pathways contributing to sex disparities in ADEs. Rigorous application of the Gender Hypothesis to additional datasets and in future research studies could yield new insights into the causes of sex disparities in ADEs.

BTEX in indoor air of barbershops and beauty salons: Characterization, source apportionment and health risk assessment

BACKGROUND

Volatile organic compounds, mainly BTEX, are among the pollutants of concern in beauty salons and barbershops that threaten both staff personnel and clients' health. This study aimed to determine the concentration of BTEX in barbershops and beauty salons and assess the carcinogenic and non-carcinogenic risks based on the actual risk coefficients. Also, possible sources of BTEX were determined.

METHOD

Samples were collected by passive sampling. Quantitative and qualitative measurements of BTEX compounds were performed using gas chromatography-mass spectrometry (GC-MASS). Subsequently, the health risks were assessed according to the US Environmental Protection Agency. SPSS24 software and positive matrix factorization (PMF) analysis were used for statistical analysis and source apportionment respectively.

RESULTS

Toluene is the most abundant compound in beauty salons, with a maximum concentration of 219.4 (μg/m3) in beauty salons. Results indicated that the mean ELCR value estimated for benzene regarding female staff exposure (1.04 × 10-5) was higher than that for men (4.05 × 10-6). Also, ELCR values of ethylbenzene for staff exposure were 2.08 × 10-6 and 3.8 × 10-6 for men and women, respectively, and possess possible carcinogenesis risks.

CONCLUSION

Use of solvents and cosmetic products, improper heating systems, and type of service are the sources that probably contribute to BTEX emissions in beauty salons. It is necessary to follow health guidelines and conduct continuous monitoring for their implementation, in addition to setting a mandated occupational regulation framework or air quality requirements, to improve the health conditions in beauty salons.

The need for a multi-level approach to occupational safety and health among Asian and Asian American beauty service workers

Asian and Asian Americans (A/AA) are a group overlooked in general health outcomes but especially occupational safety and health outcomes. In the United States, the beauty service microbusiness industry (e.g., nail salons) predominantly employs immigrant Asian women who regularly encounter a plethora of occupational hazards (e.g., harmful chemical exposures -toluene, formaldehyde, bloodborne pathogens, fungi. However, due to the precariousness of beauty service jobs, cultural and linguistic barriers, and social determinants of health, A/AA beauty service workers face complex occupational safety and health challenges that require interdisciplinary collaboration and cultural competency to address. This commentary will discuss a multi-level approach including specific outreach partners that will offer the required diverse skillsets necessary for improving the occupational safety and health for this worker population in this microbusiness industry. Implications and suggestions for interventions and policy changes are also recommended utilizing the National Institute on Minority Health and Health Disparities' Research Framework.

A participatory approach to designing and implementing an occupational health intervention for the nail salon community in the Greater Philadelphia region

BACKGROUND

The nail salon industry in the US comprises mostly immigrant-owned, small mom-and-pop salons that employ primarily first-generation immigrant workers from Asia. Because of the cultural and language barriers, both owners and workers may not avail themselves of the occupational safety resources. We formed an academic-community partnership to co-design a feasibility study and multi-level occupational health intervention for Vietnamese-speaking salon owners, workers, and community-based organization.

METHODS

The intervention for each salon included (i) 2-h in-person training covering chemical safety, infection control, musculoskeletal prevention, and workers' rights for both the owners and their employees, (ii) a tailored recommendation report for the owner, and (iii) check-ins with the owner during the 3-month follow-up. Community partner was trained to deliver the in-language training with technical assistance from the research team. Baseline and post-intervention individual data about health symptoms and behaviors, as well as personal chemical exposures were collected and analyzed.

RESULTS

A total of 44 participants from 12 consented salons enrolled in the study. One salon dropped out at follow-up due to change of ownership. Analysis of the differences between post-and pre-intervention showed a tendency toward reduction in some self-reported symptoms in the respiratory system, skin, and eyes, neurotoxicity score, as well as chemical exposures. We could not rule out seasonality as an explanation for these trends. Increase in self-efficacy in some areas was observed post-intervention.

CONCLUSIONS

Our study demonstrated a successful academic-community partnership to engage community members in the intervention study. While the intervention effects from this feasibility study should be interpreted with caution, our preliminary results indicated that our community-based intervention is a promising approach to reduce work-related exposures among Asian American nail salon workers.

Self-reported symptoms in Swedish hairdressers and association with exposure to volatile organic compounds (VOCs), including aldehydes

BACKGROUND

Working as a hairdresser involves combined exposure to multiple chemicals in hair treatment products that may induce symptoms in airways and skin.

METHODS

In this cross-sectional study, perceived symptoms among Swedish hairdressers at 10 hair salons were surveyed through a questionnaire. Associations with personal exposure to volatile organic compounds (VOCs), including aldehydes, and their corresponding hazard index (HI), based on the estimated risk for non-cancer health effects, were examined. The prevalence of four out of 11 symptoms was compared to available reference datasets from two other studies of office workers and school staff.

RESULTS

All 11 surveyed symptoms were reported among the hairdressers (n = 38). For the whole study group, the most prevalent symptoms were dripping nose (n = 7) and headache (n = 7), followed by eczema (n = 6), stuffed nose (n = 5), cough (n = 5) and discomfort with strong odors (n = 5). Significant relationships between exposure and symptoms were scarce. The exception was total VOC (TVOC) exposure adjusted to worked years in the profession; a difference was observed for any symptom between hairdressers in the group with 20 + years compared to 0-5 years in the profession (logistic regression, OR 0.03, 95% CI 0.001-0.70). Out of the four symptoms available for comparison, the prevalence of headache and cough was significantly higher in hairdressers than in controls (OR 5.18, 95% CI 1.86-13.43 and OR 4.68, 95% CI 1.17-16.07, respectively).

CONCLUSIONS

Adverse health effects related to occupation was common among the hairdressers, implying a need for exposure control measures in hair salons. Symptoms of headache and cough were more frequently reported by hairdressers than staff in offices and schools. A healthy worker effect among the hairdressers was indicated in the group with 20 + years compared to 0-5 years in the profession. Significant relationships between measured exposure and symptoms were scarce but gave information about advantages and disadvantages of the different exposure measures. The study design could be improved by increasing the size of the study population, using a better match of reference data and increasing the applicability and representability over time of the measured exposure.

Implementing a suspect screening method to assess occupational chemical exposures among US-based hairdressers serving an ethnically diverse clientele: a pilot study

BACKGROUND

There are over 700,000 hairdressers in the United States, and it is estimated that >90% are female and 31% are Black or Hispanic/Latina. Racial and ethnic minorities in this workforce may be exposed to a unique mixture of potentially hazardous chemicals from products used and services provided. However, previous biomonitoring studies of hairdressers target a narrow list of compounds and few studies have investigated exposures among minority hairdressers.

OBJECTIVE

To assess occupational chemical exposures in a sample of US-based Black and Latina hairdressers serving an ethnically diverse clientele by analyzing urine specimens with a suspect screening method.

METHODS

Post-shift urine samples were collected from a sample of US female hairdressers (n = 23) and office workers (n = 17) and analyzed via reverse-phase liquid chromatography coupled to high-resolution mass spectrometry. Detected compounds were filtered based on peak area differences between groups and matching with a suspect screening list. When possible, compound identities were confirmed with reference standards. Possible exposure sources were evaluated for detected compounds.

RESULTS

The developed workflow allowed for the detection of 24 compounds with median peak areas ≥2x greater among hairdressers compared to office workers. Product use categories (PUCs) and harmonized functional uses were searched for these compounds, including confirmed compounds methylparaben, ethylparaben, propylparaben, and 2-naphthol. Most product use categories were associated with "personal use" and included 11 different "hair styling and care" product types (e.g., hair conditioner, hair relaxer). Functional uses for compounds without associated PUCs included fragrance, hair and skin conditioning, hair dyeing, and UV stabilizer.

SIGNIFICANCE

Our suspect screening approach detected several compounds not previously reported in biomonitoring studies of hairdressers. These results will help guide future studies to improve characterization of occupational chemical exposures in this workforce and inform exposure and risk mitigation strategies to reduce potential associated work-related health disparities.

Stakeholders' Perspectives on the Feasibility of Adopting a Healthy Nail Salon Recognition Program in Philadelphia: A Qualitative Study

OBJECTIVES

The California Healthy Nail Salon Recognition Program is a statewide initiative to incentivize nail salons to adopt occupational health and safety best practices such as the use of safer nail products without certain harmful chemicals, ventilation systems upgrade, proper personal protective equipment use, and staff training. This public policy intervention is in response to the call to protect nail care workers, mostly women of color, who bear a disproportionate burden of chemical exposure at work. Because there is an interest to adopt a similar program in the Greater Philadelphia region, we conducted this formative research to document stakeholders' perspectives on the feasibility of adopting a Healthy Nail Salon Recognition Program in Philadelphia.

METHODS

We conducted semi-structured interviews with a purposive sample of 31 stakeholders in Philadelphia in 2021. Using the Consolidated Framework for Implementation Science as our theoretical framework, we developed the interview guide and analysed the data using qualitative research methods to identify key facilitators and barriers.

RESULTS

Key facilitating themes were perceived need and benefits of program to improve workers' health and working conditions, and willingness of stakeholders to leverage their organizational resources. Barriers included perceived high cost and time commitment from salon owners and employees, lack of funding and implementation leaders at the city government, community members' willingness to be visible and advocate for the program affected by the stigmas of being immigrant workers, and fear of interacting with authorities, as well as the impact of COVID-19 pandemic.

CONCLUSIONS

Our results suggest successful adoption of a Healthy Nail Salon Recognition Program in Philadelphia will require outreach within the community to raise awareness of the benefits of the program and close partnership with community-based organizations to facilitate mutual understanding between the authorities and the ethnically diverse nail salon communities.

Occupational Exposure to Volatile Organic Compounds (VOCs), Including Aldehydes for Swedish Hairdressers

Working as a professional hairdresser involves the daily usage of many different hair treatment products containing chemicals in complex mixtures. Exposure may induce symptoms in the airways and on the skin. In this study, exposure of hairdressers to volatile organic compounds (VOCs), including aldehydes, was measured in the personal breathing zone in the spring of 2017. The study included 30 hairdressers evenly distributed over ten hair salons in the town of Örebro, Sweden. Work tasks and indoor climate were also surveilled. A hazard index (HI) based on chronic reference values for health was calculated to indicate combined exposure risk. In total, 90 VOCs, including nine aldehydes, were identified. Individual exposure expressed as a total concentration of VOCs (TVOCs) were in the range of 50-3600 µg/m3 toluene equivalent (median 460 µg/m3) and the HI was in the range 0.0046-13 (median 0.9). Exposure was more strongly influenced by variability among hairdressers than among salons. The HI indicated an increased risk of non-carcinogenic effects (HI ≥ 1) at four of the 10 hair salons. Individual working procedures, ventilation, volumetric usage of hair treatment products, certain chemicals in products (formaldehyde, isopropanol, and 2,4- and 2,6-toluene diisocyanate), and availability of reference values may have affected estimates of exposure risks. Nevertheless, the HI may be suitable as a screening tool to assess potential exposure risk posed to hairdressers since it considers the complexity of chemical mixtures and the chronic component of VOC exposure occurring in all indoor environments.

Measuring Short-Term Exposures to H2O2 Among Exposed Workers; A Feasibility Study

Hydrogen peroxide (H2O2) is a strong oxidizing agent often used in hair coloring and as a component in disinfecting and bleaching processes. Exposures to H2O2 generate reactive oxygen species (ROS) that can cause significant airway irritation and inflammation. Even though workers have reported symptoms associated with sensitivity and irritation from acute exposures below the H2O2 occupational exposure levels (OELs), a lack of sensitive analytical methods for measuring airborne concentrations currently prevents evaluating low or peak H2O2 exposures. To fill these gaps, we propose two different sensitive approaches: (i) luminol chemiluminescence (CL) to specifically measure H2O2; and (ii) photonic sensor method based on the ferrous-xylenol orange assay to evaluate total oxidative potential (OP), a measure of ROS in sampled air. We chose two exposure scenarios: hairdressers preparing and applying hair color to clients (both in simulated and field environments) and workers operating disinfecting cycles at a bottling company. Hair coloring took about 1 h for each client, and the application of the coloring product generated the highest H2O2 concentrations. OP values were highly correlated with H2O2 concentrations (CL measurement) and allowed peak measurements as low as 6 µg m-3 of H2O2 concentrations. The bottling company used a disinfectant containing H2O2, acetic acid and peracetic acid (PAA) in an enclosed process. The photonic sensor was immediately saturated. The CL results showed that the process operator had the highest exposures during a 15-min cycle. There is still a need to develop these direct reading methods for operating in the field, but we believe that in the future an OEL for OP could protect workers from developing airway irritation and inflammation by reducing exposures to oxidizing chemicals.

Microbiome alterations associated with phthalate exposures in a US-based sample of Latino workers

Low-wage service sector jobs are largely occupied by racial/ethnic minority workers who often experience an increased risk of elevated chemical exposures, including chemicals like phthalates, compared to the general public. Phthalates have been linked with adverse health effects, including increased risk of atopy and asthma. An important etiological component in respiratory disease, including asthma, is the role of the upper respiratory microbiota in atopic disease development. However, it is unclear how the upper respiratory microbiome is affected by chemical exposures, and how this may impact respiratory outcomes. As Latino workers are often disproportionately exposed to increased concentrations of chemicals and Hispanics have higher rates of adverse respiratory health conditions such as asthma, the aim of this pilot study was to evaluate the effects of 10 unique phthalate urinary biomarkers on the 16S rRNA nasal microbiome. Nasal and urinary samples were collected from 20 facility workers (plumbers, landscapers, electricians) and 20 custodial workers. Our analysis revealed altered microbial composition and diversity according to phthalate urinary biomarker concentration within the two worker groups. Higher urinary biomarker concentrations of select phthalates (MBP, MBIP, and ∑DEHP) were associated with increased Moraxella relative abundance, which has been positively associated with asthma. Within-sample alpha diversity levels were decreased in facility workers and were generally inversely associated with most phthalate urinary biomarker concentrations. Our research suggests that exposure to chemicals in this vulnerable worker group may impact the respiratory microbiome, which may increase risk of development of adverse health conditions. Further research is warranted to refine the mechanistic pathways that underpin the relationships between phthalate exposures and respiratory microbial communities to provide key insights on respiratory pathologies and, most importantly, to identify modifiable risk factors that can be used to direct mitigation efforts aimed at ameliorating the harmful effects of chemical exposures in this understudied occupational population.

Microbiome alterations from volatile organic compounds (VOC) exposures among workers in salons primarily serving women of color

Salon workers, especially those serving an ethnically and racially diverse clientele (i.e., Black/Latina), may experience disparately high levels of workplace exposures to respiratory irritants, including volatile organic compounds (VOCs). Salon workers are also reported to have a greater risk of developing respiratory conditions compared to the general population. Emerging evidence suggests that occupational chemical exposures may alter the human microbiome and that these alterations may be an important mechanism by which workplace VOC exposures adversely impact respiratory health. This preliminary research investigated the potential effects of 28 VOC urinary biomarkers on the 16S rRNA nasal microbiome in 40 workers from salons primarily serving women of color (Black and Dominican salons) compared to office workers. Our exploratory analysis revealed significant differences in microbial composition by worker group; namely dissimilar levels of Staphylococcus species (S. epidermidis and S. aureus, specifically) in salon workers compared to office workers, and higher alpha diversity levels in workers in Dominican salons compared to workers in Black salons. Within-sample alpha diversity levels tended to be decreased with higher VOC urinary biomarker concentrations, significantly for carbon disulfide, acrolein, acrylonitrile, crotonaldehyde, and vinyl chloride biomarkers. Our research highlights that occupational exposures, particularly to chemicals like VOCs, can impact the respiratory microbiome in the vulnerable salon worker group. Further understanding of the potential effects of chemical mixtures on microbial composition may provide key insights to respiratory health and other adverse health outcomes, as well as direct prevention efforts in this largely historically understudied occupational population.

Maternal occupational exposure to chemicals and child cognitive function

BACKGROUND

Limited data exist regarding child neurodevelopment in relation to maternal occupational exposure to endocrine-disrupting chemicals (EDCs).

METHODS

We included 1058 mother-child pairs from the INfancia y Medio Ambiente (INMA) project (2003-2008). Using a job-exposure matrix, exposure probability scores for ten EDC groups were assigned to each mother based on her longest held job during pregnancy. At the child's 5-year visit, the McCarthy Scales of Children's Abilities was administered, yielding the general cognitive index and scales for specific cognitive domains. We analyzed region-specific associations between EDC exposures and each outcome separately using adjusted linear regression and combined region-specific effect estimates using random-effects meta-analyses.

RESULTS

Approximately 24% of women were exposed to at least one EDC group, but exposure to most individual EDC groups was low (<5%). Maternal organic solvent exposure was associated with lower quantitative scores among children (-5.8 points, 95% confidence interval: -11.0, -0.5). Though statistically non-significant, exposures to polycyclic aromatic hydrocarbons, phthalates, alkylphenolic compounds, and miscellaneous chemicals were associated with poorer offspring performance for most or all cognitive domains.

CONCLUSIONS

This study found limited evidence for a role of maternal occupational EDC exposures on child cognition. Further research is needed to better characterize exposures among pregnant workers.

IMPACT

Using data from a prospective birth cohort, we help fill an important research gap regarding the potential consequences of work-related exposure to endocrine-disrupting chemicals (EDCs) among pregnant women on child neurodevelopment. We expand on existing literature-largely limited to pesticide and organic solvent exposures-by using a job-exposure matrix to estimate exposure to several EDC groups. We found limited evidence of an association between maternal occupational EDC exposure and children's overall cognition. We did observe specific associations between exposure to organic solvents and lower quantitative reasoning scores.

Evaluating Indoor Air Phthalates and Volatile Organic Compounds in Nail Salons in the Greater New York City Area: A Pilot Study

The Greater New York City area ranks highest in the United States in the number of nail salon technicians, primarily Asian immigrant women. Nail salon technicians are exposed to toxic phthalates and volatile organic compounds daily in nail salons. The purpose of this pilot study was to measure a mixture of phthalates and volatile organic compounds in nail salons in the Greater New York City area, and to characterize work-related determinants of indoor air quality in these nail salons. Working with four Asian nail salon organizations in the Greater New York City area, we measured indoor air phthalates and volatile organic compounds at 20 nail salons from February to May 2021 using silicone wristbands and passive samplers, respectively. Nail salon characteristics were also examined. We measured six phthalates and 31 volatile organic compounds. Di(2-ethylhexyl) phthalate and Diethyl phthalate had the highest concentrations among the six phthalates measured. Concentrations of toluene, d-limonene, methyl methacrylate, and ethyl methacrylate were higher than that of the rest. Manicure/pedicure tables, the number of customers per day, and application of artificial nail (acrylic) services were positively associated with the levels of phthalates and volatile organic compounds. Given the large number of people employed in the nail industry and the even larger number of customers visiting such establishments, exposures to these toxic chemicals are likely to be widespread.

Voice Problems and Related Risk Factors Among Hairdressers

OBJECTIVE

Hairdressers are more prone to respiratory diseases, bronchitis, asthma, shortness of breath, and cough due to the nature of their occupation and the constant use of cosmetics. Therefore, they may be prone to voice disorders or laryngeal problems. Voice problems may affect not only their social and emotional relationships but also their jobs. The current study was conducted to investigate voice problems and related risk factors in hairdressers.

DESIGN

Cross-sectional, descriptive-analytical.

PATIENTS AND METHODS

A total number of 293 women participated in the study. The study group consisted of 147 hairdressers and the control group consisted of 146 women with other jobs. All study participants were requested to complete a self-reported questionnaire. This questionnaire investigated demographic characteristics, voice problems and symptoms, laryngeal discomfort, working features, and workplace conditions. Chi-square, independent t-test, Fisher's exact test, and logistic regression were used to analyze the data.

RESULTS

The prevalence of voice problems in hairdressers and the control group was 33.33% and 15.75%, respectively, and this difference was statistically significant (P < 0.001). Results of the Chi-Square test showed that prevalence of hoarseness, vocal fatigue, dryness, and cough were higher in hairdressers than the control group (P < 0.05). According to regression logistic results, work time (hours per week) (P = 0.014; OR = 2.35; CI = 1.18-4.66) and presence of phonotraumatic behaviors (P = 0.012; OR = 2.73; CI = 1.24-5.96) increased the possibility of increasing the presence of voice symptoms among hairdressers.

CONCLUSION

The findings revealed that self-reported voice problems were more prevalent in the hairdressers group than in the control group and therefore the hairdressers were more prone to an increased risk of developing voice problems. The most common symptoms in the hairdressers group were cough, hoarseness, and dryness in the vocal tract. Based on these results, in addition to paying attention to recommendations related to environmental issues and exposure to chemical hazards, hairdressers may benefit from receiving appropriate training in voice production, voice disorders, and the prevention of voice disorders.

Licensure and citations among nail salons in Michigan from 2017 to 2021: A cross‐sectional study of an overlooked and vulnerable industry

Background

Nail salon workers (NSW) in the United States (U.S.) are predominantly immigrant women who face a number of occupational hazards, such as biological, ergonomic, and chronic chemical exposures. Additionally, there are challenges to keeping up with the latest practices in this evolving small business industry. Licensure requirements are intended to keep not only consumers but also workers safe, however licensure requirements vary between states creating little skill, education, and occupational health and safety knowledge and practice consistency among the nail salon workforce. The current state of nail salons and licensure of workers in the State of Michigan—an overlooked state and region (Midwest) in NSW research—was determined to better characterize this workforce.

Methods

A Freedom of Information Act request was submitted to the Michigan Department of Licensing and Regulatory Affairs regarding nail salon establishments and their workers, formally termed manicurists, and citation data for breaches. Data were provided on the number of licensed cosmetologists and cosmetology businesses from January 2017 to March 2021. From there, the total number of licensed manicurists was determined, and the cosmetology establishment list was analyzed to see if the businesses exclusively or predominantly provided nail services.

Results

As of Mach 2021, there were 1372 nail salons that exclusively provided nail services and over 12,000 licensed manicurists. Over half of the disciplinary actions cited were for salons not officially licensed. Michigan has reduced licensure requirements compared to other states and no continuing education (CE) requirements for license renewals.

Conclusion

There is a need for industry educational and training standardization, across the nation, as well as heightened licensure requirements for these vulnerable workers. CE not only keeps workers abreast of the latest practices in the industry, but also provides them the skills and knowledge to enhance their worker health, safety, and wellbeing.

Respiratory afflictions during hairdressing jobs: case history and clinical evaluation of a large symptomatic case series

OBJECTIVES

Respiratory symptoms at work are common among hairdressers. Various working materials, most notably bleaching ingredients such as ammonium persulfate, have been made responsible. The objective of this study is to achieve a better understanding of work-related respiratory symptoms of hairdressers by describing common features in a large affected collective.

METHODS

One hundred forty-eight hairdressers with respiratory symptoms at work presenting between 2012 and 2019 were consecutively included in a case series. Anamnestic and diagnostic data including pulmonary function and allergy testing were retrospectively compiled from records and analysed. Additionally, cases were categorised in five groups with respect to occupational causation certainty.

RESULTS

30% of the predominantly female collective had changed jobs or were on longer sick-leave. Besides respiratory symptoms, 10% also reported contact urticaria to blonde dyes. In 60% an obstructive airway disease was confirmed. A specific hypersensitivity reaction to ammonium persulfate was found in 15%. Group 1 with a proven immunological occupational causation showed significantly lower age (p < 0.001) and tenure time (p = 0.001), higher sensitization rates against environmental allergens as well as a higher total IgE (p = 0.015), compared to group 4 (obstructive airway disease, specific occupational causation unlikely).

CONCLUSIONS

This case series contributes to a better characterization of work-related respiratory symptoms in hairdressing as one of the largest examined collectives of symptomatic hairdressers. Ammonium persulfate as the most common specific cause showed signs of a type-I-like hypersensitivity reaction with typical risk factors for atopy. Prick testing is recommended in all symptomatic cases. However, a specific occupational causation often cannot be proved.

TD-GC/MS analysis of indoor air pollutants (VOCs, PM) in hair salons

Hairdressing personnel is daily exposed to various chemical air pollutants, and specifically to Volatile Organic Compounds (VOCs) and Particulate Matter (PM) in hair salons. This is of concern, due to the hazardous effects of these chemicals on the individual's health. Nevertheless, a limited exposure assessment of indoor air quality (IAQ) has been performed. The aim of this study was to analyze the indoor air in 5 hair salons, to assess the IAQ of the occupational exposure, and to identify the main VOCs produced or activities responsible for the respective indoor pollution. The chemical analysis took place inside the salon environment by monitoring the emitted VOCs, as well as the PM of 1, 2.5, 4, and 10 μm aerodynamic diameter. The sampling of VOCs was performed by adsorption of pollutants on Tenax TA sorbent tubes, that were subsequently analyzed using a thermal desorption unit coupled to gas chromatography/mass spectrometry (TD-GC/MS). The obtained results showed that hair products are a major source of air pollutants, as elevated concentrations of VOCs and PM are released in the working environment. Furthermore, the type and concentration of VOCs are affected by the various hair treatment activities taking place in the salons. Among the main compounds detected there was benzene, toluene, ethylbenzene, and xylenes, known as BTEX, as well as, diethyl phthalate, 1,4-dioxane, etc. More than 50 VOCs were identified (occurrence ≥60%) and 14 of them were quantified. Their average concentration levels varied from 12 μg m^-3 for naphthalene to 941 μg m^-3 for toluene. The measuring levels for PM revealed violations of the EPA and WHO international standards for permissible limit concentrations; this was the case in all hair treatment activities but mostly during keratin treatment. Hence, much more effort is needed to reduce the respective concentration levels of PM and VOCs, that contribute to self-reported health problems.

Maternal occupation as a nail technician or hairdresser during pregnancy and birth defects, National Birth Defects Prevention Study, 1997-2011

OBJECTIVE

Nail technicians and hairdressers may be exposed to chemicals with potential reproductive effects. While studies have examined birth defects in children of hairdressers, those in children of nail technicians have not been evaluated. We investigated associations between selected birth defects and maternal occupation as a nail technician or hairdresser versus a non-cosmetology occupation during pregnancy.

METHODS

We analysed population-based case-control data from the multisite National Birth Defects Prevention Study, 1997-2011. Cases were fetuses or infants with major structural birth defects; controls were live-born infants without major birth defects. Expert raters classified self-reported maternal jobs as nail technician, combination nail technician-hairdresser, hairdresser, other cosmetology work or non-cosmetology work. We used logistic regression to calculate adjusted ORs and 95% CIs for associations between occupation during pregnancy and birth defects, controlling for age, smoking, education and race/ethnicity.

RESULTS

Sixty-one mothers worked as nail technicians, 196 as hairdressers, 39 as combination nail technician-hairdressers and 42 810 as non-cosmetologists. The strongest associations among nail technicians included seven congenital heart defect (CHD) groups (ORs ranging from 2.7 to 3.5) and neural tube defects (OR=2.6, CI=0.8 to 8.4). Birth defects most strongly associated with hairdressing included anotia/microtia (OR=2.1, CI=0.6 to 6.9) and cleft lip with cleft palate (OR=2.0, CI=1.1 to 3.7). All oral cleft groups were associated with combination nail technician-hairdresser work (ORs ranging from 4.2 to 5.3).

CONCLUSIONS

Small samples resulted in wide CIs. Still, results suggest associations between maternal nail technician work during pregnancy and CHDs and between hairdressing work and oral clefts.

Real-time air monitoring of occupational exposures to particulate matter among hairdressers in Maryland: A pilot study

Hairdressers are exposed to particulate matter (PM), a known air pollutant linked to adverse health effects. Still, studies on occupational PM exposures in hair salons are sparse. We characterized indoor air PM concentrations in three salons primarily serving an African/African American (AA) clientele, and three Dominican salons primarily serving a Latino clientele. We also assessed the performance of low-cost sensors (uRAD, Flow, AirVisual) by comparing them to high-end sensors (DustTrak) to conduct air monitoring in each salon over 3 days to quantify work shift concentrations of PM_2.5 , respirable PM (RPM), and PM₁₀ . We observed high spatial and temporal variability in 30-min time-weighted average (TWA) RPM concentrations (0.18-5518 μg/m³ ). Readings for the uRAD and AirVisual sensors were highly correlated with the DustTrak (R²  = 0.90-0.99). RPM 8-hour TWAs ranged from 18 to 383 µg/m³ for AA salons, and 9-2115 µg/m³ for Dominican salons. Upper 95th percentiles of daily RPM exposures ranged from 439 to 2669 µg/m³ . The overall range of 30-min TWA PM_2.5 and PM₁₀ concentrations was 0.13-5497 and 0.36-,541 μg/m³ , respectively. Findings suggest that hairdressers could be overexposed to RPM during an 8-hour shift. Additional comprehensive monitoring studies are warranted to further characterize temporal and spatial variability of PM exposures in this understudied occupational population.

Occupational exposures and respiratory symptoms and lung function among hairdressers in Iran: a cross-sectional study

Objective

Exposures at hairdressers’ work have been reported to lead to an increased risk of several health outcomes. The present study aimed to investigate the relations between occupational exposures and respiratory symptoms and lung function among hairdressers in Iran.

Methods

We conducted a cross-sectional study to compare potential respiratory effects among 140 women working as hairdressers to such effects among 140 women working as office workers (administrative personnel). Both groups worked in Shiraz, Iran. Respiratory symptoms were assessed by a standard respiratory questionnaire. The questionnaire also inquired about substances used and workspace conditions, including ventilation type. Lung function levels were measured by spirometry.

Results

Respiratory symptoms, including cough, wheezing, shortness of breath, and chest tightness were significantly more frequent in hairdressers compared to the reference group (p < 0.05). After controlling for potential confounders, hairdressers had a prevalence ratio (PR) of 2.18 (95% CI 1.26–3.77) for cough, 9.59 (95% CI 1.004–91.73) for wheezing, 2.06 (95% CI 1.25–3.39) for shortness of breath, and 3.31 (95% CI 1.84–5.97) for chest tightness compared to the reference group. Lung function parameters (including VC, FVC, and FEV1) were significantly reduced in hairdressers (p < 0.001). Absence of air conditioning predicted greater reduction in lung function (p < 0.05) in the exposed. Decrease in FVC with normal FEV1/FVC in the exposed group suggested existence of restrictive lung function.

Conclusions

This study provides evidence of increased prevalence of respiratory symptoms and restrictive lung function impairment among hairdressers in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-020-01645-z.

"Worrying About Getting Sick in the Future": Lived Experience of Health Seeking and Healthcare Utilization Among Korean Immigrant Nail Salon Workers

To understand the health and safety concerns of Korean immigrant women nail salon workers in the Greater New York City area and their experiences of health seeking and health service utilization, 20 semi-structured interviews were conducted and analyzed using interpretive hermeneutic phenomenology. Most worried about working in nail salons and experienced work-related health symptoms. However, they were disinclined toward personal protective device use because of discomfort and inconvenience. Major barriers to healthcare utilization limited their healthcare use to times when they had intolerable symptoms, preventing opportunities for regular screening tests. To overcome these limitations, workers actively sought available resources and health-related information online and through personal networks, the latter facilitated by living in a Korean community. Despite efforts to maintain their health and manage their symptoms, Korean nail salon workers worried about getting sick as they got older due to prolonged occupational chemical exposure and limited healthcare access. Appropriate education and intervention should aim to resolve current barriers to personal protective device use and healthcare use and provide a source of care for uninsured workers.