T. Quach conceptualized and supervised the discipline, conducted some of the data analysis, and led the write of the article. R. Gunier and J. Von Behren conducted the data management and datum analysis. A. Tran collected all the data and helped in the results interpretation and communication. P. A. Doan-Billings, K. D. Nguyen, and L. Okahara provided significant input in the rendition of the results and the write of the article. Given their cognition of the work force members. B. Y.-B. Lui and M. Nguyen provided critical remark in the results interpretation. J. Huynh entered the data and assisted in psychoanalysis and results interpretation. P. Reynolds, who was the principal investigator of the study, provided overall scientific direction for the project, including review development, data collection, data analysis, and results rendition. All authors contributed to the write of the article. Conclusions. Using a CBPR access that engaged community members in the inquiry process contributed to the successful recruitment of salon workers. Measured levels of toluene, methyl methacrylate, and sum explosive organic compounds were higher than recommended guidelines to prevent health symptoms such as headaches, irritations, and breathing problems, which were frequently reported in this work force. Results. For personal measurements, the arithmetic mean was 0.53 parts per million ( scope = 0.02–5.50 ) for ethyl acetate rayon, 0.04 parts per million ( compass = 0.02–0.15 ) for isopropyl acetate, and 0.15 parts per million ( rate = 0.02–1.0 ) for toluene. area measurements were lower in comparison, but we detected celebrated levels of methyl methacrylate, a compound long banned from pinpoint products. Predictors of solvent levels included different forms of public discussion and whether the salon was located in an insert build. In response to the growing concerns for the nail salon work force, a community-research partnership between a cancer prevention research organization and a residential district health center serving destitute asian populations was established to examine workplace exposure and prevailing health problems to inform actor health and guard promotion efforts. As an initial step to examining the relationship between workplace exposures and adverse health outcomes, we collected personal and area measurements of selected solvents in complete salons with vietnamese workers. We intended this navigate plan to provide descriptive information on solvent levels in breeze through salons and inhalation exposure among salon workers. furthermore, we assessed the feasibility of engaging vietnamese salon owners and workers, a group that has been historically understudy, for future research endeavors. This cogitation is the first to focus on vietnamese nail salon workers to collect personal and area air out monitoring data along with relevant salon and actor characteristics.

The assume emergence of the nail salon industry, with a work force composed largely of vietnamese immigrant workers, combined with the miss of governmental regulation of compounds in cosmetics, underscores the complexity of worker health and base hit issues in this vulnerable population. A primary business lies with the grave use of volatile compounds in ill ventilated salons. Solvents such as toluene are used randomly in this profession and pose a threat to workers because they are linked to adverse neurological and generative effects american samoa well as endocrine disruption. 5, 6 occupational exposure studies in collar salons are limited, and most are either decades old or were not conducted in the United States. 7 – 9 thus, data to date have inadequately captured the complexities of this burgeoning diligence, the changes in pinpoint concern services that are likely to result in changes in chemical use, and the changes in salon characteristics as the commercial enterprise expands. The health and guard of workers in this industry drew public attention because of concerns about hazardous chemical ingredients in personal wish products. Nail technicians handle solvents, glues, polishes, and other agents on a daily basis, exposing them to numerous chemicals, many of which are known or suspected to cause cancer, allergies, and respiratory, neurological, and generative damage. Despite their heavy practice, industrial chemicals in cosmetic products are largely unregulated in the United States. Of the 10 000 chemicals used in personal caution products, closely 90 % have not been assessed for safety. 4 Nail care services has been a booming industry over the past 2 decades. According to industry estimates, the United States presently has more than 58 000 beauty salons and about 350 000 accredited nail down technicians. 1 California, in particular, experienced the largest expansion in this sector ; the number of license breeze through technicians grew closely 3-fold from 35 500 in 1987 to 114 000 in 2007. 2 The emergence of this service sector was besides accompanied by significant demographic shifts in this work force, with the proportion of vietnamese breeze through technicians increasing from 10 % in 1987 to 59 % in 2002. 3 We calculated standard descriptive statistics for the questionnaire and air-monitoring data, including base, median, proportions, standard deviation, and range. Because personal air measurements were not normally distributed, we used nonparametric methods for statistical comparisons. We calculated Spearman absolute correlation coefficients to examine continuous variables and used the Wilcoxon rank-sum test for categorical comparisons. We did not conduct categorical comparisons for isopropyl acetate rayon because the levels were always at or near the method report limit. We set the statistical meaning level to .05 and performed all analyses using SAS Version 9.1 ( SAS Institute Inc., Cary, North Carolina ). 14 In addition to personal air monitoring, we besides conducted area air monitor in a few nail down salons to quantify air concentrations for a more comprehensive set up of volatile organic compounds. We collected area samples using 6-liter summa canisters in 3 randomly selected complete salons at which we had previously conducted personal air measurements. The summa canisters were placed near manicure or pedicure stations, and we sampled using a stream rate of 1 liter per hour for 6 hours at each salon. The canisters were analyzed by GC–MS at the same lab. 13 The method report limits for toluene and ethyl acetate rayon were 0.002 parts per million. testing ground analysis was conducted by an american Industrial Hygiene Association–accredited lab ( Columbia Analytical Services, Monrovia, California ), using solution desorption followed by gas chromatography and batch spectroscopy ( GC–MS ) to determine the mass collected on the charcoal absorbent. 12 Quality assurance procedures included field and solution blanks to check for contamination, regular calibration with certify standards, and duplicate samples to determine measurement variability. We calculated personal air concentrations using the batch absorbed, sampling time, and dispersion coefficient for each colonial. The method acting report limits for a sample collected over a typical sampling time of 360 minutes were 0.03 parts per million for toluene, ethyl acetate rayon, and isopropyl acetate. To obtain personal air out measurements, we measured time-weighted average concentrations during the bring transformation for toluene, ethyl acetate, and isopropyl acetate rayon among worker participants using a passive voice organic vaporization monitor ( Organic Vapor Monitor 3500 ; 3M, St. Paul, Minnesota ). The worker participant clipped the passive monitor on the collar of her shirt or coat to obtain samples near the breathing zone. We measured the temperature and relative humidity in the salon at the begin of each monitor period. Each participant wore the device for an entire work switch, with a minimum sample time of 4 hours. We collected and sealed the air-monitoring devices at the end of each sampling event. The air-monitoring devices were stored at 4°C for up to 1 month until lab analysis. The staff administered the questionnaire at the end of each influence fault when the air-monitoring device was worn. The questionnaire included information on the distance of time that the actor wore the device, including any times when the worker may have taken it off to go outside the salon, the type and total of nail down care services, the number of customers in the salon, and the different types and duration of time that specific types of public discussion were used ( for example, postpone sports fan, ventilation table, roof fan, doors or windows open, and central ventilation system ). In addition, we collected information about the workers, including demographics, work history, self-reported health problems, and use of protective work equipment ( for example, gloves and masks ). Our interview staff documented experimental data about choose salon characteristics during visits to collect the air-monitoring devices and administer the questionnaire. Staff measured the book ( cubic feet ) of the salon using an supersonic magnetic tape quantify to obtain the salon ‘s length, width, and stature. early experimental salon characteristics included whether the shop class was in an enclosed build such as an indoor promenade and the act of manicure and pedicure stations in the salon. The overall reply rate for salons was 50 %. Of the 20 salons in which owners and workers agreed to participate in the air-monitoring study, 13 ( 65 % ) shops agreed on a first visit by our staff. Midway through the recruitment phase, the study was publicized in local popular Vietnamese ethnic media, with a resulting addition in reception rate from 30 % to 75 %. We selected salons from different areas of Alameda County, California, through public toilet sample. To our cognition, no rosters of nail salons with vietnamese workers exist ; our selection of salons was informed by our cognition of and existing relationships with salon workers and owners. During recruitment, our staff first approached salon owners to explain the determination of the study and what type of information would be collected from the salon and workers for the air-monitoring measurements. With license from the owners, our staff then approached Vietnamese female workers in that salon to recruit them into the analyze. We based survival of actor participants in the salon on the workers present at the time and, in some cases, recommendations from salon owners. We asked workers who participated in the report to wear a small personal air-monitoring device during their employment fault. Each actor player contributed 2 to 3 measurements on nonconsecutive work days. Participants besides responded to a questionnaire that was administered by a bicultural and bilingual interviewer after each sampling event. In summation, we collected area samples in a few salons using stationary monitors. The study protocol was reviewed and approved by the institutional review board of the Cancer Prevention Institute of California. Air monitor and survey administration were conducted between November 2008 and June 2009.

We built this study on a developmental community-based participatory research undertaking between a research constitution and a community health center to characterize nail salon worker chemical exposures and health problems. 10 In addition, members of the California Healthy Nail Salon Collaborative, a large network of community advocates, public health experts, health practitioners, and environmental activists, provided input signal into the development of the study instruments, protocols, recruitment process, and interpretation of results. 11 We besides convened a community advisory committee composed of vietnamese salon owners and workers to provide guidance on recruitment strategies and review development. Results from our categorical analyses showed that salons using table ventilators had significantly lower measured personal levels of toluene and ethyl acetate ( ). Salons that were in an enclosed construction had higher measured levels of both compounds. Salons using early forms of ventilation besides had lower measured personal levels, including opening doors for toluene and the use of postpone or ceiling fans for ethyl acetate rayon. however, worker participants who reported use of a cardinal breathing system had higher personal levels of ethyl acetate rayon than those who did not. Workers who performed pedicures were more probable to have higher measured levels of ethyl acetate. We besides found that those who performed silk nails and acrylic nails had lower personal levels of toluene and ethyl acetate rayon, suggesting that products used for these services may not contain those compounds or contain lower levels. Distributions of personal and stationary air-monitoring concentrations are shown in. For personal atmosphere measurements, the arithmetic mean for ethyl acetate was 0.53 parts per million ( range = 0.02–5.50 ) ; for isopropyl acetate rayon, 0.04 parts per million ( range = 0.02–0.15 ) ; and for toluene, 0.15 parts per million ( range = 0.02–1.0 ). In comparison, area measurements were lower, with an arithmetic hateful of 0.09 parts per million ( range = 0.02–0.15 ) for ethyl acetate rayon and 0.04 parts per million ( range = 0.01–0.06 ) for toluene. Area monitoring besides detected other volatile compounds, including methyl methacrylate in all 3 salons, with the highest level at 1.3 parts per million. Measured personal concentrations of the 3 compounds were reasonably correlated, with Spearman correlation coefficient coefficients between 0.21 and 0.55. temperature was weakly correlated with toluene and isopropyl acetate levels. sample time in minutes or percentage of relative humidity had no relationship with measured personal concentrations for any of the compounds. We collected data from 80 vietnamese female pinpoint salon workers from 20 different nail down salons. Each pinpoint salon worker had 2 to 3 measurements ( atmosphere monitor and questionnaire completion ), for a full of 167 measurements. Characteristics of the salons and actor participants are shown in. Each salon had on average 4 worker participants and 8 personal air measurements. one-half of the salons that participated were in the city of Oakland. Salons ranged, an regulate of magnitude in size, from approximately 127 to more than 1300 square feet, with a average of 512 square feet. Six salons ( 30 % ) were located in enclosed buildings, and entirely 1 salon besides offered hair’s-breadth care services. The think of actor long time was 41 years and ranged from 21 to 67 years. On modal, participants had worked in the nail down salon sector for 8 years. One participant started working equally early as 13 years old. Workers typically worked 35 hours per week, which, however, often included hanker ( > 8 hours ) days. When asked whether workers had experienced certain health symptoms such as irritations, headaches, nausea, and breathing problems, approximately one one-third ( 31.3 % ) responded that they had experienced at least 1 of these symptoms after entering this work force ( ). Irritations of the nozzle, throat, lungs, peel, and eyes were the most common symptoms reported ( 26.5 % ) .

DISCUSSION

The complexities of this largely immigrant work force, characterized by chronic vulnerability to several different compounds, and the lack of governmental oversight in chemical regulation in cosmetics and worker health surveillance, underscore the challenges but importance of evaluating exposures in this hard-to-reach population. By applying a community-based participatory research approach that engaged residential district advocates and members in our research process, we were successful in recruiting participants from this vulnerable population and in beginning to understand some of the hazards they face in their workplace. Measured personal concentrations in this analyze were similar to personal measurements from a recent sketch in California for toluene, 15 higher than those measured in Europe for both toluene and ethyl acetate, 9, 16 but lower than toluene levels measured in the United States 20 years ago. 8 personal air-monitoring levels were higher than stationary air-monitoring levels. stationary monitors are sensitive to placement in the salon, and personal air out monitors placed on the shirt collar of the proletarian are closer to the reservoir and better reflect actor vulnerability. previous studies using stationary monitors may have underestimated worker exposures, even when stationary monitors were placed close to the worker ‘s breathing zone. 9, 16 All measured values were a lot less than the occupational limits set by the California Division of Occupational Safety and Health. 17 however, the average measured floor of toluene from personal air monitoring was higher than the California Environmental Protection Agency ‘s commend ambient air travel levels of 0.08 parts per million. 18 In 1974, the Food and Drug Administration identified methyl methacrylate as a hazardous substance and banned its use in adhesives for cosmetic nail products. 19 so far, in our study the average measured level of methyl methacrylate was 0.54 parts per million, which is more than 3 times higher than the US Environmental Protection Agency ‘s recommend ambient air levels of 0.17 parts per million. 20 furthermore, the levels of total volatile organic compounds measured using sphere samples were much higher than recommended guidelines ( < 0.2 mg/m3 ) in indoor air for nonindustrial workers and may explain some of the health symptoms reported by workers in this study. 21 – 23 Although concentrations from area samples were less than those from personal samples, the concentration of total explosive constituent compounds from our area samples were in the compass ( 3–25 mg/m3 ) at which discomfort is expected and complaints of health symptoms, including headaches and irritations of the eyes, nose, and throat, are coarse. 22 When asked whether they experienced blue-ribbon acute health symptoms after they began working in the nail down care diligence, one one-third of our sketch participants responded positively. The highest prevalence was for irritations of the eyes, nose, throat, and peel, with more than one quarter reporting experiencing such symptoms. In our previous surveil of 201 vietnamese breeze through salon workers in Alameda County, California, we found that 47 % of workers reported health symptoms potentially related to solvent exposure. 10 yet, despite the high prevalence in both studies, we suspect that this figure is still an lowball of the overall preponderance of health problems in this work force because many workers have probably already left the work force because of baffling health symptoms. Nail salon workers and owners have a prevail distrust of regulative agencies because most of their interactions have focused on penalizing workers and owners for violations of standards in the workplace. Workers frequently complain that they do not always understand why they are being cited. 24 therefore, we initially encountered some challenges in engaging their engagement in our research study. however, the partnership with a long-familiar community health center that had a farseeing history of serving this population helped to address some of the challenges and to alleviate some of the perceived terror to workers ’ job security in participating in a research project of this nature. furthermore, our use of cultural media helped to inform workers of the function of our study and served to enhance study engagement. We applied a right-to-know principle in which we communicated results to study participants to inform them of their exposures and to help promote future efforts to reduce their workplace photograph. After obtaining air-monitoring results, we communicated grouped results to worker participants and salon owners and made recommendations on how they could lower their exposures. We reported grouped results preferably than individual results to safeguard individuals and salon owners from any liability.

As a preliminary exploration, our cogitation had some limitations worth noting. The little number of participating salons and salon workers and convenience sampling may have resulted in a study population that was not representative of all collar salons and workers in California or the United States. We focused on airborne exposures to solvents and measured only a few compounds, although several early compounds may besides be of gamey concern in this work force. We did not address hide assimilation, which may be an significant route of exposure to solvents and could besides contribute to the health problems reported in our learn. Our questions about health symptoms were abbreviated and did not include questions about chronic health problems. thus, we could not assess the type and extent of health problems that may be associated with chronic exposures to these compounds and the synergistic effects from the numerous compounds handled by workers. overall, we intended this study to provide a descriptive overview of inhalant exposures, which are of high concern, and provide some insight into the feasibility of recruiting vietnamese immigrant workers into research studies that can help inform future targeted outreach efforts. future analyses will include the habit of mixed-effects models to account for correlation between measurements taken within the same proletarian over clock time and between workers in the like nail down salon. ultimately, this information can inform future research efforts, such as a cohort study on chronic health effects and a randomized treatment trial to evaluate the potency of training both smash salon workers and owners in ways to reduce workplace chemical exposures. Our study highlighted the importance of identifying appropriate recruitment and monitor strategies to characterize work force exposures in this immigrant population, and it could not have been accomplished without active collaboration between the inquiry and community partners. Our study findings highlight, the motivation to go beyond the traditional approach of comparing measured values with existing occupational exposure limits, which were set decades ago and do not take into account changes in the industry. These standards are besides based on serious health outcomes ( for example, death or cancer ) and do not address early health symptoms that may be early on admonitory signs of more serious health problems to come. Our findings underscore the need for more care to preventive populace health strategies for this work force. Recommendations to promote worker health and safety include policy changes to update occupational exposure limits that take into report diverse chronic health conditions, better regulative oversight of chemicals in cosmetic products, and more inquiry focused on the health of understudy and vulnerable proletarian populations .

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