A new study from researchers at the University of Colorado has identified that nail salons have higher levels of some harmful and cancer-causing chemicals than auto garages and oil refineries.
The study, published in the journal Environmental Pollution, looked at levels of chemicals known as volatile organic compounds (VOCs), commonly found in nail products, including formaldehyde-most popularly known for preserving organic specimens.
The dangers of these chemicals has been documented before and they have been long-suspected to have an effect on the health of nail salon workers, but the study is among the first to make these definitive links.
"The study provides some of the first hard evidence that these environments are dangerous for workers and that better policies need to be enacted to protect them," said Lupita Montoya, lead author of the research and Research Associate in The University of Colorado, Boulder's Department of Civil, Environmental and Architectural Engineering.
There are numerous potentially harmful chemicals in products typically used in nail salons and benzene, in particular, is a proven carcinogen, which has mostly been linked to the development of blood cancers.
The researchers studied workers in 6 nail salons in the Colorado area and also modeled the impact of the increased exposure to benzene and formaldehyde over 20 years on the risk of the workers developing certain types of cancer. The risk for squamous cell carcinoma (lung cancer), head and neck cancer and Hodgkin's lymphoma was projected to increase in all of the workers. Strikingly, they calculated that the relative risk of developing leukemia due to exposure was over 100-fold greater in some of the workers.
"For squamous cell cancers of the nose and throat, they predicted that people had a 6-38 fold higher risk and for leukemia due to formaldehyde exposure, it was between 21- and 135-fold higher risk. This is a fairly small study, but if this is representative, this is very concerning. Leukemia isn’t that common but if the risk is increased by this much, it is no longer a small number of cases," said Brian Christman, MD. Volunteer Spokesperson for the American Lung Association and Professor and Vice-Chair at Vanderbilt Medicine.
However, caution is certainly warranted regarding the proposed increase risk of cancer in nail salon workers as no large studies to evaluate whether these people actually get more cancers have been done to-date. There were also other factors to consider which may have contributed to the levels of some of the VOCs in some of the salons.
"It is unclear whether the pollutant levels can be attributed to work in the nail salons rather than other nearby exposure sources," said Dr Lauren Teras, Senior Principal Scientist in the Epidemiology Research Program for the American Cancer Society.
"The authors note that their benzene findings were not consistent with previous nail salon studies, and also that the three salons with the highest benzene levels were in close proximity to gas stations, a known source of high benzene levels. Cigarette smoke also contains high levels of benzene and other pollutants and it is unclear if the study participants were exposed to smoke or other non-salon-related sources of pollution." said Teras.
While a direct link to cancer is currently unproven, it is certain that nail salon workers often spend long hours being exposed to the chemicals with the study. The research showed that nail technicians reported working an average of 52.5 hours a week and as many as 80 hours in some cases. 70 percent of workers reported experiencing at least one symptom likely related to their exposure to the VOCs, including eye and skin irritation and headaches.
Americans spent over $8 billion on nail salon services in 2018 and it is very important to note that people who visit salons for short periods of time or do their own nails at home are very unlikely to be exposed to a significant concentration of these chemicals.
"It really depends on how much time you spend in and around that environment. Customers spend a fraction of the time in salons that workers do. Unless they have pretty severe allergies or asthma, there's not much for customers to be concerned about," said Montoya.
"The duration of the exposure from going into these businesses as customers, the risk is very small, I’m mainly worried about the workers there several hours a day," said Christman.
Montoya's inspiration for the research comes from visiting a salon several years ago and being struck by the pungent smell of the chemicals involved in nail applications. She suspected the air quality for the workers might be poor and set about designing a study to find out more.
On two occasions she tried to get permission to test for VOC levels in salons, but had difficulties finding locations to agree to work with her for the studies. Over 90 percent of nail salons in the U.S. are small businesses and employ a predominantly minority workforce, with many lacking resources to ensure worker safety.
"This is an issue that requires tremendous sensitivity and a respectful approach to the communities being served. The reason that we haven’t had much success in working with these problems historically is that representatives from the communities are not well-represented in science, so typically the people who care about these people most aren’t able to be involved in addressing the problems," said Montoya, referring to the diversity problem present in U.S. science.
Fearing consequences, many salons declined to participate. Eventually, six salons did agree to participate on condition of anonymity and equipment to monitor VOCs over an 18 month period was set up, yielding the shocking results.
"The workers are being placed at risk and this is concerning. This study shows us we need to invent new ways to mitigate this exposure at relatively low cost. Surely we can find a way in the U.S. to do a better job with this," said Christman.
Although the study represents some of the most persuasive evidence to-date showing that levels of harmful chemicals are likely to cause health problems in salon workers, some areas are already taking steps to bring in safety standards to protect workers.
Last month, Santa Clara County, California, home to Silicon Valley launched a voluntary safety certification program which salons can sign up for in order to promote good ventilation and the use of safer products. So far, 120 salons have signed up.
"We have a genuine interest in helping this community achieve a safe working environment. Our ultimate goal is to provide evidence that this is an important problem and the initiative that they have in California can be expanded to other states. Ideally, I want these programs to spread out throughout the country so that there are more protections for these workers," said Montoya.
"Further research is needed, particularly longitudinal studies, to assess the health risks of employment in the nail salon industry," said Teras.
