Health risks beneath the painted beauty in America’s nail salons

By Thu Quach, Research Scientist, Cancer Prevention Institute of California and Director of Community Health and Research, Asian Health Services and Consulting Assistant Professor of Epidemiology at Stanford University

The desire for beautiful nails has fueled an entire nail salon industry that’s growing rapidly, with storefronts cropping up on every major street across the nation. Yet, the recent articles from the New York Times exposed an industry that’s left workers struggling both with unlivable wages and with damaged health. Everyone who enters a nail salon can be affected, yet the workers are the ones left entirely unprotected.Perfect nails, at what cost?

A chemical by any other name

Nail care products contain, in varying amounts, many toxic and potentially hazardous ingredients.

Chemical ingredients in nail care products range from cancer-causing compounds such as formaldehyde to others that disrupt the endocrine system. Researchers have identified toluene, formaldehyde and dibutyl phthalate – nicknamed the “toxic trio” because of their serious health impacts – as three chemicals of high concern for salon workers.

Toluene is a commonly used solvent that creates a smooth finish across the nail and keeps the pigment from separating in the bottle, but can affect the central nervous system and cause reproductive harm. Its major use is as an additive in gasoline.

Formaldehyde, a known carcinogen, is used as a nail-hardening agent and disinfectant for nail care tools.

Exposure to dibutyl phthalate, added to polishes to provide flexibility, has been linked to reproductive problems. In addition to this trio, there are many other harmful chemicals used in nail care products.

Many nail salons lack adequate exhaust ventilation or multiple pathways – such as open windows and doors – to increase indoor-outdoor air exchange. Evaporated chemicals from nail products are often trapped inside salons, meaning workers are continuously exposed. So workers’ exposure is amplified: first they experience direct contact with the chemicals in the products, then they continuously breathe in these chemicals within small, poorly ventilated salons.

Lack of regulatory oversight

Despite nail care products’ heavy use, industrial chemicals in cosmetics are largely unregulated in the US.

In fact, of the 10,000 chemicals used in personal care products, only about 10% have been assessed for safety. While the US Food and Drug Administration is responsible for the regulation of cosmetics, it lacks the legal authority to require manufacturers to conduct product pre-market testing to ensure consumer safety or to require listing of ingredients in products sold for professional use.

What does that mean for the average consumer? Bottom line, that bottle of nail polish you apply to your nails or the nails of your five-year-old little girl was put on the market without ever having been tested for safety.

For workers using nail care products daily, there is no requirement for product manufacturers to disclose ingredients on their labels. And even if they do, no one is really checking to ensure that these are accurate listings. A report by the California Department of Toxic Substances Control on product testing of various nail polish brands in the San Francisco Bay Area found that some contained harmful chemicals despite misleading labels that claimed they were free of such compounds.

The rising awareness of the health hazards posed by the chemical ingredients in nail care products has pressured manufacturers to create safer alternatives in the form of nail polishes free of the toxic trio. But many products still contain them and there is no regulatory oversight.

Health effects aren’t hypothetical

Nail salon workers pay a huge price in the form of their health. Exposure to nail care products with harmful chemicals can result in a number of health effects, ranging from skin irritations, eye injuries, allergic reactions, cognitive and neurological symptoms, nausea, respiratory problems, cancer and uncontrollable muscle contractions to impaired reproductive and development processes.

Research studies, including my research at the Cancer Prevention Institute of California, have documented acute health effects in these workers, such as headaches, breathing problems and skin irritations, commonly associated with overexposure to solvents used in these products. Studies have also shown that working in salons is linked to reproductive health problems, including spontaneous birth, preterm delivery and undersized babies as well as pregnancy complications. The exposures and health effects are enough to lead some governmental agencies, including the US Environmental Protection Agency (EPA), to invest in research and outreach to the salons.

As an epidemiologist, I have conducted multiple research studies to examine workplace exposures and health effects for nail salon workers. In my talks with hundreds of salon workers and owners, many have shared their personal stories of health problems, ranging from chronic headaches to tragic cases of cancer and pregnancy complications. While research doesn’t always provide definitive answers on the links between their workplace exposures and health problems, it’s hard to ignore the patterns in these stories.

What can be done?

California has been leading the charge to create healthier environments for both workers and owners. The California Healthy Nail Salon Collaborative has worked with multiple counties to establish the Healthy Nail Salon Program. These counties provide training and formal recognition for salons that participate in the program, which means they use safer alternative nail care products that do not contain the toxic trio. Our research in partnership with the US EPA has shown that these programs can be effective in improving worker safer practices and the salon environment. Their workers wear gloves to minimize direct contact with the chemicals, and the salons have ventilation methods to improve air quality. Other local and state agencies should follow suit to encourage healthy salons for workers and customers. This program would provide healthy choices for consumers who like to frequent salons.

Consumers who regularly buy nail care products should look for nail polishes without the toxic trio – formaldehyde, toluene and phthalates. These purchasing choices will put the pressure on manufacturers to create safer alternative products.

Ultimately, the first line of defense for the workers and customers is to ensure that the chemicals never enter the salons in the first place. Customers can leverage their buying power toward this end.

Thu Quach the Cancer Prevention Institute of California and Asian Health Services. As a research scientist, she receives governmental funding for research on the topic of nail salon health and safety. She does not receive any funding from for-profit organizations or any additional external funding outside of her current employment at the two organizations listed above.

Source: The Conversation

Facing Death But Fighting The Aid-In-Dying Movement

Stephanie Packer was 29 when she found out she has a terminal lung disease.

It’s the same age as Brittany Maynard, who last year was diagnosed with terminal brain cancer. Maynard, of northern California, opted to end her life via physician-assisted suicide in Oregon last fall.  Maynard’s quest for control over the end of her life continues to galvanize the “aid-in-dying” movement nationwide, with legislation pending in California and a dozen other states. [Read more…]

Federal advisory committees are critical to the legislative process – and the public should be more involved

By Megan Colleen McHugh, Research Assistant Professor, Center for Healthcare Studies at Northwestern University

In mid-April, President Obama signed a law that fixed Medicare’s controversial and unpredictable payment formula for physicians. Called the “Doc Fix,” the law puts in place a more stable payment schedule that provides small increases for doctors for the next five years. Notably, physicians who participate in alternative payment models – models that reward quality, value and accountability instead of quantity – will receive a 5% annual bonus between 2019 and 2024. [Read more…]

Feds Say That In Screening Colonoscopies, Anesthesia Comes With No Charge

Earlier this week the federal government clarified that insurers can’t charge people for anesthesia administered during a free colonoscopy to screen for colorectal cancer. That’s good news for consumers, some of whom have been charged hundreds of dollars for anesthesia after undergoing what they thought would be a free test. But the government guidance leaves important questions unanswered. [Read more…]

The Healthy Debate About Mental Health

dsm-5May 2013 may be remembered as a watershed (or maybe a Waterloo) in the history of psychiatry. Two major events have set the stage for a fundamental debate about how we should think about the nature of mental illness.

The American Psychiatric Association (APA) is about to publish the fifth edition of its diagnostic system of classification: DSM-5. And, three weeks before the publication, Thomas Insel, director of the National Institute of Mental Health (NIMH), announced that his agency will be moving away from funding studies based on the DSM categories. [Read more…]

Debate Over Psychiatry Bible DSM-5 Grows Days Before Release

With the release of the fifth edition of the so-called psychiatrist’s bible — the “Diagnostic and Statistical Manual of Mental Disorders (DSM),” days away, the controversy surrounding the new publication is heating up.

The National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA), which publishes the DSM, issued a clarifying statement Tuesday saying that they were working together to ensure that people with mental disorders would have better diagnostic resources available to them. However, while they emphasized that the new version, dubbed the “DSM-5,” will have the most up-to-date information for clinical diagnoses of mental disorders, the NIMH did not waver from its initial ruling that it would no longer use diagnoses listed in the DSM for its’ funded studies.
NIMH director Thomas Insel wrote in a statement earlier in May that the NIMH felt the proposed definitions for psychiatric disorders were too broad and ignore smaller disorders that were lumped in with a larger diagnosis.

Read more: CBS News

Flu in Pregnancy May Increase Child’s Bi-Polar Risk 4x

Pregnant mothers’ exposure to the flu was associated with a nearly fourfold increased risk that their child would develop bipolar disorder in adulthood, in a study funded by the National Institutes of Health. The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza.

“Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic,” said Alan Brown, M.D., M.P.H, of Columbia University and New York State Psychiatric Institute, a grantee of the NIH’s National Institute of Mental Health (NIMH). “In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.” [Read more…]

Men’s Brains Respond Differently to Hungry Infant’s Crying

Researchers have uncovered firm evidence for what many mothers have long suspected: women’s brains appear to be hard-wired to respond to the cries of a hungry infant.

Researchers asked men and women to let their minds wander, then played a recording of white noise interspersed with the sounds of an infant crying. Brain scans showed that, in the women, patterns of brain activity abruptly switched to an attentive mode when they heard the infant cries, whereas the men’s brains remained in the resting state.

“Previous studies have shown that, on an emotional level, men and women respond differently to the sound of an infant crying,” said study co-author Marc H. Bornstein, Ph.D., head of the Child and Family Research Section of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the institute that conducted the study. “Our findings indicate that men and women show marked differences in terms of attention as well.”

The earlier studies showed that women are more likely than men to feel sympathy when they hear an infant cry, and are more likely to want to care for the infant.

Dr. Bornstein collaborated with Nicola De Pisapia, Ph.D., Paola Rigo, Simona DeFalco, Ph.D., and Paola Venuti, Ph.D., all of the Observation, Diagnosis and Education Lab at the University of Trento, Italy, and Gianluca Esposito, Ph.D., of RIKEN Brain Science Institute, Japan.

Their findings appear in NeuroReport.

Dr. Bornstein says this research not only helps understand the specific wiring of the brain, but helps understand how the brain has developed. (MP3 – 00:01:12, 1,140 KB)

Transcript – Dr. Bornstein says this research not only helps understand the specific wiring of the brain, but helps understand how the brain has developed.

Previous studies have shown differences in patterns of brain activity between when an individual’s attention is focused and when the mind wanders. The pattern of unfocused activity is referred to as default mode, Dr. Bornstein explained. When individuals focus on something in particular, their brains disengage from the default mode and activate other brain networks.

For about 15 minutes, participants listened to white noise interspersed with short periods of silence and with the sounds of a hungry infant crying. The patterns of their brain activity were recorded by a technique known as functional magnetic resonance imaging.

The researchers analyzed brain images from 18 adults, parents and nonparents. The researchers found that when participants listened to the typical infant cries, the brain activity of men and women differed. When hearing a hungry infant cry, women’s brains were more likely to disengage from the default mode, indicating that they focused their attention on the crying. In contrast, the men’s brains tended to remain in default mode during the infant crying sounds. The brain patterns did not vary between parents and nonparents.

Infants cry because they are distressed, hungry, or in need of physical closeness. To determine if adults respond differently to different types of cries, the researchers also played the cries of infants who were later diagnosed with autism. An earlier study of Dr. Bornstein and the same Italian group found that the cries of infants who develop ASD tend to be higher pitched than those of other infants and that the pauses between cries are shorter. In this other study, both men and women tended to interrupt their mind wandering when they heard these cries.

“Adults have many-layered responses to the things infants do,” said Dr. Bornstein. “Determining whether these responses differ between men and women, by age, and by parental status, helps us understand instincts for caring for the very young.”

In an earlier study, Dr. Bornstein and his colleagues found that patterns of brain activity in men and women also changed when they viewed an image of an infant face and that the patterns were indicative of a predisposition to relate to and care for the infant.

Such studies documenting the brain activity patterns of adults represent first stages of research in neuroscience understanding how adults relate to and care for infants, Dr. Bornstein explained. It is possible that not all adults exhibit the brain patterns seen in these studies.

Source: National Institutes of Health (NIH)