One profession is projected to expand at a pace surpassing all others — a staggering 12 percent annually — until 2033: nail salon employment.

This influx commenced in 2023, leading to the present workforce of nail salon employees in the United States reaching over 365,000.

However, this trend carries risks. Their engagement with nail lacquers and removers, synthetic nails, adhesives, hardeners, sanitizers, and various instruments exposes them to a broad spectrum of chemicals and airborne volatile organic compounds (VOCs).

“These encompass recognized carcinogens like formaldehyde and other hazardous VOCs such as acetone, ethyl acetate, butyl acetate, isopropanol, toluene, methyl methacrylate, and ethyl methacrylate — and this is just the beginning,” remarked Aurora Le, Ph.D., from the Texas A&M University School of Public Health. “These substances are known to cause irritation to the eyes, skin, and respiratory systems, inflict damage on the liver and kidneys, and may lead to neurological impairments and negative reproductive effects.”

While Le is optimistic about recent initiatives aimed at raising awareness regarding these risks, particularly by the federal Occupational Safety and Health Administration (OSHA) and the California Healthy Nail Salon Collaborative, she emphasized that significant efforts are still necessary to assist nail salon employees in reducing the potential hazards they encounter.

“In addition to the large workforce, two other elements greatly influence worker awareness and training,” she noted.

One aspect is the insufficiency of comprehensive regulation regarding the chemicals utilized by nail salon employees. OSHA governs some substances — but not all — and lacks the capacity to enforce the current rules. Furthermore, the U.S. Food and Drug Administration does not adequately oversee the components in most cosmetic goods, particularly nail-related products.

The second element is the absence of training resources on chemical exposure and safety that are linguistically suitable and user-friendly for those predominantly engaged in this profession, particularly women of Vietnamese heritage.

“With limited English abilities, these practitioners face challenges in understanding warning labels, available training documents, or Safety Data Sheets,” Le pointed out. “In one of our focus groups, we discovered that most nail salon employees promptly discard any English-language educational materials handed to them.”

To tackle these challenges, Le and her team from the University of Michigan School of Nursing evaluated the requirements of nail salon employees in Michigan and created what they believe is the first free, online training program aimed at enhancing nail technicians’ understanding of chemical exposure and safety. Their research, published in the Journal of Occupational and Environmental Medicine, was initiated by the Michigan Healthy Nail Salon Cooperative.

The research team utilized a three-phase Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model for their project. In the initial phase, they carried out a needs assessment via focus group discussions with nail salon employees in Michigan, alongside reviewing academic studies and federal and state regulations on chemical exposure and safety procedures for nail salon tasks. From this, they formulated content for the online training program.

The self-paced program concentrated on chemical use in five core functions typically performed by a nail technician (nail cleaning, applying and removing nail polish, applying and removing artificial nails, sanitizing and sterilizing tools, and managing equipment storage) as well as the OSHA Hazard Communication Standard (Labels and Safety Data Sheets).

“We engaged participants through interactive queries and employed a pretest and posttest to measure knowledge acquisition, with a passing score of 70 percent or higher leading to certification,” Le stated.

During the second phase, the researchers refined the program through a three-month partnership with a community advisory board made up of salon workers and owners who would also aid in disseminating and implementing the program. In the third phase, they translated the program into Vietnamese with help from native speakers and conducted a pilot test. Based on feedback from the committee, they also raised the final required training score to 80 percent or higher for the posttest in either English or Vietnamese.

A pilot evaluation of the Phase 1 program with four nail salon employees, eight industrial hygiene students, and two occupational health nursing students showed that the training enhanced their understanding of chemical exposure and safety methods. Following their input, the researchers incorporated additional interactive components and improved module usability on mobile devices.

In the evaluation of the English version in Phase 2, the team, incorporating feedback from the advisory board, revamped the module using a new learning management system for the storyboard platform and made it accessible to the public. Seven participants completed the final English module, achieving an average pretest score of 81.43 percent and an average posttest score of 98.57 percent, demonstrating an increase in their chemical exposure knowledge.

In Phase 3, which focused on the Vietnamese translation, 24 nail salon employees who engaged with the module scored an average of 58.33 percent on the pretest and 91.67 percent on the posttest, indicating a significant rise in their understanding of the subject matter.

The average pretest scores for seven individuals who completed the English version and 24 who finished the Vietnamese version were 81.43 percent and 58.33 percent, respectively. The average posttest score was 98.57 percent for English and 91.67 percent for Vietnamese. Additionally, participants who took part in a voluntary survey regarding the module’s content expressed satisfaction with its relevance, duration, and applicability of knowledge, along with increased confidence in their understanding of workplace chemical exposure and their ability to safeguard themselves.

“This module, available in both English and Vietnamese, is free, self-paced, and accessible to anyone with internet connectivity worldwide,” Le remarked. “Workers in Vietnam have completed the training, and we aim to promote it in Texas and other regions as an invaluable resource for enhancing health and well-being among both licensed and unlicensed nail salon workers.”