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    • A manicurist with gloved hands is giving a manicure to customer.

In Safer Hands

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Through a grassroots effort, Fielding School graduates have empowered the low-wage, Vietnamese immigrant-dominated nail salon workforce to fight for healthier conditions.

Nail salons offering “manis” and “pedis” have become a booming business in the United States, setting up shop on seemingly every corner and approaching $8 billion in annual sales. In California, an estimated 80 percent of nail salon workers and owners are Vietnamese, drawn to a profession in which it’s easy to obtain a license and set up a storefront, and speaking fluent English isn’t required. “The Vietnamese community made this an affordable luxury by offering quick, inexpensive manicures and pedicures featuring creative art designs,” says Julia Liou (MPH ’00), director of program planning and development for Asian Health Services, an Oakland-based community health clinic.

Headshot of Julia Liou with her quote.

Liou continues to manage the collaborative, but she gets plenty of help. Her former Fielding School classmate Thu Quach (MPH ’00, PhD) brought her epidemiology training to the effort from the beginning, chairing the research arm of the work – including convening a national Research Advisory Committee. Quach is a research scientist with the Cancer Prevention Institute of California and research director for Asian Health Services, a member and fiscal sponsor of the collaborative. Lisa Fu (MPH ’03) is the collaborative’s outreach and program director, based in Los Angeles.

Headaches, dizziness, rashes and breathing difficulties are among the symptoms well documented in the salon worker population, Quach says. More ominous is the suggestion that the occupational exposures might increase the risk of respiratory illnesses, birth defects and cancer. Unfortunately, chronic impacts have been little studied, and industry regulations are minimal. Although the U.S. Food and Drug Administration is responsible for the safety of cosmetics, the agency can’t require pre-market testing or demand safety data from manufacturers. Of the thousands of chemicals used in beauty, personal care and salon products, Quach notes, 89 percent have yet to be independently tested for safety and impact on human health.

“You have numerous chemicals being mixed, new products coming out all the time, limited available data on health effects and weak accountability for the manufacturers,” says Quach. “That would make it difficult for the workers to protect themselves even if there weren’t language barriers.”

When concerns are raised, many salon workers feel they have no choice but to accept the risk. “This is an economic cornerstone for the population,” says Liou, “and they take pride in their work.”

A collage of four images relating to nail salon workers’ safety program.
The California Healthy Nail Salon Collaborative has engaged Vietnamese nail salon workers through a variety of efforts, including a core-leader curriculum to build skills in organizing, outreach and public speaking; and a campaign to establish Healthy Nail Salon criteria.

Absent stronger regulations, the collaborative has partnered with counties and cities through its California Healthy Nail Salon Campaign. In 2010, San Francisco County adopted legislation creating a program to assist shops in implementing safer practices while recognizing their efforts by publicly designating them as Healthy Nail Salons. In partnership with the San Francisco Department of the Environment, the collaborative helped to establish the Healthy Nail Salon criteria, a list of 10 requirements that include using less toxic products, providing personal protective equipment and improving ventilation. Since then, the collaborative has worked with Alameda and San Mateo counties, as well as the City of Santa Monica, to develop similar programs.

Initially, salon workers and owners greeted the collaborative’s outreach efforts with suspicion. Many saw the staff as an extension of the state Board of Barbering and Cosmetology, which would conduct unannounced inspections and impose fines for infractions the salon owners didn’t understand. “We had to convince them we were there to help, and recognize that they had other priorities besides their health that we needed to address if we wanted to build trust,” Liou says. Her group succeeded by recruiting staffers who spoke the language and understood the culture.

A manicurist and a customer in a nail salon.


Beyond winning the trust of salon workers, the collaborative has sought to build leadership within the community. A core-leader curriculum was established to train workers and owners in organizing, outreach and public speaking skills. This has led to once-reluctant nail salon workers going to Sacramento and Washington, D.C., to meet with policy makers and provide testimony before committees.

“Many customers who go into nail salons don’t really think about what the workers are experiencing,” says Fu. “When the workers speak for themselves and demand changes in the industry, that’s very powerful.” Once the issue is brought to consumers’ attention, Fu adds, they are strongly supportive.

Headshot of Thu Quach with her quote.

Thu Quach has heard the refrain from countless nail salon workers over the years – Vietnamese immigrants who know about the health risks, but feel they must sacrifice so that their children can have a better life. It’s a refrain she first heard from her own mother.

Quach was 4 when her family fled Vietnam, staying in a refugee camp for a year before moving to the United States. Here, her mother got her cosmetology license and began working at Vietnamese nail and hair salons. The many chemicals she encountered on the job always gave her pause; Quach remembers her mother saying, “I hope you never have to do this kind of work.”

At the Fielding School in the early 2000s, Quach studied epidemiology and grew fascinated with issues around occupational health and workers’ rights. The nail salon boom had just begun, and Quach decided to investigate the health effects of the chemical exposures, about which little was known. Just as Quach was delving into the data, her mother was diagnosed with cancer. She died a year later. As an epidemiologist, Quach knows it’s impossible to say whether the cancer was a result of her mother’s work, “but you wonder.”

She and Liou had met in an FSPH classroom and became close friends. When Liou secured funding for the California Healthy Nail Salon Collaborative, she knew where to turn for research leadership.

What once felt like a personal crusade for Quach has become part of a much larger movement. “This has helped me realize that there are many other children of immigrants with the same experience,” she says. “It’s been gratifying to see so many taking up this cause.”