Breast Cancer Risk Profile of Vietnamese Nail Salon Workers

Institution: Asian Health Services
Investigator(s): Kim Nguyen,  - Peggy Reynolds, Ph.D. -
Award Cycle: 2005 (Cycle 11) Grant #: 11AB-2401 Award: $67,322
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer

This is a collaboration with: 11AB-2400 -

Initial Award Abstract (2005)
Breast cancer is the number one cancer among Vietnamese women in California. However, relatively little is known about factors that affect breast cancer risks and health care access/utilization in the Vietnamese population. In California, Vietnamese women often find work in the rapidly-growing nail care sector, where 80% of the nail salons are operated by professionals of Vietnamese background. Breast cancer and environmental advocates have been pushing for the elimination and labeling of suspected carcinogens in nail care products. Because nail salon workers are heavily exposed to these toxins, they are an important group to monitor while researchers continue to elucidate the relationship between breast cancer and cosmetics toxins. For Vietnamese nail salon workers, risks for breast cancer and occupational hazards are further complicated by language barriers and their challenges in accessing health care.

To lay the groundwork to reduce the risk of breast cancer in Vietnamese women, this project will systematically collect information on Vietnamese women working in nail salons in Alameda County. We will collect information on health care access and utilization, risk behaviors such as smoking and exercise, and occupational exposures. The results of this research will guide future interventions to reduce breast cancer risk among Vietnamese women.

To gather information about this workforce, we will convene two focus groups and conduct a survey among 200 Vietnamese nail salon workers in Alameda County. Both the focus groups and survey participants will be recruited from nail salon workers contacted through Asian Health Services’ (AHS) outgoing outreach efforts to these workers. Information from the focus groups will be used to inform the design of our survey. To develop a research partnership that values both sound science and community participation, we will convene an Advisory Committee composed of key stakeholders including nail salon workers, community health specialists, breast cancer advocacy organizations, scientific researchers and leaders within the Vietnamese community. This Advisory Committee will provide essential community input to the focus group and survey design and will advise how to use the research results in future advocacy, health interventions and environmental controls to reduce breast cancer risk among Vietnamese women.

The project is innovative in its ability to gather information on a population that is often difficult to reach because of issues related to language and distrust. By building on the experience and trust fostered by the on-going outreach efforts of AHS, we will be able to gather important information on factors that may impact the risk of breast cancer in a workforce that likely suffers prolonged exposures to potentially carcinogenic chemicals. Likewise, the Vietnamese population, a more-recent immigrant group that faces many barriers to health care access and utilization, is also understudied and underserved with respect to cancer risk. Study findings would inform future research aimed at reducing the risk of breast cancer not just among the workforce and within the Vietnamese community, but also among other immigrant communities that may share similar characteristics associated with issues of acculturation.

We plan to conduct this project with a process-driven approach, whereby community input plays an essential role in the direction and design of the research. Through our Advisory Committee and our focus groups, we invite participation from nail salon workers, breast cancer advocates, and scientific researchers, as well as advocates from the broader Vietnamese and immigrant communities. While the data collected as part of this project will be used to guide the design of future interventions and health research among this population, the collaborations built in the process of this study will be fundamental to the success of such future efforts.

Final Report (2007)
The nail salon industry has been one of the fastest growing professions in the U.S. California alone has over 35,000 salons with over 300,000 technicians licensed to provide nail care. Nail salon workers routinely handle cosmetic products that contain carcinogens and endocrine disruptors, which may increase a woman’s risk of breast cancer; yet, little is known about the health of the workers. Additionally, over 80% of California nail salons are run by Vietnamese workers who face socio-cultural barriers that may compromise their understanding of workplace safety and their access to health care. The purpose of this community-research collaborative pilot project was to systematically collect baseline data that would characterize the Vietnamese women currently employed in nail salons in Alameda County, in order to help inform future targeted health interventions and to reduce occupational exposures in this immigrant worker population.

The study consisted of three major elements: 1) We convened a community advisory committee comprised of ten Vietnamese community members (e.g. nail salon workers, clinic patients, cosmetology instructors, and breast cancer survivors) to advise on the focus groups and surveys as well as to provide guidance on issues that affect the Vietnamese nail salon community. 2) We conducted two focus groups, each with ten Vietnamese nail salons workers and stratified by years of U.S. residency (= 5 years versus > 5 years), to identify health concerns and work conditions in nail salons as well as help inform our strategies for effective survey participation. 3) We conducted face-to-face surveys with a convenience sample of 201 Vietnamese nail salon workers at 74 salon shops in Alameda County, to ask about their immigration history, reproductive history, work history, health experience, health concerns, health care utilization and work environment.

Surveys: The more-recent (= 5 years) workers were less satisfied with their profession than the less-recent workers (> 5 years). However, both groups (nearly all are immigrants) reported high levels of concern about chemicals-of-use and acute health effects. Of the workers surveyed, nearly all are immigrants, with a large proportion having lived in the U.S. for more than 10 years. Over half of the women surveyed have been working in the nail salon industry for more than five years. Furthermore, a majority of these workers reported that they have experienced some health problem as a result of working in the industry, particularly acute health problems that are likely associated with high-level solvent exposure (e.g. skin and eye irritation, breathing difficulties, headaches and asthma). These health problems are likely to be work-related since symptoms subsided when the workers were away from work for more than one day.

Eighty-four percent of the participants reported having some type of health insurance, typically Medi-Cal (45%) although only four workers were covered through work-based coverage. Among women over forty years of age, eighty-nine percent of them reported having been screened (either through a mammography or a clinical breast examination) for breast cancer, most (83%) within the last two years. No significant differences were observed between the less-recent and more-recent immigrant groups or among women with different insurance types.