What stands out upon entering Mai Dang's nail salon, located on a busy street in Berkeley, Calif., is what's missing — the stinging smell of polish, remover and other nail products. That wasn't always the case. For a decade, Dang suffered from the effects of the chemicals she used at work every day.
"When you do nails, workers get itchy skin and watery eyes," says Dang, 40. She also used to have frequent headaches, and one of her workers developed asthma. So when she heard about an opportunity to improve the safety at her salon, she signed up.
"I work every day. I need the air to be pure, to be better for me. I have to take care of my health this way," she says, speaking in Vietnamese through an interpreter.
"Practically every worker was experiencing some kind of health issue. And we realized that this was an epidemic," says Julia Liou, planning and development director at the clinic and the co-founder of the collaborative.
Nail salons are big business in the United States — approximately $8.5 billion in revenue in 2015. Some of the chemicals used in salons are known to cause skin disorders and respiratory problems, and possibly even cancer, miscarriages and birth defects. Formaldehyde and toluene are just two of the risky ingredients in the nail polishes, solvents, glues and hardeners in constant use in salons; the Environmental Protection Agency lists at least 20 such worrisome chemicals.
But, so far, there's been little government regulation to protect workers. Liou is trying to get salon owners to make changes voluntarily to improve worker safety.
"We don't want to create a fear where it's like, 'Oh nail salons are so scary that people can't go to them,' " explains Liou. "But we want to create a space where both the owner and the customer can feel comfortable, and actually create a model where the return on investment ends up being worker health."
Salons that participate in the collaborative must make significant changes to their business, including buying less toxic nail polishes, thinners and removers. All workers are required to wear specific types of gloves and masks when using certain products. Owners are also required to purchase a portable mechanical ventilation unit.
"It sucks in the air when I do artificial nails so the workers don't have to breathe in the toxic chemicals anymore," explains Dang, as she turns on the machine with a remote control. More than 80 percent of salon workers in California are Vietnamese American, and more than half are of reproductive age, according to the collaborative.
Alameda County certified Dang's salon, Fashion Nails, as a healthy salon in 2013, based on her changes. In return, Dang got a certificate that she hangs in her window to let customers know she is part of the collaborative. Fashion Nails is also listed as a healthier nail salon on a county website.
The process, however, was not cheap. Dang says the products she now uses, while safer, cost about 30 percent more. Overall, she estimates that she spent about $3,000 on the upgrades. To pay for it, she raised her prices by $2 per service.
One of Dang's customers, Genell Johnson, says she's more than willing to pay extra for the service.
"You get what you pay for," Johnson says. "That's what they always say, and it's very true."
A survey of customers by the collaborative found that 90 percent were willing to pay at least a dollar more for services they knew were healthier. Johnson says she's a regular at Fashion Nails but had no idea it was a healthy salon.
"Now I'm going to spread the word," says Johnson. "This will be the perfect place, knowing they're so health conscious."
For Dang, the investment in a healthier salon seems to be paying off. Visits to her salon have increased, and her business has become more profitable, she says.
But getting businesses to make changes voluntarily is a slow process. Out of more than 8,000 nail salons in California, only 120 have joined the collaborative so far.
"I think the ultimate root of the issue is that the chemicals are still in the products," says collaborative co-founder Liou. "If we want to look at really how do we improve worker health, we also need the manufacturers to consider how they can they make safer products as well."
Still, the Healthy Nail Salon Collaborative is making progress. The EPA recently gave the collaborative a grant to help them offer microloans to salons wanting to upgrade.
In September, California passed legislation to help expand the program across the state, by training cities and counties on how to certify healthy nail salons in their regions.
Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. You can follow Jenny Gold on Twitter: @JennyAGold.
ROBERT SIEGEL, HOST:
More than half of all the states have legalized marijuana, also known as cannabis, for medical use, and eight states have legalized it for recreational use. Well, now a report from the National Academies of Sciences, Engineering and Medicine examines what we know about the health effects of marijuana. NPR's Patti Neighmond reports.
PATTI NEIGHMOND, BYLINE: Researchers looked at more than 10,000 scientific studies. Marie McCormick with Harvard's T.H. Chan School of Public Health headed the research which is timely not only because marijuana is more widely available and used. It's also stronger than ever and comes in lots of new and different forms.
MARIE MCCORMICK: There's vaping, which is same as it is for nicotine. There's dabbing, which is taking a concentrated form, heating it up and inhaling the vapor. There is also edibles - the classic marijuana brownie but also chewy bears and things of that sort.
NEIGHMOND: The report explores 11 different health conditions. It finds cannabis can be beneficial when it comes to chronic pain or nausea related to chemotherapy.
MCCORMICK: Some people with chronic pain, muscle spasms for multiple sclerosis or nausea and vomiting from cancer chemotherapy obtained some relief of their symptoms from using cannabis-based products or cannabis.
NEIGHMOND: But there are potential harms. Marijuana may increase the risk of developing schizophrenia, although McCormick says it could be that people with the disorder are more likely to smoke it. The drug may also increase the risk for certain social anxiety disorders. For pregnant women, marijuana, like cigarettes, can increase the risk of having a low-birth-weight baby.
MCCORMICK: It's generally thought that smoking cannabis limits the growth of the infant, limits the effectiveness of the transfer of nutrients across the placenta.
NEIGHMOND: Smoking marijuana regularly is associated with more bouts of bronchitis and other respiratory problems. People already diagnosed with heart disease may have an increased risk of heart attack.
But for healthy individuals, there seems to be no increased risk of stroke or cancer, including tobacco-related lung and head cancers. And while marijuana does not seem to increase the use of other drugs or tobacco products, it may increase the risk of dependency, particularly among younger users.
MCCORMICK: The adolescent brain is very sensitive to these kinds of substances. And so they continue to use it and may use it in increasing amounts and are at risk for developing problematic cannabis use.
NEIGHMOND: Which can impair functioning, both academically and socially. Erik Altieri directs the National Organization for the Reform of Marijuana Laws, or NORML, which wants to see marijuana legalized for adult use nationwide. He says lots of research finds little harm in marijuana use. And a hidden benefit of legalization - he says it could actually reduce marijuana use among teenagers under 18.
ERIK ALTIERI: That's because we are taking marijuana off of the street corner, out of the hands of drug dealers who have nothing but incentive to sell to everyone and anyone, putting it behind the counter of a regulated business that has to check for ID, that has to answer to the government and has oversight.
NEIGHMOND: And in states that have legalized recreational marijuana, Altieri says there has not been an increase in use among underage teens in part because it may be harder to get and in part because the cool factor is lessened.
ALTIERI: By legalizing it and normalizing it, it's become just another everyday thing that adults partake in. It doesn't have that same draw to it that it used to.
NEIGHMOND: Even so, researchers say a lot more information about potential harms of marijuana needs to be studied and understood. Patty Neighmond, NPR News.
(SOUNDBITE OF GENERATIONALS SONG, "SAY WHEN") Transcript provided by NPR, Copyright NPR.