Stakeholders’ perspectives on the feasibility of adopting a Healthy Nail Salon Recognition Program in Philadelphia: A qualitative study (preprint)

ABSTRACT Background The California Healthy Nail Salon Recognition Program is a statewide initiative to incentivize nail salons to adopt safer practices such as use of safer nail products without certain harmful chemicals, installation of ventilation systems, proper personal protective equipment use, and staff training. This public policy intervention is in response to the call to protect nail care workers, mostly women of color, who bear disproportionate burden of chemical exposure at work. Because there is interest from the community to adopt similar program in the Greater Philadelphia region, we conducted this formative research to document stakeholders’ perspectives on the feasibility of adopting the Healthy Nail Salon Recognition Program in Philadelphia. Methods We conducted semi-structured interviews with a purposive sample of 31 stakeholders in Philadelphia in 2021. Using the Consolidated Framework for Implementation Science as our theoretical framework, we developed the interview guide and analyzed the data using qualitative research method to identify key facilitators and barriers. Results Key facilitating themes were perceived need and benefits of program to improve workers’ health and working conditions, and willingness of stakeholders to leverage their organizational resources. Barriers included perceived high cost and time commitment from salon owners and employees, lack of funding and implementation leaders at the city government, community members’ willingness to be visible and advocate for the program affected by the stigmas of being immigrant workers, fear of interacting with authorities, as well as the impact of COVID-19 pandemic. Our results suggest successful adoption of the Healthy Nail Salon Recognition Program in Philadelphia will require outreach within the community to raise awareness of the benefits of the program and close partnership with community-based organizations to facilitate mutual understanding between the authority and the ethnically diverse nail salon communities.

Development of health and safety training for Vietnamese American nail salon owners and workers (preprint)

Background Nail salon workers are an underserved worker population that faces multiple barriers to accessing occupational health training and services. We developed a series of occupational health training modules, which were culturally tailored to Vietnamese-speaking workers, covering topics on infection control, musculoskeletal disorder prevention, chemical safety, and labor practices. We delivered the training online (due to COVID-19) to a small group of Vietnamese owners and workers in the Philadelphia metro area to obtain feedback on the training content and potential implementation challenges. Methods Seven participants (three owners and four workers) were recruited to attend the training. Qualitative feedback was obtained after each training session, followed by a more in-depth interviewer-assisted open-ended questionnaire to gain better understanding of the potential challenges of implementing the recommended changes. The Health Belief Model was used to guide the analysis of the participants’ responses to identify the perceived benefits and barriers of the training. Results Themes of perceived benefits of the training were bridging the gap of cosmetology school training, offering practical tips to protect their health at work, and inspiring conversations about work dignity and labor practices. Themes of perceived barriers were availability of affordable safer products and lack of resources, desire to please customers, lack of commitment from owners, and ubiquitous low wage that impacts employee’s job satisfaction and motivation to change, and difficulty in obtaining a work license. Conclusions Our study revealed the multitude of social and economic barriers facing immigrant nail salon owners and workers. Potential policies and strategies to overcome some of these structural barriers are discussed for the long-term health protection of nail salon workers.

Experiences of coping with the first wave of COVID-19 epidemic in Philadelphia, PA: Mixed methods analysis of a cross-sectional survey of worries and symptoms of mood disorders. (preprint)

Our objective was to describe how residents of Philadelphia, PA, coped psychologically with the first wave of COVID-19 pandemic. In a cross-sectional design, we aimed to estimate the rates and correlates of anxiety and depression, examine how specific worries correlated with general anxiety and depression, and synthesized themes of "the most difficult experiences" shared by the respondents. We collected data through an on-line survey in a convenience sample of 1,293 adult residents of Philadelphia, PA between April 17 and July 3, 2020, inquiring about symptoms of anxiety and depression (via Hospital Anxiety and Depression Scale), specific worries, open-ended narratives of "the most difficult experiences" (code into themes), demographics, perceived sources of support, and general health. Anxiety was evident among 30 to 40% of participants and depression -- about 10%. Factor analysis revealed two distinct, yet inter-related clusters of specific worries related to mood disorders: concern about "hardships" and "fear of infection". Regression analyses revealed that anxiety, depression, and fear of infection, but not concern about hardships, worsened over the course of the epidemic. "The most difficult experiences" characterized by loss of income, poor health of self or others, uncertainty, death of a relative or a friend, and struggle accessing food were each associated with some of the measures of worries and mood disorders. Respondents who believed they could reply on support of close personal network fared better psychologically than those who reported replying primarily on government and social services organizations. Thematic analysis revealed complex perceptions of the pandemic by the participants, giving clues to both positive and negative experiences that may have affected how they coped with the pandemic. Despite concerns about external validity, our observations are concordant with emerging evidence of psychological toll of the COVID-19 pandemic and measures employed to mitigate risk of infection.

Symptoms of anxiety and depression in relation to work patterns during the first wave of the COVID-19 epidemic in Philadelphia PA: a cross-sectional survey (preprint)

ObjectiveWe investigated whether patterns of work during COVID-19 pandemic altered by effort to contain the outbreak affected anxiety and depression. MethodsWe conducted a cross-sectional online survey of 911 residents of Philadelphia, inquiring about their working lives during early months of the epidemic, symptoms of anxiety and depression, plus demographics, perceived sources of support, and general health. ResultsOccupational contact with suspected COVID-19 cases was associated with anxiety. Concerns about return to work, childcare, lack of sick leave, and loss/reduction in work correlated with anxiety and depression, even when there was no evidence of occupational contact with infected persons; patterns differed by gender. ConclusionsHeightened anxiety and depression during COVID-19 pandemic can be due to widespread disruption of working lives, especially in "non-essential" low-income industries, on par with experience in healthcare. The significance to clinical practice of the information being presented: Anxiety and depression symptoms that emerged during COVID-19 pandemic may be related to disruption of working lives even among people who are not the "essential" workers with one-one-one contact with infected persons. Clinicians may find this evidence of occupational correlates and articulated specific worries useful in treating such patients.