A Critique of Risk Disclosure as the Solution for Minimizing Toxic Exposures in Pregnancy

Abstract

The issue of pregnant women's exposures to everyday chemicals and the implications for the health of future children are receiving increased attention in popular media and in the academic press. In response, health profession organizations are developing clinical practice guidelines for warning pregnant women about the risks associated with exposures to certain toxics. We evaluate different sides of a risk-avoidance approach for pregnant women in the context of a hypothetical case study involving phthalates and women who work in nail salons. We consider the ubiquitous nature of low-dose exposures and both the positive aspects and limitations of promoting avoidance measures with respect to phthalate exposures. We conclude that a risk-disclosure approach has both practical limitations and equity dimensions which must be factored in to public health guidelines and messaging and the development of clinical practice guidelines. Upstream solutions including regulatory action on chemicals and heightened attention to environmental justice would result in optimal management of this issue.

Perceived work exposures and expressed intervention needs among Michigan nail salon workers

“…Nail salon workers are a population vulnerable to several notable occupational hazards. Chemical exposures are of chief concern as nail salon workers handle and utilize products that contain hazardous and carcinogenic compounds, such as the “Toxic Trio” of toluene, formaldehyde, and dibutyl phthalate (DBP) (Ford and Scott 2017 ; Huynh et al 2019 ; OSHA n.d.; Quach et al 2018 ; Shendell et al 2018 ). These and other chemicals utilized in nail salons have been connected to adverse human health outcomes such as respiratory and dermal irritation (e.g., allergy, asthma, contact dermatitis), endocrine and neurological consequences, and potentially cancer (Gorman and O’Connor 2007 ; Kwapniewski et al 2008 ; Ma et al 2019 ; Quach et al 2008 , 2013 , 2018 ; Shendell et al 2018 ).…”

“…It is estimated approximately 80% of the nail salon workforce are women and 80%% are immigrants, with more than half of those immigrants being of Vietnamese descent (UCLA Labor Center 2018 ). Working in this field can be appealing to those who are foreign-born because of the lower barriers and requirements for education/training and English fluency (Ford and Scott 2017 ; Huynh et al 2019 ; Ma et al 2019 ; UCLA Labor Center 2018 ). However, the language barrier in tandem with the lack of culturally-appropriate education, training, or occupational safety and health information available in languages besides English can result in additional or exacerbated occupational hazards (Huynh et al 2019 ; Quach et al 2018 ; Zhong et al 2019 ).…”

“…However, the language barrier in tandem with the lack of culturally-appropriate education, training, or occupational safety and health information available in languages besides English can result in additional or exacerbated occupational hazards (Huynh et al 2019 ; Quach et al 2018 ; Zhong et al 2019 ). While research in the past decade has aimed to highlight the occupational hazards faced by nail salon workers, the workers of this industry still comprise a population that is underserved and often overlooked in occupational safety and health (Ford and Scott 2017 ; Huynh et al 2019 ; Ma et al 2019 ; OSHA n.d.; Quach et al 2018 ; Shendell et al 2018 ; Zhong et al 2019 ). Given the vulnerabilities and disparities that this worker population of nail salon workers faces, research conducted on or with nail salon workers and owners has generally taken a community-based participatory approach (CBPR).…”