background/objectives: Hepatitis B (HBV) is the world’s most common serious liver infection and the leading cause of liver cancer. Asian Americans and Pacific Islanders comprise approximately 6% of the US population, but account for over 50% of all HBV infected individuals. Vietnamese-Americans have one of the highest rates of HBV infection (12.5%) among all Asian ethnicities and comprise an estimated 56% of the nail salon workforce. Nail salon workers present a unique opportunity for targeted public health intervention to increase HBV awareness, education, testing, and access to care.

methods: Qualitative interviews were conducted with seven community stakeholders including community-based organizations, a local health department, and other experts to understand barriers to HBV education and access to care among nail salon workers. Telephone calls were conducted to state health departments or state cosmetology boards to inform a policy analysis of all 50 states to evaluate current regulations and identify gaps in HBV prevention and education in the nail salon industry.

results: Limited English proficiency is one of the largest barriers to accessing medical care, management of chronic HBV, and compliance with nail salon policies. Nail technician licensing curricula do not emphasize the importance of HBV education. Disinfection regulations remain inconsistent between states and may not fully protect workers. Arkansas, New Jersey, Oklahoma, and Texas restrict HBV-infected individuals from working in the nail salon industry, a violation of the Americans with Disabilities Act.

conclusion: To advance the protection of nail salon workers, we recommend: integrating HBV education into licensing curriculum, providing multilingual course materials and exams, adopting of a sanitation rating system, continuing education requirements for HBV prevention, and promoting partnerships between community organizations and nail salons to increase HBV education, testing, and vaccination.