Commands in Nepalese fly back and forth across the Gramercy nail salon as customers are shuffled from one station to another. Dust from the acrylic nail glue hovers above the seats, with only a single rotating fan to circulate the air throughout the salon.

A customer is at the register paying for her $25 manicure and pedicure. She hands a $3 tip to the woman at the register, but not before complaining about the smell of the chemicals. She was only in the salon for 40 minutes but says she has a headache from the fumes. Meanwhile, her Nepalese manicurist who goes by the name ‘Stacy’ has been working for the past eight hours, with three and a half more hours to go. By the time she goes home, she will have inahled at least 17 times more chemical fumes than her customer.

Stacy’s hands may itch, and her eyes are swollen and watery, but that is just part of the job. When Stacy finally steps outside of the salon just after 9 p.m. she takes some deep breaths, letting the fresh air flow through her lungs as she walks to the bus stop.

More than 87,000 people work in nail salons in the United States, and their safety is a growing concern as researchers learn more about volatile chemicals in salon products that have been linked to respiratory problems, birth defects, and cancer. Yet New York City, unlike San Francisco and Boston and a few other American cities, has no legal responsibility to oversee conditions in the approximately 2,000 salons within the five boroughs. Instead, just 27 state-employed inspectors are responsible for about 5,000 salons throughout New York State – a disparity some observers think is dangerous. They hope the New York City Council will soon vote to toughen regulations, beef up enforcement, conduct more research on health risks and create financial incentives for salons to improve ventilation.

“When we spoke to the different cities that have proposed legislation we were really encouraged because they all said: ‘Great, New York City is finally doing something,’ but New York City should have been doing something years ago, and it’s a shame that we haven’t, and hopefully its something the Public Advocate’s office can spearhead, said Amber Greene, Director of Policy at the NYC Public Advocate’s Office.

Nail salons are a $7 billion industry, and growing fast. They appear in every neighborhood, regardless of demographics, and are estimated to grow 16 percent by 2022. They often employ recent immigrants, some undocumented, who do not speak English and know very little about the potential health risks they face.

Toluene, Formaldehyde, and Dibutyl Phthalate—referred to as the “toxic trio”—are found in many nail products, and have been associated with reproductive harm, respiratory problems, and cancer in health studies. They can be absorbed by inhalation, contact with skin or eyes, and through ingesting food or drinks that are left uncovered in salons. But the true scope of the health risks salon workers face is unknown because 89 percent of the 10,000 chemicals contained have not been tested by an independent agency for safety, according to the National Asian Pacific American Women’s Forum.

A survey of 100 New York City nail salon employees, 37 percent experienced skin problems, 57 percent reported having allergic reactions, 37 percent had eye irritations, and 66 percent had neck or back discomfort, and 18 percent suffered from asthma. Two advocacy groups conducted the survey: the New York Committee for Occupational Safety and Health, and the Young Korean American Service and Education Center of Flushing, New York.

“We know the toxic trio is a dangerous group of chemicals, and so instead of waiting until we see diseased nail salon workers we believe that these chemicals should be switched or the product should be reformulated as the precautionary way of making products,” said Catherine Porter, Policy Director for the California Healthy Nail Collaborative.

“There are a lot of toxic products, and there’s often very poor ventilation,” said Dr. George Friedman-Jiménez, Director of both the Bellevue and New York University Occupational and Environmental Medicine Clinic. “Many salon chemicals cause skin problems, he said, and nail dust and fumes from glues and acrylics used to make artificial nails can cause breathing problems,” he said in an interview in 2007.

Product manufacturers are required by law to provide salon owners with Material Safety Data Sheets for every product that contains one percent or more of a hazardous toxin, or 0.1 percent or more of a chemical that could potentially cause cancer. However these sheets are translated in only a few languages and are not adequately dispersed among workers, according to a report issued in September by the New York City Public Advocate’s Office. That report, entitled “How Safe is Your Nail Salon?” calls for an epidemiology study to be conducted by the NYC Board of Health and Mental Hygiene in order to evaluate the working conditions of nail salon technicians in the New York Area, as well as proposing financial stipends for proper ventilation.

“We are pushing the Health Department to increase monitoring salons, but there isn’t a lot of data in New York City to back up making a huge investment in the monitoring,” said Greene. “So we asked as part of our legislation package for a health study to be conducted to document what is happening in New York City salons,” she said.

As early as this month, the City Council is scheduled to consider the report’s recommendations, which also includes expanded efforts to reach non-English speakers with safely information. “Unless you improve language capacity of inspectors going out to nail salons, it’s not going to do that much good for nail salons just to have more inspectors,” said California’s Porter.

The state’s licensing system makes the problem even worse, said Charlene Obernauer, Executive Director of the New York Committee for Occupational Safety and Health. “In New York City there are a lot of women who speak Nepalese who work in nail salons, however the state licensing exam which certifies someone to become a nail salon specialist is not available in Nepalese, so a lot of the workers are unlicensed because the exam is not offered in their language,” she said.

The September report from the New York City Public Advocate’s office also endorsed offering salon owners a $500 stipend to improve ventilation. Levels of some toxic chemicals in salons often exceed 826 parts per million during the application process of acrylic nails, according to the federal Occupational Safety and Health Administration. Those levels could be reduced to 12.4 parts per million with proper ventilation, according to agency.

Ventilation is especially important because many salon workers do not wear protective equipment. Seventy-one percent of employees never or rarely wear facemasks, 46 percent never or rarely wear gloves, and 63 percent never or rarely wear protective eyewear, according to 2012-2013 industry statistics published in Nails Magazine.

“We would not recommend using anything less than gloves, and depending on the ventilation in the salon some form of respirator should be used,” Obernauer said. “If nail salons do not want their workers to be wearing respirators because they think it gives off an unhealthy appearance to customers, then they need to invest in appropriate ventilation systems so their workers are not just breathing in these chemicals unrestrictedly for 10 hours a day.”

In 2011, the Boston Board of Health instituted a new proposal, which gave the BPHC the authority to require nail salons to apply for permits and to be subjected to routine health inspections. Additionally the BPHC has the power to shut down any salon that does not meet the improved safety standards. The fear of being shut down has forced Boston salon owners to change their practices and create a safer atmosphere for customers and workers alike.

The Public Advocate’s report defines proper ventilation standards as a fan being placed in the proper direction of each worker’s station in order to disperse airborne chemicals away from customers and employees, opening windows, and continuously running the heating, ventilation, and air-conditioning systems.

“It’s definitely cut down on the dust,” said Kellie Deaganzio, a nail technician at the Boston nail salon Forever-French. Deaganzio said she is no longer covered from head to toe with the dust at the end of the day in an interview from 2014.

San Francisco has taken a different tack by giving official recognition to salons that use less-toxic polishes and polish removers. The city’s Healthy Nail Salon Recognition Program, adopted in 2012, has so far given 17 of the roughly 250 salons an eco-friendly stamp for meeting the city’s standards for a ‘healthy nail salon’.

New Yorker’s have been slower to embrace eco-friendly nail salons, though one has opened earlier this year in Williamsburg, Brooklyn. The eco-luxe nail salon is called pH 7, a name that emphasizes the neutral nature of the products used—pure water has a pH very close to 7. But an eco-friendly manicure and pedicure at pH 7 doesn’t come cheap: it’s $48, compared to about $20 at a typical New York City salon.

Advocates insist that consumers are willing to pay extra if given the choice. Green salons “are better for business and better for health,” says California’s Porter. “We’ve done informal surveys and one question we ask is: Would someone pay more if the nail salon was using less toxic products? And (in San Francisco) across the board people responded, ‘yes’.”

At least some salon customers in New Yorkers seem ready to support safer salons, even if they have to pay more. Sara Chase has been going to the same salon for five years, and has developed a “strong bond” with her manicurist.

“I think when women know and realize that there are some businesses that care about their employees, and have the fans, and use the masks, they would want to support women’s health, and their own health by patronizing those businesses,” Chase said.