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Prevalence and Characteristics of
Body Piercing and Tattooing
Among High School Students
Marthe Deschesnes, PhD
1
Stéphanie Demers,
MA
2
Philippe Finès,
PhD
1
ABSTRACT
Background: Although body piercing and tattooing seem to be gaining popularity among a
diversity of social and age groups, studies of these practices in general adolescent
populations are scarce. This study establishes the prevalence of body modification
(tattooing and body piercing) among high school students in grades 7-11 (aged 12 to 18).
Methods: Data come from a 2002 in-school survey conducted among a representative
sample of 2,180 students (81% response rate) enrolled in the 23 high schools of the
Outaouais region in Quebec. Systematic sampling was performed. Specific data on
tattooing and body piercing are available for 2,145 students (1% non-response rate).
Results: A prevalence of 27% for body piercing and 8% for tattooing is observed among
high school students. Differences between girls and boys are observed in many ways: i.e.,
frequency and number of tattoos or piercings; aftercare practices. While most teens say
that a “professional” in a studio performed their body modification and that they received
aftercare instruction, a high percentage of students report health complications following
the procedure.
Conclusion: Results show that tattooing and body piercing are common among
adolescents and may involve health risks. Consequently, appropriate preventive measures
should be adopted by professionals such as school counsellors, nurses, physicians and
others who are in contact with teenagers to help them make informed choices.
MeSH terms: Tattooing; body piercing; adolescents; survey
M
ost articles on tattooing and
body piercing published in the
last 10 years suggest that the
popularity of these practices is on the rise
in Western societies, especially among
youth.
1-4
Today, these practices are per-
ceived by many as adornment or artwork,
1,5
while others categorize them as deviant
behaviour.
6,7
The reasons invoked by youth
for tattooing or piercing refer mostly to the
expression of individuality (i.e., to feel
unique and special), to the confirmation of
their personal identity, and to aesthetics.
2,7,8
Studies among adolescents are very lim-
ited, particularly regarding body piercing,
and respondents are often those identified
as “at-risk” youth, such as prison detainees
and military population. According to the
studies, the prevalence of tattoos in adoles-
cents ranges from 4.5-23%.
9-13
One
American study of body piercing identified
a prevalence of 27%.
10
Literature pertaining to the medical
complications of body piercing and tattoo-
ing remains relatively scant.
2,14
Complications arising from body piercing
and tattooing are mostly limited to case
reports.
14,15
They cover allergies and sensi-
tivity to dyes used in tattoos, allergic reac-
tions to certain metals used in body jew-
ellery, and scar tissue formation.
16,17
Body
piercing has also been associated with bac-
terial infections,
18
bleeding, skin tissue
tearing, hypertrophic scars, dermatitis and
endocarditis.
2,15
Many authors recognize
tattooing and body piercing as possible
vectors for the transmission of blood-borne
diseases such as hepatitis B, hepatitis C or
HIV.
8,17,19-22
A 1999 United Kingdom sur-
vey of family practitioners showed that
95% of them have seen patients with com-
plications resulting from a piercing.
23
In order to gain a more current picture
of these practices among the general ado-
lescent population, the objectives of the
present study were to: 1) establish the
prevalence of tattooing and body piercing
in a population of high school students,
and 2) describe these practices in terms of
number of tattoos and piercings (other
than earlobes), status of the performer, rea-
sons for getting it done, aftercare instruc-
tion, and medical complications.
METHODS
Data come from a 2002 in-school survey
conducted among a representative sample
La traduction du résumé se trouve à la fin de l’article.
1. Outaouais Public Health Unit, Health and Social Services Agency of Outaouais and Université du
Québec en Outaouais
2. Coeur-des-Vallées Schoolboard
Correspondence: Dr. Marthe Deschesnes, Health and Social Services Agency of Outaouais, Public
Health Unit, 104 Lois St., Gatineau, QC J8Y 3R7, Tel: 819-777-3871, Fax: 819-777-0271,
E-mail: Marthe_Deschesnes@ssss.gouv.qc.ca
Acknowledgements: This study was conducted through a grant from the Public Health Grant Program
of the Quebec Ministry of Health and Social Services.
JULY – AUGUST 2006 CANADIAN JOURNAL OF PUBLIC HEALTH 325
of students grades 7-11 (aged 12 to 18)
enrolled in all high schools (N=23) of the
Outaouais region in Quebec (located in
proximity to Canada’s national capital). A
systematic sampling was used from the
complete list of students (N=20,700)
from each school and across each grade.
Of the 2,700 students selected, 2,180 par-
ticipated in the survey (81% response
rate). Twelve percent were lost due to
their being absent on the day of the sur-
vey (absences were justified by parents) or
because they had moved. Questions per-
taining to body modification represent
one of the many dimensions of the sur-
vey, which included an array of health-
related issues. Data on tattooing and body
piercing were available for 2,145 students
(1% non-response rate). Participants’
socio-demographic characteristics reflect
those observed in the general high school
student population of the region. Most
participants (73%) live in an urban area.
Their average age is 14.7 years
(SD=1.51), with girls making up 52% of
the sample. Three quarters (74%) of stu-
dents spoke French as their first language,
19% spoke English, and 7% spoke anoth-
er language.
Selected students who completed the
anonymous self-administered question-
naire were assured of the confidentiality of
responses. All of the questions relating to
tattooing (n=9) and body piercing (n=10)
are from the «Body Art Survey» designed
by Armstrong for high schools students.
11
Face and content validity of the instru-
ment were confirmed by an expert panel
of physicians, nurses, and counsellors in a
study among college students.
24
The ques-
tionnaire was pre-tested in one class each
of grade 7 and 8 students (N=50; not
included in the study) in order to ensure
that the vocabulary level was relevant and
the questions were understood by the stu-
dents. See the Appendix for a sample of
questions retained for the study. Approval
from the Ethics Committee of the
University of Quebec in the Outaouais
was obtained before conducting the sur-
vey.
Comparisons of variables relating to
body piercing or tattooing by sex and by
age were tested using Pearson Chi-Square,
at a level of significance of 0.05. Analyses
were performed using SPSS 9.0 for
Windows.
RESULTS
Overall, 7.7% of students reported having
a tattoo while 27.3% of them reported a
body piercing other than on their earlobe.
Girls are more likely than boys to indicate
that they have a tattoo and both forms of
body modification increase with age (Table
I). Most (79%) tattooed students only
have one tattoo and the majority (62.1%)
of those with a body piercing only have
one. Among tattooed students, 7% have
three or more tattoos while 16.8% of
pierced youth have three or more pierc-
ings. While boys are three times more like-
ly than girls to have three or more tattoos
(11.9% vs. 4.1%, n.s.), girls are twice as
likely to have three or more piercings
(18.8% vs. 7.8%, p<0.01).
Age at first tattoo or piercing
Both practices begin at an early age: 32.1%
of tattooed students and 52.7% of pierced
students got their first tattoo or piercing,
respectively, before age 15. Boys are pro-
portionally more likely than girls to have
been tattooed (16.9% vs. 1.0%, p<0.001)
or pierced before age 12 (29.4% vs.
13.1%, p<0.001).
Body piercing sites
Sites most frequently chosen for a body
piercing vary greatly according to gender.
For example, while boys most often opt to
have their eyebrow pierced (46.4%), only
9% of girls choose this site (p<0.001); con-
versely, girls prefer to have their navel
pierced (61.8%) while very few boys
choose this site (0.9%)(p<0.001). On the
whole, girls prefer to have their navel
(61.8%), upper ear (43%) or nose (16.5%)
pierced, while boys most often opt to have
their eyebrow (46.4%), nipple (19.1%) or
lip (10.9%) pierced. Genital site is rarely
chosen among students of both genders
(G: 1.5%, B: 3.6%). Analysis by age shows
that tongue is the only site that becomes
increasingly popular with age: 6.6% of
12 and 13 year-olds; 13.5% of 14 and
15 year-olds; and 17.0% of 16 to18 year-
olds (p<0.05).
Reasons invoked for getting body
modification
Both boys and girls most frequently invoke
aesthetic reason (“beauty mark”) for
acquiring their first tattoo or piercing
(Table II).
Status of tattoo or body piercing artist
Most students called on a “professional” in
a studio for their first tattoo (90.4%) or
their first body piercing (89.9%). Girls are
proportionally more likely than boys to
have called on a “professional” for a tattoo
(94.9% vs. 82.5%; not significant) or a
piercing (91.6% vs. 81.7%, p<0.01) rather
than to have used the services of an ama-
teur or to have performed the procedure
on themselves.
Medical complications
Table III shows that skin irritation is the
most frequent health complication reported
(19%) among tattooed teens, followed by
unusual bleeding (10.1%). In the case of
body piercing, infection at the site is the
more prevalent complication (45.8%) and
the second one is skin irritation (32%). Boys
are more likely than girls to report complica-
tions in most documented categories.
Aftercare instructions
Most tattooed (92.9%) or pierced (95.0%)
students indicate that they received some
aftercare instructions following the proce-
dure. More specifically, 56.6% of those
with tattoos and 46.2% of those with body
piercing received both verbal and written
instructions concerning the care of their
tattoo or piercing. These proportions are
higher among girls than among boys (tat-
too: 64.2% vs. 43.3%, p<0.01; body pierc-
ing: 48.3% vs. 37.8%, p<0.05).
TATTOOING AND BODY PIERCING AMONG HS STUDENTS
326 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 97, NO. 4
TABLE I
Prevalence of Tattooing and Body Piercing, by Gender and by Age Groups
Tattooing Body Piercing
% p-value % p-value
Gender Girls (n=1,077) 9.8 <0.001* 43.7 <0.001*
Boys (n=1,068) 5.6 10.6
Total (n=2,145) 7.7 27.3
Age Groups (years) 12 to 13 (n=557) 3.8 <0.001† 19.3 <0.001†
14 to 15 (n=876) 6.1 26.7
16 to 18 (n=712) 12.9 34.0
* p-values are shown for the comparison between girls and boys.
† p-values are shown for the comparison between age groups.
DISCUSSION
Body modification practices are frequent in
the general high school population of
Eastern Quebec. To our knowledge, these
are the first data available in Canada for a
general adolescent population. They are
identical to the results obtained by Carroll
et al.
10
for older youth aged 12 to 22 who
attended a military clinic in California.
Prevalence of tattooing in our study is
slightly lower than that obtained by
Armstrong et al. in 1993 (9%)
11
and 1995
(10%)
12
for high school students, using the
same instrument. It does differ markedly,
however, from the prevalence found by
Roberts and Ryan (4.5%)
9
and Houghton et
al. (13.6%)
13
among high school students.
Our results confirm higher prevalence
rates for tattoos and body piercing among
young women and a greater frequency of
multiple tattoos among men.
10,25
Results
also show that tattoos and body piercing
increase with age, as was the case in other
studies.
10
Overall, the sites most often cho-
sen by adolescents for body piercing
(excluding the earlobes) are the navel and
upper ear, and some sites seem gender-
specific. The reasons for getting body
modification are mostly aesthetic and
identity-related in nature. This confirms
results from previous studies.
5,12,26
Most students with body modification
indicate that they used the services of a
“professional”. This result is similar to that
observed by Carroll et al.
10
but differs
greatly from the results obtained by
Houghton et al.
13
from a sample of high
school students in Australia, which
revealed that the majority of the tattooed
participants had self-administered tattoos.
The main complications associated with
tattooing and piercing were similar to
results obtained by Greif et al. for
American college students.
24
In our study,
boys were more likely than girls to resort to
an amateur or to do the procedure them-
selves and they reported more complica-
tions than girls in general.
Limitations
The population under study does not
include adolescents who have dropped out
of school, which may lead to a slight
underestimation of the practices as drop-
outs and street youth are proportionately
more likely to have undergone some body
modification.
27
Because results of the pre-
sent study rely on self-reports, some infor-
mation pertaining to medical complica-
tions or aftercare instructions may suffer
from a lack of precision. For example, as
suggested by Marcoux,
28
in many cases,
tattoos and body piercing are done in tat-
too parlors, by so-called “professionals”
(i.e., tattoo artists working in custom
shops), who may have limited knowledge
about sanitation standards, infection con-
trol and skin care procedures.
Concomitant to research data, information
about studios and parlors warrants further
study (artist qualifications, type of proce-
dures used, type of aftercare instructions
given, etc.), as do cases where health ser-
vices were sought out following body mod-
ification procedures. Moreover, the choices
presented to participants about their moti-
vation for getting a tattoo or a body pierc-
ing do not allow us to ascertain their true
meaning. It may be possible that “to be
different” refers to a form of aesthetic
expression for one respondent and a mark
of rebellion against authority for another.
As a structured survey does not allow for
the probing of deep information, qualita-
tive data would be necessary in the future
to better interpret these results.
Nevertheless, results show the diversity of
reasons that lead adolescents to desire body
modification and they most probably rep-
resent a quest for individuality within a
framework of conformity for some, and of
revolt for others.
26,29
CONCLUSION
The popularity of tattooing and piercing
warrants a more systematic documentation
of physical and psychosocial risks that may
be associated with them. The potential
health risks involved with skin piercing
procedures suggests the importance of set-
JULY – AUGUST 2006 CANADIAN JOURNAL OF PUBLIC HEALTH 327
TATTOOING AND BODY PIERCING AMONG HS STUDENTS
TABLE II
Frequencies (%) of Reasons Given by Tattooed or Pierced Students for Body Modification, by Gender
Tattooing Body Piercing
Reasons Girls Boys Total p-value* Girls Boys Total p-value*
(n=98) (n=57) (n=155) (n=446) (n=96) (n=542)
Beauty mark 33.3 35.1 34.0 n.s. 39.6 34.4 38.7 n.s.
To remember an event in my life 27.3 35.1 30.1 n.s. 28.2 21.9 27.1 n.s.
To be different 18.2 35.1 24.4 0.018 15.4 26.8 17.5 0.008
“Femininity/Masculinity” 17.3 28.1 21.3 n.s. 20.0 7.3 17.7 0.003
To feel independent 16.3 30.4 21.4 0.041 11.9 23.7 14.0 0.002
For luck 14.1 28.1 19.2 0.034 8.3 10.4 8.7 n.s.
“Someone forced me” 4.1 8.9 5.8 n.s. 0.7 9.3 2.2 <0.001
To be part of the group 1.0 8.8 3.8 0.015 3.8 7.2 4.4 n.s.
Sexual enhancement 1.0 8.8 3.8 0.015 5.6 17.7 7.7 <0.001
Other (“for the heck of it”, “I just wanted one”) 28.3 14.3 23.2 0.047 30.9 33.3 31.3 n.s.
* p-values are shown for the comparison between girls and boys.
TABLE III
Frequencies (%) of Complications Following a Tattoo or Body Piercing, by Gender
Tattooing Body Piercing
Complications Girls Boys Total p-value* Girls Boys Total p-value*
(n=94) (n=64) (n=158) (n=422) (n=99) (n=521)
Unusual bleeding 4.3 18.8 10.1 0.003 3.3 7.1 4.0 n.s.
Skin irritation at the site 16.0 21.9 19.0 n.s. 34.3 22.2 32.0 0.021
Infection at the site 3.2 12.5 7.0 0.024 46.9 41.4 45.8 n.s.
Allergy to the dye or metal 2.1 10.9 5.1 0.019 6.6 7.0 6.5 n.s.
Swollen glands several times close to the site 1.1 9.4 4.4 0.013 2.6 8.1 3.6 0.009
* p-values are shown for the comparison between girls and boys.
ting guidelines and educating artists and
operators.
2,16,22,30
In Canada, the Centre for
Infectious Disease Prevention and Control
(Health Canada)
14
has established guide-
lines describing procedural norms required
to prevent infectious disease in tattooing
and body piercing. However, at present,
no law regiments these practices, leaving
the door open to procedures that may
compromise adolescents’ health.
Health education measures aimed at
adolescents also need to be put in place in
order to prevent undesired consequences
among those wishing to experience body
modification.
3
These measures should
inform youth about potential health risks
associated with body modification and
about precautions that should be taken in
order to make an informed and safe deci-
sion (i.e., avoiding impulsive choices, clan-
destine studios, etc.). Education originat-
ing from well-informed health care profes-
sionals, free of prejudice towards tattooed
or pierced individuals, is essential to ensure
that these measures are appropriate for
youth.
1,8
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328 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 97, NO. 4
Appendix
Examples of questions on tattooing and body piercing
Tattooing and Body Piercing
1. Did you ever get a tattoo?
1. Yes
2. No If you answered NO, go to question 4.
2. How old were you when you got your first tattoo? ___________
3. How many tattoos do you have? ___________
4. Did you ever get a body piercing? (besides your earlobe)
1. Yes
2. No If you answered NO, go to question 8.
5. How old were you when you got your first body piercing? ___________
6. How many body piercings do you have? ___________
(Do not count those in your earlobe)
7. Where are your body piercings? Circle all answers that apply.
1. Eyebrow 5. Nipple
2. Nose 6. Navel
3. Lip 7. Genital organ
4. Tongue 8. Ears (besides your earlobe)
The following statements apply to tattoos and/or body piercing.
If you don’t have any tattoos or body piercing, go to question 12
8. Why did you get your first tattoo or body piercing?
(Check all the answers that apply)
Tattoo Body Piercing
A. To mark my femininity/masculinity
B. To feel independent
C. For no reason
D. I wanted one
E. Someone made me do it
F. For good luck
G. To remind me of an event in my life
H. As a beauty mark
I. To be different
J. To be part of a group
K. To increase stimulation and sensual pleasure
L. Other (please specify) ____________________________
RÉSUMÉ
Introduction : Le tatouage et le perçage corporel semblent de plus en plus populaires dans des
groupes sociaux très divers. Cependant, les études menées auprès de populations générales
d’adolescents sont encore rares. Notre étude vise à décrire ces pratiques de modification corporelle
et à établir leur prévalence chez des élèves du secondaire âgés de 12 à 18 ans.
Méthode : Les données proviennent de l’enquête transversale réalisée en 2002 auprès d’un
échantillon représentatif de 2 180 élèves inscrits dans les 23 écoles secondaires de la région de
l’Outaouais au Québec. L’échantillonnage a été réalisé de façon systématique à partir de la liste
complète des élèves de chaque école. Le taux de réponse était de 81 %. Les données spécifiques
sur le tatouage et le perçage corporel sont disponibles pour 2 145 élèves (taux de non-réponse
partielle de 1 %).
Résultats : Des prévalences de 27 % pour le perçage corporel et de 8 % pour le tatouage ont été
observées chez les élèves. Plusieurs différences existent selon le sexe, comme par exemple au
niveau du nombre de modifications. Bien que la plupart des adolescents affirment avoir fait faire
leur modification corporelle par un « professionnel » et avoir reçu de l’information sur les soins à
prendre, un pourcentage élevé d’élèves fait état de complications de santé après l’intervention.
Conclusion : Les résultats montrent que le tatouage et le perçage corporel sont fréquents chez les
adolescents, et qu’ils peuvent représenter un risque pour leur santé. Par conséquent, des mesures
préventives appropriées devraient être adoptées par les professionnels qui sont en contact avec les
jeunes (conseillers en milieu scolaire, infirmières, médecins et autres), de manière à les aider à faire
des choix éclairés sur la base d’informations valides.
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21. Pugatch D, Mileno M, Rich JD. Possible trans-
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1 from body piercing. Clin Infect Dis
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22. Brathwaite RL, Stephens T, Sterk C, Brathwaite
K. Risks associated with tattooing and body
piercing. J Public Health Pol 1999;20(4):459-70.
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News. 2002 Jan 8. Available online at:
http://www.aegis.com/news/bbc/2002/BB02010
4.html (Accessed February 18, 2004).
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body piercing: Body art practices among college
students. Clin Nurs Res 1999;8:368-85.
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28. Marcoux D. Regard sur l’apparence et les modes
corporelles à l’adolescence. Le Clinicien
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Received: June 2, 2005
Accepted: March 5, 2006
JULY – AUGUST 2006 CANADIAN JOURNAL OF PUBLIC HEALTH 329
TATTOOING AND BODY PIERCING AMONG HS STUDENTS
Book Reviews/Recension
Public Health: Past, Present and Future. Celebrating Academic Public Health in
Edinburgh, 1902-2002
Raj Bhopal and John Last (Eds.), Norwich, UK: The Stationery Office (Nuffield
Trust), 2004
The celebration of 100 years of academic public health at the University of Edinburgh
brought together approximately 330 participants with 17 contributors. The output from
this meeting is the content of this book. There are three sections, as noted in the title.
The discussion of the development of Edinburgh and the effects of these developments
on the health of the inhabitants speaks to the interactions of crowding, poor sanitation,
poverty and poor health care on morbidity and mortality. The section on the past also out-
lines the roles that medical officers of health played in bringing about the changes neces-
sary to improve the lot of the citizenry. I enjoyed the historic reviews that comprised the
first five chapters. There was considerable overlap and repetition of the material, but it
clearly demonstrated the interactions that occur in public health.
The next six chapters were less informative as the authors discussed issues that are cur-
rently being debated in public health circles. At times, these issues would have been better
informed by the review of the past and the observations made on the past interactions of
health and the environmental social and economic conditions that are relevant today.
Nevertheless the issue of increasing emphasis on healthy survival, the continuing risk of
communicable disease (much less than in the past but not entirely defeated) and the roles
of statistics and social sciences summarized the contribution of the University of
Edinburgh in these areas.
The three chapters on the future of public health include the role of genomics, legisla-
tion and public health practice. As “looks into the future”, these were necessarily less evi-
dence based.
As a light read, especially for graduates of the University of Edinburgh and particularly
the Department of Public Health and the Usher Institute, this book could be worthwhile.
Generally speaking I cannot recommend this book for the average reader unless there is a
strong interest in history and/or in the University of Edinburgh.
Richard Mathias, Professor
Getnet Asrat, Clinical Fellow
Dept. of Health Care and Epidemiology
University of British Columbia
...continues page 341
