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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). 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). 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. 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.
Prevalence and Characteristics of
Body Piercing and Tattooing
Among High School Students
Marthe Deschesnes, PhD
Stéphanie Demers,
Philippe Finès,
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
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
Today, these practices are per-
ceived by many as adornment or artwork,
while others categorize them as deviant
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.
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%.
American study of body piercing identified
a prevalence of 27%.
Literature pertaining to the medical
complications of body piercing and tattoo-
ing remains relatively scant.
Complications arising from body piercing
and tattooing are mostly limited to case
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.
piercing has also been associated with bac-
terial infections,
bleeding, skin tissue
tearing, hypertrophic scars, dermatitis and
Many authors recognize
tattooing and body piercing as possible
vectors for the transmission of blood-borne
diseases such as hepatitis B, hepatitis C or
A 1999 United Kingdom sur-
vey of family practitioners showed that
95% of them have seen patients with com-
plications resulting from a piercing.
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.
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,
Acknowledgements: This study was conducted through a grant from the Public Health Grant Program
of the Quebec Ministry of Health and Social Services.
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.
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.
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-
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
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
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).
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.
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.
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%)
and 1995
for high school students, using the
same instrument. It does differ markedly,
however, from the prevalence found by
Roberts and Ryan (4.5%)
and Houghton et
al. (13.6%)
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.
also show that tattoos and body piercing
increase with age, as was the case in other
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.
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.
but differs
greatly from the results obtained by
Houghton et al.
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.
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.
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
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,
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.
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-
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.
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
In Canada, the Centre for
Infectious Disease Prevention and Control
(Health Canada)
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
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
1. McCormack-Brown K, Perlmutter P,
McDermott R. Youth and tattoos: What school
health personnel should know. J Sch Health
2. Stirn A. Body piercing: Medical consequences
and psychological motivations. Lancet
3. Peate I. Body piercing: Could you answer your
patient’s queries? Br J Nurs 2000;20:2163-69.
4. Armstrong M, Kelly L. Tattooing, body piercing,
and branding are on the rise: Perspectives for
school nurses. J Sch Nurs 2001;17:12-23.
5. Sweetman P. Anchoring the (postmodern) self?
Body modification, fashion and identity. Body
Soc 1999;5:51-76.
6. Fisher JA. Tattooing the body, marking culture.
Body and Society 2002;8:91-107.
7. Rouers B. Perçage et autres modifications cor-
porelles en Occident : de la revendication du
rituel à l’interprétation par le rite. Organdi Q
8. Armstrong M, Owen DC, Roberts AE, Koch JR.
College students and tattoos: Influence of image,
identity, family, and friends. J Psychosoc Nurs
Ment Health Serv 2002;40(10):20-29.
9. Roberts TA, Ryan SA. Tattooing and high-risk
behavior in adolescents. Pediatrics
10. Carroll ST, Riffenburgh RH, Roberts TA, Myhe
EB. Tattoos and body piercing as indicators of
adolescent risk-taking behaviors. Pediatrics
11. Armstrong ML, McConnell C. Tattooing in ado-
lescents: More common than you think. J Sch
Nurs 1994;101:26-33.
12. Armstrong ML, Pace Murphy K. Tattooing:
Another adolescent risk behavior warranting
health education. Appl Nurs Res 1997;10:181-89.
13. Houghton S, Durkin K, Parry E, Turbett Y,
Odgers P. Amateur tattooing practices and beliefs
among high school adolescents. J Adolesc Health
14. Santé Canada. Pratiques de prévention des infec-
tions dans les services personnels : tatouage,
perçage des oreilles, perçage corporel et électro-
lyse. Relevé des maladies transmissibles au Canada
25s3. Laboratoire de lutte contre la maladie,
bureau des maladies infectieuses. Ottawa, 1999.
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) ____________________________ 
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.
15. Samantha S, Tweeten M, Rickman LS.
Infectious complications of body piercing. Clin
Infect Dis 1998;265:735-40.
16. Stewart C. Body piercing: Dangerous decora-
tion? Emerg Med 2000;32(2):92-102.
17. Haley RW, Fisher RP. Commercial tattooing as
a potentially important source of hepatitis C
infection. Clinical epidemiology of 626 consecu-
tive patients unaware of their hepatitis C serolog-
ic status. Medicine 2001;80(2):134-51.
18. Tweeten SS, Rickman LS. Infectious complica-
tions of body piercing. Clin Infect Dis
19. Long GE, Rickman LS. Infectious complications
of tattoos. Clin Infect Dis 1994;18:610-19.
20. Hayes MO, Harkness GA. Body piercing as a
risk factor for viral hepatitis: An integrative
research review. Am J Infect Control
21. Pugatch D, Mileno M, Rich JD. Possible trans-
mission of human immunodeficiency virus type
1 from body piercing. Clin Infect Dis
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.
23. AEGiS. Piercing problems for ‘one in five’. BBC
News. 2002 Jan 8. Available online at:
4.html (Accessed February 18, 2004).
24. Greif J, Hewitt W, Armstrong M. Tattooing and
body piercing: Body art practices among college
students. Clin Nurs Res 1999;8:368-85.
25. Brooks TL, Woods ER, Knight JR, Shrier LA.
Body modification and substance use in adoles-
cents: Is there a link? J Adolesc Health
26. Beauregard JA. Embodied identities: College
women’s perspectives on body piercing using
developmental models of psychology (disserta-
tion doctorale). Fairfax, VA: George Mason
University, 2001.
27. Roy E, Haley N, Leclerc P, Boivin JF. Risk fac-
tors for hepatitis C virus infection among street
youths. CMAJ 2001;165(5):557-60.
28. Marcoux D. Regard sur l’apparence et les modes
corporelles à l’adolescence. Le Clinicien
29. Atkinson M. Pretty in ink: Conformity, resis-
tance, and negotiation in women’s tattooing. Sex
Roles 2002;47(5/6):219-35.
30. Armstrong M, Fell PR. Body Art: Regulatory
issues and the NEHA Body Art Model Code.
J Environ Health 2000;62(9):25-30.
Received: June 2, 2005
Accepted: March 5, 2006
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
... [1][2][3] Prevalence of tattooing in these age groups vary by country and setting, ranging from 1to 24%. [4][5][6][7][8][9][10][11][12][13][14][15][16] Unfortunately, with this higher demand, the number of unprofessional tattooists has increased creating more complications due to frequent procedures carried out without any knowledge of health and hygiene rules. 12,13 Evidence showed that tattooed individuals have a higher risk of being infected by blood-borne viruses, including hepatitis B and C, HIV. ...
... Sample size was calculated based on the formula: 4PQ/L 2 , where, prevalence of tattoo was 8%, absolute allowable error taken as 2% at 95% confidence level and a design effect of 1.5 and a non-response rate of 20%, the final estimated sample size come to 1325. 16 Stratified two -stage cluster sampling with probability proportionate to size was used to select a representative sample. For this study, clusters identified were institutions providing higher secondary education. ...
... Most of the previous studies are predominantly among adolescents and young adults of western countries and the prevalence of tattooing ranges from 3-24%. [5][6][7][8][9][10][11][12][13][14][15][16] From the study result, it shows 185(13%) ...
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Background: Tattooing has emerged as common activity among adolescents. Therefore, it is important to informed adolescents about possible health hazards associated with it. The objective of the study was to determine the prevalence of tattooing and knowledge of health risks associated with it among higher secondary students and association between knowledge on risk factors with selected socio-demographic variables.Methods: A cross-sectional study was conducted from September to October 2015 among 1325 students studying in class XI and XII in Thoubal district of Manipur in Northeast India. A self-administered questionnaire was used for data collection. Based on the obtained score, knowledge was divided into adequate and inadequate. Descriptive statistics like mean (SD) and percentages were used. Chi-square test was used for testing the significance and p<0.05 was considered as statistically significant.Results: Total of 1378 students participated in the study. Almost all the students (99.5%) have heard of tattoo but only 75 of them (5.5%) had ever tattooed. Majority (87%) of the students had inadequate knowledge. Ever tattooed was more among male students compared to female. There was significant association between adequate knowledge and male students, parents who had secondary and above education. Significant association was found among those who had adequate knowledge and risk of transmission of disease through tattooing.Conclusions: Prevalence of ever tattooed was 5.5%. Though majority of the participants had heard of tattoo but most of them had inadequate knowledge about health risk associated with tattooing.
... Deschesnes et al observed unusual bleeding, local skin irritation, local infection, dye allergy and swollen glands near to the site. 63 Grodner et al found complications in 6.6% of tattoos (oedema, pruritus, allergy, local infection and Koebner phenomenon). 64 Overall complication rate in psoriasis patients after tattooing was low, but complications were most likely in patients who underwent tattooing after psoriasis onset and while undergoing treatment. ...
Background Tattoos were historically associated with deviant behaviours or religious and other social purposes, but in the last decades, they have gained increasing popularity and have become a mainstream. The aim of this systematic review is to assess the literature evidence about decorative tattoos complications, considering both infective and non-infective risks. Methods This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We searched the following electronic bibliographic databases: PubMed, Scopus and Web of Science (science and social science citation index). Results The literature search resulted in 6473 studies. A total of 207 full articles were considered potentially relevant and were reviewed independently by researchers. After full-text evaluation, 152 of 207 articles were excluded, as they did not meet selection criteria. The remaining 55 studies were included in the systematic review and their quality assessment was performed. Ten studies reported microbiological complications, 37 reported non-microbiological effects and eight reported either microbiological and non-microbiological complications. Conclusions Several well-known and uncommon risks are associated with tattooing and tattoo after-care. Public health authorities could take into account health education programmes for tattooists and customers in order to prevent health complications in people with tattoos. PROSPERO registration number CRD42020177972.
... The resent studies carried out in different parts of the world point out that there are more similarities than differences between their tattooed and non-tattooed participants. Therefore, one can conclude that tattoos are becoming a part of our mainstream culture (Antoszewski, Sitek, Fijałkowska, Kasielska & Kruk-Jeromin, 2016;Armstrong, Owen, Roberts & Koch, 2002;Armstrong, Roberts, Koch, Saunders, Owen & Anderson, 2008;Armstrong, Stuppy, Gabriel & Anderson, 1996;Broussard & Harton, 2017;Claes, Vandereycken & Vertommen, 2005;Daniszewska, 2012;Deschesnes, Demers & Fines, 2006;Jaworska, Fijałkowska & Antoszewski, 2018;Pajor, Broniarczyk-Dyła & Świtalska, 2015;Swami, Gaughan, Tran, Kuhlmann, Stieger & Voracek, 2015;Swami, Tran, Kuhlmann, Stieger, Gaughan & Voracek, 2008;Tate & Shelton, 2008;Zeiler & Kasten, 2016;Naude, Jordaan & Bergh, 2017). ...
... Tattooing especially gains popularity among both men and women in adulthood from the wide range of socioeconomic groups. It is noted as a risk taking behaviour in adults mainly for aesthetic reasons [2][3][4][5][6][7][8][9][10]. Tattooing involves piercing of the skin by the use of sharp instruments and inking the skin with one or more pigments to form a permanent design. ...
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Introduction: Tattooing especially gains popularity among both men and women in adulthood from the wide range of socioeconomic groups and is noted as a risk taking behaviour in adults. Especially when tattooing does not perform to the highest standards, it can potentially be the hazardous practice. Myanmar has a paucity of evidence-based information on the estimated prevalence of tattoos and awareness of potential disease transmission from tattooing under insanitary conditions as well as the infection risk. The present research was undertaken to help identify the self-reported prevalence of tattooing among adults (18-35 years) and their knowledge of transmission risk of blood-borne infections and its determinants. Methods: A community-based cross-sectional study focused on residents aged 18-35 years was carried out in two urban and two rural areas in Mandalay district, Mandalay Region during 2015. Trained interviewers used a pre-tested structured questionnaire for face-to-face interviews with one eligible participant per selected household (n = 401). Bivariate analysis and multivariable analysis using binary logistic regression were done to ascertain the relevant explanatory variables. Results: The overall self-reported prevalence of tattooing was 19.5% (78/401) (95% CI = 16-24). Nearly 80% of participants (318/401) knew at least one blood-borne viral infection that could be transmitted from tattooing. The persons who had high formal education, manual laborers and those who lived with their families were significantly more likely to cite at least one blood-borne viral infection. Their perceived possibility to remove tattoo independently influenced the practice of tattooing (aOR = 1.91, 95% CI = 1.06-3.45; p = 0.03) compared with participants who reported no perceived possibility. Tattooing was more common in male (aOR = 13.07, 95% CI = 6.25-27.33; p<0.001) compared to female which was independently significant. Conclusions: This study ascertained the tattoo prevalence as two in ten adults of working age especially among male in central part of Myanmar in the context of lack of registration system for tattoo parlours and the issuance of safety guidelines. Findings have suggested the target groups and risk factors to be included in future health promotion programs. Future research directions should focus on perspectives of tattooists to create and sustain the sanitary practices to reduce the chance of transmission of blood-borne viral infections.
... Also, instruments, equipment, wound dressing, all may act as sources of infection as a result of contamination from blood and blood products (16,20) . Results from epidemiologic studies regarding the risk of viral infections among tattooed individuals are conflicting (21,22) , therefore, this study also tried to investigate the relationship between TTV infection and tattoo in order to determine the risk of transmission of TTV infection. The present study didn't find any association between history of tattooing and TTV infection in all study groups (P > 0.05), these findings are consistent with a previous study in Japan (17) . ...
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Background: Several lines of evidence have suggested the presence of new hepatitis agents, in addition to established hepatitis viruses A-E. Torque Teno virus (TTV) was more prevalent in patients with hepatitis, so it was thought to have hepatotropic properties. Objective:To detect TTV Ag in apparently healthy blood donors and patients infected with chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) by enzyme linked immunosorbent assay (ELISA) technique. Also, to find out any possible association between the study population demographic data and TTV status. Methods: This study was conducted from the beginning of November, 2017 to the end of March, 2018. Serum samples were collected from 50 patients who had chronic hepatitis HBV or HCV and attended to Gastroenterology and Hepatology Teaching Hospital. Also, sera were collected from a total 43 healthy blood donors from the Blood Donation Center in Al-Imamein Al-Kadhimein Medical City. The clinical characteristics of both patients and controls such as alanine transaminase (ALT), aspartate transaminase (AST), hepatitis C virus antibody (HCV-Ab), hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) were obtained from hospital records. Serum samples were tested by ELISA technique for detection of TTV Ag. Results: TTV was detected in 89.2% (33 out of 37) of the HBV-positive patients and in 30.8% (4 out of 13) of the HCV-positive patients versus 23.3% of the healthy blood donor (10 out of 43). Results of this study showed that the prevalence of TTV in HBV patients is significantly higher than HCV patients and healthy blood donors. Concerning risk factors, it was found that there was statistically significant relationship between TTV positivity and mean level of ALT but results indicated that the presence of TTV was not associated with AST, sex, age and history of transfusion, surgery and tattooing. Conclusion: TTV may play a role in hepatitis and its presence was associated with biochemical signs of liver disease, and among patients infected with chronic HBV or HCV. Keywords: Torque Teno virus, hepatitis B virus, hepatitis C virus, healthy blood donors.
Objective Body piercing is defined as the penetration of jewellery into openings made in different body areas. In the last decades, it has become increasingly common in the general population. The aim is to analyse the available literature about complications from body piercing for contributing to raise the awareness towards this issue and to plan and perform appropriate prevention interventions. Study design This is a systematic review. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform this systematic review; the protocol was registered with PROSPERO [CRD42020177972]. PubMed, Scopus and Web of Science were searched from database inception to April 2020, and articles in English language reporting a proven association between piercings and health risks were included, and their quality were assessed by adequate quality assessment tools. Results A total of 4748 studies were found, and after duplicates removal and screening, 84 articles were included. Studies dealing with microbiological effects reported these complications both locally and at distant sites as a result of the spreading of the primary site infection: mastitis, endocarditis, glomerulonephritis, cephalic tetanus, viral hepatitis, HIV, cerebellar brain abscess and toxic shock syndrome. In addition, bleeding, gingival recession, dental injuries, contact dermatitis, granulomatous dermatitis, keloid, fibroma and basal cell carcinoma were reported. Conclusions Health authorities should promote educational campaigns to spread the knowledge on health risks related to piercings. Besides, piercers are often not adequately aware of all the possible adverse effects due to piercings because their professional training differs among countries. It is therefore advisable to provide periodical upgrade of their education in this field.
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Although tattoos have been historically characteristic of criminals and drug addicts therefore carrying negative associations, it is now an accepted and appreciated form of body modification. Tattoos could be considered as a projective psychological test, most people use their body as blackboard to represent the most varied meanings related to the way they perceive themselves. It is also true that tattoos can assume the role of diagnostic indicators for a possible abuse of psychoactive substances, as well as their aggregating and communicative functions within the group of drug addicts. The aim of this cross-sectional study was to explore the relation among personality traits, self-efficacy, locus of control and motivations for tattooing. The sample consisted of 150 subjects , 50 tattooed adults, 50 tattooed drug addicted adults, and 50 non-tattooed adults. Data were collected by using the Big Five Questionnaire (BFQ), the Perceived Self-efficacy Test, the Mini Locus of Control scale and a Tattoos Inventory. Results of the present study contribute to a deeper understanding of the new meaning of tattoos, they no longer represent personality traits, they rather have the function of reinforcing beliefs about how to perceive oneself, this happens especially in drug addicts in which the presence of tattoos reinforces the illusory belief of self-esteem and internal locus of control. Given the rising presence of tattoos today, this could be useful to get a better understanding of the existential unease of certain populations.
Résumé Cette étude descriptive transversale et rétrospective a été réalisée avec un volet quantitatif et qualitatif sur les cicatrices pathologiques apparues après un deuxième piercing auriculaire à but esthétique dans une population négroïde de sexe féminin issue d’une zone endémique de chéloïdes. Sur une période de 10 ans (du 1er janvier 2010 au 31 décembre 2019), 172 patientes ont consulté pour des cicatrices pathologiques auriculaires après un deuxième piercing à but esthétique, dont 65,7 % d’étudiantes et 22,1 % d’élèves. Cliniquement, 143 patientes (83,1 %) présentaient des chéloïdes et 29 (16,9 %) des cicatrices hypertrophiques. L’âge moyen du deuxième piercing était de 22,62 ans ; 98 patientes (57 %) avaient des lésions uniques sur l’oreille percée et 74 (43 %) des lésions multiples ; 168 (97,7 %) n’avaient pas d’antécédents familiaux de cicatrices pathologiques. Nos patientes, originaires d’une zone endémique de chéloïdes, n’ont pas développé de cicatrices pathologiques lors du premier piercing dans l’enfance, mais en ont toutes présentées après le deuxième piercing. Plusieurs facteurs de risque peuvent être incriminés : hérédité, environnement, race, âge, genre, port de bijoux de mauvaise qualité, infection, dérèglement du processus de cicatrisation occasionné par le premier piercing, tension mécanique par le nouvel objet d’ornement. Mais aucune de ces hypothèses n’a pu être vérifiée. Au vu de ces résultats, nous déconseillons un deuxième piercing auriculaire à but esthétique chez les sujets négroïdes à risque, originaires des zones de forte endémie chéloïdienne.
Piercing Applications among High School Students ÖZ Amaç: ‹ngilizce'de "delmek" anlam›na gelen "piercing (pirsing)"cilt, cilt alt› tabakas›n›n ya da k›k›rda¤›n delinmesi ile vücuda tak› tak›lmas›d›r. Gençler aras›nda moda olan pirsing, cinsel organ dahil vücudun her bölgesine yap›labilmekte-dir. Pirsing uygulamalar›n›n, kafl ya da kulakta sinir zedelenmesi, Hepatit B ve C, HIV, tetanoz baflta olmak üzere bir çok hastal›¤a neden oldu¤u belirtilmektedir. Yöntem: Adolesanlar›n pirsing ile ilgili bilgi ve uygulamalar›n› belirlemek amac› ile tan›mlay›c› olarak gerçeklefltirilen araflt›rman›n verileri, araflt›rmac›lar taraf›ndan oluflturulan soru formu ile ‹stanbul'da rastgele belirlenen 7 lisede ö¤renim gören 1726 ö¤renciden elde edildi. Veriler SPSS 11.0 program›nda frekans da¤›l›m, yüzdelik ve ki-kare testleri ile de¤erlendirildi. Bulgular: Ö¤rencilerin; yafl ortalamas›n›n 17.2±0.6 y›l, % 87.5'inin k›z oldu¤u, %82.6's›n›n uygulama riskleri hakk›nda bilgi sahibi olmad›¤›, %16.6's›n›n (287 ö¤renci) pirsing yapt›rd›¤›, yapt›rmayanlar›n (1439 kifli) %14.2'sinin yapt›rmay› düflündü¤ü saptand›. Ö¤rencilerin; kulak (%88.5), burun (%10.5), göbek (%7.7), dudak (%4.9), cinsel organ ve meme ucu (%4.2), kafl (%3.5), dil (%2.1) gibi bölgelerine pirsing yapt›rd›klar›, arkadafl (%66.1), aile üyesi (19.6) ve sanatç›lar› (%14.3) örnek ald›klar› belirlendi. Uygulama s›ras›nda steril i¤ne kullan›lmad›¤›n› belirtenlerin oran› %28.2, riskleri hakk›nda bilgi verilmedi¤ini belirtenlerin oran› %78.0 idi. Araflt›rmaya kat›lanlar›n ço¤unlu¤u (%66.9) tekrar pirsing yapt›rmay› düflündü¤ünü ifade etti. Sonuç: Ö¤rencilerin pirsing riskleri konusunda bilgilerinin yeterli olmad›¤›, ço¤unlukla kula¤a pirsing yapt›rd›klar›, e¤itim düzeyi ve gelir durumu yüksek olan ailelerde pirsing uygulamalar›n›n daha fazla oldu¤u saptand›. Her ortamda görev yapan, toplumun sa¤l›¤›n›n korunmas› ve gelifltirilmesinde önemli yeri olan hemflirelerin, gençlere, ailelere ve ö¤retmenlere pirsing ve riskleri konusunda e¤itim yapmas› önerilebilir. Anahtar Kelimeler: Piercing, adolesan, riskli davran›fllar, hemflirelik. ABSTRACT Purpose: It is a fashion among teens and can be applied to any part of the body, including genital organs. It is well known that piercing may cause to nerve damage in eyebrow and ear, and diseases like Hepatitis B, C, HIV, Tetanus. Method: This descriptive research is done to define adolescent's knowledge level on piercing. Data was derived out of 7 randomly selected high schools in Istanbul from 1726 students. The data evaluated by the persentages ve Chi-Square statistical methods in SPSS 11.0 Programme. Results: Students average ages are 17.2±0.6 years old, 87.5 % female, 82.6 % don't have an idea about the risks of having a piercing, 16.6% had piercing. Students mostly have their body pierced on, ears (88.5 %), nose (10.5%), navel (7.7%), lips (4.9%), genital organ and nipples (4.2%), eyebrows (3.5%), tongue (2.1%), and that they have inspired from their friends (66.1%), family members (19.6%), and artists (14.3%). Students emphasized that during the application non sterile pins are used (28.2%), they have not informed about the procedure (78%), and most of the students (66.9%) think to do it again. Conclusion: Students' knowledge about the risks of piercing was not sufficient. Generally, they had piercing on the ear and piercing was more common in the families who had higher education and higher income level. It is suggested that nurses who work in different environments and have important roles in the health promotion and prevention in the community should give information to youth, their families and teachers about piercing and its risks.
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The popularity of body art, especially of invasive tattooing and body piercing procedures, has prompted safety concerns, The four primary areas of concern are (1) the equipment and associated materials, (2) the artists' education, (3) the physical environments where body art is performed, and (dr) the paucity of regulations and enforcement associated with the procedures. (Approximately half the states in this country have tattooing regulations. A few states have regulations for body piercing.) To address these concerns, a 21-member expert committee Ras formed under the auspices of NEHA, This committee, which assumed a leading role by creating a Body Art Model Code, comprised environmental and public health professionals: representatives from three body art organizations; and physicians: nurses, health educators, and individuals from relevant federal agencies. The Model Code is designed to serve as a professional advisory document for health officials who wish to regulate the body art industry in their jurisdictions, It also establishes public health criteria and recommendations for operators so that they can safely provide body art services to the general public.
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Adolescents are obtaining tattoos, yet professionals in medical and sociological fields attribute it mostly to gang affiliation. Further information about this at-risk behavior is needed so school nurses can plan and implement applicable health promotion strategies. A total of 642 adolescents from five suburban high schools and one large urban school district in Texas participated in this study. Tattooed adolescents (N = 105) described their decisions, events, and experiences before, during, and after the tattoo procedure so purchase, possession, and health-risk factors could be examined. Over one-third of the non-tattooed adolescents are considering tattooing in the future.
Recent years have seen a considerable resurgence in the popularity of tattooing and piercing, a development that some have dismissed as a fashionable trend. Others have argued that the relative permanence of such forms of body modification militates against their full absorption into the fashion system. Drawing on interviews with a variety of body modifiers, the article examines this debate, and notes that certain tattooees and piercees appear, in some respects, to regard their tattoos and piercings as decorative accessories. At the same time, however, such corporeal artifacts are approached and experienced as distinct from other, more free-floating products in the `supermarket of style'. Whether or not their meaning is fixed in these terms, tattoos and piercings are employed by some as a form of anti-fashion and as a way of fixing or anchoring the reflexively constructed self. In this sense they share both affinities and differences with other forms of contemporary body project.
This article examines the complex relationship between power and the physical and social practices of tattooing in contemporary United States. Briefly tracing the history of tattooing from ancient Greece to contemporary America, I highlight the temporal and geographical changes in the practices and perceptions of tattooing. In addition to creating a historical narrative, I situate the sociocultural practice of tattooing the body for the tattooist and the `tattooee'. This investigation into body inscription serves as a means to elucidate the contemporary practice of tattooing as one that is simultaneously physical and social, with multiple levels of constructed meaning. Finally, I will explore how tattooing, as a form of body modification, can be analyzed as a form of resistance to or a symptom of a culture that has commodified the body.
Since the early 1990s, Canadian women have participated in tattooing in unprecedented numbers. These women are utilizing tattoo body projects (C. Shilling, 1993) to communicate a wide range of personal and cultural messages, and challenging the long-standing association between tattooing and masculinity. However, and perhaps more consequentially, women's tattoo projects express diverse sensibilities about femininity and the feminine body. For some Canadian women, contesting culturally established (N. Elias & J. Scotson, 1965) constructions of the female body is central in their tattoo body projects, whereas others participate in tattooing as an explicit form of consent to such constructions. In this paper, women's tattooing activities and their subsequent tattoo narratives are critically inspected as deeply gendered practices and discourses. I present participant observation and interview data on tattoo enthusiasm in Canada. The focus is directed toward the ways in which conformity to, resistance against, and the negotiation of established cultural ideas about femininity are equally embedded in women's tattooing. Drawing upon feminist theories about bodies (cf. S. Bordo, 1990; K. Davis, 1994; J. Price & M. Shildrick, 1999; S. Williams & G. Bendelow, 1998) and central tenets of process-sociology (N. Elias, 1991, 1994, 1996; N. Elias & J. Scotson, 1965), emphasis is given to how women employ tattooing as a communicative signifier of established and outsider constructions of femininity.
Typescript. Thesis (Ph. D.)--George Mason University, 2001. Includes bibliographical references (leaves 213-220). Vita: leaf 221.
Tattooing carries several medical risks, including the transmission of infectious diseases. We review the published literature on the transmission of hepatitis B virus, human immunodeficiency virus, Treponema pallidum, papillomavirus, Mycobacterium tuberculosis, and other organisms by tattooing. Education, through public health measures, should promote the prevention of infectious disease transmission. Particular populations who could benefit from education include prisoners, individuals involved with correctional facilities, youths, military personnel, and health care providers coming in contact with populations at risk for tattoos.
The objective of this research was to investigate the reasons, experiences, methods, and perceived health consequences of obtaining tattoos among a sample of Western Australian high school adolescents. Information pertaining to levels of health awareness and school social behavior were obtained. Data were gathered in two phases using a questionnaire and follow-up interviews. Findings revealed that over 13% of participants had acquired tattoos and that the majority had been self-administered with crude implements. Some participants identified possible methods of removal, with a small number having attempted removal, again using crude implements. Statistical analyses revealed a number of significant main effects for gender, age, and tattoo status on the dependent variables for health awareness and school social behavior.