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Tattoos and Piercings Go Mainstream, but Risks Continue

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June 12, 2006

Almost a fourth of men and women between age 18 and 50 currently sport a tattoo, and almost 15 percent have at least one body piercing, according to a survey from Northwestern University. Survey results were published in the June issue of the Journal of the American Academy of Dermatology.

Dr. Anne E. Laumann, associate professor of dermatology at the Feinberg School of Medicine, and colleagues conducted the study in 500 randomly selected people aged 18 to 50 from across the United States in 2004 to assess the prevalence of body art - tattoos and body piercing (other than soft earlobes) - and the medical complications and social risks associated with these activities.

WHO'S TATOOED?

Laumann and co-researcher Dr. Amy Derick, of the University of Chicago, found that year of birth was a predictive factor for tattoos: 36 percent of people aged 18 to 29; 24 percent of those aged 30 to 40; and only 15 percent of those aged 40 to 50 had tattoos.  Sixteen percent had obtained their first tattoo before age18.

People of lower educational status were more likely to have a tattoo and also more likely to have more than one tattoo than those of higher educational status.

Drinking alcohol and using recreational drugs were related to having tattoos. Over a third of ex-drinkers and a fourth of current drinkers had tattoos, as did almost 40 percent of those who have ever used recreational drugs and 60 percent of those who have been in jail for more than three days.

Tattoos were seen in all ethnic groups but were more common among those with Hispanic ancestry than among all other ethnic groups combined.

HEALTH EFFECTS OF TATTOOS

Only 13 percent of those with a tattoo reported any problems with healing during the first two weeks after the tattoo, and most of those individuals had had their procedure done outside of a professional tattoo parlor. Fewer than 2 percent reported any ongoing problems.

“Self-reported complications of tattooing were surprisingly rare, although whether there is an increased risk of hepatitis C and other blood-borne infectious diseases remains unclear,” Laumann said.

“The Centers for Disease Control says hepatitis C is not an issue, but tattooing clearly presents a mechanism for transmission. Other demographic features associated with tattoo prevalence are associated with hepatitis C risk as well. More data on this issue are needed,” Laumann said.

TATTOO REGRETS COMMON

About a quarter of study participants had regrets about their tattoo. About 5 percent had already covered a tattoo with a new tattoo and a further 17 percent said they were considering tattoo removal. Individuals who were younger than 18 when they were first tattooed were more likely than older persons to have regrets.

“These data indicate there is a sizeable population of persons interested in tattoo removal, and that supports ongoing research on pigment composition, labeling and removal methods,” Laumann said.

WHO'S PIERCED?

The researchers found that women accounted for almost three fourths of people with body piercings (not including earlobes); a third got their first piercing under the age of 18. Unlike in those with tattoos, the prevalence of body piercing did not vary by educational status or income level. However, as in those with tattoos, there was a strong association of piercing relative to alcohol and recreational drug use, jail time and lack of religious affiliation.

MEDICAL COMPLICATIONS OF PIERCING

Complications were very common with body piercing. About a fourth of those with body piercing reported complications, consisting mostly of minor skin infections, but the majority lasted longer or began later than three weeks.

Strikingly, in those with tongue, lip, or cheek piercings, a fourth had broken teeth attributed to their oral jewelry.

Prevalence of jewelry allergy increased with the number of piercings. While 12 percent of those never pierced reported a jewelry allergy, the reaction rate doubled to 25 percent among those with only soft ear lobe piercings, and was even higher - over 40 percent -- among those with soft ear lobe and body piercings.

LEGISLATION NEEDED?

Few states have effective regulation relating to body art, Laumann said, and up to three fourths of children younger than age 18 who have tattoos or body piercings did not ask permission of or even inform their parents.  Laumann noted that state regulations regarding tattooing and body piercing vary widely. The stringency of the regulations has increased in recent years, and a bill (SB927) regulating the tattoo and body piercing establishments in Illinois has recently passed both houses and is on the governor's desk for signature at this time.

“The real question is whether any hepatitis C association found is related to direct transmission of disease through the needle pricks or whether tattoos and body piercings are markers for other risky behaviors that lead to infection,” Laumann said. “We have documented that these associations continue to exist.”

This study was supported by grants from the Portes Center, administered though the Institute of Medicine of Chicago, and the Sage Foundation.