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Tattooing and Body Piercing: Body Art Practices Among College Students
Judith Greif, Walter Hewitt and Myrna L. Armstrong
Clin Nurs Res 1999; 8; 368
DOI: 10.1177/10547739922158368
The online version of this article can be found at:
http://cnr.sagepub.com/cgi/content/abstract/8/4/368

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CLINICAL
Greif
et al.NURSING
/ BODY ART
RESEARCH
PRACTICES
/ November 1999

Tattooing and body piercing are increasing, especially among college students. A
study of 766 tattooed and/or body-pierced college students in 18 universities
across the United States and one in Australia was conducted to discover the
demographic characteristics, motivational factors, and health concerns. The traditional college time of 18 to 22 years of age (69%) was when they obtained their
tattoo (73%) and/or body piercing (63%). More frequent health problems and impulsive decision making were noted for those with body piercing when compared
to those tattooed. Three cases of hepatitis were reported. Health professionals
should openly discuss body art with students, convey a nonjudgmental attitude,
and assist with informed decision-making information to either reduce risks or
dissuade. Open communication and applicable health education will be very
important.

Tattooing and Body Piercing


Body Art Practices Among College Students

JUDITH GREIF
WALTER HEWITT
Rutgers University Health Service

MYRNA L. ARMSTRONG
Texas Tech University Health Sciences Center

Body art, specifically tattooing and body piercing, has been practiced in almost every culture around the world, and for thousands of years. Tattoos are now being reported on archaeological findings including a 2,400-year-old Russian mummy with a
tattoo still clearly visible on her biceps (Polosmak, 1994). Royalty, especially the name of Queen Victoria, is frequently mentioned as having had a tattoo, and her consort, Prince Albert, is
Authors Note: We gratefully acknowledge the thoughtful review of Janet K.
Bundy, M.S., R.N. C.I.C., Dr.PH(c); also, services of Judy Soncrant, project
manager, and Dawn Wald, supervisor, computer services, and the late Rita Puritz, administrative assistant, Rutgers University.
CLINICAL NURSING RESEARCH, Vol. 8 No. 4, November 1999 368-385
1999 Sage Publications, Inc.

368

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Greif et al. / BODY ART PRACTICES

369

said to have had a penile piercing through his urethra (Greif &
Hewitt, 1998). Anthropologists describe body art or modification as a way of identifying oneself as being a part of a specific
group, whether a religious group, a tribe, or gang; of denoting
ones financial or marital status; or even as a way of beautifying
the body (Myers, 1992; Saunders, 1989). Many, from pirates to
Roman Centurions, have had body piercingssometimes symbolizing royalty, bravery, virility, or as a rite of passage. Yet in
Western culture, tattooing and piercing often have been considered taboo, perhaps stemming from the Bibles Old Testament citing in Leviticus 19:28 and Deuteronomy 14:1 that prohibits the marking of ones flesh in celebration of other gods.
Today, both genders are almost equally represented in
obtaining tattoos and body piercing. This description includes
both adults and adolescents from a wide range of occupations
and socioeconomic groups (Anderson, 1992; Armstrong, 1991;
Armstrong, Ekmark, & Brooks, 1995). Between 7 million and
20 million adults are reported to be tattooed. Armstrong and
Pace Murphy (1997) reported 1 in every 10 adolescents are tattooed, and Sperry provided an even higher estimate of 25% of
all 15- to 25-year-olds being tattooed (quoted in OHara, 1995).
Websters Dictionary (1993) defines the word tattoo, from the
Tahitian term, tatu, as an indelible mark or figure fixed upon
the body by the insertion of pigment under the skin or by the
production of scars (p. 1207). Today, that is often accomplished in a studio by artists using a rapid-injecting electrical
device that delivers a uniform series of punctures into the dermal layer of the skin (Greif & Hewitt, 1998). The pigment for the
tattoo is injected into the skin 50 to 3,000 times per minute up
to, or into the dermis at a depth of 1/64 to 1/16 of an inch
(Armstrong, 1991, p. 216). Although many of the ingredients in
tattoo pigments were approved as cosmetics for topical use by
the FDA in 1938, they have not been approved for invasive procedures, with some pigments containing lead, mercury, and
trace amounts of arsenic (Tope, 1995). In addition, many of
these tattoo pigments do not contain standardized ingredients.
This lack of purity and identity can prevent effective results if
the tattoo recipients change their mind about the tattoo and
want it removed (Anderson, 1992). Although almost all tattoos
can be lightened, Q-switched laser treatment truly clears only
about [70%] and some inks have proven to be resistant to laser

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CLINICAL NURSING RESEARCH / November 1999

treatment, particularly dark green and yellow varieties (Armstrong, Stuppy, Gabriel, & Anderson, 1996, p. 415).
Piercing involves the insertion of a needle into various areas
of the body to create an opening through which decorative
ornaments such as jewelry may be worn (Greif & Hewitt, 1998,
p. 26). The procedure only takes a few minutes to perform and
is frequently done on body areas such as the ears, nose, eyebrows, lips, tongue, nipples, naval, and genitals. Specific jewelry (surgical-grade stainless steel or solid 14-karat yellow
gold, niobium, or titanium) is strongly recommended for insertion into the opening to avoid allergic and infectious responses.
Most body piercing is performed in tattoo studios; unfortunately it is also self-inflicted and done in temporary establishments such as flea markets, rock concerts, and college parties
as part of the entertainment. Gauntlet, an international chain
of body piercing shops in California, New York, and Paris,
reports at least 30,000 piercings each year (Michaela Grey, personal communication, June 17, 1997). Statistics on the
amount of body piercing done is difficult to determine as the
procedure lacks the permanency of tattooing; if the person
doesnt like the piercing, they can remove the jewelry and the
hole will close. Then, other than the frequent formation of scar
tissue at the site, no one knows of their previous piercing
actions.
Tattooing and body piercing are still primarily an artistconsumer regulated business (Armstrong, 1991). Many states
(N = 27) do not have any regulations for tattooing (Tope, 1995)
and few states (N = 5) have statutes for body piercing (Armstrong & Fell, in press). If there are regulations, enforcement is
of concern as most local and state health departments prioritize inspections; those with complaints are reviewed and those
with no complaints are often left alone (Armstrong & Pace Murphy, 1997). Thus, the customer must have knowledge of the
health concerns and risks for safe practice of body art.
In general, for the amount of body art that is done, there
seem to be relatively few health problems although the potenial of blood-borne disease risk still exists and the medical
literature describing the complications seems to be evolving.
The major risk is due to the small amount of bleeding present
with both procedures. Hepatitis B remains the significant concern and recently both the American and Canadian medical

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Greif et al. / BODY ART PRACTICES

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literature have documented transmission of Hepatitis C (Long


& Rickman, 1994, Shimokura & Gully, 1995; Sperry, 1992;
Tweeten & Rickman, 1998). Two brief reports have raised the
question of human immunodeficiency virus (HIV) transmission
in both types of body art (Doll, 1988; Pugatch, Mileno, & Rich,
1998). Following body piercing, local site infections remain
common. Some life-threatening outcomes with body piercings
have been reported including septic arthritis, acute glomerulonephritis, and endocarditis (Armstrong, Ekmark, & Brooks,
1995; Tweeten & Rickman, 1998). Psychosocial risks with body
art are also documented and include embarrassment, low selfesteem, and disappointment (Armstrong, 1991; Armstrong &
McConnell, 1994; Armstrong & Pace Murphy, 1997; Armstrong,
Ekmark, & Brooks, 1995).
Although the phenomenon of obtaining body art is gaining in
popularity, little is known about the tattooed and pierced
college-age student. The purposes of this exploratory study
were to identify the characteristics of students enrolled in college that have a tattoo(s) and/or body piercing, the frequency of
occurrence, their decision making and experiences, and health
issues of those with body art. Information about the college
students decision making when obtaining a tattoo or body
piercing could alert the health care professional to risk-taking
behavior and help in effective planning for health promotion
strategies. Information from this type of study can build a
larger knowledge base for further work on the risk-taking
behavior of college students.

METHODOLOGY
A descriptive and primarily quantitative design, similar to
the Armstrong and McConnell (1994) and the Armstrong and
Pace Murphy studies (1997), was used to describe the present
situation and generate knowledge.
INSTRUMENT

An 86-item self-reporting, anonymous survey was used that


focused on questions about the participants experiences of
tattooing and body piercing. The survey instrument was based

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CLINICAL NURSING RESEARCH / November 1999

on a review of literature, personal interviews with college students with body art, data from a pilot study, and four published
studies on body art (Armstrong, 1991; Armstrong, Ekmark, &
Brooks, 1995; Armstrong & McConnell, 1994; Armstrong &
Pace Murphy, 1997). An expert panel of college health physicians, nurses, and counselors reviewed the questionnaire for
this study. Thirty questions of the survey were from the Armstrong Tattoo Survey (ATS). Face and content validity were
established for these questions and reestablished by expert panels before the initiation of the studies. Similar questions about
body piercing were incorporated, based on author experiences.
A pilot study (N = 12) was conducted to test and refine the survey tool used in this research. The pilot study helped clarify the
direction of questioning for the college student respondents.
An introduction to the survey provided the studys purpose,
benefits, and statements regarding the respondents voluntary
participation; completion of the survey implied consent to participate in the study. The survey was divided into four sections
with 31 questions about tattooing, 31 questions about body
piercing, 4 general questions related to body art, and 20 demographic questions. Demographic questions included age, race,
gender, sexual orientation, academic major, academic performance, family history and income, and attendance at religious
services. The reading level of the survey was at the 10th grade.
A variety of query formats were used such as multiple choice
and Likert scale questions. Questions inquired about motivating factors, costs, number of body art procedures, health
issues, risk behaviors, as well as parental involvement in decision making. Open-ended questions were provided so respondents could comment more extensively on their participation
with body art.
PROCEDURE

Following approval by the institutional review board as an


exempt study, personnel from college health services were
sought from a wide geographic region by word of mouth and
messages on the college health bulletin board of the Internet.
College health personnel from 18 American universities, as
well as one Australian university, responded and volunteered
to assist in the distribution of the survey. School size of these

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19 universities varied from one student body of 479, to the largest campus of 46,000 (Figure 1). The number of surveys sent to
each university depended on specific requests of the college
health personnel; a total of 1,700 surveys were sent out.
DISTRIBUTION

When college students with body art presented at the participating universities for any health services, they were asked by
the health care providers if they would like to volunteer to complete a questionnaire about their body art experiences. Students with only traditional earlobe piercings were excluded for
this study because reasons for this type of piercing tend to be
different than body piercing. All respondents were asked to
complete the general body art and demographic questions. In
the directions of the survey, tattooed and/or body-pierced
respondents were asked to complete the specific section(s) of
the survey applicable to them; that is, if they were tattooed,
they were to complete those questions. If they had a body piercing, they were asked to complete those questions. If they were
both tattooed and pierced, they were asked to complete two
sections. For the purpose and eligibility of this study, tattoos
were defined as permanent marks or designs applied to the
skin, not temporary decals (Armstrong & McConnell, 1994).
Body piercing was referred to as the penetration of the skin with
a sharp implement to create openings through which jewelry
may be worn (Greif & Hewitt, 1998). On completion of the survey, respondents placed their answers in a large envelope and
this envelope was placed in a sealed drawer for confidentiality.
To achieve an adequate sample size, data collection extended
over two full semesters. At the end of the second semester, the
surveys were sent to the authors for analysis.

RESULTS
A total of 828 surveys were returned to the investigators for a
49% response rate. Reasons for not returning the other surveys
included lack of time to distribute the surveys and the lack of
tattooed and/or pierced students that presented for health services during the time of data collection. On review, several

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Figure 1. Participating collegiate sites.

Greif et al. / BODY ART PRACTICES

375

surveys (N = 52) were disqualified due to large blocks of incomplete data. Data were analyzed using the Statistical Package for
the Social Sciences (SPSS) computer software. For those
schools with 40 or more completed surveys, specific data for
their university were later provided following data analysis. The
following is a discussion of 766 completed surveys. Qualitative
comments were reviewed and recorded separately; many of
these comments are not addressed in this analysis.
SAMPLE

Respondents in this cross-sectional, convenient sample (N =


766) were from 18 universities in the United States and one
university in Australia. No unique responses were noted from
the international school so all students were grouped together
and included 630 full-time undergraduate students, 86 fulltime graduate and doctoral students, and 45 part-time or nonmatriculating students. Five subjects did not answer this question. More women (70%) participated in this study than men
(29%); 1% of the respondents did not identify their gender. The
age range of the respondents was from 17 to 54 years of age,
with 69% of the respondents between the ages of 18 to 22. That
specific 4-year age span, the traditional college age years, is
also when 74% of the tattooed respondents and 63% of those
with body piercings had obtained their first body art procedure.
Ethnic representation included White (71%), Black (7%),
Asian (5%), Hispanic (4%), and others (13%). Class distribution included freshmen (17%), sophomores (16%), juniors
(23%), seniors (26%), graduate students (11%), and others
(6%). Many of the respondents were first or only born (46%),
had grown up with both natural parents (66%), and were raised
in households with an income of $35,000 or more (73%). The
respondents attended religious services between one to five
times per year (33%) and another 33% never attended church.
Almost one third (30%) declared their academic majors as liberal arts, social science studies (27%), and basic sciences
(22%). Nearly 60% self-reported grade point averages of 3.0 or
better.
The average cost of a respondents tattoo was $67 and of a
piercing, $50, with the total cost for the entire 766 respondents
body art as $148,000. The highest amount reportedly paid for a

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CLINICAL NURSING RESEARCH / November 1999

Table 1
Reasons Why Students Obtain Body Art
Tattoo (N = 561)

Self-expression
Just wanted one
To remember an event
Feel unique
Independence

296
200
121
100
62

53
35
21
17
11

Body Piercing (N = 391)

189
149
81
80

48
38
21
21

Self-expression
Just wanted one
To be different
Beauty mark

NOTE: Total percentage is higher than 100 because multiple reasons could be
selected by respondents.

tattoo was $750 and another respondent paid $215 for a single
piercing, including the jewelry. Most students (76%) did not
notify their parents of the intent to obtain a tattoo or body
piercing, even when some were minors, but eventually the parents were informed (75%). Both those with tattoos and piercings cited the same major reasons for their body art as selfexpression (50%) and just wanted one (48%) (Table 1).
When asked about the purpose of their body art, 61% of the
respondents strongly agreed/agreed with the statement to be
myself, I dont need to please or impress anyone. Other statements that inquired about the purpose of the body art and the
relationship of their friends acceptance and expectations were
strongly excluded. Those with multiple body piercings, as well
as tattoos, often commented that they found them to be
addicting and I like the way they feel.
RISK-TAKING BEHAVIORS

Questions were asked about the respondents risk-taking


behaviors such as the use of drugs, cigarettes, and alcohol.
More than half of the respondents (53%) reported having more
than five drinks of alcohol weekly or monthly. Thirty-nine percent of these college students had used recreational drugs and

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24% reported daily cigarette use. Only 13% cited the use of
drugs and/or alcohol before their body art procedure.
Three demographic questions asked about sexual intercourse, the number of sexual partners, and sexual preference.
Only 5% of the participants in this study reported never having
sexual intercourse. Forty percent of the respondents reported
between 1 and 5 partners, 6 to 10 partners (24%), and 11 or
more partners (26%). The majority of students (87%) reported
heterosexual orientation, 12% reported bisexual activity, and
less than 1% reported homosexual preference.
Most students (88%) reported their first body art was done
by professional artists in a studio using sterile, disposable needles, skin disinfection, proper handwashing, and clean latex
gloves. Following the procedure, 66% of the respondents
reported receiving both written and verbal instructions regarding potential risks and aftercare.
TATTOOED COLLEGE STUDENTS

In this study, 561 college students or 73% of the respondents were tattooed; 84% of them had one or two tattoos. One
respondent was tattooed at the age of 13 and another respondent obtained his first tattoo at 40 years of age. The most tattoos one respondent reported was 20 tattoos. Decision making
concerning having tattoos seemed to range from a group of
respondents (20%) that took a few minutes to make their decision to another group that took years to decide (23%). Most of
the respondents (90%) reported continual satisfaction with
their tattoos and 82% would do it again.
Although many students (71%) reported no health problems
secondary to their tattooing, 14% had skin irritations (shortterm redness, dry skin, or tenderness) and 1% cited site infections (blister, pus, swelling, pain, or redness). Only 4% of those
with skin problems sought assistance from a health professional. One student reported contracting hepatitis after her
tattooing procedure. This respondent had obtained her first
tattoo at 16 in a professional studio with an autoclave on the
premises, an artist using a new pair of disposable latex gloves
for the tattoo, and skin disinfection done before and after the
procedure. She denies use of alcohol or drugs before her tattoo,
has never smoked cigarettes or used recreational drugs, and

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CLINICAL NURSING RESEARCH / November 1999

limits alcohol use. She commented, I tested positive for antibodies twice after the tattoo and then 2 years later tested negativeI never displayed symptoms of the disease. Currently,
she ranked herself as a junior in college, would have the tattooing done again, and would not have the tattoo removed as it
makes me feel unique and individual. In her comments to the
question of What would you like to tell someone else considering body art?, she wrote check health [and] NEW NEEDLES.
COLLEGE STUDENTS WITH BODY PIERCINGS

Fifty-one percent (n = 391) of the respondents in this study


report body piercings. Most had one or two piercings (76%). The
earliest age reported for an initial piercing was 11 and the oldest at the time of their first piercing was 42. One respondent
reported 12 piercings. More of the respondents took a few minutes for their decision (29%) with body piercing as compared to
thinking about it for a year (5%).
Health problems with body piercing were frequent and
sometimes produced multiple problems. Although 30%
reported no problems, 45% reported infections at the site
(blister, pus, drainage, pain, and redness). Skin irritation
(short-term redness, dry skin, or tenderness) was the second
most prevalent problem (39%), yet overall, only 13% presented
themselves to health professionals for assistance in managing
their body-piercing problems. Despite these health problems,
91% reported continued satisfaction with their body piercing
and 78% would do it again.
Two students from different universities reported hepatitis
after their piercings. Both respondents described the use of
sterile, disposable needles to puncture the skin for their piercing, but aftercare instructions were not provided. Both still like
their piercings, would have it done again, and would recommend the procedure to others, although one mentioned that
it limits job possibilities. The respondents have never used
alcohol or smoked cigarettes but use recreational drugs
monthly. One recommended to others that they take care of
it during the healing process and go to [a] well-established
studio.
Almost one quarter of the pierced respondents (24%) reported
nipple and genital piercings. Their major reason for getting this

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Greif et al. / BODY ART PRACTICES

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particular body art was enhanced sexual experiences.


Although many respondents in the study (69%) reported no
change regarding their sexual experiences and less than 1%
stated their sexual experiences were worse after their body art,
70% of those respondents with nipple and genital piercings
reported significant improvement.

DISCUSSION AND APPLICATION OF


RESEARCH TO CLINICAL NURSING
This research expands on earlier work by Armstrong and
McConnell (1994) and Armstrong and Pace Murphy (1997) and
is the first published research investigating body art practices
of college students (N = 766) enrolled in universities. In this
study, the respondents reported most of their body art was
done after they were enrolled in college (tattooing, 74%, and
body piercing, 63%) and obtained during the traditional college
age years of 18 to 22. Three areas of interest will be discussed,
namely the decision making for the body art, characteristics of
the sample and the reported risk-taking of those who were
pierced and/or tattooed, and the cited health problems. The
authors are aware that these findings have limited general
application as a small sample was used and any college students who volunteered may be a unique sample wanting to discuss their experiences with body art. In addition, self-reporting
can be subject to bias due to inaccurate recall or a desire to
relate things as they should be; yet, this was thought to be the
best method to obtain initial data from such a diverse, widely
scattered group of subjects.
DECISION MAKING FOR THE BODY ART

Decision making for the body art seemed to vary. In this


study, about one quarter of the respondents reported their
class ranking as freshmen and sophomores. Almost one third
of those with body piercing reported only taking a few minutes
deciding on their body art, illustrating impulsive decision making. As the media portrays body art as carefree and risqu
behavior, many could perceive body piercing as a temporary
procedure or at least one that can be undone, with little, or no

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CLINICAL NURSING RESEARCH / November 1999

residual, giving them freedom to feel they can proceed with the
piercing without many perceived risks (Armstrong, Ekmark, &
Brooks, 1995, p. 25). Thus, could the nature of body piercing
procedure produce more casual decision making?
A small group of impulsive decision makers with tattooing
was also reported. This finding seems to correspond with
Armstrong and McConnell (1994) and Armstrong and Pace
Murphys studies (1997) with tattooed adolescents where the
short decision making was frequently present. Could these
responses still correspond to the late adolescent developmental
activities of impulsiveness and the lack of effective decision
making when away from home?
In this study, there also was a sizable group of respondents
who took more time for deliberate decision making, especially
with tattooing; some describe making their decisions over
months and even years. The price of the body art also related to
their deliberate decision making; reported costs were not
inexpensive. This subgroup of respondents seemed to align
more with the Armstrong study (1991) examining tattooed
career-oriented women where more deliberate decision making
was observed for the body site, the artist, the studio, and the
design. This delayed decision making could correspond to the
group of the respondents (more than half ) who were enrolled in
upper division undergraduate and graduate education. The
longer amount of time taken for the tattoo decision could relate
to the permanency of the tattoo procedure as well as the
increased education level. This better decision making also
seemed to lead to the high rate of satisfaction with their body
art and the large amount of respondents that would do the procedure again.
The college students made the decision to obtain body art.
Often, the parents were not consulted on decisions for tattooing and body piercing. If they were minors, parental permission
was not sought. College health personnel were not part of their
decision making also. If there were complications from the
body art, many times the participants tried to take care of it
themselves rather than consult with health professionals.
The participants major reasons for the body art were the
same, self-expression and just wanted one. The body art procedures seemed to be deliberate, done specifically for themselves as illustrated by their strong agreement about the

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Greif et al. / BODY ART PRACTICES

381

purpose of their body art to be myself, I dont need to please or


impress anyone. This agreement of strong self-identity for the
body art is similar to findings in Armstrong and McConnell
(1994) and Armstrong and Pace Murphy (1997) studies.
Overall, these participants were intent to obtain some form
of body art regardless of money, regulations, or risks, focusing
more on the identity rather than the assessment of risks. These
findings are similar to other studies examining body art participants (Armstrong, Ekmark, & Brooks, 1995; Armstrong &
McConnell, 1994; Armstrong & Pace Murphy, 1997). The
respondents did not report any feelings of deviancy when they
obtained their body art; in fact, many provided comments hoping society could accept their tattoo and/or piercing as a work
of art that made them feel good, unique, and special. These
feelings correspond with Delene and Brogowiczs (1990) top
findings of health care concerns of college students as body
image and personal appearance.
As with all art forms, tattooing and body piercing seem to be
means of communicating thoughts, ideas, and feelings. Thus,
the development of proactive, applicable communication about
this topic is important. Avoid using instructional scare tactics.
Purposeful dissemination of information, whether with brochures, videos, and/or even college health fairs, is helpful.
Health professionals should share information about body art
in general, including the inherent risks, maintaining a nonjudgmental perspective and continuing an open channel of
communication. As part of that message, students must be
encouraged to contemplate their decisions carefully. Encourage them to take time in their decision making to talk with others about body art, ask specific questions of the artists, and
know enough about the procedure to judge the quality and
hygiene of the activity. The authors have found that open communication about body art is often a bridge for further expression about other issues that may be concerning their physical
and emotional well-being while within the college milieu.
CHARACTERISTICS AND RISK TAKING

Many of the respondents in this study were White women in


undergraduate programs from a variety of class rankings, academically successful, and majoring either in liberal arts or

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CLINICAL NURSING RESEARCH / November 1999

social sciences. Could women be more interested in body art?


Although there are no previous studies investigating college
age students with body art, Armstrong and Pace Murphys
(1997) study examining adolescents (N = 2101) had more tattooed girls (55%, n = 117) as compared with boys (45%, n = 96).
Those authors commented on the gender distribution as supporting Keyes and Blocks (1984) belief that greater risk-taking
behaviors are present in adolescent girls because of their earlier maturation. Further investigation regarding this observation is suggested.
Specific risk-taking behaviors of drugs, cigarettes, and alcohol use were reported with the participants of body art. These
risk-taking behaviors also could reflect the developmental
phase of late adolescence in the college student who is away
from the family for the first time and lacks experience with
health-influencing activities and mature decision making. Further study should examine the association of body art as a
risk-taking behavior with other risk-taking behaviors commonly cited for this population.
HEALTH CONCERNS WITH TATTOOING
AND BODY PIERCING

Health problems can arise either during the body art procedure or from lack of proper aftercare. Repeated needle injections of a foreign substance for tattooing and bleeding can predispose subjects to bloodborne diseases as well as the
penetration of a needle or piercing gun for body piercing. Overall, for the amount of body art that is done, most of the respondents in this study reported effective, safe hygiene practices of
their tattooist and piercer with the use of sterile, disposable
needles, skin disinfection, proper handwashing, and latex
gloving for the procedure. Many seemed to observe the procedure and artists techniques before the procedure, yet some
respondents received no aftercare instructions for proper skin
treatment. This could be one reason for almost half of the
respondents with body piercing, and others with tattoos, to
have skin irritations and infections. Informed customers
should know that skin care is essential following procurement
of the body art. Specific written and verbal instructions from

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383

the artist should be followed, especially with body piercing that


inherently has higher rates of infections. Consumers should
know that a consistent amount of cleansing of the piercing site
is necessary to assure proper healing. More research is also
recommended to obtain larger proportions of student populations on campuses and expand beyond those coming for health
services to further explore the amount, decision making, and
health concerns associated with body art.
In this college population, 3 respondents reported contracting hepatitis, a major risk factor of body art procedures.
Although the methodology of this study did not include serum
antibody screenings for verification of the participants report
of infectious hepatitis, the documentation of this health risk
remains troublesome when students in higher education
encounter serious health threats that can influence their
health status over a long-term basis. Further research is recommended that includes a pre-body art blood sample and subsequent testing at 3 and 6 months post-body art to determine
any changes.
Health care professionals should be advocates for college
students as well as the community. Thus, it would be good to
investigate current body art legislation locally and statewide as
well as visit the local studios to observe techniques and procedure. Ask specific questions because often it is assumed that
body art establishments are routinely inspected and monitored
by health officials. If your jurisdiction does not have any regulations or they are limited, contact the National Environmental
Health Association (303-756-9090, staff@neha.org, or http://
www.neha.org). Obtain the Model Body Art Code, a document
produced by a 21-member committee of body artists, sanitation specialists, and health professionals to proactively promote the standardization of body art regulations and acknowledge the universal public health mission for the protection of
disease. All or parts of this code can be used in health jurisdictions. These actions, as well as effective health education, can
assist college students in enhanced decision making on a variety of body art issues such as health risks, anticipatory generation biases, and permanence factors to reduce risks or even
produce dissuasion from body art.

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384

CLINICAL NURSING RESEARCH / November 1999

REFERENCES
Anderson, R. R. (1992). Tattooing should be regulated. New England Journal of
Medicine, 326, 207.
Armstrong, M. L. (1991). Career-oriented women with tattoos. IMAGE: Journal
of Nursing Scholarship, 23(4), 215-219.
Armstrong, M. L. (1998). A clinical look at body piercing. RN, 61(9), 26-30.
Armstrong, M. L., Ekmark, E., & Brooks, B. (1995). Body piercing: Promoting
informed decision-making. Journal of School Nursing, 11(2), 20-25.
Armstrong, M. L., & Fell, P. R. (in press). Popular or not, a model body art code
is needed for tattooing and body piercing. Journal of Environmental Health.
Armstrong, M. L., & McConnell, C. (1994). Tattooing in adolescents, more common than you think: The phenomenon and risks. Journal of School Nursing,
10(1), 22-29.
Armstrong, M. L., & Pace Murphy, K. (1997). Tattooing: Another adolescent
risk behavior warranting health education. Applied Nursing Research,
10(4), 181-189.
Armstrong, M. L., Stuppy, D. J., Gabriel, D. C., & Anderson, R. R. (1996). Motivation for tattoo removal. Archives of Dermatology, 132(4), 412-416.
Delene, L. M., & Brogowicz, A. A. (1990). Student health care needs, attitudes,
and behavior: Marketing implications for college health centers. Journal of
the American College Health, 38(1), 157-164.
Doll, B. C. (1988). Tattooing in prison and HIV [Letter]. Lancet, 8575, 66-67.
Greif, J., & Hewitt, W. (1998). The living canvas: Health issues in tattooing, body
piercing and branding. Advances for Nurse Practitioners, 12(3), 26-31, 82.
Keyes, S., & Block J. (1984). Prevalence and patterns of substance use among
early adolescents. Journal of Youth & Adolescents, 13, 1-13.
Long, G. E., & Rickman, L. S. (1994). Infectious complications of tattoos. Clinical Infectious Disease, 18(4), 610-619.
Myers, J. (1992). Nonmainstream body modification. Journal of Contemporary
Ethnography, 21(3), 267-306.
OHara, D. (1995, December 18). Risky fashions. AM News, pp. 11-12, 21-22.
Polosmak, N. (1994). Mummy unearthed from the pastures of heaven. National
Geographic, 186(4), 80-103.
Pugatch, D., Mileno, M., & Rich, J. D. (1998). Possible transmission of human
immunodeficiency virus type 1 from body piercing. Clinical Infectious Diseases, 6(3), 767-768.
Saunders, C. (1989). Customizing the body: The art and culture of tattooing.
Philadelphia: Temple University Press.
Shimokura, G. H., & Gully, P. R. (1995). Risk of hepatitis C virus infection from
tattooing and other skin piercing services. Canadian Journal of Infectious
Diseases, 6(5), 235-238.
Sperry, K. (1992). Tattoos and tattooing: Part II, Gross pathology, histopathology, medical complications, and applications. American Journal of Forensic
Medical Pathology, 13(1), 7-17.
Tope, W. D. (1995). State and territorial regulation of tattooing in the United
States. Journal of the American Academy of Dermatology, 32(5), 791-799.
Tweeten, S. S., & Rickman, L. S. (1998). Infectious complications of body piercing. Clinical Infectious Diseases, 26(3), 735-740.

Downloaded from http://cnr.sagepub.com at Umea University Library on July 24, 2008


1999 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.

Greif et al. / BODY ART PRACTICES

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Merriam-Websters collegiate dictionary (10th ed.). (1993). Springfield, MA:


Merriam-Webster.

Judith Greif, R.N., N.P., C., M.S., is a family nurse practitioner at the Hurtado Health Center, Rutgers University Health Service, New Brunswick, NJ.
Walter Hewitt, R.N., C., B.S.N., is the assistant clinical coordinator, Hurtado
Health Center, Rutgers University Health Service, New Brunswick, NJ.
Myrna L. Armstrong, Ed.D., R.N., F.A.A.N., is a professor in the School of
Nursing, Texas Tech University Health Sciences Center, Lubbock, TX.

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