PEDIATRICS Vol. 111 No. 5 May 2003, pp. 1126
Tattooing and Body Piercing
To the Editor.—Carroll and colleagues deserve praise for their carefully performed study of tattooing and body piercing among adolescents.1 The 88% survey response rate achieved (requiring parental consent for their minor subjects) is a tribute to their relationship with their patients.
We have reported2 a survey of body art prevalence in undergraduate university students, finding 60% of females to be pierced (earlobes excluded) and 26% to be tattooed. Among male students, 42% had piercings and 22% had tattoos. The prevalence of body art in our students overall was 51% pierced (range: 1–5 sites pierced/student) and 23% tattooed (range: 1–3 tattoos/student).
These findings suggest that, among our students (average age: 21), body piercing is "mainstream" and tattooing is common. Although we did not assess risk-taking behavior, we did compare the prevalence of body art in varsity athletes (reported to be risk-takers)3,4 to nonathletes and found no significant differences except for an increased frequency of tattooing in male athletes.
Our personal experience caring for elite Olympic athletes and our student-athletes has not suggested to us that body art is associated with an increased propensity for disordered behavior in these groups although we acknowledge that we have not systematically studied this point. The results of any survey are only applicable to the specific population studied, and Carroll et al properly conclude that a different population of adolescents "may show significant differences ..."
We, therefore, suggest that observing body art on a patient should not lead to the reflexive conclusion that he/she manifests disordered behavior and requires counseling. However, specific inquiry concerning such behavior may lead to the conclusion that such counseling is indicated.
Lester B. Mayers, MD
Barry W. Moriarty, ATC
Division of Sports Medicine-Athletics Department
Pace University
Pleasantville, NY 10570
Daniel A. Judelson, MS
Kenneth W. Rundell, PhD
Sports Science and Technology Division
United States Olympic Committee
Lake Placid, NY 12946
REFERENCES
- Carroll ST, Riffenburgh RH, Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking behaviors.
Pediatrics.2002; 109
:1021
–1027
[Abstract/Free Full Text] - Mayers LB, Judelson DA, Moriarty BW, Rundell KW. Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications.
Mayo Clin Proc.2002; 77
:29
–34
[Abstract/Free Full Text] - Garry JP, Morrissey SL. Team sports participation and risk-taking behaviors among a biracial middle school population. Clin J Sports Med.2000; 10 :185 –190[CrossRef][Web of Science][Medline]
- Aaron DJ, Dearwater SR, Anderson R, et al. Physical activity and the initiation of high-risk health behaviors in adolescents. Med Sci Sports Exerc.1995; 27 :1639 –1645[Web of Science][Medline]
In Reply.–
I agree with the suggestion of Mayers and colleagues that observing body art on patients should not lead to the reflexive conclusion that they manifest disordered behavior and require counseling. Tattooing and body piercing does seem to be more prevalent in our country today, and many well-adjusted adolescents who are not participating in risk-taking behaviors possess them.
However, there are differences in the populations being discussed. Our study population was younger than the population commented on by Mayers and colleagues. Their students’ reported average age is 21. Eighty-three percent of our population was younger than 20 years old. Many of these patients were and still are progressing through the stages of adolescent development. It is well-known that this may be a time in an adolescent’s life of exploration and risk-taking. Although there is no set age for completion of adolescent development, by 21 years of age many adolescents can foresee the consequences of their actions and tend to decrease their risk-taking behaviors. This may be why Mayers’ and colleagues’ "personal experience...has not suggested ... that body art is associated with an increased propensity for disordered behavior ..."
Our findings show that adolescents with tattoos and body piercings participated in risk-taking behaviors more so than adolescents without these body modifications. Roberts and Ryan1 reported similar results in a nationally representative sample.
Since some of these behaviors may lead to outcomes that interfere with healthy adolescent development, we suggest that identification of such body modifications should prompt the provider to take a good history regarding sexual behavior, drug use, and mood disorders. This may lead to identification of issues that might not have otherwise been addressed in a routine office visit, such as gynecologic health needs or accurate information about the dangers of some illicit drugs. However, this does not mean that all of these patients need counseling.
Sean T. Carroll, MD
Adolescent Medicine
Department of Pediatrics
Tripler Army Medical Center, HI 96859-5000
REFERENCE
- Roberts TA, Ryan SA. Tattooing and high-risk behavior in adolescents.
Pediatrics.2002; 110
:1058
–1063
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics
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