Did you know that the earliest tattoos date back to 5000 BC, and that their uses ranged from body art and right-of-passage symbols to designations of slavery or membership in certain religious sects? Early Christians, for example, used ornate markings on their hands to identify themselves as fellow believers. Medicinal references are found, too.
Indeed, tattoos do have a curious past, pediatric resident Meghan Bernier revealed at a recent Hopkins Children’s Grand Rounds presentation, but how prevalent are they in today’s adolescent population, and what behavioral and health risks do they pose? Also, what are pediatricians’ attitudes about the issue and their inked patients, and what kind of recommendations do they make about blood-borne pathogens?
Who is getting inked? In a study of 6,000 youths, those who were tattooed (4.6 percent) were more likely to be older adolescents in single-parent households in the lowest quartile of family income. Also, those who had parents with a high-school education on less were more likely to be tattooed. But surprisingly, Bernier said, gender, ethnicity, and neighborhood type – suburban or urban – did not affect tattooing rates (Pediatrics 2002;110(6):1058-1063).
Associated behaviors? The study showed that those with tattoos were also more likely to engage in substance use – 11.6 percent reported daily cigarette smoking and alcohol or marijuana use within the past month – and sexual activity – 83 percent reported sexual intercourse during the past year vs. 36 percent of non-tatooed youths. Also, 54 percent of the tattooed youths had been involved with violent acts like a physical fight or joining a gang, vs. 32 percent of non-tatooed youth.
In a second study of 480 youths 12-to-22 years of age, 13.2 percent had tattoos, and of those 5.2 percent had multiple tattoos. Interestingly, 4.6 percent of the tattooed youths had acquired their tattoo before age 14, and of those 30 percent were inked by an amateur, typically in a basement or on the street. Those youths, Bernier said, had a significantly greater risk of involvement with drug use and sexual activity, as well as eating disorders and suicide attempts. Also, tattooed girls were at higher risk of suicide than their non-tatooed counterparts (Pediatrics 2002;109(6):1021).
“If they had a tattoo, their risk of a suicide attempt increased with the number of years they had the tattoo,” Bernier said. “Also, the younger they were when they got their tattoo, the greater their risk of a suicide attempt.”
Providers’ perceptions? In a survey of 600 healthcare providers and students, 8.5 percent of whom had tattoos, physicians and registered nurses rated tattooed people less positively than did the students. Women’s attitudes were consistently less favorable than those of the men, especially toward tattooed professional women, and attitudes towards tattooed adolescents were generally less positive than attitudes toward the adult groups. Noting that research has found that negative attitudes impact patient care, the authors concluded that tattooed adolescents may be at risk of being negatively perceived when they seek healthcare, and that increased efforts are needed to assure that those with tattoos receive non-judgmental care (Journal of Advanced Nursing, June 1998).
Regarding screening for infections like hepatitis C, Bernier noted that there are no specific recommendations for tattooed youth. But pediatricians, Bernier said, can recommend that adolescents considering a tattoo go to a licensed parlor where the needles are clean and each ink pot new and freshly opened. Otherwise these young patients risk complications like infections, rubbery lesions known as Keloids, and warts, as well as some rare and unexpected complications.
“Some of the darker tattoos have metals in them,” Bernier explained, “which under an MRI can cause a second degree burn.”
Bernier concluded, “Tattooing is very prevalent among youth, and its presence is associated with several high-risk behaviors. It remains up to us to reconcile our own personal feelings about tattoos, and to use them as a conversation starter and a springboard for discussion and anticipatory guidance.”
For more information, see the American Academy of Pediatrics Q&A on teen tattoos.