Piercing among adolescents: body art as risk marker: a population-based survey

Journal of Family Practice, Feb, 2007 by Joan-Carles Suris, Andre Jeannin, Isabelle Chossis, Pierre-Andre Michaud

Practice recommendation

* Without stigmatizing adolescents with piercing, use the topic of body piercing as a starting point for discussing unhealthy behaviors

Body piercing among young people has been linked with risk behaviors such as the abuse of legal and illegal substances, (1-5) risky sexual behavior, (2,5) school truancy and running away, (2) suicide ideation and attempts, (2) and delinquent behavior. (4)

Body art and, more specifically, piercing is becoming normative among adolescents, (6,7) with prevalence close to 70% in some studies. (1) However, studies of adolescents are few, (1-5, 8-10) and most used local (10) or convenience (2,5,8,9) samples or populations known to be at high risk, such as detainees. (1) To date, the only population-based study among adolescents reported a prevalence rate of 7.2% among females and 1.5% among males. (3)

Our objectives:

* to ascertain the prevalence of piercing among a nationally representative sample of adolescents

* to assess whether a piercing is a marker for risk behaviors

* to assess whether having more than one piercing is a cumulative marker for risk behaviors.

* Implications

Our results indicate that body piercing (other than earlobes) is a marker for risk behaviors, and that, among females, multiple piercing seems to be a cumulative marker. We should pay particular attention to potential harmful behaviors among these adolescents. We should not stigmatize pierced adolescents. (See Dr Susman's editorial, "Perspicacity, profiling, andf prejudice," on page 83.) Body art is more than just an indicator of deviancy. (11) In other words, as all adolescents should be screened for risky behaviors, this specific population offers the advantage of piercing as a starting point for a discussion.

We found that body piercing is increasingly popular among adolescents in Switzerland, especially among females. Our prevalence rates are higher than those reported by Roberts, (3) but (as they suggest) it may well be due to the societal trend, as their data were collected in 1996.

The pierced and the unpierced

Academic performance was the main sociodemographic difference between pierced and unpierced adolescents. As a marker of risk, piercing was negatively associated with academic performance, as found elsewhere regarding healthy behaviors. (12) Like other studies, this sample exhibited increased drug use (1,35) and risky sexual behavior, (10) but no increase in suicide attempt. (3)

Among females in our sample, more than 1 piercing is associated with having multiple sex partners and marijuana use. Carroll et al (5) also found that having multiple piercings was associated with illegal drug use. For males in our study, the only association with multiple piercings was an increase in suicide attempts.

From our results, it could be hypothesized that more than 1 piercing is a cumulative marker for some risk behaviors, mainly among females. Though associations for males were similar to those for females, the differences between pierced and unpierced groups did not reach statistical significance. However, the relatively small sample of pierced males discourages definitive conclusions.

Pierced adolescents were less satisfied with their bodies than their unpierced counterparts, though the difference is significant only for females.

Young people indicate that the main reasons they obtain a piercing are a sense of uniqueness or self-expression, with only one fifth indicating that they obtain it for aesthetics only. (2,8) As we did not assess the reasons to obtain a body piercing in this study, it could be that they had it done to increase their body satisfaction, that their body satisfaction was lower after having it done, or simply that they do not get pierced to increase their satisfaction with their body.

* Methods

Population. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a survey of 7548 students ages 16 to 20 years (3658 of whom were female). In Switzerland, school is mandatory up to age 16. Afterwards, about 30% of adolescents follow to further high school, 60% go to vocational school as an apprentice (1 or 2 days of class per week and the rest spent at work), and 10% do not continue their education.

Classroom survey. The survey was an anonymous classroom questionnaire approved by the ethical committee of the Medicine Faculty in Lausanne. The questionnaire and sampling method are described elsewhere. (13) Ninety-one subjects (1%) did not answer the question referring to body piercing and were excluded. The final sample had 7457 subjects (3628 females).

TABLE 1 lists selected characteristics and background variables analyzed. Analyses were performed separately by gender, as the literature indicates that females are more likely to have piercings. (2-5) We conducted all analyses with Stata 8 (College Station, TX), which computes coefficient estimates taking into account sampling weights, clustering, and stratification procedure. All significant variables in the bivariate analysis were included in a logistic regression.