Children's and Adolescents' Awareness of the Physical and Mental Health Risks Associated with Tattooing: A Focus Group Study

Houghton, Stephen, Durkin, Kevin, Carroll, Annemaree, Adolescence

Recent research demonstrates that tattoos or body marking practices are increasingly prevalent among adolescents. Many of these tattoos are self-administered or are obtained from friends or amateur tattooists (Houghton & Durkin, 1993). Medical literature dating back to at least the 1920s points to recurring problems of infection and tissue damage due to unprofessionally administered tattoos, including venereal diseases, tuberculosis, skin diseases and injuries, allergic reactions, warts (Beerman & Lane, 1954; Cohen, 1927; Scutt, 1972; Stokes, Beerman, & Ingraham, 1954), and even leprosy (Rook & Thomas, 1952). Contemporary risks of Hepatitis B and C and HIV transmission indicate that body marking practices are potentially lethal. These diseases can be transmitted by shared needles, and shared tattooing equipment has been recognized for some time as a cause of hepatitis transmission (Smith, 1950) and HIV (Dolan, 1990).

In addition to physical and mental health risks, amateur tattoos and related body marking practices pose risks of stigmatization. Markings on visible parts of the body such as hands, forearms, and face are often regarded unfavorably by nontattooed people (Grumet, 1983). As a result, unsightly markings obtained during adolescence may seriously reduce a young person's employability. Further, it has been reported that delinquent youths themselves interpret the presence of tattoos on peers as indicators that such individuals belong to the same subculture, and attempt to coerce them into antisocial or criminal activities (Taylor, 1968; 1970).

Body markings reflect transient adolescent interests and emotions, but their consequences are permanent. For example, in a retrospective study conducted by Grumet (1983), half of a sample of 819 tattooed military recruits surveyed saw their body marks as a handicap reflecting rashness, intoxication, foolishness, and identity struggles. Many wished to erase their tattoos because of personal discomfort with the image' conveyed, the reactions of others (potential employers, wives) or because they wished to distance themselves from aspects of their past. Hamburger and Lacovara (1963) report several instances of institutionalized youths trying to remove tattoos themselves, typically using rudimentary and potentially injurious methods.

Despite the short- and long-term risks associated with amateur tattoos and body-marking practices, little is known about the development of attitudes toward them or about children's and adolescents' awareness of the health and social consequences. The purpose of the present investigation was to obtain data by addressing the topic directly with groups of young people in a cross-sectional focus group study. This approach is based on the premise that in opening an investigation of a hitherto neglected area it is vital to listen first to the subjects. The information obtained will also provide a guide to future research in terms of choice of vocabulary and other aspects of instrumentation.

The focus group interview is a qualitative methodology frequently used to obtain data about feelings and opinions of small groups of participants about a given problem, experience, service or phenomenon (Basch, 1987). This usually involves a small group of subjects being asked a series of progressively more difficult open-ended questions by a trained person in a nonthreatening supportive climate that encourages all group members to share their views. Focus group methodology has been widely used to generate ideas and solutions pertaining to various social problems, and for encouraging participants to disclose behavior and attitudes that they might not consciously reveal in an individual interview situation (Basch, 1987).

In the area of traffic safety Basch, DeCicco, and Malfetti (1989) utilized focus group format discussions to identify feelings and opinions of small groups about drinking and driving. Hedlund, Arnold, and Cerelli (1983) used a similar procedure to explore young people's opinions and feelings toward the efficacy of seatbelts. More recently, focus group methodology has been employed as a means of advancing health education programs. Kisker (1985), for example, employed focus groups to gain insights into why sexually active teenagers do not use contraceptives effectively. Data have also been generated from such discussions to design adolescent tobacco use prevention and cessation programs (Heimann-Raitain, Hanson, & Peregoy, 1985).

The main aims of the focus groups in the present study were: to obtain a preliminary overview of issues, themes, and attitudes in children's and adolescents' discussion of tattoos; to generate information helpful in the construction of quantitative instruments; to provide overall background information on a subject area; and to generate hypotheses that can be further tested in later research. In addition, the aim was to obtain as full an account as possible of young people's perspectives in their own terms, and to elicit any relevant views, concerns, or misunderstandings that may exist among particular age groups that have not been indicated in the present literature. Although body marking is predominantly a problem associated with adolescence, younger subjects were also included in order to gain an overview of any developmental shifts that may come about in terms of attitudes.

METHOD

Subjects and Settings

Forty-eight primary school students and 32 high school students participated in the study. Of these, 36 were male. The students, whose ages ranged from six years one month to 16 years 5 months, were randomly selected from grades one through 11.

The participating institutions, one primary and one high school, were located in middle-class socioeconomic status areas of the Western Australian city of Perth. The primary school enrollment was approximately 450 students with two grades at each of the year levels (i.e., one through seven) while the high school had 800 students and five classes at each grade level.

All focus group sessions were undertaken separately in special rooms in both schools which were made available, without interruption, for the duration of the research project. In the primary school a small music room was used, and in the high school an interview room was used.

Materials

A standard focus group format was employed, comprised of 24 open-ended questions centering around 15 color slides used to depict both males and females with varying numbers and types of tattoos. To ascertain participants' opinions of body adornment more generally, two of the 15 slides depicted males and females wearing normal cosmetic make-up rather than tattoos.

The questions sequentially solicited children's views pertaining to knowledge of tattoos and the tattooing process; health beliefs; attitudes toward tattoos and beliefs …

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Publication information: Article title: Children's and Adolescents' Awareness of the Physical and Mental Health Risks Associated with Tattooing: A Focus Group Study. Contributors: Houghton, Stephen - Author, Durkin, Kevin - Author, Carroll, Annemaree - Author. Journal title: Adolescence. Volume: 30. Issue: 120 Publication date: Winter 1995. Page number: 971+. © 1999 Libra Publishers, Inc. COPYRIGHT 1995 Gale Group.

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