Purpose. This study assessed tattoos and body piercings as markers of risk-taking behaviors in adolescents.

Methods. A 58-question survey, based on the 1997 Centers for Disease Control and Prevention Youth Risk Behavior Survey, was offered to all adolescent beneficiaries that came to the Adolescent Clinic. The survey contained standard Youth Risk Behavior Survey questions that inquire about eating behavior, violence, drug abuse, sexual behavior, and suicide. Questions about tattoos and body piercings were added for the purposes of this study.

Results. Participants with tattoos and/or body piercings were more likely to have engaged in risk-taking behaviors and at greater degrees of involvement than those without either. These included disordered eating behavior, gateway drug use, hard drug use, sexual activity, and suicide. Violence was associated with males having tattoos and with females having body piercings. Gateway drug use was associated with younger age of both tattooing and body piercing. Hard drug use was associated with number of body piercings. Suicide was associated with females having tattoos and younger age of both tattooing and body piercing. Tattoos and body piercings were found to be more common in females than males.

Conclusions. Tattoos and/or body piercings can alert practitioners to the possibility of other risk-taking behaviors in adolescents, leading to preventive measures, including counseling. Tattoo and body piercing discovery should be an important part of a health maintenance visit to best direct adolescent medical care.

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