Case Reports

Piercing among adolescents: Body art as risk marker

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A population-based survey.



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, Perspicacity, profiling, and prejudice

Body art and, more specifically, piercing is becoming normative among adolescents, ("Perspicacity, profiling, and prejudice,”) 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 use1,3,5 and risky sexual behavior,10 but no increase in suicide attempt.3

Tattoos, piercings, and problems in US youth

Since the late 1990s, estimates for body modification among US adolescents range from 10% to 25%.8,14 A 2002 study5 assessed tattoos and body piercing as markers of risk-taking in 484 adolescents presenting to an adolescent clinic in California; both were markers of greater instances of, and participation in, such behaviors as eating disorders, illegal drug use, sexual activity, and suicide. Tattooing was reported by 13.2% of respondents, with 5.2% having more than 1 tattoo. Excluding earlobes, 26.9% of adolescents had body piercings at some point during their lifetime, and 11.8% had a history of multiple piercings. Tattooing and body piercing were found to be more common in females than males, 16.6% vs 8.1% for tattoos and 36.7% vs 10.1% for body piercings, respectively. Index scores on 5 of 6 risk-taking indices—including the Disordered Eating Behavior Index, the Gateway Drug Index, the Hard Drug Index, the Sexual behavior Index, and the Suicide Index—were significantly higher in participants with at least 1 tattoo or body piercing compared with those with neither. Illegal drug use also increased with the number of piercings.

Another study15 looked at 14- to 18-year-olds presenting to an urban adolescent clinic in Massachusetts. Of 210 surveyed, 48% reported at least 1 body modification, with girls more likely than boys (59% vs 28%; P≥.0005). Forty-two percent reported piercings, 10% had tattoos, 4% had scarification; 21% had more than 1 type of modification. One third of the sample screened positive for problem substance use. Controlling for age, adolescents with body modification had 3.1 times greater odds of problem substance abuse with alcohol or drugs than those without (95% CI, 1.7–5.8).

Among females in our sample, more than 1 piercing is associated with having multiple sex partners and marijuana use. Carroll et al5 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.


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.


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