Piercing among adolescents: Body art as risk marker
A population-based survey.
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.
In a second step, adolescents having one piercing were compared with those having more than one piercing, using the same method.
TABLE 1
Selected characteristics of pierced and unpierced adolescents—females (N=3628) and males (N=3829)
| FEMALES | MALES | |||||||
|---|---|---|---|---|---|---|---|---|
| PIERCED (N=1225) | UNPIERCED (N=2403) | P VALUE | AOR (95% CI) | PIERCED (N=283) | UNPIERCED (N=3546) | P VALUE | AOR (95% CI) | |
| Age (years±SD) | 17.98±1.17 | 17.77±1.13 | <.001 | 0.94 (0.88–1.01) | 18.21±1.20 | 17.86±1.18 | <.001 | 0.90 (0.80–1.00) |
| Academic track (apprentice) | 73.1% | 53.1% | <.001 | 2.05 (1.75–2.41) | 91.5% | 71.0% | <.001 | 2.97 (1.92–4.62) |
| Body satisfaction (dissatisfied) | 67.4% | 71.2% | .02 | 0.96 (0.82–1.14) | 82.3% | 86.3% | .064 | — |
| Nationality (Swiss) | 10.9% | 13.5% | .027 | 0.72 (0.57–0.92) | 16.6% | 13.3% | .119 | — |
| Perceived puberty (advanced) | 36.6% | 30.2% | <.001 | 1.06 (0.91–1.25) | 39.6% | 23.3% | <.001 | 1.41 (1.07–1.86) |
| Parental status (not together) | 31.3% | 20.8% | <.001 | 1.30 (1.10–1.55) | 32.5% | 21.7% | <.001 | 1.35 (1.02–1.79) |
| Father’s education (low)* | 11.4% | 15.9% | <.001 | 0.67 (0.53–0.84) | 15.5% | 14.0% | .476 | — |
| Mother’s education (low)* | 21.2% | 22.9% | 0.24 | — | 23.0% | 20.8% | .379 | — |
| Sensation seeking (high) | 21.9% | 15.5% | <.001 | 1.14 (0.94–1.39) | 53.0% | 40.0% | <.001 | 1.13 (0.87–1.47) |
| Feeling depressed (yes) | 45.0% | 36.2% | <.001 | 1.16 (0.98–1.36) | 29.0% | 21.7% | .005 | 1.05 (0.78–1.42) |
| Number of sexual partners (≥4) | 20.6% | 8.3% | <.001 | 1.50 (1.20–1.87) | 45.6% | 17.9% | <.001 | 1.71 (1.29–2.28) |
| Condom use at last intercourse (no) | 46.9% | 27.5% | <.001 | 1.63 (1.39–1.92) | 39.6% | 19.5% | <.001 | 1.49 (1.12–1.98) |
| Regular smoker (yes) | 48.9% | 21.9% | <.001 | 2.06 (1.74–2.45) | 66.4% | 30.9% | <.001 | 2.28 (1.72–3.02) |
| Intoxication (last 30 days) | 26.9% | 15.7% | <.001 | 1.19 (0.98–1.44) | 60.8% | 39.0% | <.001 | 1.51 (1.15–1.97) |
| Cannabis use (last 30 days) | 40.9% | 20.6% | <.001 | 1.58 (1.32–1.89) | 67.5% | 39.1% | <.001 | 1.37 (1.05–1.79) |
| Illegal drug use (last 30 days) | 8.7% | 3.4% | <.001 | 1.67 (1.21–2.31) | 26.9% | 8.3% | <.001 | 2.17 (1.59–2.98) |
| Suicide ideation (last 12 months) | 26.8% | 21.2% | <.001 | 1.07 (0.88–1.29) | 22.6% | 15.5% | .002 | 1.22 (0.87–1.72) |
| Suicide attempt (last 12 months) | 5.3% | 2.7% | <.001 | 0.97 (0.65–1.45) | 3.2% | 1.4% | .02 | 1.02 (0.45–2.31) |
| AOR, adjusted odds ratio; CI, confidence interval. | ||||||||
| Statistically significant differences are in bold. | ||||||||
| *Low education=mandatory schooling or less. | ||||||||
Results
Overall, 20.2% (95% confidence interval [CI], 19.3–21.1) of our sample had a piercing, and it was significantly more prevalent among females than males: 33.8% (95% CI, 32.2–35.3) vs 7.4% (95% CI, 6.6–8.2); P<.001.
Single piercing
Bivariate analysis. Having a piercing was significantly associated with all the risk behavior variables both in males and females. In both genders, pierced adolescents were significantly older, more frequently on an apprentice academic track, perceived advanced puberty, not living with both parents, had felt depressed, and were sensation-seeking. Additionally, pierced females were less likely to be satisfied with their body, less likely to be foreign-born, and more likely to have a mother with low education (mandatory school or less).
Multivariate analysis. Controlling for all significant background variables, pierced females were more likely to have had multiple sexual partners, not to have used a condom at last intercourse, to be regular smokers, and to be current users of cannabis or other illegal drugs. Among males, all risk behavior variables remained significant, except suicide ideation and attempt (TABLE 1).
Multiple piercings
One third (34.1% [95% CI, 31.7–36.5]) of pierced subjects had more than 1 piercing, with similar rates for males (35.3% [95% CI, 29.8–40.9] and females (33.8% [95% CI, 31.1–36.4]).
Bivariate analysis. Among females, having more than one piercing was associated with being an apprentice, perceived advanced puberty, parents not living together, sensation seeking, and being depressed. With the exception of condom use at last intercourse, they were significantly more likely to engage in all risky behaviors.
For males, the only difference between single and multiple piercings was that the latter were more likely to have attempted suicide (TABLE 2).
Multivariate analysis. The only variables associated with females having more than one piercing were having multiple sexual partners (adjusted odds ratio [OR]=1.53 [95% CI, 1.13–2.09]) and using cannabis (adjusted OR=1.39 [95% CI, 1.06–1.82]).
TABLE 2
Characteristics of adolescents with more than 1 piercing
| FEMALES | MALES | |||||
|---|---|---|---|---|---|---|
| 1 PIERCING (N=811) | >1 PIERCING (N=414) | P VALUE | 1 PIERCING (N=183) | >1 PIERCING (N=100) | P VALUE | |
| Age (years±SD) | 17.97±1.16 | 18.01±1.18 | .55 | 18.15±1.23 | 18.34±1.15 | .190 |
| Academic track (apprentice) | 67.7% | 83.8% | <.001 | 91.3% | 92.0% | .830 |
| Body satisfaction (dissatisfied) | 67.7% | 66.9% | .781 | 81.4% | 84.0% | .587 |
| Nationality (Swiss) | 11.2 % | 10.4% | .658 | 16.9% | 16.0% | .839 |
| Perceived puberty (advanced) | 33.8% | 42.3% | .004 | 35.5% | 47.0% | .059 |
| Parental status (not together) | 28.1% | 37.4% | .001 | 29.0% | 39.0% | .085 |
| Father’s education (low)* | 11.6% | 11.1% | .803 | 15.3% | 16.0% | .877 |
| Mother’s education (low)* | 20.3% | 22.9% | .292 | 21.9% | 25.0% | .548 |
| Sensation seeking (high) | 81.5% | 72.0% | <.001 | 47.5% | 46.0% | .804 |
| Feeling depressed (yes) | 42.7% | 49.5% | .023 | 29.5% | 28.0% | .789 |
| Number of sexual partners (≥4) | 16.9% | 28.0% | <.001 | 47.0% | 43.0% | .519 |
| Condom use at last intercourse (no) | 45.2% | 50.0% | .115 | 36.6% | 45.0% | .168 |
| Regular smoker (yes) | 44.1% | 58.2% | <.001 | 65.0% | 69.0% | .499 |
| Intoxication (last 30 days) | 23.8% | 33.1% | .001 | 57.4% | 67.0% | .113 |
| Cannabis use (last 30 days) | 36.1% | 50.2% | <.001 | 67.2% | 68.0% | .893 |
| Illegal drug use (last 30 days) | 6.9% | 12.3% | .002 | 24.6% | 31.0% | .245 |
| Suicide ideation (last 12 mo) | 24.4% | 31.4% | .009 | 20.2% | 27.0% | .192 |
| Suicide attempt (last 12 mo) | 3.9% | 8.0% | .003 | 1.6% | 6.0% | .046 |
| Statistically significant differences are in bold. * Low education=mandatory school or less. | ||||||
Limitations of this study
The main strength of our study is that it is based on a nationally representative sample of adolescents. However, a few limitations need to be stressed.
Body piercing leads to medical complications in a non-negligible percentage of cases7,9,10 particularly if done by nonprofessionals.9 Given the high prevalence of adolescents, particularly females, who do body piercing, and their greater tendency to engage in risk-taking behaviors (and thus may be less careful about potential medical consequences), it seems important to make sure that they can do it under the safest conditions. Indeed, in Switzerland, new legislation regulating body piercing went into effect in 2006.
