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 等
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 about normative behavior; Future Time Perspective (this was included in order to address issues relating to young people's awareness of the long-term consequences of body marking); and stigmatization.
A Kodak model SAV 2000 slide projector was employed to project the slides onto a whiteboard, approximately three meters in front of the participants. In all of the focus group sessions, participants were videotaped using a Panasonic AD450 Videocamera which was set approximately three meters from the subjects at an angle which ensured that all subjects were in full view during the entire session. The video-camera was operating prior to entrance of participants into the room.
Procedure
Parental consent was obtained before conducting the sessions. A response rate of 85% was obtained from the primary school, while a rate of 78% was obtained from the high school. Of the sampled primary and high school classrooms, six students were randomly selected via the returned slips to produce one focus group (n = 6) in each class. Thus there was a sample of three boys and three girls from each of the two classes in years one (aged six years), three (eight years), five (ten years), seven (12 years, early adolescence), nine (14 years, mid-adoles-cence), and eleven (16 years). Two children were randomly selected as reserves in case of absences. More children participated in the high school focus groups because the school principal expressed a desire for all selected children (i.e., six plus the two reserves) to participate in the focus groups.
The furniture arrangement was identical for each of the groups. Six or eight chairs were placed in a semi-circle around one side of a desk. A slide projector was placed centrally on the desk, with the moderator sitting to one side; the moderator used a hand-held control to determine the speed and sequence of the slides.
Each group of students was brought to the room where they were met by the moderator who introduced herself and explained that they were going to see some slides of people. On reviewing each slide, the students were asked a general question from the standard format schedule and encouraged to express their ideas with each other. On obtaining several responses, the moderator asked additional questions until all relevant views had been expressed. The moderator then moved to the next question. If the children digressed from the question, they were allowed to continue for a time before the moderator guided them back to the original point. On average, each focus group session lasted from 30 to 45 minutes.
RESULTS
The findings are presented in five sections: (1) knowledge of tattoos and the tattooing process; (2) health beliefs; (3) attitudes toward tattoos and beliefs about normative behavior; (4) Future Time Perspective; and (5) stigmatization.
Zemke and Kramlinger's (1985) procedures were then adopted, which consisted of generating a list of key ideas, words, phrases, and verbatim quotes; using ideas to formulate categories and placing ideas and quotes in appropriate categories; examining the contents of each category for subtopics and selecting the most frequent and most useful illustrations for the various categories.
Knowledge of Tattoos and the Tattooing Process.
Generally, the discussions revealed that all participants from year one to year 11 knew what tattoos were. All participants noticed the tattoos on the people in the first three slides shown and knew that these were called tattoos, the only exception being one boy in year one who was unsure. The female depicted in slide two also wore several earrings in one ear, and most of the participants, particularly the high school students, commented on this feature.
Moderator (M): What do you notice about these people?
Oh! That's a tattoo. (Year 1)
She's got a tattoo. (Year 1)
That's what some people do [have a tattoo] if they think they are really tough. (Year 1)
Ohh! That's ugh. (Year 3)
Wicked. He's got a tattoo. (Year 3)
That's gross! Horrible! (Year 7)
Ugh - he must be sick to have that. (Year 7)
If you have a tattoo of your boyfriend/girlfriend and then break up, you still have the tattoo for the rest of your life - stupid! (Year 9)
That's a tattoo. It would be alright if it was quite small. (Year 11)
Tattoos are quite fashionable. (Year 11)
Almost all of the participants said they knew someone with a tattoo - a member of the family, a friend of parents, a relative, or someone else.
M: Do you know anyone with tattoos?
A famous basketball player and strong men. (Year 7)
My cousin and lots of her friends have tattooed little roses, because it's just most of the girls at that school in Melbourne have little roses . . . someone just did it, and then another did it so everyone followed her. (Year 7)
M: How do you think people get these pictures on their skin?
Younger children's accounts were idiosyncratic and fanciful: You are born with them. (Year 1) Someone draws them on. (Year 1) By Year 3 participants had an idea that needles and ink were used to put tattoos on people.
They inject ink into your skin and use needles to draw it. (Year 3)
They use lots of needles to puncture their skin and they puncture their skin, and then they fill it up with ink type stuff, and then it gets all scabs and then there it is. (Year 7)
If it's not done properly, either you can get a compass and dig out your skin or you can get pins and dig out your skin . . . That would be gross!! (Year 7)
Some participants in Year 9 had witnessed both amateur and professional tattoos being administered.
A special needle that makes lots of holes and ink goes in and then it just stays there. (Year 9)
M: Do you think they can get rid of them easily?
In the discussion on this point only the very young children in Year 1 answered affirmatively. The remaining participants were very aware of the permanency of tattoos. A number of older (Year 11) students mentioned cover up work or tattooing over old tattoos.
Once they've lost the ink they can come off. . . . you wash them off.
You lose them the same way you put them on.
You just unstitch them the way you put them on.
Yes, you get some water and wash them off. (All Year 1)
Once they're there you can't get rid of them. (Year 3)
Maybe if you die, but it's there for life. (Year 3)
You need skin grafts. (Year 7)
You have to cut out a lot of skin and then you'd be scarred. (Year 7)
Only skin grafts. Or you can dye over them. You can put in white ink. (Year 7)
Color over them. (Year 11)
Is it grafting and scraping? You can scrape it off. (Year 11)
Health Beliefs
M: Someone told me that you can sometimes get ill from having tattoos. What do you think?
All of the participants except one boy in Year 1 said that you can become ill from having tattoos. The high school students made some frequent and interesting comments pertaining to where you get a tattoo.
Depends. If you have it done on the streets - people re-use needles, not at a professional's, not if done professionally. (Year 9)
Depends how you get them. If you do them yourself or a friend does them with compasses and stuff well. (Year 11)
M: What kind of illness would you get?
The younger subjects reported illnesses such as tattoo sickness, measles, chicken pox (Year 1); can "start stealing illness," skin cancer and "damage your clean blood" (Year 3). By Year 5 onward there was a consensus that AIDS, Hepatitis B, tetanus, and skin infection were illnesses that could be acquired in this way.
You don't have to get ill from the actual tattoo but you can get ill from like people harassing you about the tattoos - stress. (Year 7)
If you get it done professionally, it's all right but let's say if you do it illegally or something like that, then you have a really big chance of catching Hepatitis B. They push the needle into your skin until it bleeds, so it gets into your blood. And if it's been in someone else and then into you. . . . (Year 7)
Among the high school participants many instances of spontaneous interchange occurred. For example, the following took place between three Year 9 participants:
Child 1: Unlikely to get AIDS.
Child 2: AIDS is possible if you share needles.
Child 1: Yes, but you would have to share the needles very quickly 'cause
AIDS virus is volatile and dies within seconds when it gets out of the body.
Child 2: Yes, but still possible.
Child 3: Yes, but you wouldn't just tattoo someone and then just switch over very quickly. The only thing possible, not in professional tattooing studios, but in any amateur or backyard tattoo and they are doing friends or something like that, there would be a chance - they just use compasses.
Say you get it done somewhere else - a place where you can get it done cheap, got no qualifications, could be dangerous. (Year 11)
M: What about skin infections?
All participants replied affirmatively; that is, they recognized that skin infection was a risk involved in tattooing. Interestingly, the older participants commented that self-marking was a problem. For example,
When you do it on your own you always get one. (Year 11)
M: What sort of things have you done on your skin?
Did one on my leg. . . . went white, just did it with a compass, it was awful. (Year 11)
M: Has anyone else marked themselves?
A number of Year 11 female students replied affirmatively. When asked to explain, the consensus was very clear:
Just a thing we did in Year 9.
The mediator asked the participants how they might get an illness from tattooing. From Year 5 onward it was widely agreed that infected blood from dirty needles would be the main concern.
If the person giving you the tattoo has a cut in their finger. (Year 5)
They push the needle into your skin until it bleeds so it gets into your blood, and if it's been in someone else and then you get it as well - you have a high risk. (Year 7)
M: Could you pass the illness on to another person?
The majority of the participants stated that you could pass on an illness to someone else through tattooing. The younger children were a little unsure of the precise mode of transmission:
If you went near them and you still got the smell, you could pass it on. (Year 1)
However, the majority of the older participants held more conventional medical opinions:
Using the same needles. If someone passes it on to you, you can pass it on to someone else. (Year 5)
Just say you had AIDS and you went there and you had the same needle as someone else, then they could get AIDS too. (Year 7)
Not unless you touched each other. If they use the same needle without sterilizing it, then you could transmit AIDS. (Year 7)
If the needle is dirty, then someone else will get the same. (Year 9)
Definitely if you use the same needles. (Year 11)
Attitudes toward Tattoos and Beliefs about Normative Behavior
In the context of a discussion about attitudes toward tattoos, almost all participants expressed a negative opinion. However, the attitude toward tattoos appeared to become more positive, especially among females during the early adolescent to adolescent period. Small tattoos in particular seemed to become more acceptable and favored by Year 11 female students.
M: Do you like these tattoos?
They look yukky; they're really ugly; they're not in the right places; you can't wash them off; they spoil your blood. (Year 1)
If you really like them at one point, and then say two weeks later someone made a rude comment, then you would feel silly that you got it because everyone was making fun of you. (Year 3)
Maybe I'd like it at first but then I might not want it any more. (Year 3)
They might admire it for a while and then 2 years later they might think this is getting boring . . . but they can't wash it off. They're there forever. (Year 3)
They really look daggy. (Year 5)
Well, it doesn't make any difference to people, just because they've got a marking on them. It's like someone burning themselves on the face. (Year 7)
I think it spoils the natural look of your normal body. (Year 7)
High school students commented:
Wouldn't want anything permanent on my skin. (Year 9)
It's just an image type thing, if you get heaps of tattoos - trying to make an impression - it's an image thing. Probably regret it after a while. (Year 9)
I don't like them, big or small, 'cause they're permanent and the diseases associated with them, when you're getting them, and what you can get is like Hepatitis B. (Year 11)
The more positive comments (all from females) are:
I like them but you have to wait and think about it before making your skin disgusting. (Year 9)
Depends. Some sort of tattoos are really awful, like people have them all over their body and that's really sick. But some I can handle; they're just small ones. (Year 9)
Some tattoos are OK. I mean, I've seen some people with quite little ones on their arms and they look good. (Year 11)
I don't mind some but they have to be small, little ones where you can't really notice them. (Year 11).
Suns or something nice but only really small ones that you don't really go out to show. (Year 11)
M: If you were out shopping with your mom what would she say if she saw someone with a tattoo?
The majority of the participants reported that either nothing would be said or their mother would suggest that they should not get a tattoo. A number of high school students did mention that the size of the tattoo would influence their mother's comments, suggesting that a large tattoo would draw a more negative remark.
It looks nice but don't you get one. (Year 3)
People like bikies or gangsters get tattoos. (Year 5)
They're old fashioned. They were brought up to be like that. People who have tattoos must be bad. (Year 9)
Depends on the age of the person. If it was a young person she would probably say something. She'd just say it makes someone look a bit cheap if it was a big one. If it was small she probably wouldn't say anything. (Year 11)
Participants were shown slides of men and women with more extensive tattoos (i.e., tattoos covering larger areas of the body, such as all of arms, back or chest) and asked if there was any difference between those pictures and the ones just seen? All of the participants, with the exception of six early adolescents, responded that the tattoos were bigger, looked more colorful, and on the whole were worse than small ones. Generally, the most frequently cited reason for not liking them was difficulty in covering up the larger type tattoos. Among the comments were:
It would take a long time to get it off because you wouldn't be able to reach it, because it's on your back and you'd have to get somebody else to reach it. (Year 1)
She can't wear a bare back dress because everyone would see her tattoo and it wouldn't look very nice. She's a freak. (Year 5)
It can really put some people off. Like some people would think you're revolting . . . and then if you get into trouble with the police and they see the tattoos, they'll think you're some sort of person that would do that kind of crime. (Year 7)
If you're at the beach, people would stare at you. (Year 7 female)
It would look good if it was on a piece of paper and it was framed, but not on skin. (Year 7)
These [larger ones] look cheap. They are not like some tattoos that can look elegant. (Year 11)
A small one on your ankle, say, you can pull your sock over it but these larger ones are pretty hard to disguise. (Year 11 female)
The only positive comments came from the early adolescent groups and included:
It's on her back so you can cover it. (Year 5)
It's a better picture - it's more artistic. I wouldn't want people just scribbling all over me. I'd like something that looks good and there's thought put into it. (Year 7)
When asked why they thought people had tattoos, image was frequently suggested as an important reason. The replies included: to be cool, to make an impression, to look like a hunk, to be attractive, to show they are not scared of getting it done, and to portray a tough image - "I'm really a bad boy so I've got a tattoo." Interestingly, some of the high school females in the two Year 11 groups reported that they might get small tattoos. An example of the spontaneous interchange between Year 9 participants was:
Child 1: Tattoos are supposed to make people rebel.
Child 2: I've got friends who don't have tatooos and they rebel.
Child 3: You get tattoos to make people go "Yuk!" Maybe get tattoos 'cos they like them.
Child 2: They like them 'cos their mums etc. don't; they get them for an image.
To ascertain participants' views on differences between tattoos and facial/body cosmetic makeup a number of slides were shown of men and women without tattoos. When asked "Does this person have anything on his/her skin?" almost half of the primary school participants said they did not, whereas only two of the high school students said they did not. When asked the difference between the previous slides (showing tattooed individuals) and the cosmetic makeup, individuals readily commented that makeup enhances natural features, can be washed off, and is not permanent. Comments included:
She's pretty smart for not putting on a tattoo. (Year 3)
She hasn't got tattoos and she's safer . . . she's not at risk at all of getting AIDS. (Year 5)
She looks more natural as a person. She looks more clear. Her skin is more pure. (Year 7)
Tattoos take away from natural features (Year 9)
Future Time Perspective
Future Time Perspective refers to the ways in which people conceive of, organize, and feel about their future. To ascertain participants' opinions about the long-term effect of tattoos, they were asked the following questions:
M: Do you think they (the tattooed people depicted in the slides) will still like them [tattoos] when they are older?
Only three (one Year 1 and two Year 7) of the 80 participants replied yes to this question; they were unsure why, however. A number of high school students thought it would depend on the person's circumstances.
The girl will because it's quite artistic but I don't think the man will. That's ultimate junk. (Year 7)
The person with the bigger tattoos would have a higher chance of not liking it, than the smaller ones. (Year 7)
If they worked in a business or something it wouldn't be very good for reputation. (Year 9)
If she was a model - that's the fashion. (Year 9)
M: Do you think they will still like them [tattoos] when they go out to parties?
There was a difference of opinion on this question, with many of the early adolescent and high school students responding either yes or depends on the context.
It depends what party they're going to. If it's a wild party, then you'd be right in, but if it was a wedding, then it would be worse. (Year 7)
Depends if they wore a backless dress or clothes that showed off the tattoo. (Year 9)
If she got to the party and everyone started giving her strange looks then she might start regretting it and by then it's too late. I doubt whether this would happen if tattoos are in fashion. But fashions change! (Year 11)
M: Do you think they will still like their tattoos when they are grandparents?
Overall the response was a resounding "no." However, two high school participants commented (separately) that they would forget about the tattoos as they got older, and two commented that it depends if they are proud of the tattoos. Many comments related to grandchildren. For example:
No, because their grandchildren might not like them either. (Year 1)
If you get one and you grow old and stuff, your grandchildren might get interested in tattoos and go and get one on their skin when they get older. (Year 3)
I think they might be ashamed if they have grandchildren; that the grandchildren might be ashamed of them if they have tattoos, or the grandchildren might want to get them. (Year 5)
Their kids and grandkids might be embarrassed. (Year 9)
Stigmatization
Participants were asked about the image people with tattoos seem to have acquired. Most believed they were either bikies, laborers, truckies or were involved in physical/manual type work. Some of the younger participants mentioned actors, sailors, circus attractions, models (Years 3 and 5), garbage men, singers, drug dealers, and prostitutes (Years 5 and 7). Some of the high school participants commented that it is unfair to stereotype people because of their tattoos.
M: What types of jobs do you think people with tattoos have?
They might just have common jobs, like anything that is common to do. (Year 3)
It wouldn't be a businessman because their boss wouldn't allow them to have tattoos on. (Year 5)
They might not even work. They might just hang around shops and that. (Year 5)
If people have tattoos, it doesn't mean that they have rotten jobs or anything. (Year 7)
But if they have tattoos, it could change their employer's attitude toward them. Like if you were the boss and you saw all these tattoos, would you want to employ someone? (Year 7)
Lots of people get it [tattoos] done when they are really young and not thinking. It's not fair to stereotype them. It's hard not to - doctors, lawyers - anyone to have a tattoo. (Year 9)
Your initial reaction was the fact that they'd be laborers, truckles, and builders but any type of professional can have a tattoo. (Year 9)
Heavy metal singers have tattoos, and females have them too - lots of singers and celebrities. (Year 9)
M: What do you think these people do at night?
During the discussions the younger participants reported that tattooed people go to pubs, stay up late and party, watch a lot of TV, smoke, and work as drug dealers. The older participants were of the firm opinion that it is not justifiable to stereotype a person because he/she has tattoos, and tattooed people probably do the same things as nontattooed people at night.
It's just the image they have. Just because of that one tattoo, it changes the whole way you think of the person. (Year 7)
You think they're going to go out to night clubs, partying on the street, wander around big and tough and menacing, but they don't necessarily. (Year 9)
When the older participants were asked how they feel when they see people with tattoos, the overwhelming opinion was negative:
Cross the road, think, "Oh my God, that's a person I'm not sure about," so keep away. (Year 9)
You shouldn't really do it but you can't help thinking that there may be something a bit different about them. A bit of a shady character. (Year 9)
Three slides were then shown, two of people without tattoos and one (a male) with a tattoo. Two of the people depicted were male and one was female. All three were approximately the same age, all were casually dressed and similar in physical appearance, and all were displaying most of their upper torso and limbs.
M: One of these people was in trouble last night. Who was it?
Typically, children pointed at the tattooed individual. Only 10 of the 80 participants did not. Examples of comments include:
He's the sort of guy that would hate police. (Year 5)
He looks a tough kind of guy - the kind of guy that would be in trouble with the police. (Year 7)
Your immediate reaction is the one with the tattoo. (Year 9)
But tattoos do influence you. So you always think, they've got tattoos, they must be that sort of person. (Year 9)
Tattoos are related to crime. (Year 11)
Many of the participants associated tattoos with bikies. When shown a slide depicting four different modes of transport and asked: How do you think people with tattoos get to work? Fifty-six of the 80 participants replied "by motorbike." Many qualified their reply by suggesting that the general public had formed a stereotype of the tattooed person's favored transport.
You'd think motorbike, but they might have cars. The majority of bikies have tattoos. (Year 7)
Participants were then shown a slide which depicted eight different professions and asked what sort of jobs are held by people with tattoos. The illustrations (taken from a book) of working people were simple, each with an item associated with the profession (e.g., stethoscope, fire engine), and a name label of the profession under each person. While the younger children thought that sailors, builders, hairdressers, drug dealers, prostitutes and others would have tattoos (the last three were not depicted on the slide), from Year 7 (early adolescence) onward, participants were of the clear opinion that people from all professions can have tattoos. It should be emphasised that the slides did not introduce any bias and that the association of tattoos with drugs and prostitution was of the children's own volition.
M: What type of friends do you think people with tattoos have?
The generally expressed view was that people with tattoos were associated with undesirable types of persons and activities. This stereotyping was more pronounced in the younger children, many of them suggesting that people with tattoos have friends who are:
Robbers and criminals. (Year 1)
Druggies (Year 3)
Bikies (Year 5)
People with night jobs, garbage service - not professional jobs - they'd be people more inclined to have tattoos. (Year 7)
However there was some recognition that:
They might have friends who don't have tattoos. Just because they have tattoos, it doesn't mean that they're not nice. There's nothing wrong with them just because they've got tattoos. (Year 5)
The three hairdressers I've been to all have tattoos. They care about the way they look. They seem to be models and they care about the way they're seen. It might be thoroughly in. (year 7)
The following is an example of a frequent type of interchange between participants which depicts the stereotyping.
Child 1: If you saw a person in the street, chances are you wouldn't want to make friends with them because you'd think they were into drinking and drugs.
Child 2: But they're not necessarily all like that.
Child 1: First impression though is to stay away from them. (Year 7)
The older adolescents tended to present a more balanced view, recognizing the dangers of stereotyping, but also suggesting that it was something which could not be prevented.
Druggies! Other friends with tattoos. (Year 9)
Depends what they are into. You think most people with tattoos are into bikes and would have bikie friends, or if into drugs would have druggie friends. But most have normal people as friends - just like themselves. It's just that you can't help thinking this way. (Year 9)
In another strategy chosen to solicit attitudinal responses, two slides were shown (one male and one female with tattoos) and participants were asked "If this was your teacher next year, what would you think?" None of the participants were specifically positive in their comments, although in the high school some said they would give the teacher a chance first. Overall, participants most frequently suggested they would be disgusted, scared, think the teacher was strange/weird, that they were not going to learn much, not comply with the teacher's requests, want to change teachers and/or schools, tell more and dad that the teacher would be a model for them to get tattoos, couldn't respect the teacher, and couldn't take them seriously. A large number also suggested that their parents would object.
Yukky, and I'd like to leave and change teachers. (Year 1)
I'd tell mum and my mum would probably tell all the other teachers and then they'd tell the headmaster or something like that. (Year 3)
I would ask my mum to tell the principal, because it would give us a bad idea to do that as well. (Year 5)
They [parents] might think she's a rebel who'll let us go anywhere and do anything and then we'd have a problem with our education. (Year 7)
Would have quite a bad influence on kids 'cause teachers are meant to be setting a good example. (Year 9)
If people found that [tattoo] they would give the teacher hassles. (Year 9)
If you didn't know the teacher had a tattoo and then found out, well, they were normal before when you didn't know, so now you know it doesn't change them. (Year 11)
DISCUSSION
This sample of students was aware of the nature of tattoos. Virtually all of them recognized and were able to label tattoos correctly. Many knew someone with a tattoo, and were knowledgeable about the process involved in getting a tattoo. Further, older participants were well aware of their permanency.
With reference to health information, all students generally appeared to be aware of the possibilities of viral transmission, particularly AIDS, Hepatitis B, tetanus, and skin infections. A common point of discussion centered around the use of dirty needles, sharing of contaminated needles, and viral transmission through contaminated blood. A number of participants knew, however, that needles would have to be shared very quickly because the AIDS virus is volatile and dies within a relatively short time when out of the body. This is particularly interesting given the alarming rate at which AIDS is reported to be spreading among teenagers (Kolata, 1989).
A number of older participants also commented that where the tattoo is obtained is important, suggesting that tattooing by qualified people was much safer than amateur- or self-administered tattoos. In marked contrast to this informational base, however, subsequent comments by high school female participants indicated that many of them had at some stage tattooed themselves or had a friend tattoo them using a compass. This appears to be an example of the adolescent fable that "it wouldn't happen to me" (Elkind, 1983).
Generally, attitudes toward tattoos were negative. However, there was a more favorable attitude toward small tattoos among females during early adolescence. Professional tattooists have told us consistently that, while historically tattoos have been predominantly a male preserve, the majority of their clients currently are females in their late teens and early to mid-twenties. Perceptions of attractiveness are strongly influenced by existing cultural stereotypes of feminine and masculine beauty (Seifert & Hoffnung, 1991). Many role models, such as fashion models, rock singers, and actors, have tattoos and display them quite openly. Hence, they may help create widespread acceptance for these images. It is worth noting that when shown a slide of a teacher with a tattoo, many of the adolescents who commented positively about tattoos on actors, for example, commented that the teacher would be a poor role model and that they could not respect the teacher. This suggests the possibility that even among those adolescents who are becoming more accepting of tattoos, there is an assumption that their desirability is restricted to the peer group (and possibly salient adult figures from the world of entertainment or sport).
The data reveal that tattoos often convey a negative image; there was overwhelming agreement that people with tattoos were often bikies - clearly seen as an undesirable social category. Further, people with tattoos tended to be associated with lower status types of employment or illicit activities. Some of the high school participants did dispute the fairness of stereotyping people because of their tattoos, but the same students subsequently commented that they would cross the road if they saw a person with tattoos coming toward them. Almost 88% of the sample identified a tattooed person (shown next to two nontattooed people) as the individual "in trouble last night."
The majority were aware that tattoos are permanent and expressed grave concern that their "mistake" would be with them for the rest of their lives. Similarly, many were concerned that they might not be able to cover a tattoo with their clothing and that this might lead to embarrassment, particularly at formal functions and when they themselves became grandparents. Such thinking appears to reveal that many participants were taking into account their long-term goals.
One important issue for future research concerns the shift in attitudes among females around early adolescence. It was clear in the present sample that the female students' interests in tattoos did not reflect the traditional associations of young male adolescents, who are generally attracted to tattoos as a means of asserting masculinity and toughness and of identifying with an anti-authority peer culture (Harry, 1987; Hawkins & Popplestone, 1964). In contrast, the female subjects' concern was predominantly with appearance.
Subjects who expressed interest in tattoos favored small, decorative ones, similar to those adorning some current media celebrities. When commenting on others' tattoos, they were concerned about the implications for clothing choice such as shoulderless tops. In addition, however, the findings also point to a period in mid-adolescence when many females may be experimenting with self- or peer-inflicted markings. The motives for and psychological consequences of these practices call for further attention, since there are risks of disfigurement and long-term distress to females who lose control over their appearance.
The present study has generated preliminary information in an area where little is available. Specifically, it has provided data on attitudes toward what may be an attractive practice to some during adolescence, but one which poses serious physical and mental health risks in the immediate and long-term. While quantitative data are required to confirm trends suggested by the present findings, a change in attitude toward body marking around early adolescence appears to be occurring, and that young people are entering into this practice with some awareness of the risks involved. We now need to learn more about the prevalence of marking, how it is attained by underage individuals, its significance in adolescent peer culture, and its function in the course of adolescent identity development. Above all, there is an urgent need for research aimed at prevention of the unsafe use of tattooing and piercing implements.
The authors express their gratitude to the Division of Economics and Commerce, Education and Law of the University of Western Australia for providing financial support for this research.
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Stephen Houghton, Ph.D., Department of Education, Kevin Durkin, Ph.D., Department of Psychology, and Annemaree Carroll, M.Ed., Department of Education, The University of Western Australia.
