BACKGROUND AND OBJECTIVES: This study's purpose was to investigate, in a large cohort of adolescents, the prevalence and association of personal and family characteristics with having or considering body piercing or tattoo. METHODS: We surveyed students from the Veneto Region of northeast Italy with a self-administered questionnaire that asked about body piercing and tattoo and about personal and family characteristics. Multinomial weighted regression analysis was used to generate adjusted relative risk ratios with 95% confidence interval (CI) for piercing and tattooing separately. RESULTS: A total of 4,277 of 4,524 surveyed students completed and returned a usable questionnaire. For piercing, the prevalence was 20%. Girls, students with a less educated father, and those dissatisfied with their physical appearance were more likely to be interested in and to have undergone this procedure. For tattooing, the prevalence was 6%. Boys and students whose father was younger than 48 were more likely to have experienced tattooing. A strong association was found between having a piercing and having a tattoo. Fify-six percent of pierced students and 48% of tattooed students were underage (<18 years). CONCLUSIONS: We found that male gender (for tattoo), female gender (for piercing), dissatisfaction with physical appearance, positive attitudes toward either piercing or tattoo, and having a younger and less educated father were associated with having or desiring body modification. These factors could be considered for targeted patient education.