Tattooing among Iranian prisoners: results of the two national biobehavioral surveillance surveys in 2015-2016

Abstract Background: Tattooing is among identified risk factor for blood-borne diseases. Objective: This study aims to determine the prevalence of tattooing during lifetime and in prisons and its related factors among Iranian prisoners. Methods: This is a cross-sectional study. The required data was obtained from hepatitis B and C surveillance surveys in prisons in 2015-2016 that was collected through face-to-face interview. 12,800 prisoners were selected by multi-stage random sampling from 55 prisons of 19 provinces in Iran. Weighted prevalence and associated factors (using Chi-Square test and multivariate logistic regression) were determined by Stata/SE 14.0 survey package. Results: Out of 12,800 prisioners, 11,988 participated in the study (93.6% participation rate). The prevalence of tattooing in lifetime and in prisons was 44.7% and 31.1% respectively. The prevalence of tattooing during lifetime was significantly associated with age < 35 years, being single, illiteracy, history of imprisonment, drug use, piercing during lifetime, extramarital sex and history of STI; the prevalence of tattooing in prison had a significant association with history of imprisonment, drug use, piercing in prison, and history of extramarital sex (p < 0.05). Study limitations: Information and selection bias was one of the study limitations. Conclusion: The results of this study showed that the prevalence of tattooing during lifetime and in prison among prisoners was significantly high especially in high-risk groups such as drug users and sexually active subjects. Given the role of tattooing, drug injection and sex in the transmission of blood-borne diseases, harm reduction programs are recommended to reduce these high-risk behaviors in prisons.

Tattooing among Iranian prisoners: results of the two national biobehavioral surveillance surveys in 2015-2016.

BACKGROUND: Tattooing is among identified risk factor for blood-borne diseases. OBJECTIVE: This study aims to determine the prevalence of tattooing during lifetime and in prisons and its related factors among Iranian prisoners. METHODS: This is a cross-sectional study. The required data was obtained from hepatitis B and C surveillance surveys in prisons in 2015-2016 that was collected through face-to-face interview. 12,800 prisoners were selected by multi-stage random sampling from 55 prisons of 19 provinces in Iran. Weighted prevalence and associated factors (using Chi-Square test and multivariate logistic regression) were determined by Stata/SE 14.0 survey package. RESULTS: Out of 12,800 prisioners, 11,988 participated in the study (93.6% participation rate). The prevalence of tattooing in lifetime and in prisons was 44.7% and 31.1% respectively. The prevalence of tattooing during lifetime was significantly associated with age<35 years, being single, illiteracy, history of imprisonment, drug use, piercing during lifetime, extramarital sex and history of STI; the prevalence of tattooing in prison had a significant association with history of imprisonment, drug use, piercing in prison, and history of extramarital sex (p<0.05). STUDY LIMITATIONS: Information and selection bias was one of the study limitations. CONCLUSION: The results of this study showed that the prevalence of tattooing during lifetime and in prison among prisoners was significantly high especially in high-risk groups such as drug users and sexually active subjects. Given the role of tattooing, drug injection and sex in the transmission of blood-borne diseases, harm reduction programs are recommended to reduce these high-risk behaviors in prisons.

Hidradenitis Suppurativa Influences Tattooing Practice in Women.

BACKGROUND: The reasons or the motivations that compel people to get a tattoo or a body piercing (BP) are plentiful and personal. Patients with chronic cutaneous or systemic conditions may be interested in getting tattooed or pierced. OBJECTIVE: To determine the frequency of body art practices in hidradenitis suppurativa (HS) and to evaluate the possible impact of HS in the decision-making process. METHODS: An anonymous specific paper-based questionnaire was prospectively offered to patients (≥18 years) consecutively managed for HS from September 2016 to March 2017 in a French specialized center. RESULTS: In total, 209 patients participated in the study, of whom 77 (37%) and 50 (24%) had tattoos and BP, respectively. These proportions were higher than those reported in the French population. HS prevented the decision to get a BP or a tattoo in 2 and 5%, respectively (fear of infection or healing difficulties). Fifteen patients (7%) got tattooed to hide a surgical HS scar (n = 5, 2%), to regain control over the pain or their bodies (n = 9, 4%), or to turn others' eyes away from HS lesions or scars (n = 1, 0.5%). HS severity influenced a proportion of patients who intended to get a new tattoo. CONCLUSION: HS is associated with a significant increase in body art practices.

Prevalence of periodontal pathogenic bacteria at different oral sites of patients with tongue piercing - results of a cross sectional study.

Aim of this cross-sectional study was to investigate the prevalence of selected potentially periodontal pathogenic bacteria in different sites of patients with tongue piercing (TP) in comparison to a control group (C). Fifty participants in each group were recruited. Samples from the biofilm originating from the piercing surface (TP group), periodontal pocket, tongue as well as cheek surface were examined regarding presence of 11 selected potentially periodontal pathogenic bacteria based on polymerase-chain reaction (PCR). In the periodontal pocket of the participants, the majority of examined bacteria were more frequently detected in TP compared to C group (pi < 0.05). At tongue and cheek surface, the prevalence of Treponema denticola (P < 0.01) and Prevotella intermedia (P < 0.01) was significantly higher in TP. For the majority of bacteria, a significant correlation between TP surface and periodontal pocket was detected (P < 0.05). In conclusion TP must be considered as potentially important ecological niche and reservoir for periodontal pathogens.

Body modification in Germany: prevalence, gender differences and attitude towards cosmetic surgery.

BACKGROUND: The most popular body modifications are tattoos and piercings and their prevalence has increased in recent years. The current study gathered statistics regarding tattoing, piercing and body-hair removal, differentiated by gender and attitude towards cosmetic surgery. METHODS: The study was based on 2512 individuals and was performed as a population-based survey with the assistance of a demographic consulting company. In addition to sociodemographic questions, specific issues concerning body modification were asked. RESULTS: Men get tattoos more frequently while women more often choose piercings and body hair removal. Women are catching up in the tattoo department and one can no longer observe age differentiations among the younger age groups. Instead there is a decrease in piercings among men. Body hair removal is widespread above all women. People with body modifications tend to be more open-minded about cosmetic surgery. CONCLUSIONS: Tattoos and piercings continue to be the most popular body modification among young adults. The number engaged in tattooing is rising while piercings are still popular among women. Individuals being engaged in body modification are prone to consider cosmetic surgery procedures.

Pierced identities: Body modification, borderline personality features, identity, and self-concept disturbances.

Little is known about the connection between body modification and borderline personality disorder (BPD). This study investigated the relation between a wide range of body modification practices (piercing, tattooing, scarification, pubic hair removal, and cosmetic surgery) and BPD features, with a special focus on identity and identity dysfunction, in an adult community sample (N = 330). Results indicated BPD features were positively correlated with total number of body modifications and breadth of body modification practices endorsed, as well as, specifically, increased piercings, tattoos, and scarifications. Furthermore, identity problems (i.e., identity diffusion and low self-concept clarity) were associated with body modifications. Implications of these findings are discussed, including their heuristic value in understanding body modification in light of its connection to BPD (and particularly identity/self-concept functions). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Body Piercing: A National Survey in France.

BACKGROUND: There are no recent data available in France regarding body piercing (BP). OBJECTIVE: We examined the demographics, motivations, quality of life, cutaneous conditions, and cutaneous side effects after BP within the French population. METHODS: A representative sample of 5,000 individuals (aged 15 and over) from the general population responded to a survey online between April and August 2017. Data regarding demographics, BP characteristics (location, age at first piercing, hesitation, regrets, motivations, cutaneous side effects), tobacco, skin conditions (acne, contact eczema, atopic eczema, rosacea, psoriasis, vitiligo), and tattoos were collected. Respondents also filled an SF-12 quality of life questionnaire. RESULTS: Overall, 12% of the respondents reported at least one BP (women: 19.4%, men: 8.4%, p < 0.01). The prevalence was highest among those aged between 25 and 34 years (25.8%). Individuals with BP were more likely to smoke (p < 0.01). The most common body parts for piercings were the external part of the ear (42%), the navel (24%), the tongue (15%), and the nose (11%). Gender differences included localization (belly button and nose for women, eyebrows for men) and motivations (embellishment of the body for women, individuality and sexuality for men). A total of 33.6% of the study participants reported having skin problems after BP, primarily infection (44%). Individuals with BPs were more likely to report having contact eczema, atopic dermatitis, and acne. BP was associated with a lower mental quality of life score. CONCLUSION: This is the largest epidemiological study on BP in France to date. It allows us to draw a precise current snapshot of French indi viduals with BP.

Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates.

Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%); low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.

Prevalence of contact allergy to metals in the European general population with a focus on nickel and piercings: The EDEN Fragrance Study.

BACKGROUND: Studies on sensitization to metals in the general population are scarce. OBJECTIVES: To determine the prevalence of sensitization to metals in the general population, and factors associated with nickel sensitization. METHODS: In 5 European countries (The Netherlands, Germany, Italy, Portugal and Sweden), a random sample (N = 3119) from the general population (aged 18-74 years) was patch tested and interviewed by use of a questionnaire on exposure to metals, piercing, and jewellery. RESULTS: Overall, the age-standardized prevalences of sensitization to nickel, cobalt and chromium were, respectively, 14.5%, 2.1%, and 0.8%. The highest prevalence of nickel sensitization was seen in Portugal (18.5%) and the lowest (8.3%) in Sweden. The prevalence of cobalt sensitization varied between 3.8% (The Netherlands) and 0.9% (Italy), and the prevalence of chromium sensitization varied between 1.3% (Portugal) and 0.2% (Sweden). Significant associations were observed between nickel allergy and female sex (odds ratio [OR] 5.19; 95% confidence interval [95%CI]: 3.99-6.74), past piercing use (OR 3.86; 95%CI: 2.85-5.24), and currently having ≥3 piercings (OR 5.58; 95%CI: 4.02-7.76). CONCLUSIONS: The prevalence of sensitization to metals in the European general population was high, mostly because of nickel. The lowest prevalence of contact allergy to nickel and chromium observed in Sweden supports the effectiveness of long-standing regulation.

Emergent predictors of hepatitis C infection among non-injection drug users.

BACKGROUND: Hepatitis C virus (HCV) presents a significant public health issue, especially among high-risk populations, such as truck drivers, prisoners, people living with HIV, people living with tuberculosis, and people who are homeless. METHODS: This cross-sectional study analyzed the data of 1600 individuals recruited from high-risk populations who denied the use of injection drugs and/or history of blood transfusion to better understand on epidemiology of HCV. RESULTS: The presence of HCV antibodies was independently associated with the following risk factors: age >40years, tattoo or body piercing, sharing of personal care items, and non-injection drug use. CONCLUSIONS: While the use of injection drugs is a prevalent mode of HCV transmission, the findings of this study indicate additional routes that lead to viral transmission among vulnerable populations. Since an HCV vaccine is not currently available, public health and education programs should be developed that specifically target high-risk populations to prevent infection acquisition and secondary transmission.

Piercing and Metal Sensitivity: Extended Analysis of the North American Contact Dermatitis Group Data, 2007-2014.

BACKGROUND: Body piercing provides a unique route of metal exposure. OBJECTIVE: The aim of this study was to update previous analyses using the North American Contact Dermatitis Group data comparing pierced and unpierced individuals. METHODS: This was a retrospective cross-sectional analysis of 17,912 patients patch tested by the North American Contact Dermatitis Group from 2007 to 2014 for demographics, positive reactions to metals (nickel, cobalt, chromium), and detailed analysis of nickel reactions by age, sex, and source of exposure. RESULTS: Piercing was significantly associated with female sex, being older than 18 years, and atopy (P < 0.003). Nickel sensitivity was associated with 1 or more piercing for men and women combined (P < 0.0001; relative risk [RR], 2.54; 95% confidence interval [CI], 2.35-2.75), although this association was stronger for men (RR, 2.21; 95% CI, 1.77-2.76) than women (RR, 1.47; 95% CI, 1.31-1.65). The frequency of positivity to nickel increased with number of piercings (14.3% for 1 piercing to 34.0% with ≥5 piercings). Piercing was not significantly associated with cobalt sensitivity alone (P = 0.8992) and was negatively associated with chromium sensitivity (P < 0.0001). Jewelry was the most common source of allergic reactions to nickel irrespective of sex or pierced status. CONCLUSIONS: Nickel sensitivity was significantly associated with piercing in both men and women. Jewelry was the most common source.

Adolescent and Young Adult Tattooing, Piercing, and Scarification.

Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.

El fenómeno piercing en Uruguay: aspectos patológicos y socioculturales / Piercing phenomenon in Uruguay: pathological and sociocultural aspects

El piercing se exterioriza como una práctica intrínsecamente vinculada a la conformación de las diversas organizaciones colectivas humanas. Numerosos autores han tipificado las lesiones orgánicas acaecidas por su utilización, pero no así, el marco sociocultural en el que se encuadran. Objetivos: este estudio buscó analizar los alcances patológicos y socioculturales concernientes al uso de piercing,en una muestra uruguaya. Metodología: consistió en la aplicación de un cuestionario, con 26 preguntas estructuradas y abiertas, a los estudiantes de un instituto de educación media de la ciudad de Rivera, Uruguay. Resultados: 21 (40.38%) de los 52 poseedores depiercings padecieron complicaciones provenientes de su uso, en tanto que 24 (46.15%), 26 (50%) y 14 (58.33% de los que trabajaban),respectivamente, no notaron reacciones sociales, familiares ni laborales. Conclusiones: trátase de un comportamiento potencialmenteriesgoso, a pesar de que en esta oportunidad, la totalidad de las alteraciones se topografió localmente, la mayoría de los usuarios realizabadeportes y un porcentaje significante de ellos, no advirtió ninguna repercusión en su vida cotidiana.

Piercing is externalized as a practice intrinsically linked to the construction of diverse human collective organizations. Numerous authorshave typified organic lesions occurred by its use, but not sociocultural framework that characterize it. Objectives: the aim of this paperwas to analyse pathological and sociocultural scopes concerning the use of piercing in a Uruguayan sample. Methods: the research wasdeveloped by applying a questionnaire with 26 structured and open questions, answered by students of a secondary education institute of the city of Rivera, Uruguay. Results: 21 (40.38%) of the 52 pierced individuals suffered complications from its use, while 24 (46.15%),26 (50%) and 14 (58.33% of those who worked), respectively did not notice social, family or employment impacts. Conclusions: piercingis a potentially risky behaviour, although in this opportunity all alterations were locally situated, most users performed sports, and asignificant percentage of them did not point out no repercussion on their daily life.

Comparison of risk-taking behaviour and frequency of piercing and tattooing among university students.

OBJECTIVE: To assess the frequency of piercing and tattooing among university students and to determine the extent of risk-taking behaviour in this age group. METHODS: The descriptive cross-sectional study was conducted at a university in Istanbul, Turkey, from December 2009 to February 2010. Data was obtained from students through a questionnaire. SPSS 20 was used for statistical analysis. RESULTS: Of the 1303 subjects, 838(64.3%) were girls. The overall mean age of the sample was 21.7±1.9 years. A total of 107 (8.2%) had piercings and 56(4.3%) had tattoos. It was seen that young people who had piercings and tattoos were significantly more likely (p<0.05) to exhibit certain types of risk behaviour including smoking, alcohol, substance abuse, extreme sports, carrying switchblades/knives, unprotected sexuality and having multiple sex partners. CONCLUSIONS: In the face of the steadily increasing fads of piercing and tattooing among the youth, families, teachers and health professionals need to be constantly on the alert.

Piercings in medical students and their effects on the skin

BACKGROUND: Piercings are body embellishments commonly seen in young people, however their inherent risk of infection and scarring disorders are less divulged. OBJECTIVE: To evaluate the prevalence of body piercings among medical students and their possible dermatologic consequences. METHODS: Cross-sectional study with 58 medical students, by means of a structured questionnaire covering socio-demographic characteristics, technical issues related to the piercing and characteristics of the dermatologic complications. RESULTS: The sample was predominantly female (86.2%), with mean age 24 ± 3 years. The placement of the first piercing occurred during adolescence (median age 15), without medical supervision (91.4%) or knowledge of parents/guardians (74%). Most piercings were made of metal alloy/stainless steel, in a dumbbell model (51.7%), inserted in the umbilical area (53.5%) or ear (41.4%), with frequent cutaneous reactions in the first six months post-piercing. Hypertrophic scarring, pain, swelling and infection (p<0.05) had significantly higher frequencies among those with navel piercings. CONCLUSION: Piercing insertion occurred during adolescence. Local inflammatory and infectious reactions were common. Scarring disorders and dermatitis appeared in the long term. There is need for preventive and educational activities, starting with those in the academic environment. .

Piercings in medical students and their effects on the skin.

BACKGROUND: Piercings are body embellishments commonly seen in young people, however their inherent risk of infection and scarring disorders are less divulged. OBJECTIVE: To evaluate the prevalence of body piercings among medical students and their possible dermatologic consequences. METHODS: Cross-sectional study with 58 medical students, by means of a structured questionnaire covering socio-demographic characteristics, technical issues related to the piercing and characteristics of the dermatologic complications. RESULTS: The sample was predominantly female (86.2%), with mean age 24 ± 3 years. The placement of the first piercing occurred during adolescence (median age 15), without medical supervision (91.4%) or knowledge of parents/guardians (74%). Most piercings were made of metal alloy/stainless steel, in a dumbbell model (51.7%), inserted in the umbilical area (53.5%) or ear (41.4%), with frequent cutaneous reactions in the first six months post-piercing. Hypertrophic scarring, pain, swelling and infection (p<0.05) had significantly higher frequencies among those with navel piercings. CONCLUSION: Piercing insertion occurred during adolescence. Local inflammatory and infectious reactions were common. Scarring disorders and dermatitis appeared in the long term. There is need for preventive and educational activities, starting with those in the academic environment.

HCV seropositivity in inmates and in the general population: an averaging approach to establish priority prevention interventions.

OBJECTIVES: Despite the fact that a considerable portion of hepatitis C virus (HCV) positive individuals are viraemic, the risk of transmitting HCV to others is context dependent. Prison is a particularly risky environment as HCV prevention tools are often unavailable. Using data from a cross-sectional study conducted in centres for HCV testing in southeastern France, we aimed to compare the patterns of risk factors in HCV-positive inmates with those in the general population. SETTING: 26 centres for HIV/HCV testing in southeastern France (23 in the general population and 3 in prison). PRIMARY OUTCOME MEASURE: HCV seropositivity measured with ELISA test. METHODS: A propensity score method to ensure that the general and inmate populations could be compared and a multimodel averaging to estimate the degree (strong, weak, none) of the association of a number of specific factors with HCV seropositivity in each group. RESULTS: Among the 52,082 participants, HCV infection prevalence was 1.5% and 5.2% in the general (n=46,125) and inmate (n=5957) populations, respectively. In both populations, 'drug injection without snorting' and 'drug injection with snorting' were very strongly associated with HCV seropositivity. Among inmates, 'drug snorting alone' (OR (95% CI) 2.21 (1.39 to 3.52) was also a strong correlate while tattoos, piercings (OR (95% CI) 1.22 (0.92 to 1.61)) and the sharing of toiletry items (OR (95% CI) 1.44 (0.84 to 2.47)) were weak correlates. CONCLUSIONS: The pattern of risk factors associated with HCV seropositivity is different between the general and prison populations, injection and snorting practices being more prevalent in the latter. Access to prevention measures in prisons is not only a public health issue but also a human right for inmates who deserve equity of care and prevention.