1. A Holistic & Global Look at Body Art (Body Piercing & Tattooing) Myrna L. Armstrong RN, Ed.D, FAAN Professor & Regional Dean, Highland Lakes Campus Myrna L. Armstrong RN, Ed.D, FAAN Professor & Regional Dean, Highland Lakes Campus

2. Research Goals (1990-Present) Describe the phenomenon Determine risks (physical & psychosocial) Promote informed decision- making Research team since 1999

3. Research Participants Women Adolescents Soldiers College students

4. Historically Bible Slaves Holocaust Blood Typing in US for War Transplants – sole of foot

5. Trends... Mainstream activity Popularity sweeping the world Media describe as risqué, carefree behavior More creativity, especially piercing Movement toward branding, suspensions, implants

6. An artist-customer regulated business with: No money-back guarantee government testing samples with the procedure Limited regulations and controls AND, blood-borne disease potential.

7. Why? Body Art Self-Identity  “makes me feel good, special, unique ” Other reasons Affiliation Marking special occasions Religious markings

8. Body Piercing.... Rate 33-50% Not a difficult procedure Hollow, lancet-point needle, 12-16 gauge Jewelry should be Gold, Niobium, Platinum, Stainless Steel, or Titanium Skin and site infections are common 17-28% Removal: client-centered, usually scar tissue

9. Major concerns with body piercing: The artist The equipment The environment The invasive procedure (jewelry, technique) and after care.

10. Risks?? Lack of documented risks does not mean risks do not exist, rather just not reported.

11. Recommendation for Piercing Studio vs mall Piercing guns: Research/literature Should be outlawed, but strong lobbyist action Unable to sterilize Crush surrounding tissue Need further research

12. “ Complete” site healing Phase I Immediate Phase II 6-10 months. Skin inside hole epithelializes Phase III A year or longer. Hole “toughens up” Continual portal for organisms

13. Body Piercing Infections occur because:  The individual’s health  Contaminated procedure (hepatitis B & C)  Poor after-care  Type of jewelry

14. ?????Removing jewelry???? Infections: Obstacle or portal for drainage Procedures: Teflon post, suture, fishing line Remember, you haven’t removed the reason they have it

15. Organisms & treatment Organisms: Staphyloccus aureus Pseudomonas aeruginosa B-hemolytic streptocci Treatment Dicloxacillin, clindamycin Ciprofloxacin (only >18 years of age)

16. Systemic Infections Occur because: Previous health conditions i.e. endocarditis Untimely medical attention Limited attention by health care provider

17. Cartilaginous ear piercing Includes pinna, helix, and tragus Area prone to infections Left untreated, necrotizing lesions, deformities Body image concerns

18. Naval piercings: Site appeals to many, “invisible” Often self-inflicted Up to 45% infected Clothing, sweat, and “fuzzies” problems Pregnancy

19. Tongue piercings: American Dental Association Aspiration, tooth, or nerve damage Tend to “play” with jewelry Speech difficulties Other oral sites- lip & labaret Gly-oxide ©, non-alcohol mouthwash

20. Nipple piercing Different piercing sites for females & males Infected or scarred lactation ducts? Avoid tight, restrictive clothing Breastfeeding

21. Limited data/many myths Various piercings for males & females. Genital Piercing Major reason: Sexual Enhancement Women: also reclaim body w/ rape & abuse

22. Variety of Male Genital Piercings AmpallangApadravyaGuiche Prince Albert Dydoe Foreskin Hafada

23. Creativity vs self-mutilation Beyond usual sites Lack of knowledge regarding location For example: vulva, chest, knuckles, 3-D implants

24. Tattooing... Multiple injections of pigment: (non-FDA approved, “lack of purity/identity,” i.e. car paint and printer’s ink) 50 to 3,000 times per minute 1/64 to 1/16th deep to epidermis junction using 1 to 14 solid needles on a single bar Both body and cosmetic tattooing popular

25. Tattooing... Transcends gender, socioeconomic groups and occupations. Incidence: 13-17 years old = 15-19% 18-30 years old = 19-25%

26. Major concerns The artist The equipment The environment The invasive procedure (pigment, technique) and after care.

27. Adolescents with tattoos Can be amateur or studio tattooing Some start at an early age, tend to have impulsive decision-making, group pressure, undue stress/crisis, and lack of support. Select unconcealed sites and big designs.

28. Adolescents with tattoos.... Dissonance w/ self-identity vs deviancy Believe they have a right to a tattoo Determined, will obtain, regardless of costs, regulations, or risks

29. Influences Image – yes Identity – yes Friends – yes Family - no

30. Tattooing, after care/problems Risks are limited, but present Reactions to pigment Photosensitivity Hepatitis B and C Psychosocial concerns

31. Tattoo Removal “semi "permanent (“2 x 2” cost = $50, removal = $1250 ++) Costly and time consuming Need the right equipment, BUT Pigment: (non-FDA approved, “lack of purity/identity”) Black/blue tattoos – satisfactory response Yellow, red, green - challenge

32. Tattoo Removal Freedom2Ink-designed by MD, removal 100% Two studies re “Motivation for Removal” Recent study: more women because of more negative comments home, work & school. Suggest strategic placement for control

33. Cosmetic Tattooing Very popular – all ages 20-90++ Check the Yellow Pages Eyebrows, eyelids & lip liner “Natural appearance Limited literature and complications

34. Tattooing in Prisons More research done outside of US Difficult to conduct here in US. Illegal activity, high risk population Recent research: 58% of those tattoo were HCV antibody-positive. Many use same needle and/or ink Type of products used for needle and ink Question of “prison tattooists”

35. How about this?

38. Branding... Many non-traditional objects used, (coat hangers, paper clips, etc) Thin strips of surgical stainless steel Several “strikes” are done, infections are common

39. Applicable health education: Their belief: a right to have body art Encourage belief of self ever-changing. Emphasize direct involvement with health decisions and informed decision-making. Removal-applicable approaches

40. YOUR Response Non-judgmental approach from ALL Procurement “without” our blessing Avoid “no” and scare tactics Learn as much as you can Demonstrate we know our stuff!! Proactive education