By Suz Redfearn

Special to The Washington Post

Tuesday, June 11, 2002; Page HE01

A new study confirms what many already suspect: Adolescents who get tattoos or body piercings are more likely than their undecorated age-mates to have sex, drink excessively, do drugs and even consider suicide. But the association between looking bad and being bad surprised even the researchers, who thought that the increasing prevalance of teens' tattoos and piercings would weaken the link.

"With tattoos and piercings becoming much more common these days, I didn't expect the correlation to be as strong as it was," said Army doctor Sean Carroll, the study's lead author.

While the implications of the study are limited by several factors -- its participants, for example, were drawn from a single clinic that treats military families -- it is one of the first studies to look at body adornment in kids who were encountered in a primary care environment. Most studies of adolescent tattoos have been conducted in detention and psychiatric settings.

The new study, published in the June 6 issue of the journal Pediatrics, surveyed 484 individuals from age 12 to 22 about their behavior patterns and whether they had tattoos and piercings in places other than their earlobes. All were patients at the Adolescent Medical Division of the Naval Medical Center in San Diego.

The researchers found that participants with tattoos and/or piercings were more likely to have engaged in risk-taking behaviors -- and to have done so to a greater extent -- than individuals without either type of body modification. Risk-taking behaviors included eating disorders, drug and alcohol abuse, sexual activity, violence and considering suicide.

Carroll and his colleagues observed that 72 percent of kids with piercings had had sex within the last 30 days, compared with 41 percent of kids without piercings. Ninety percent of participants with tattoos had recently had sex, compared with 41 percent among those without tattoos.

Differences in consumption of gateway drugs like alcohol and marijuana was also significant.

Thirty-three percent of study participants with piercings had recently engaged in binge drinking, while 11 percent of their non-pierced age-mates had. Among tattooed kids, 38 percent admitted to recent binge drinking; 13 percent of those without tattoos did.

Thirty percent of kids with piercings had smoked pot in the last month, compared with 15 percent of those without piercings. The numbers were similar for kids with tattoos and those without.

For males, violence was more associated with tattoos; for females, violence was associated more with piercings.

The researchers also found that hard drug use was closely associated with a teen's number of body piercings. And the younger a kid was when he or she got a tattoo or piercing, the higher the chance that the child would use gateway drugs. Kids were more likely to have considered suicide if they obtained their first tattoo or piercing at age 13 or younger.

Whether kids are are getting tattoos to be rebellious or to fit in with their friends, the number of those going under the needle are high. About 60 percent of the survey's participants had at least one tattoo, with 29 percent having acquired their first by age 17. Almost 5 percent got their first tattoo before age 14.

While the authors admit the study simply validates assumptions that many already had, they hope it spurs health care providers and parents to recognize a tattoo or piercing as a prompt for a serious discussion.

"We wanted to give physicians and nurse practitioners an idea that, yes, if you see a child with piercings or tattoos, this is somebody who could be at risk . . . and you need to start asking questions," said Elizabeth Myhre, a nurse practitioner and one of the study's researchers.

If the child is found to have undertaken serious risk-taking behaviors or seems headed in that direction, the clinician can offer precautionary measures and counseling, said Myhre.

Some physicians say the study's conclusions may be overly dramatic and outdated. David Kaplan, chief of adolescent medicine at the University of Colorado and chairman of the American Academy of Pediatrics's committee on adolescence, said that 10 or 15 years ago, he would have accepted the notion that tattoos and piercings were closely correlated with risk-taking behaviors. In more recent years, he said, there's been such an explosion in kids' doing body modification that it's nearly become mainstream.

"You can't necessarily assume a kid with a tattoo is spending all his time smoking pot. And even some of the goody-goody kids that come from 'Ozzie and Harriet' homes have their bellybutton pierced these days. It's much more normative in that population now," said Kaplan.

Carroll says that when he began the study, that's what he thought, too. "Given what I know now, I wouldn't make the assumption that because everyone around my kid is getting tattoos and piercings, too, my child isn't involved in risk-taking behaviors," said Carroll.

Ronald Feinstein, a professor in the department of pediatrics at the University of Alabama-Birmingham, agrees that it's wise to identify more factors associated with risk in teens, but he worries whether pediatricians can find the time to do it.

"Pediatricians spend 8 to 10 minutes with each patient now, and the number of things that we're being asked to discuss with a person on a visit is immense," Feinstein said. "It's almost impossible to do."

He added that when pediatricians see a tattoo or body piercing, they're already expected to ask if it was done by a professional with sterile equipment and, if it wasn't, whether needles were shared.

Those in the tattooing industry are predictably defensive about the assertion that kids with tattoos and piercings are more likely to be involved in risky behaviors.

"You have lots of kids without tattoos doing that stuff, too," said Joe Kaplan, president of the Tattoo Artists Guild, based in Mount Vernon, N.Y.

Carroll said he and his colleagues hope to conduct a similar study using larger populations and clinics in various cities.

Meantime, some doctors hope Carroll's findings don't encourage clinicians and parents to be too heavy-handed.

"I went to Woodstock," said Feinstein. "Kids today do body modification. Every generation of teens tends to find its own way of testing the boundaries of society. We need to walk a fine line between letting them do that and protecting them from hurting themselves."