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    Tattoos: Health Care and Tattoo Essay

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    JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 56, NO. 5 Tattoos Can Harm Perceptions: A Study and Suggestions Annette Resenhoeft, BA; Julie Villa, RN; David Wiseman, PhD Abstract. Objective: Health researchers have claimed that perceptions toward a person with a tattoo are more negative than are perceptions toward non-tattooed persons. However, support for this has been obtained almost completely by nonexperimental research.

    Participants: In 2 experiments with 158 community college student participants, the authors found that tattoos harmed perceptions. Methods: Students viewed a photograph of a female model with and without a visible tattoo, and rated her on 13 personal characteristics. Results: In Experiment 1, ratings of a model with a dragon tattoo were significantly more negative (p < . 05) on 5 of the 13 personal characteristics than were ratings of the same model shown without the tattoo.

    In Experiment 2, which included different participants, a different model, and a different tattoo, the authors found that a dolphin tattoo led to more negative ratings on 2 of the 13 characteristics. Conclusions: The authors discuss possible impacts of tattoos on person perception as well as implications of the results for college student healthcare providers. Keywords: college students, perception, tattoo he desire to express oneself can lead to risky behaviors. Some of these behaviors, in turn, can cause health problems. One such behavior is tattooing.

    The physical risks of tattoos have been well-established (eg, infection, scarring, exposure to bloodborne illness, allergic reactions)1–3; however, a tattooed person also may experience negative social consequences, including negative perceptions formed toward that person because of the tattoo. 4 Such negative perceptions or their own regret may ultimately induce a tattooed individual to undergo costly tattoo removal procedures. Results from a national probability sample of 253 women and 247 men aged 18 to 50 years indicated that 24% had tattoos. Given their popularity, the prospect that tattoos affect At the time of the study, Ms Resenhoeft was an undergraduate psychology student, Ms Villa was enrolled in the nursing program, and Dr Wiseman was an assistant professor in the Psychology Department at Brookdale Community College in Lincroft, NJ. Copyright © 2008 Heldref Publications 593 T interpersonal perceptions merits study. Although an experimental approach can determine cause–effect relations most directly, few researchers have used this method to assess whether a person’s tattoo may affect others’ perceptions of that individual.

    Hawkes et al6 and Degelman and Price4 conducted 2 such studies. In their study of 268 male and female undergraduates at a medium-sized Canadian university, Hawkes et al6 presented students with a written description of a fictional young woman, including age, body build, current school status, work status, and information about a tattoo she had. The researchers found that when the woman was described as having a tattoo (particularly a relatively large and visible tattoo), participants rated her in more negative terms than when she was described as not having a tattoo.

    Degelman and Price4 presented 2 groups of participants (a majority [57%] of whom were high school students) with a photograph of a female model. One group saw the pictured model with a tattoo, and the other saw the model without a tattoo. After viewing the photo, participants rated the model on 13 interpersonal characteristics. The researchers found that participants rated the model with a tattoo less positively on many characteristics than they did the model without a tattoo.

    These 2 study findings suggest that tattoos can cause others to judge a person more negatively than would be the case without the tattoos. To our knowledge, no prior experimental investigatiors have used photographs to analyze interpersonal tattoo perception among college students. In our study, we used an experimental methodology (and photographs) to test whether tattoos on a person can harm college students’ perceptions of that individual. Our goals in our 2 experiments were to (1) assess the consistency of Degelman and Price’s4 findings using a sample of exclusively college students (Exp. ) and (2) determine perceptual effects of a relatively small and inconspicuous tattoo (Exp. 2). Each experiment involved a participant being shown 1 photograph. We showed participants Resenhoeft et al a photo of a woman either with (experimental group) or without (control group) a tattoo. The independent variable was the presence or absence of a tattoo on a woman (ie, the model in the photograph). The dependent variables were participant ratings of 13 interpersonal characteristics of the model (eg, fashionable).

    Participants indicated the level of their perceptions of the 13 characteristics by using a 5-point scale for each. Labels such as very unfashionable and very fashionable anchored the scale ratings. On the basis of the results of the experimental studies mentioned previously combined with those of other studies that were descriptive (ie, nonexperimental), we predicted that our 2 experiments would show that tattoos negatively affected perceptions. Our sample came from a population of students attending a New Jersey community college.

    All were volunteers from the school’s psychology and nursing classes. We randomly assigned each participant to either a tattoo (experimental group) or nontattoo (control group) condition. Our 158 participants provided written informed consent. The appropriate institutional review board approved the procedures of this study. EXPERIMENT 1 Methods Participants Eighty-five students at a New Jersey community college volunteered as participants (37% male, M age = 21. 64 years, SD = 5. 34). Thirty-two percent of participants reported having permanent tattoos.

    Materials We distributed a packet of materials to each participant. Packets contained a color photograph of a woman (used by Degelman and Price4), a rating scale for each of 13 personal characteristics with which to indicate perceptions of the model, a demographic survey, and a 24-item attitude scale (shortened from that used by Degelman and Price4). The attitude scale was unrelated to the goals of the present study; it simply provided a task prior to the viewing of the photograph to decrease the prospect of participants guessing the purpose of the study.

    Each packet contained a color photograph of a 24-year-old woman dressed in a black tube top, black pants, and close-toed shoes. She was kneeling and looking into the camera. In the experimental group’s photo, the woman had a black tattoo of a dragon on her upper left arm. In the control photo, the model appeared without the tattoo, which we removed via Macromedia’s Fireworks version 3. 0 (Adobe Systems Inc, San Jose, CA). Procedure We informed participants that the study was designed to investigate the ways that people make judgments about other people.

    We told them they would first fill out a series of surveys. In the first survey, we asked participants the extent to which they agreed with each of a series of statements pertaining to personality traits (the distracter task). Participants 594 were also told that they would be looking at a photograph and then rating the person in the photograph on 13 characteristics using a 5-point scale for each. A score of 1 indicated the most negative perception; a score of 5 was the most positive.

    Characteristics used were very unfashionable/very fashionable, very unathletic/very athletic, very unattractive/very attractive, very uncaring/very caring, very uncreative/very creative, very undetermined/very determined, very unmotivated/ very motivated, very dishonest/very honest, very ungenerous/very generous, very unmysterious/very mysterious, very unreligious/very religious, very unintelligent/very intelligent, and very unartistic/very artistic. On the demographic questionnaire, we asked participants to indicate their age, sex, and whether they had permanent tattoos.

    After participants rated the person, they had completed the demographic survey. Results We first conducted a multivariate analysis of variance (MANOVA) to determine whether a tattoo had an effect on the vector of dependent variables formed by the ratings each participant made. A MANOVA can assess an independent variable’s impact on a group of dependent variables but may have low power to detect differences in a single dependent variable. Thus, we conducted a second analysis procedure with a set of 13 univariate analyses (one for each dependent variable).

    We analyzed participant ratings on all 13 personal characteristics in a one-way MANOVA (model condition: tattoo/no tattoo). This showed a significant multivariate difference between the ratings of the model with the tattoo and without the tattoo, using Wilks’ criterion (F[13, 71] = 3. 64, p < . 01). We observed an association between the model tattoo condition and the combined ratings of the 13 personal characteristics (partial ? 2 = . 40). Follow-up univariate analyses showed statistically significant differences between the model tattoo conditions on 6 of the 13 characteristic ratings (p < . 5). Participants shown a photo of a model without a tattoo, compared with those shown a model with a tattoo, rated the model as more fashionable, more athletic, more attractive, more caring, more intelligent, and less creative. Comment We found that participants’ perceptions of the model with a tattoo were more negative with regard to physical appearance (eg, attractiveness) and personality traits (eg, caring) than were perceptions of the model without a tattoo. This is consistent with past research. ,6 In the Degelman and Price4 study, participants rated the model without the tattoo as significantly more athletic, attractive, motivated, honest, generous, mysterious, religious, intelligent, and artistic. We similarly found that participants in our study judged the model without a tattoo as more attractive, athletic, and intelligent than the same model shown with a tattoo. EXPERIMENT 2 In Exp. 2, we used a different photo set (including a different tattoo) than in Exp. 1: the model was different and the JOURNAL OF AMERICAN COLLEGE HEALTH

    Perceptions of Tattoos tattoo in Exp. 2 was smaller, less visible, and possibly not as intimidating in content (ie, dolphins vs a dragon). Methods Participants Seventy-three students at a New Jersey community college volunteered as participants (25% male; M age = 28. 90 years, SD = 10. 32). Twenty five percent of the participants reported having permanent tattoos. (These were different participants than those in Exp. 1. ) One participant did not complete the demographic survey; another did so only partially. Materials The materials used in Exp. were the same as those used in Exp. 1, except for the photographs. Exp. 2 photographs were of a 27-year-old woman dressed in a white sleeveless t-shirt, looking at the camera from an angle. In the experimental group, the woman had a blue and black tattoo of a pair of dolphins on the back of her upper right shoulder. In the control group, she did not have a tattoo. (We again used the Fireworks software to remove the tattoo. ) Procedure The procedure was the same as in Exp. 1. Results We completed the same analyses as in Exp. 1.

    Using a MANOVA, we found no significant multivariate difference between the ratings of the model with the tattoo and the ratings of the model without the tattoo (F[13, 59] = 1. 44, p > . 05). We found a strong association between the model tattoo condition and the combined ratings of the 13 personal characteristics (partial ? 2 = . 241). Univariate analyses showed a significant difference between the model tattoo conditions on 2 of the 13 measures (p < . 05). Those participants shown a model without a tattoo rated the model as being more honest and religious than did participants shown a model with a tattoo.

    Comment Although Exp. 2 scores indicated that tattoos had a smaller impact, the results still provide experimental support that tattoos can affect (and impair) perceptions of that person. This was shown with a tattoo that is small, of low visibility, and nonthreatening in subject matter. COMMENT Our overall results show that having a tattoo hinders interpersonal perceptions. This study appears to be the first to demonstrate this while combining the following 3 features: use of an experimental procedure, an exclusively college student sample, and photographs (rather than a written description) of a model.

    This study provides experimental evidence that, in certain circumstances, obtaining a tattoo may lead to one being judged less positively than would be the case without a tattoo. More generally, these findings add tattooing to a list of behaviors identified by psychologists VOL 56, MARCH/APRIL 2008 as stemming from self-presentational motives that yield potential adverse health or social effects. Limitations Our study, like others, had limitations. First, we did not assess whether variations in the models’ dress may have moderated the perceptual effect of the tattoo.

    Second, we did not use models who were actual peers of the participants. The Exp. 1 model was slightly older than the mean age of Exp. 1 participants; the Exp. 2 model was slightly younger than Exp. 2 participants. Last, we conducted the study at a single college rather than at multiple schools. Suggestions Healthcare providers could inform a college student considering getting a tattoo that despite the apparent popularity of tattooing, a tattoo may harm perceptions of them by their peers. If a student considering getting a tattoo realizes that peers may negatively view a tattoo, that student may be less likely to get a tattoo. However, if a tattoo is obtained, the student might later regret it because of peer disapproval. Thus, the suggestion ultimately may spare a patient from mental, physical, and financial costs of future tattoo removal. ) The logic behind this suggestion is the same logic that has served as the basis for an intervention that has been effective with college students in a different issue: binge drinking. In trying to reduce drinking, college administrators have publicized misperceptions held by students that their peers drink more than they actually do.

    Such misperceptions can lead to one student believing that dangerous behaviors are condoned or encouraged by peers (ie, are social norms). This effort has been called the social norms approach. 7 The logic behind such campaigns is that once accurate information regarding the behavior is presented to the target population, its members will reduce that behavior to act in accordance with these newly received norms. In regard to tattooing, if one student does not like a behavior (eg, getting a tattoo) and another student considering this action is aware of this dislike, the chances of getting a tattoo may decrease.

    A second suggestion is for a healthcare provider to warn a college student considering obtaining a tattoo that a difference may exist between the perceptions of peers (other college students) who like tattoos and older adults (ie, nonpeers) who do not. Whelan8 found disparities between how younger adults view tattoos (eg, positively as objects of self-identity and body art) and how older adults view them (eg, negatively, such as marking deviant behavior).

    This disparity may lead to difficulties for tattooed college students in securing employment when nontattooed older adults are in charge of hiring. Results of past studies4,6,9 also suggest this. Conclusions The previous suggestions may not seem needed because some people like tattoos. However, despite their popularity, Varma and Lanigan10 documented regret among people with 595 Resenhoeft et al tattoos. The regret was felt both shortly after (ie, weeks) and in the long term (ie, years). Our results hopefully will be an impetus for further experimental (as opposed to descriptive) research.

    Researchers may want to assess how the perceptions of those who work in healthcare settings may affect the care that is provided to individuals who have visible tattoos, particularly tattoos that evoke strong reactions (eg, a dragon vs a butterfly). ACKNOWLEDGMENT The authors thank the following for their encouragement and assistance throughout the course of the investigation: Jennifer Wiseman, Joel Morgovsky, Adeline Griffin, Douglas Degelman, Claudia Oben Villa, and the members of the Psi Beta Chapter of Brookdale Community College. NOTE

    Authorship listing was determined by alphabetical order. All 3 individuals contributed substantially to this article. For comments and further information, address correspondence to Dr David Wiseman, Brookdale Community College, Dept of Psychology, 765 Newman Springs Rd. , Lincroft, NJ 07738, USA (e-mail: [email protected] edu). REFERENCES 1. Armstrong ML, Owen DC, Roberts AE, Koch JR. College tattoos: more than skin deep. Dermatol Nurs. 2000;14:317–323. 2. Brown KM, Perlmutter P, McDermott RJ. Youth and tattoos: what school health personnel should know. J School Health. 000;70:355–361. 3. Armstrong ML, Owen DC, Roberts AE, Koch JR. College students and tattoos: influence of image, identity, family, and friends. J Psychosoc Nurs Mental Health Serv. 2000;40:20–29. 4. Degelman D, Price ND. Tattoos and ratings of personal characteristics. Psychol Rep. 2002;90:507–514. 5. Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol. 2006;55:413–421. 6. Hawkes D, Senn C, Thorn C. Factors that influence attitudes toward women with tattoos. Sex Roles J Res. 2004;50:125–146. 7. Perkins WW.

    The Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco, CA: Jossey-Bass; 2003. 8. Whelan D. Ink me, stud. Am Demograph. 2001;23: 9–11. 9. Fiorilli A, Szuchman LT. Perceived stigma of tattoos in hiring decisions. Poster session presented at the annual meeting of the Association for Psychological Science, New York, New York. May 25–28, 2006. 10. Varma S, Lanigan SW. Reasons for requesting laser removal of unwanted tattoos. Br J Dermatol. 1999;140,483–485. American College HEALTH JOURNAL OF

    Executive Editors Reginald Fennell, PhD, CHES, F-ACHA Dr. Fennell is a professor of health education at Miami University in Oxford, Ohio, in the Department of Kinesiology and Health. He earned his PhD in health education from The Ohio State University and his undergraduate and master’s degrees from North Carolina State University. His scholarly focus is on health education and human sexuality education, with an emphasis on HIV/AIDS. He developed—and since 2001 has served as the director of—a 5-week study abroad program in international health, based in France and Switzerland. Dr.

    Fennell is a past president of the American College Health Association. Peggy Ingram Veeser, EdD, APRN, BC Dr. Veeser is a professor of nursing at the University of Tennessee Health Science Center at Memphis, where she has been the Director of University Health Services for more than 20 years. She is a Fellow of the American College Health Association and the American Academy of Nurse Practitioners. She presently serves on the ACHA Board of Directors as Member at Large. Dr. Veeser is also on the editorial board of The Nurse Practitioner: The American Journal of Primary Health Care. Ted W.

    Grace, MD, MPH Dr. Grace left the private practice of medicine in 1987 to obtain a Master of Public Health degree and complete a 2-year fellowship in college health administration. Afterward, he served as the medical director of the Student Health Center at San Diego State University for 3 years, leaving in 1992 to accept a position as the director of student health services at The Ohio State University. In June 2007, he became senior director of disaster preparedness and student health policy within the division of student affairs at Ohio State. 596 JOURNAL OF AMERICAN COLLEGE HEALTH

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