Tattoo and Body Piercings among Young Adults in Nigeria

Objective: Both tattoo and body piercing have a long history and are well known in various cultures in African, American, Asia, and Oceania. Although the appearance of the two varies geographically, they always possess a specific meaning for a particular culture. This study examined awareness, attitude, and knowledge of students towards tattooing and body piercing in Delta State University, Abraka. Nigeria. Material and Methods: Data was collected through the use of well-structured questionnaires. The study made use of 400 young adults randomly selected from six faculties in Delta State University, Abraka. Result and Discussion: Findings revealed that the majority of students (85%) are aware of tattoo and body piercing and 31.3% gave fashion as the main reason why they engage in body modifications. It was however observed that 40% of the subjects under survey regard their colleagues involved in tattooing and body piercing as irresponsible and reckless. Conclusion: The study gave a growing convergence on both gender toward tattooing and a sharp difference in the involvement of both gender towards body piercing. Majority of these young adult are also aware of the health risks associated with body modifications and may not consider them in future.


Introduction
A tattoo is a form of body beautification where indelible ink, dyes, and pigments are used to make an inscription on dermis that remains underneath the epidermis layer of the skin 1 for temporary or permanent reasons. A tattoo is temporary when the immune system of the participant can dissolve the pigments found in the tattoo ink or the use of laser treatment that requires identification of a colour in the pigment and breakdown of the colour for macrophages to act on it 2 .
The various pigments or colourants mixed with carriers to produce tattoo inks are sometimes made from heavy metals and minerals such as carbon, iron oxide, Cinnabar. The functions of the carriers are for dissolving and movement of the pigment from the point of needle insertion to the various mapped out surfaces of the skin 2 . It is arguably claimed that tattooing has existed since 12,000 years BC with its purpose varying from culture to culture and its place on the timeline. Tattoos are drawn to express one's state of independence, for religious or cultural reasons, or to adorn one's body. The importance of tattoos in ritual and tradition is seen in Borneo women whose tattooed forearm symbolizes a particular craft they are skilled on.
Body piercing is an act of body modification done through penetration or opening of body parts such as eyebrows, lips, tongues, nose, nipples, or genitals to insert ornaments 3 . Both tattoo and body piercing have a long history and are well known in various cultures in African, American, Asia, and Oceania 4 . Although the appearance of the two varied geographically, they always possess a very specific meaning for a particular culture. Whereas piercings are often used in initiation rites to assign their bearer to a certain social or age group 5 , tattoos are utilized to signal religious affiliations, strength, or social status 6,7 . Body modifications are potentially an important aspect of human identification 8 , and they have significantly aided forensic anthropological cases in recent years 9 . Starkie articulates that the increasing use of body modifications encourages those undertaking the practices for their "extreme" nature to seek new methods of modifying their bodies 8 .
Youths in higher institutions of learning, music artists, movie actor/actress, beauty experts, sportsmen/women, fashion models are now engaging in tattooing and body piercing 10,11 . Although there is growing popularity of tattooing and body piercing among youths in Nigeria, yet, their excessive application and practice may have serious social and health body implications for body modifiers. Skin damage and rashes are common skin problems, while emotional detachments from the old image or collapsed relationships are usually difficult to remove 12 . According to Wohlrab, Stahl, and Kappeler 13 , tattoos can cause skin problems such as granulomas (red bumps caused by inflammation) and keloid scars. It can also provoke allergic reactions like skin itches and break out 13 . Also, viral infectious diseases, such as hepatitis A, hepatitis B, and HIV/AIDs can also be contracted via discharged body fluids and needles used during modification exercise. Also, tattoos and body piercing in some situations can limit the opportunity, as well as accentuate the tendency to discriminate against their wearers.
This study therefore, seeks to examine the awareness and attitude of young adults towards tattooing and body piercing.

Materials and Methods
A total of 400 students'aged 16-30 at various faculties of Delta State University, Abraka. Nigeria were administered questionnaires.Ethical approval was obtained from the research and ethics committee of Human Anatomy and Cell Biology Department of Delta State University, Abraka.
Students were randomly selected from six faculties and were assessed using a cross-sectional survey design. Questionnaires that were not accurately filled were excluded.
Respondents were informed of the purpose of study and their consent was sort and obtained. Questionnaires were thereafter distributed to respondent whose privacy were kept confidential by not including any of their bio data. Respondents filled the questionnaire after carefully going through the questions with the right understanding of the questions and the questionnaires were retrieved.
The data obtained were processed and analyzed through the use of Statistical Package for Social Sciences (SPSS), version 25. Results are presented in simple percentages

Results
From table 1: It was observed that the majority of the respondent(85.0%) are aware of tattoo and body piercing, 78%of respondent indicated males are mostly involved in tattooing as compared to female,8% had no idea of tattooing. However, fewer males were indicated to be involved in body piercing as compared to females (80.5%).   14.0%claimed that students who engage in these two forms of body modifications believe that they serve as a source of strength and identification, 24.3% indicated that tattoo and body piercing enhance sexual attraction, 25.8% attributed that students involvement in tattoo and body piercing is as a result of peer pressure. 4.8% stated other reasons why students engage in piercing and tattooing.
As shown in Table 5 & 6, the majority of the respondents consider students who wear tattoo and engage in body piercing as irresponsible and reckless, while 23.3% are indifferent, 19.8% believe they are bad and dangerous however, 13.0% sees them as fashionable and 4.0% consider them being decent. About 44.5% see students without tattoo and body piercing as decent and responsible however 18.5% see them as not being fashionable and others see them as inferior. Table 7 revealed 62.5%of respondents are aware of health risks associated with tattooing and body piercing while others are not. 61.8%of the respondents are in agreement that tattooing and body piercing can transmit infectious disease, while 9.8% of disagreed with 28.3% having no idea. Table 8 showed that of the 400 respondents, 19.5% would consider tattooing in the future while majority (65.8%) would not. 68.0% of the respondents would not consider body piercing in the future, 20.3% and 11.8%would consider piercing and have no idea respectively. Table 9 showed that of the400 respondents, 18.0% agreed that tattoo and body piercing is accepted in Christianity, 15.8%of the respondents agreed that tattoo and body piercing is accepted in Islam, however majority believed it is against their religion.           The study recorded an equal number of persons in gender (male or female) who gave a response about their knowledge of tattoo and body piercing. Fig 1.revealed that the total number of males (n = 200, 50%) was equal to the total number of females (n = 200, 50%). This shows that the concepts of discussion are known to the populace irrespective of how it is done and who is involved in the process .  Fig 2 showed that the majority of the respondents were within the age group 21-25 years, a total of 63%, followed by age group 16-20 years, 25.5%, and age group 26-30 years, 11.5%.

Discussion and Conclusion
In this study, we discovered from the responses obtained that majority of the students in Delta State University are aware of tattoo and body piercing and these act is progressively increasing among young adults. This finding agrees with Demello's 14 observation that tattoo and body piercing has increased tremendously in popularity, rising not only in numbers but also dependent on the social classes of those involved. A similar observation was also recorded by Ezeibekwe et al. 15 stating that these two forms of body modifications are increasingly gaining ground among University undergraduate students from Ibadan.It is obvious that the ills and believes previously associated with tattooing and body piercing is gradually been eroded.
From our study, males were mostly involved in tattooing while females are mostly involved in body piercing. These findings are in terms with the observation of Totten et al. 16 and Atkinson 17 that tattoos and body piercing have been noted to be subjected to gender norms, and as such, male and female are being accessed differently. Ezeibekwe et al. 15 also stated that unlike the growing convergence in the deposition of the two sexes toward tattooing, a sharp difference still exists in the involvement of the two sexes in body piercing. Body piercing among females is usually seen as a norm in most part of the world without negative attachment as compared to body piercing among men.
Students wear tattoo and/or engage in body piercing for different reasons which include: fashion, peer pressure, sexual attractions, show for strength and Identification. Other reasons given were an imitation of role models and love for artwork. Craik 18 and Turner 19 have similarly observed that tattoos and body piercing today are mainly fashion accessories. These findings also equally corroborate the position of Wessely 20 that people's motivations for tattooing could be emotional, practical, complex, or very simple.
Also, Currie 21 and Meltzer 22 found that 62% of people who have had piercings have done so in an effort "to express their individuality." Some people pierce, permanently or temporarily, to enhance sexual pleasure. Genital and nipple piercings may increase sexual satisfaction.
Despite the acceptance gained by body modifiers, 40% of respondent still find their colleagues who engage in tattoo and body piercing as irresponsible and reckless. A similar observation was recorded by Ezeibekwe et al. 15 stating that those who engage in any of these modifications are still largely viewed by their colleagues who do not embrace the practice, as irresponsibleand dangerous. It was given from this study that 65.8% and 68.0% maintained that they will not consider tattooing and body piercing respectively in the future. This could be a result of the health risk, personal opinion, religious and cultural believes. This finding implies that the presence of these body modifications may cause people to avoid social contact and intimacy with the wearer, since they are presumed to have physical abnormalities and deviations that occur naturally 12 .
This study disclosed that students of Delta State University are aware of tattoo and body piercing and also gave a growing convergence on the two sexes toward tattooing and a sharp difference in the involvement of the two sexes towards the body piercing. Majority of these young adult are also aware of the health risks associated with body modifications and may not consider it in the future.

Conflict of interest: Nil
Ethical clearence: Permission was sought from the Department of Human Anatomy Ethics and Research Committee.
Authors's contribution: All authors in the study read the manuscript and made great input Data gathering and idea owner of this study: All authors were involved in the gathering of data Editing and approval of final draft: All authors were involved in the editing and approval of final draft