UNIVERSITY OF CINCINNATI Date:___________________ I, _________________________________________________________, hereby submit this work as part of the requirements for the degree of: in: It is entitled: This work and its defense approved by: Chair: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ A Content Analysis of On-Line Information on Body Piercing and Body Modification A thesis submitted to the Division of Graduate Studies and Research University of Cincinnati in partial fulfillment of the requirements for the degree of Master of Science In the Division of Human Services of the College of Education, Criminal Justice & Human Services 2008 by Rebecca Lehman B.A., University of Cincinnati, 2002 Abstract AN ABSTRACT OF THE THESIS FOR MASTER OF SCIENCE DEGREE IN HEALTH PROMOTION AND EDUCATION, PRESENTED ON 10 JULY 2008, AT THE UNIVERSITY OF CINCINNATI, OHIO. TITLE: A Content Analysis of On-Line Information on Body Piercing and Body Modification MASTERS COMMITTEE MEMBERS Dr. Keith King (Chair) and Dr. Amy Bernard This study was a content analysis of websites of 75 US-based body piercing establishments affiliated with the Association of Professional Piercers. The purpose of the study was to investigate the information available on the websites about studio cleanliness, safety precautions, potential complications from body piercings, body piercers‟ professional experience and affiliations, recommended aftercare, recommended resources on body modification, and the body modification procedures available. The gathered information was unique in body modification research in that the information came from within the industry, as opposed to clients of the industry. Body piercing establishments provided much information that promoted safe piercing practices and minimization of risk of negative complications. The study found that the examined establishments demonstrated frequent practice of stretching body piercings and providing surface piercings and some practice of procedures that use dermal/biopsy punches, subdermal implants, and intentional scarification. iii iv Acknowledgements Countless thanks are due to the following people: Dr. King & Dr. Bernard, for their work as committee chair and member, respectively. Meg & Ned, for their patience, continued support, and wealth of insight. Miss Faye, for her constant support, humor, and encouragement. Dawn, for her patience and invaluable support - both emotional and financial. Karie, Denise, & Un, for their feedback, insights, and help laughing through the frustrations of this project. Jesse, for grudgingly understanding the importance of “weekends off” and frequent bouts of cheerleading. v Table of Contents Page Abstract iii Acknowledgements iv List of Tables vii Chapter 1: The Problem……………………………………………………….. 1 Statement of the Problem……………………............................................... 4 Research Questions…………………………………………………...... 5 Delimitations……………………………………………………………… 6 Limitations………………………………………………………………… 6 Assumptions……………………………………………………………… 6 Operational Definitions………………………………………………...... 6 Chapter 2: Review of Literature………………………………………………. 7 Body Piercing in Cultural Context…………………………………….... 7 Prevalence of Body Piercing………………………………………….... 8 Risks and Complications of Body Piercing…………………………… 10 General Complications…………………………………………... 10 Prevalence of Complications……………………………………. 13 Perception of Risk……………………………………………...... 14 Recommendations to Decrease Complications……………………… 15 Role of Body Piercers…………………………………………………… 18 Emerging Body Modification Procedures…………………………...... 19 Stretching…………………………………………………………. 19 Punch and Taper…………………………………………………. 19 Scalpelled Piercings……………………………………………… 20 Tongue Splitting………………………………………………….. 20 Frenectomies……………………………………………………... 20 Microdermal Implant……………………………………………... 20 Transdermal Implant……………………………………………... 21 Subdermal Implant……………………………………………….. 21 Intentional Scarification………………………………………….. 21 Internet as a Source of Health Information…………………………… 22 Gaps in the Literature…………………………………………………… 22 Summary…………………………………………………………………. 23 Chapter 3: Methods……………………………………………………………. 25 Participants……………………………………………………………….. 25 Instrumentation…………………………………………………………... 26 Procedures……………………………………………………………….. 28 Data Analysis…………………………………………………………….. 30 Chapter 4: Results and Discussion…………………………………………... 32 Units of Analysis…………………………………………………………. 32 Body Piercing Establishment and Website Characteristics…………. 33 Information on Cleanliness and Safety Precautions…………………. 35 Hygiene During Body Piercing………………………………….. 35 Sterilization Equipment………………………………………….. 38 Licensure………………………………………………………….. 40 Age Policies………………………………………………………. 40 Identification Policies…………………………………………….. 41 Other Policies…………………………………………………….. 42 Jewelry Used in Initial Body Piercings…………………………. 42 vi Information about Body Piercers………………………………………. 44 Early Professional Development……………………………….. 45 Health Related Training and Certification……………………... 45 Continuing Education……………………………………………. 47 Years of Experience……………………………………………… 47 Reported Affiliation……………………………………………….. 49 Information about Potential Complications and Adverse Effects…… 49 Potential Complications and Adverse Effects During the Procedure………………………………………………….. 49 Potential Complications and Adverse Effects After the Procedure………………………………………………….. 53 Potential Psychosocial Complications and Adverse Effects… 60 Information on Aftercare………………………………………………… 61 What to Expect During Normal Healing……………………….. 63 General Aftercare………………………………………………… 63 Salt Water/Saline Soaks………………………………………… 67 Cleaning with Soap………………………………………………. 69 Oral Piercing Aftercare…………………………………………... 70 Genital Piercing Aftercare……………………………………….. 73 Recommended Resources……………………………………………... 75 On-Line Resources………………………………………………. 75 Print Resources…………………………………………………... 80 Video Resources…………………………………………………. 80 Procedures Available……………………………………………………. 80 Other Information of Note………………………………………………. 83 Availability of Information……………………………………………….. 86 Discussion………………………………………………………………... 88 Chapter 5: Conclusions and Recommendations…………………………. 99 Conclusions……………………………………………………………. 101 Discussion……………………………………………………………… 108 Recommendations…………………………………………………….. 112 Recommendations for Practice………………………………. 112 Recommendations for Improving this Research……………. 113 Recommendations for Future Research…………………….. 114 References…………………………………………………………………….. 117 Appendices……………………………………………………………………. 121 Appendix A: Body Modification Content Rating Form…………….. 121 Appendix B: Panel of Experts Information…………………………. 123 Appendix C: Tables…………………………………………………... 124 vii List of Tables Table 1.1 Site-Specific Complications of Body Piercings……………………….. 12 Table 4.1 Information on Hygiene, Cleanliness, Safety Precautions…………... 37 Table 4.2 Information on Body Piercers………………………………………....... 46 Table 4.3 Years of Experience Reported in Body Piercer On-Line Biographies……………………………………………………………...... 48 Table 4.4 Information on Potential Complications and Adverse Effects……….. 50 Table 4.5 Potential Post-Procedural Complications and Adverse Effects and Frequency of Reporting…………………………………………………. 54 Table 4.6 Information on Aftercare………………………………………………… 62 Table 4.7 Recommended On-Line Resources…………………………………… 76 Table 4.8 Availability of Body Modification Procedures…………………………. 82 Table 4.9 Other Information of Note……………………………………………….. 84 Table 4.10 Availability of Information………………………………………………... 87 Table C1 Body Piercing Establishment Hours of Operation……………………. 124 Table C2 Aftercare Guidelines and Frequency of Recommendation………….. 126 Table C3 Oral Piercing Aftercare Guidelines and Frequency of Recommendation………………………………………………………… 128 Table C4 Estimated Healing Time by Body Piercing and Frequency of Estimation…………………………………………………………………. 130 viii Chapter One The Problem Body piercing is a procedure which involves creating an opening in the surface of the skin and placing jewelry in it. The procedure is usually quick and performed without anesthesia. Body piercing has a long history throughout most cultures and has experienced a recent surge in popularity in Western culture, particularly among adolescents and young adults. According to nationally representative data collected in 2004, 14% of the U.S. population had ever had a body piercing (excluding earlobe piercings). While only 2% of those born before 1963 had ever had a body piercing, 32% of those born between 1975 and 1986 had a body piercing (Laumann & Derrick, 2006). Seventy-four percent of those who had ever had a body piercing obtained their first body piercing before age 24. One- quarter to one-half of university undergraduate students reported they had ever had a body piercing (Armstong, Roberts, Owen, & Koch, 2004; Burger & Finkel, 2002; King & Vidourek, 2007; Mayers, Judelson, Moriarty, & Rundell, 2002). The above data demonstrated that body piercing in the US was more common among younger individuals. Roberts, Auinger, and Ryan (2004) asserted that the steady increase in rates of adolescents who reported having a body piercing demonstrated the growing popularity of body piercing among adolescents. Their data collected in 1996 found that 4.3% of adolescents reported having a body piercing. More recent studies found that between 27% and 69% of adolescents had ever had a body piercing (Carroll, et al., 2002; Deschesnes, Demers, & Finès, 2006; Gold, Schorzman, Murray,