Quaranta et al. BMC Public Health 2011, 11:774 http://www.biomedcentral.com/1471-2458/11/774 The average age at the first tattoo was significantly higher than the average age at the first piercing and this result fits well with other work [26,29]; anyway, in our study, this result is affected by a large effect size. One of the limits of the present study was that the questionnaire did not include a question for those who answered “I asked someone’s advice” to specify by whom the advice was given. In fact, knowing who the advisor is could be important information to better tar- get eventual educational interventions. Moreover, we should point out that the present study did not consider some variables that may influence the attitude to body art, such as political orientation or religious persuasion. As reported in the literature by Antoszewski et al [17], body ornamentation was connected to religious rituals and was a sign of social status. In any case, Stieger et al [31], in a previous study, demonstrated that there isn’t any association between these variables and both pier- cing and tattoo practices. Conclusion Although limited to freshmen, the present study con- firms that the tendency to modify one’s own body is spreading more and more among young people. Piercing and tattoos have now overcome most prejudices and the rather tawdry image that once accompanied them; in fact, nowadays the practice has become widespread, the social and cultural extraction not relevant [26,34]. Nevertheless, the sample investigated showed that there is still much lack of information on risks of this practice. For this reason, it is even more important to make information in this respect clearer, especially before the subject decides to undertake it [36]. Information about the freshmen’s knowledge, attitudes and practices could help in effective planning for health promotion strategies; appropriate preventive measures should be adopted by professionals such as teachers, nurses, physicians and others who are in contact with young adults to help them make informed choices. Furthermore, it could be interesting to develop collabora- tive educational programs between body artists and schools, sharing information about body art in general, including the inherent risks, and encouraging young adults to contemplate their decisions carefully in advance. Authors’ contributions AQ, CN and MTM contributed equally to the definition of the study protocol, to the data collection, input and analysis and to the manuscript drafting and writing; GC contributed to the definition of the study protocol and to the data collection; CM contributed to the data collection and input; FF contributed to the data analysis. 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