Quaranta et al. BMC Public Health 2011, 11:774 http://www.biomedcentral.com/1471-2458/11/774 Page 5 of 8 Figure 3 Type of complications following the practices of piercing and tattoos. Those who live in one of Apulia’s five main towns are more inclined than those who live in smaller municipali- ties to undergo piercing (c2 = 140.37; p < 0.001). The occupation of both mother and father does not affect the practice of piercing (father c2 = 4.83; p = 0.18 - mother c2 = 0.19; p = 0.98). Tattooing Of the 1.598 sample, 153 freshmen (9.6%) declared that they have a tattoo. Of these 107 were female (69.9%) and 46 were male (30.1%), with a ratio M/F of 1:2.3. The difference between male and female was not statis- tically significant (c2 = 0.10; p > 0.05). A written informed consent, before the tattoo, was required in 48/ 153 (31.3%). The average age for the first tattoo was 17.5 years (range 10-26, SD ± 2.4). Of the 153 tattooed freshmen, 61 (39.9%) had the tattooing when they were still under- age, and of those 39 (63.9%) informed their parents before the practice. The average number of tattoos per tattooed participant was 1.8 (range 1-17, SD ± 1.92). In particular, among the 153 freshmen admitted having a tattoo, 61.2% had only one, 23% two, 9.2% three, 6.7% more than three. There were no significant sex differ- ences in the average number of tattoos (p = 0.11). In addition, 48.9% decided to place the tattoo on the limbs, 35.2% on the trunk and 15.9% on the head. Among those who stated that they had never had a tattoo (90.4%), to the question “Would you consider it in the future?”, 36.3% answered “yes”, 18.6% “I do not know”, and 45.1% “no”. There was no significant differ- ence between males and females with respect to interest in acquiring tattoos in the future: females did not show a higher interest than males in the future tattooing prac- tice (male 156/306; female 369/614; c2 = 1.93 - p > 0.05). Considering the variable of residence, of the 332 com- ing from main towns 70 (21.7%) had at least one tattoo, while of the 1.266 people coming from smaller munici- palities 83 (6.6%) had at least one tattoo. Those who live in one of Apulia’s five main towns are more inclined than those who live in smaller municipalities to undergo tattooing (c2 = 64.12 - p < 0.001). The occupation of both mother and father does not affect the practice of tattoos (father c2 = 0.55; p = 0.91 - mother c2 = 3.85; p = 0.28). Student’s t-test showed that average age for the first tattoo was significantly higher than the average age for the first piercing, even if the Cohen’s d test indicated a large effect size (t = 8.4, p < 0.001; Cohen’s d = 0.93). Discussion The results of this study show that many young adults think it is risky to undergo piercing/tattoo practices. Interestingly, freshmen of healthcare faculties seem more careful about the issues of infectious complica- tions related to body art practices. It might seem obvious that students of sanitary faculties know more of these aspects, if we did not consider the fact that this survey was conducted among freshmen, who might be supposed to have approximately the same level of knowledge. Nevertheless, this figure could be related to the fact that, in Italy, access to courses in a Faculty of Medicine requires a prior admission test on scientific matters. At the same time, young adults belonging to humanistic faculties seems more inclined than those belonging to the other two areas to undergo body art. Regarding young adults’ knowledge of infectious risks, the majority indicated AIDS as a possible infection risk, but not many people were aware of the risks associated with hepatitis B, tetanus and hepatitis C. This suggests that while AIDS-related risks are better known, other risks equally important need to be better specified and highlighted by health professionals, through information campaigns. Because there are significant health risks associated with piercing and tattooing, it is important to improve young adults awareness of them. Although 90.1% of the sample was aware of the possi- ble transmission of infectious diseases, 28.1% did not know that there are other kinds of risks, such as aller- gies, scars or bleeding. This figure could be considered an emerging problem of Public Health, in particular because the decision to undergo these procedures is often not shared with the family or experts in the field. As a matter of fact, encouraging young adults to talk with others (especially health professionals) about body art, asking specific questions and knowing enough is helpful to better judge the quality and hygiene of the artist activities [25]; thus, reducing the health risks. Furthermore, for the most, the decision to undergo body altering is taken quickly (less than a month to decide) and most of the interviewed who underwent