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INTRODUCTION
In recent years, body art practices, most commonly tattooing and piercing, have become popular, particularly in Western countries, with 11.7% to 31.5% of the population estimated to be tattooed [1]. In parallel, the literature on this subject has grown, with adolescents being the most frequently studied population segment [2-10]. Publications about tattooed persons explore various aspects of the phenomenon, including epidemiology [1, 11-19], psychological implications [7, 12, 20, 21], associations with risky behaviours [22-24], and health consequences [25].
Tattoos involve the permanent colouration of the skin through the insertion of inks. They can be classified into five main categories: professional (created by expert tattooists), amateur (done by non-professional individuals), traumatic (unintentional tattoos caused by foreign bodies embedded in the dermis), cosmetic (primarily used for permanent makeup), and medical (performed by healthcare professionals for purposes such as nipple reconstruction, scar concealment, and as markers in radiation therapy) [26]. From a public health perspective, professional and, to a lesser extent, amateur tattoos are particularly significant. The rising global trend of individuals getting tattoos has raised concerns among health professionals regarding potential risks to both clients and tattooists. Issues such as microbiological contamination during tattooing and the presence of potentially hazardous chemicals in tattoo inks can lead to various adverse health effects. These may include infections, allergic reactions, and the development of neoplastic conditions (such as melanoma, basal cell carcinoma, and squamous cell carcinoma), along with non-neoplastic lesions (like sarcoidosis and granulomatous reactions). Other possible complications include hypertrophic scars, keloids, pain, and intense itching caused by the involvement of cutaneous nerve branches, as well as photosensitization [25].
In Italy, tattooing is not currently regulated by specific national legislation. The only national reference consists of the circulars issued by the Ministry of Health, which contain the guidelines for performing tattooing and piercing procedures under safe conditions [27]. The ministerial circulars provide guidance on hygiene requirements for performing tattoos safely, address the risks of transmitting infections, and the potential toxic effects of the substances used for dermal pigmentation. They also include, among the final recommendations, proper training for tattoo artists and the need to inform clients about the risk of infectious disease transmission. At the subnational level, some Italian Regions have issued specific laws to regulate the sector. For example, the Tuscany Region promulgated a regional law in 2004 [28] and the subsequent regulation detailing the specific hygienic and sanitary requirements of the parlours, the permitted equipment and materials, and training requirements for tattooists [29]; the same was done by Friuli Venezia Giulia Region [30, 31]. Analogous laws and resolutions were issued in the Veneto Region [32], in the Marche Region [33], in the Lazio Region [34, 35], and in the Lombardy Region [36].
Based on current regulations, the hygiene and public health services of the Prevention Departments within Local Health Authorities deliver hygienic-sanitary evaluations and carry out inspection activities for tattoo businesses that are properly registered. However, there remains an unquantified proportion of unauthorized or “amateur” tattooists who evade health inspections. Oversight of these tattooing activities might seem of relatively minor importance compared to other healthcare activities. For this reason, it is advisable to determine the prevalence of tattoos to measure the magnitude of the phenomenon, the population involved, and the actual impact this phenomenon could have on public health. This information can support health authorities, lawmakers, potential clients, and professionals in implementing measures to protect both the general population and tattoo workers. It is also of interest to understand whether tattoos performed outside authorized centres – potentially at greater risk of adverse effects since they are not subject to health inspections – truly represent a significant public health issue or not.
The main aim of this literature review is to assess the existing evidence on tattoo prevalence in the general population and younger age groups across various countries worldwide. The secondary objective is to present the retrieved data about the settings in which tattoos are typically performed.
METHODS
Search strategy
We employed the CoCoPop framework to develop our search query and to establish our inclusion and exclusion criteria. Our research focused on the following question: What is the prevalence of tattooed individuals (Condition) in various countries worldwide (Context), specifically within the general population and among young people or students (Population)? We conducted a search of MEDLINE, Scopus, and Web of Science to identify relevant articles published between January 1, 2000, and September 17, 2025 (the date of our last consultation). The query string used in our search among the three databases was: ((tattoo) AND (population)) OR ((tattoo) AND (epidemiology)) OR ((tattoo) AND (prevalence)). The limits applied were: full text availability (for MEDLINE), restriction to English and Italian languages (for the three databases), and exclusion from the search of books, book chapters, corrections, and retracted articles (for the three databases).
Inclusion and exclusion criteria
Studies were included if they reported data on the prevalence of tattoos and/or the settings in which tattooing occurred, drawn from the general population, specific age groups within the general population, students, or adolescents. Additionally, studies estimating the prevalence of hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections (for which tattooing is considered a risk factor), or addressing other issues related to tattoos that encompassed information on tattoo epidemiology were also included. Conversely, the exclusion criteria were as follows: studies conducted in specific contexts, such as clinics or hospital admissions/visits, or restricted to particular population subgroups (e.g., pregnant women, inmates, blood donors, farmers, psychiatric patients, veterans); studies that did not provide sufficient information to calculate tattoo prevalence; duplicate publications; grey literature; websites; abstracts without accompanying full texts; and studies focused on traumatic, cosmetic, or medical tattooing. Critical reviews were retained for background information but were excluded as sources of original data.
Data extraction
In the first stage, all study titles and abstracts obtained from the database search were reviewed for eligibility by one of the Authors (FP). Papers that successfully passed this stage were appraised in full, and those meeting the inclusion criteria were selected for data extraction, independently of their size, by the same author. Any doubts regarding the eligibility of studies were resolved through discussion with the other Author (FV). Extracted information, reported on a spreadsheet, included citation details (authors, publication year), study period, population characteristics (country, age group), prevalence of tattooed population, and the percentage of individuals who underwent tattoos in different settings (e.g., authorized parlour, at home). References of all the included studies and relevant reviews were also screened to identify any additional eligible publications.
To validate our search, we checked if relevant publications that we were already aware of were included in the results list.
Data analysis
Measures of prevalence and the number of individuals who have received tattoos in various settings are presented as percentage values. Whenever possible, we verified the data for potential errors based on the number of tattooed individuals and the size of the population sample. We calculated prevalence estimates when they were not reported in the studies. Results were presented by country and population category (all ages, young people, and students). If a paper provided age-stratified prevalence data, we extrapolated the data for younger age groups (<40 years), if available. Within each country and category, we also analysed sex-based differences in prevalence. In cases where multiple studies used the same dataset and time frame, only the most comprehensive articles were included. Additionally, if a single study reported prevalence measures for the tattooed population from different databases or populations, all relevant results were presented.
RESULTS
Initially, we identified 7,921 potential articles. After applying inclusion and exclusion criteria, and adding 12 additional references from bibliographies, we included a total of 86 articles in our review (Figure 1).
The selected literature consisted mainly of cross-sectional studies, often utilizing convenience sampling. These studies employed structured questionnaires, which were either self-administered (including online formats) or administered by trained interviewers.
Overall prevalence
A limited number of studies specifically aimed to estimate the absolute prevalence of tattooing in general populations across different countries [1, 11-19]. However, by combining data from these studies with figures extracted from publications regarding HCV [37-52], HBV [43-45, 50, 53-57], and HIV [58, 59] seropositivity in selected populations and other related topics (e.g., the association of tattooing and personality traits [19-21, 60-65], tobacco consumption [66], hazardous sexual behaviours [67, 68], awareness of the related risks [8, 15, 69-71], etc.), we found a global prevalence that varied widely, ranging from 0.18% [51] to 63.9% [50] (as shown in Table 1). In developed countries, tattoo prevalence ranged from 5.2% [54] to 35.3% [72], with a substantially increasing trend.
Age- and sex-based differences
Findings regarding sex-based differences in tattoo prevalence were inconsistent. In contrast, research consistently shows a higher tattoo prevalence among younger individuals (Table 2), with a peak of 45.6% among people aged 18 to 44 years, according to a recent a US study [72]. Out of the 86 studies reviewed, 40 focused on tattoo prevalence and related issues among younger age groups, primarily within schools, universities, and colleges (Table 2).
Tattooing setting
Eight publications reported data on the locations where tattoos were obtained (Table 3). In Western countries, the majority of the samples (64%-93.9%) received their tattoos in authorized parlours [3, 15, 73-76], whereas a study involving Indian school students revealed that 68.6% of them were tattooed at home by friends [10].
DISCUSSION
To our knowledge, this is the first literature review that focuses exclusively on global tattoo prevalence. While one prior critical review [16] and one literature review (https://www.cieh.org/media/1982/tattoo-toolkit_part-e_-literature-review.docx) [77] have addressed prevalence as part of broader discussions on tattoo-related topics, we are not aware of any other studies that focus on where tattoos are done. Over the last 25 years, few studies have specifically addressed tattoo prevalence [1, 11-19]. Nevertheless, the literature shows a substantially increasing trend worldwide, which is expected to be accompanied by an increase in adverse reactions and tattoo removal requests as well.
Tattoo complications, removal requests, and public health concerns
The prevalence of tattoo-related complications in the general population is substantially uncertain, as they have been reported to range from 0% to 67% [4, 25, 69, 72, 75, 78, 79], with 5.6% of them requiring medical treatment [79]. While serious adverse effects are expected to be uncommon, the popularity of tattoo practices and the potential for complications to arise long after the procedure could create a considerable strain on healthcare services for many years ahead.
It has been estimated that up to 50% of tattooed persons experience regret about their tattoos [80], and some of them will attempt to erase one of their tattoos. Tattoo removal methods include surgical excision techniques (often used for small tattoos), dermatome shaving, salabrasion, and chemical removal, all of which carry the risk of scarring and dyspigmentation. Laser removal is usually preferred, but it can be painful, requires a large number of sessions, and is expensive. Additionally, it poses a risk that residues or degradation products released in the dermis as a result of the thermophotolysis process may lead to unforeseen long-term immune responses and carcinogenic effects. Further secondary effects include burns, pigmentary disruptions (hypopigmented skin areas alternated with hyperpigmented zones), and paradoxical darkening. Notably, complete removal by laser is not always accomplished, even when performed by experienced dermatologists and plastic surgeons, especially for multicoloured tattoos [16, 81].
The increase in tattoo removal requests has led to an unregulated market for such procedures, operated by beauticians, body artists, nurses, and non-specialized physicians, as well as to cheaper over-the-counter options [16].
Other matters of concern from a public health perspective are that tattoos, especially larger ones, can interfere with the performance of certain diagnostic and therapeutic procedures. Tattoos may hinder the diagnosis of various skin lesions, such as melanoma and other kinds of skin cancer. Moreover, the inks used for tattooing often contain metal filings, which can generate an electric current during magnetic resonance imaging. This reaction may cause a rise in local skin temperature, leading to discomfort, pain or even skin burns [82].
Tattoos may be performed in non-professional parlours by unlicensed personnel or even at home, possibly using low-quality and non-sterile equipment. The growth of these practices has been facilitated by the internet, which allows for easy purchase of tattoo kits and pigments and offers tutorials that claim to teach how to perform tattoos. Although studies indicate that the proportion of individuals in Western countries who receive amateur tattoos remains relatively low [3, 15, 73-76], this aspect is of relevant concern for public health and should be carefully considered due to the limited capacity to control health risks in non-professional settings. In addition, home tattooing increases the risk of low-quality tattoos, which may lead to an increased demand for tattoo removal procedures [16].
European legislation on ink safety and public health agencies’ actions
The European Council adopted on February 20, 2008 the European Resolution called ResAP(2008)1 (https://search.coe.int/cm?i=09000016805d3dc4), which outlines important criteria for ensuring the safety of tattoo inks and permanent makeup (PMU). This resolution addresses several key aspects, including the labeling and composition of these products, the risks associated with substances used in tattoo inks and PMU, and the hygienic conditions that must be upheld during tattooing and PMU procedures. It also emphasizes the obligation to inform individuals about potential health risks linked to tattoos and PMU. The resolution’s annexes feature a list of banned chemical substances in tattoo ink and in PMU formulations due to their carcinogenic and mutagenic properties, along with a list specifying substances that have maximum concentration limits and information on their permissible limits. Furthermore, it requires that inks be sterile and preferably in disposable packaging.
Italy maintains an active system for surveillance and monitoring to ensure adherence to health and hygiene standards, as well as compliance with ministerial regulations and guidelines. This system operates at various levels: inspections at the local level are conducted by the Local Health Authorities (Aziende Sanitarie Locali, ASL) and Regional Environmental Protection Agencies (Agenzie Regionali per la Protezione dell’Ambiente, ARPA), which focus on performing analytical tests on substances like inks. At the national level, oversight is handled by the Carabinieri’s Anti-Adulteration Units (Nuclei Antisofisticazioni e Sanità, NAS) and the Maritime, Air, and Border Health Offices (Uffici di Sanità Marittima, Aerea e di Frontiera, USMAF). The Italian National Institute of Health (Istituto Superiore di Sanità, ISS) plays a key role in coordinating the laboratory network and in conducting confirmatory analyses of analytical data.
A crucial tool in this framework is the European Union’s Rapid Exchange of Information System (RAPEX), designed to address products that present serious risks to health. Through this system, Member States inform the European Commission without delay about any measures taken in response to hazardous products. RAPEX facilitates swift information sharing across Member States, detailing the product concerned and the associated risks, while outlining restrictive measures such as market withdrawal. Notifications through RAPEX are publicly accessible on specific pages of the European Union’s official website (https://ec.europa.eu/safety-gate-alerts/screen/search).
In cases where tattoo products in Italy are found to contain chemical substances posing significant health risks, the Ministry of Health issues a “Consumer Alert”. This alert, published on its official website (https://www.salute.gov.it/new/it/avvisi/allarmi-consumatori-e-reazioni-notifiche-di-prodotti-non-alimentari-pericolosi/), provides detailed information about the product, its potential dangers, and the actions being implemented to protect public health.
Tattoo professionals as a source of information
Research from Italy [69, 76], has highlighted that most tattooed students who had prior knowledge of health risks cited the tattoo artist as their primary source of information. This suggests that body art professionals have the potential to serve as valuable conduits for educating clients about health risks. By providing clear and essential aftercare instructions, tattooists can guide customers effectively, helping to prevent complications. Therefore, equipping tattoo artists with comprehensive health-related knowledge could significantly reduce avoidable risks associated with body art practices.
Limitations
Research has predominantly focused on specific population groups, mainly adolescents and students [2-10, 78, 83-97], often relying on convenience samples. Studies conducted within high school and university or college settings frequently face selection bias due to the voluntary nature of student participation, the disproportionate representation of individuals from higher socio-economic and cultural backgrounds, and sex imbalances (e.g., humanistic faculties often have a higher percentage of female students). As a result, these studies are not representative of the general population and tend to be geographically limited and fragmented, which makes estimating national prevalences challenging. However, the available data illustrate a clear and sustained rise in tattooing, reflecting an increase in societal acceptance of the practice. This upward trend complicates comparisons of prevalence across studies conducted in different time periods.
Although the literature from Europe and North America is relatively well-established, there is a notable scarcity of data regarding tattoo prevalence in Oceania, Africa, and South America - Brazil being a partial exception. Many studies predominantly focused on unrelated primary topics, such as addressing sociological [7, 18, 84, 85, 87, 97-102] and labour market-related issues [103, 104], or investigating blood infection rates [37-59] and allergic reactions prevalence [105, 106] within specific populations, offering only limited insights into tattoo epidemiology (e.g., differences in prevalence between males and females or among different age groups).
To compare tattoo prevalence among young people in different countries, we also extracted youth-specific data from general population studies when available. However, differences among studies in age group definitions make precise comparisons across countries difficult.
CONCLUSIONS
As tattooing practices gain popularity in the general population, a corresponding increase in associated health risks can be expected, particularly if tattoos are performed in unlicensed settings. However, as the prevalence estimates of tattoo-related adverse reactions in the general population are unreliable, their magnitude remains unknown.
Together with the number of tattooed people, practices aimed at tattoo removal are also expected to rise. As professional interventions aimed to remove tattoos are expensive, practices performed by laypersons, using cheaper and unsafe instruments bought on the internet, or even at home using do-it-yourself products, are becoming more common. This situation requires the attention of policymakers, lawmakers, and public health agencies to issue and enforce regulations governing these activities.
The collaboration between health authorities and law enforcement agencies regarding the surveillance of inks and materials used for tattooing is of utmost importance.
As body artists and their parlours appear as fundamental in preventing the avoidable health consequences of tattoos and in counselling actual and potential customers, local health authorities, such as the Prevention Departments, should play a central role in monitoring tattoo practices, ensuring compliance with hygiene standards, providing training for safe practices, and exercising regulatory oversight of parlour environments.
According to the literature, knowledge about the contraindications and health risks associated with tattooing and tattoo removal is not always satisfactory, especially among young people [10, 15, 69, 70, 82, 86, 96, 102]. As a consequence, Prevention Departments’ involvement in educational programs addressing tattoo-related risks and complications, as well as in promoting public awareness campaigns at a local level, is highly recommended.
Other Information
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Authors’ contributions
FP: data curation, writing-original draft preparation, conceptualization, methodology; FV: writing-original draft preparation, conceptualization, methodology, supervision.
Conflict of interest statement
None declared.
Address for correspondence: Francesca Palese, Dipartimento di Prevenzione, Azienda Sanitaria Universitaria Friuli Centrale, Via Trento Trieste 4, 33038 San Daniele del Friuli (UD), Italy. E-mail: francesca.palese@asufc.sanita.fvg.it
Figures and tables
Figure 1. Flowchart of the study selection for inclusion in the literature review about the worldwide prevalence of tattoos.
| Continent | Country | Study | Time | Age§ | Sample number | Overall (%) | Men (%) | Women (%) |
|---|---|---|---|---|---|---|---|---|
| North America | USA | Laumann, Derick 2006 [75] | 2004 | 18-50 | 500 | 24.0 | 26.0 | 22.0 |
| USA | Karagas, Wasson 2012 [13] | 2008 | 14-69 | 452 | - | 16-18 | 7-29 | |
| USA | Mortensen et al. 2019 [23] | 2016 | 18-65 | 2,008 | 32.1 | 23.2 | 36.7 | |
| USA | Morlock et al. 2023 [72] | 2017 | >18 | 3,033 | 35.3 | 29.4 | 41.1 | |
| USA | Kluger et al. 2019 [1] | 2018-2019 | ≥18 | 2,008 | 31.5 | 27.8 | 35.1 | |
| USA (Utah) | McCarty et al. 2024 [19] | 2020-2021 | ≥18 | 18,687 | - | 22 | 26 | |
| Europe | Denmark | Bjerre et al. 2018 [79] | 2006 | 24-76 | 2,212 | 14.2 | 17.8 | 11.0 |
| France | Kluger et al. 2019 [1] | 2017 | ≥15 | 5,000 | 16.8 | 14.4 | 19.1 | |
| France | Kluger et al. 2019 [1] | 2018-2019 | ≥18 | 2,048 | 17.8 | 19.5 | 16.2 | |
| Italy | Renzoni et al. 2018 [15] | 2015 | ≥12 | 7,608 | 12.8 | 11.7 | 13.8 | |
| Austria and Southern Germany | Stieger et al. 2010 [6] | NA | ≥16 | 440 | 15.2 | 12.4 | 17.8 | |
| Austria and Southern German-speaking area of Central Europe | Swami et al. 2012 [62] | NA | Mean: 31.4 (SD: 13.7) | 540 | 22.2 | 20.3 | 23.8 | |
| Austria and Southern German-speaking area of Central Europe | Swami et al. 2016 [64] | NA | 18-76 | 1,006 | 19.1 | 17.6 | 20.3 | |
| Germany | Lahousen et al. 2019 [18] | 2009 | 14-94 | 2,512 | - | 14.1 | 10.2 | |
| Germany | Ernst et al. 2022 [98] | 2016 | 14-44 | 1,060 | 32.0 | - | - | |
| Germany | Stirn et al. 2006 [12] | NA | 14-93 | 2,043 | 8.5 | - | - | |
| Netherlands | Dillingh et al. 2020 [103] | 2013 | NA | 5,215 | 9.8 | - | - | |
| Norway | Sagoe et al. 2017 [14] | NA | 16-91 | 15,654 | 20.8 | 17.9 | 23.8 | |
| Romania | Gheorghe et al. 2013 [54] | 2006-2008 | 18-68 | 12,125 | 5.2 | - | - | |
| Russia | Kluger et al. 2019 [1] | 2018-2019 | ≥18 | 2,010 | 11.7 | 15.0 | 8.9 | |
| Spain (Catalonia) | Domìnguez et al. 2001 [37] | 1996 | ≥5 | 2,142 | 17.2 | - | - | |
| UK (Greater London) | Swami et al. 2015 [63] | 2014-2015 | 20-58 | 378 | 25.7 | - | - | |
| South America | Southern Brazil (Porto Alegre) | Kvitko et al. 2013 [42] | 2009 | ≥20 | 3,391 | 16.2 | - | - |
| Southern Brazil (Cássia dos Coqueiros municipality) | Melo et al. 2015 [45] | 2011-2013 | ≥18 | 1,001 | 6.8 | - | - | |
| Brazil (Amazon)* | Vasconcelos et al. 2024 [50] | 2015 | ≥0 | 430 | 63.9 | - | - | |
| Brazil | Kluger et al. 2019 [1] | 2018-2019 | ≥18 | 2,003 | 22.3 | 20.0 | 24.4 | |
| Puerto Rico (San Juan) | Pérez et al. 2005 [39] | 2001-2002 | 21-64 | 964 | 12.4 | - | - | |
| Asia | Armenia | Demirchyan et al. 2024 [49] | 2021 | ≥18 | 3,380 | 10.4 | - | - |
| Eastern China (Jiangsu province) | Huang et al. 2015 [51] | 2011-2012 | ≥0 | 149,175 | 0.18 | - | - | |
| China | Kluger et al. 2019 [1] | 2018-2019 | ≥18 | 3,010 | 12.2 | 12.1 | 12.2 | |
| Georgia | Hagan et al. 2019 [48] | 2015 | ≥18 | 6,014 | 10.2 | - | - | |
| Southern India (Andhra Pradesh) | Dandona et al. 2008 [58] | 2004-2005 | 15-49 | 12,617 | 11.2 | 7.8 | 14.5 | |
| Western Iran (Kermanshah) | Sayad et al. 2008 [52] | 2006 | 15-64 | 1,721 | 10.6 | - | - | |
| Southern Iran (Bandar Abbas) | Makiani et al. 2014 [43] | 2012 | 15-45 | 2,000 | 8.4 | - | - | |
| Western Iran (Kermanshah province) | Alavian et al. 2012 [57] | NA | 6-65 | 1,979 | 21.3 | - | - | |
| Southern India (area of Puducherry) | Rajalatchumi et al. 2025 [56] | 2021-2022 | ≥18 | 5,169 | 4.0 | - | - | |
| Western-central India (Maharashtra state) | Bhate et al. 2015 [44] | NA | ≥5 | 1,833 | 4.0 | - | - | |
| South-western Iran | Moezzi et al. 2015 [46] | 2013 | ≥15 | 3,000 | 10.4 | - | - | |
| Southern Iran (Qeshim Island) | Holakouie et al. 2015 [59] | 2013-2014 | NA | 1,500 | 4.6 | - | - | |
| Central Iran (Qom) | Ghadir et al. 2012 [53] | NA | NA | 3,690 | 4.54 | - | - | |
| Pakistan (Balochistan province) | Ahmed et al. 2012 [41] | 2007-2009 | ≥18 | 2,000 | 7.5 | - | - | |
| Central Thailand | Wasitthankasem et al. 2017 [47] | 2015 | 30-64 | 3,077 | 12.9-17.9 | - | - | |
| Northern Vietnam (Thai Binh province) | Nguyen et al. 2007 [40] | 2002 | 16-82 | 837 | 4.5 | - | - | |
| Oceania | Australia | Makkai, McAllister 2001 [11] | 1998 | ≥14 | 10,340 | 10.1 | 11.9 | 8.5 |
| Australia | Tranter, Grant 2018 [99] | 2009 | ≥18 | 1,525 | 12.6 | - | - | |
| Australia | Heywood et al. 2012 [73] | 2004-2005 | 16-64 | 8,656 | 14.5 | 15.4 | 13.6 | |
| Africa | Southwest Ethiopia | Belay et al. 2020 [55] | 2017-2018 | ≥18 | 612 | 43.1 | - | - |
| SD: standard deviation; NA: not available; §expressed in years; *sample extracted from the indigenous general population. | ||||||||
| Continent | Country | Study | Time | Age§ | Sample type | Sample number | Overall (%) | Men (%) | Women (%) |
|---|---|---|---|---|---|---|---|---|---|
| North America | Canada (Outaouais Region in Quebec) | Deschesnes et al. 2006 [3] | 2002 | 12-18 | High school students | 2,180 | 7.7 | 5.6 | 9.8 |
| USA | Roberts, Ryan 2002 [24] | 1995-1996 | 11-21 | Adolescents from general population | 5,837 | 4.5 | 4.8 | 4.2 | |
| USA | Drews et al. 2000 [87] | 1999 | Mean: 19.3 (SD: 1.2) | Undergraduate college students | 235 | 12.3 | 8.9 | 14.3 | |
| USA | Mayers et al. 2002 [88]° | 2001 | Mean: 21.0 | Undergraduate university students | 446 | 23.8 | 21.6 | 25.9 | |
| USA | Laumann, Derick 2006 [75] | 2004 | 18-29 | General population | 140 | 26.0 | - | - | |
| USA | French et al. 2016 [104] | 2008-2009 | 24-32 | General population | 15,189 | 10.9 | 12.3 | 9.7 | |
| USA | Karagas, Wasson 2012 [13] | 2008 | 14-49 | General population | - | - | 18 | 29 | |
| USA | Morlock et al. 2023 [72] | 2017 | 18-44 | General population | 1,678 | 45.6 | - | - | |
| USA | Kluger et al. 2019 [1] | 2018-2019 | 18-24 | General population | - | 40.2 | - | - | |
| USA | Kluger et al. 2019 [1] | 2018-2019 | 25-34 | General population | - | 42.8 | - | - | |
| USA (Colorado) | Dukes, Stein 2011 [83] | 2007 | 13-19 | High school students | 1,462 | 18 | 19 | 17 | |
| USA (NY State) | Mayers, Chiffriller 2008 [4]° | 2006 | Mean: 21.2 | Undergraduate university students | 650 | 21.8 | 23.0 | 21.0 | |
| USA (Utah) | McCarty et al. 2024 [19] | 2020-2021 | 18-24 | General population | 1,575 | 27.4 | 22 | 32 | |
| USA (Utah) | McCarty et al. 2024 [19] | 2020-2021 | 25-29 | General population | 1,214 | 37.5 | 34 | 45 | |
| USA (Utah) | McCarty et al. 2024 [19] | 2020-2021 | 30-39 | General population | 2,758 | 33.2 | 31 | 39 | |
| USA | Lipscomb et al. 2008 [90] | NA | 18-62 (median: 21) | Undergraduate college students | 496 | 19.5 | 16.4 | 23.2 | |
| Mid-western USA | King, Vidourek 2013 [74] | NA | Mean: 21.92 (SD: 5.37) | Undergraduate college students | 998 | 29.6 | - | - | |
| South-western USA | Forbes 2001 [60] | NA | Male-mean: 22.5 (SD: 5.6); Female-mean: 23.8 (SD: 7.5) | Undergraduate university students | 302 | 18.5 | 14.7 | 21.0 | |
| South-western USA | Armstrong et al. 2002 [84] | NA | ≥18 | Undergraduate college students | 514 | 18.9 | 20.9 | 17.5 | |
| South-western USA | Koch et al. 2005 [67] | NA | Mean: 20.9 (SD: 4.5) | Undergraduate university students | 450 | 22.2 | - | - | |
| South-western USA | Owen et al. 2013 [91] | NA | NA | Undergraduate college students | 595 | 21.0 | - | - | |
| USA (Colorado) | Manuel, Sheehan 2007 [65] | NA | 17-37 (mean: 20.0) | Undergraduate university students | 210 | 31.9 | 30.4 | 32.3 | |
| USA (Tennessee) | Tate, Shelton 2008 [20] | NA | Mean: 21.92 (SD: 5.37) | Undergraduate and graduate university students | 1,375 | 26.3 | 27.3 | 25.8 | |
| Europe | Croatia | Zrno et al. 2015 [92] | 19-30 | Undergraduate university students | 100 | 35.0 | - | - | |
| Denmark | Bjerre et al. 2018 [79] | 2006 | 24-39 | General population | 486 | 27.4 | - | - | |
| France | Kluger et al. 2019 [78]Σ | 2017 | 15-18 | General population | 175 | 10.3 | 12.8 | 6.1 | |
| France | Kluger et al. 2019 [17] | 2017 | 15-34 | General population | 1,592 | 25.3 | - | - | |
| France | Kluger et al. 2019 [1] | 2018-2019 | 18-24 | General population | - | 22.0 | - | - | |
| France | Kluger et al. 2019 [1] | 2018-2019 | 25-34 | General population | - | 30.5 | - | - | |
| France (Brittany) | Guéguen 2012 [68] | NA | Mean: 20.84 (SD: 1.35) | Undergraduate university students | 2,080 | 14.5 | 7.8 | 19.8 | |
| France (Brittany) | Guéguen 2013 [66] | NA | Mean: 20-22 | Undergraduate university students | 2,587 | 12.2 | 10.4 | 14.4 | |
| Greece (Athens) | Notara et al. 2022 [102] | NA | 18-30 | General population | 629 | 31.3 | 27.6 | 32.5 | |
| Italy (Padua and its province) | Bosello et al. 2010 [21] | 2003 | Mean: 16.5 (SD: 1.6) | High school students | 818 | 4.0 | - | - | |
| Italy (Grosseto and Scansano, Tuscany Region) | Boncompagni et al. 2005 [2] | 2003-2004 | 14-20 | High school students | 496 | 4.8 | 3.0 | 6.0 | |
| Italy (Cagliari) | Preti et al. 2006 [93] | 2004 | 15-19 | High school students | 820 | 8.5 | 14.5 | 5.4 | |
| Italy (Veneto Region) | Cegolon et al. 2010 [94]† | 2007 | 13-21 | High school students | 4,277 | 6.0 | - | - | |
| Italy (Veneto Region) | Clerici, Meggiolaro 2011 [95] | 2007 | 14-18 | High school students | 4,213 | - | 5.9-7.3 | 4.5-8.8 | |
| Italy (Naples province) | Gallè et al. 2011 [69] | 2008-2009 | Mean: 16.1 (SD: 1.3) | High school students | 9,322 | 11.3 | 11.7 | 11.0 | |
| Italy (Naples province) | Gallè et al. 2011 [69] | 2008-2009 | Mean: 21.6 (SD: 4.1) | Undergraduate university students | 3,610 | 24.5 | - | - | |
| Italy (Bari) | Quaranta et al. 2011 [70] | 2009-2010 | 17-58 | Freshmen university students | 1,598 | 9.6 | 9.1 | 9.8 | |
| Italy (Veneto Region) | Majori et al. 2013 [8] | 2009-2010 | 13-22 | High school students | 2,843 | 6.4 | 5.3-7.8 | 3.3-9.5 | |
| Italy | Renzoni et al. 2018 [15] | 2015 | 12-17 | General population | - | 7.7 | - | - | |
| Italy | Renzoni et al. 2018 [15] | 2015 | 18-24 | General population | - | 22.1 | - | - | |
| Italy | Renzoni et al. 2018 [15] | 2015 | 25-34 | General population | - | 22.7 | - | - | |
| Italy (Palermo) | Sidoti et al. 2010 [5] | NA | Mean: 21.1-21.4 (SD: 3.5-4.3) | Undergraduate university students | 1,200 | 31.8 | 43.5 | 17.6 | |
| Italy | Gallè et al. 2021 [76]* | 2020-2021 | NA | Undergraduate university students | 2,985 | 27.9 | - | - | |
| Italy | Protano et al. 2021 [96]* | 2020-2021 | Mean: 23.15 (SD: 3.99) | Undergraduate university students | 3,005 | 27.9 | - | - | |
| Italy (L’Aquila) | Scatigna et al. 2022 [85] | NA | Mean: 21.5 (SD: 4.1) | Undergraduate university students | 575 | 30.5 | 24.4 | 33.1 | |
| Austria and Southern Germany | Stieger et al. 2010 [6] | NA | 16-20 | General population | 81 | 0.9 | - | - | |
| Austria and Southern Germany | Stieger et al. 2010 [6] | NA | 21-25 | General population | 222 | 7.5 | - | - | |
| Austria and Southern Germany | Stieger et al. 2010 [6] | NA | 26-30 | General population | 109 | 6.4 | - | - | |
| Austria and Southern German-speaking area of central Europe | Swami et al. 2012 [62] | NA | Mean: 31.4 (SD: 13.7) | General population | 540 | 22.2 | 20.3 | 23.8 | |
| Germany | Lahousen et al. 2019 [18] | 2009 | 25-34 | General population | - | - | 26 | 25.5 | |
| Germany | Ernst et al. 2022 [98] | 2016 | 14-44 (mean: 30.47, SD: 8.41) | General population | 1,060 | 32.0 | - | - | |
| Germany | Stirn et al. 2006 [12] | NA | 14-44 (mean: 31.1) | General population | 864 | 15 | - | - | |
| Norway | Sagoe et al. 2017 [14] | NA | 16-19 | General population | 1,310 | 7.9 | - | - | |
| Norway | Sagoe et al. 2017 [14] | NA | 20-29 | General population | 4,358 | 26.2 | - | - | |
| Norway | Sagoe et al. 2017 [14] | NA | 30-39 | General population | 2,809 | 27.6 | - | - | |
| Poland | Rogowska et al. 2017 [82] | 2015-2016 | Mean: 22±2.5 | Undergraduate university students | 1,199 | 27.0 | - | - | |
| Russia | Kluger et al. 2019 [1] | 2018-2019 | 18-24 | General population | - | 15.0 | - | - | |
| Russia | Kluger et al. 2019 [1] | 2018-2019 | 25-34 | General population | - | 19.4 | - | - | |
| Sweden | Röhrl, Stenberg 2010 [105]# | 2000-2004 | 14.9-23.4 | Upper secondary school children | 6,095 | 4.8 | 3.0 | 6.0 | |
| Sweden | Fors et al. 2012 [106]# | 2000-2004 | 14.9-23.4 | Upper secondary school children | 6,095 | 5.1 | 3.4 | 6.2 | |
| South America | Brazil | Kluger et al. 2019 [1] | 2018-2019 | 18-24 | General population | - | 21.9 | - | - |
| Brazil | Kluger et al. 2019 [1] | 2018-2019 | 25-34 | General population | - | 30.3 | - | - | |
| Asia | China | Kluger et al. 2019 [1] | 2018-2019 | 18-24 | General population | - | 12.3 | - | - |
| China | Kluger et al. 2019 [1] | 2018-2019 | 25-34 | General population | - | 20.7 | - | - | |
| South India (Area of Puducherry) | Rajalatchumi et al. 2025 [56] | 2021-2022 | ≥18 | General population | 5,169 | 4.0 | - | - | |
| Myanmar (Mandalay Region) | Show et al. 2019 [71] | 2015 | 18-24 | General population | 198 | 22.2 | - | - | |
| Myanmar (Mandalay Region) | Show et al. 2019 [71] | 2015 | 25-35 | General population | 203 | 16.7 | - | - | |
| Central Taiwan (Taishi township) | Lee et al. 2004 [38] | 1999 | 13-16 | Junior high school students | 1,999 | 1.7 | - | - | |
| Southern Taiwan | Yen et al. 2012 [7] | 2004 | 12-17 | High school students | 9,755 | 1.0 | - | - | |
| Turkey (Istanbul) | Balci et al. 2015 [22] | 2009-2010 | Mean: 21.69 (SD: 1.55) | Undergraduate university students | 1,303 | 4.3 | - | - | |
| Turkey (Istanbul) | Ekinici et al. 2012 [61] | NA | Mean: 17.42 (SD: 0.92) | High school students | 607 | 4.8 | - | - | |
| Turkey (Istanbul) | Wise, Akınkoç 2022 [100] | NA | 18-25 | Undergraduate university students | 430 | 32.6 | - | - | |
| Oceania | Australia | French et at. 2016 [104] | 2001-2002 | 24-32 | General population | 4,279 | 20.4 | 20.8 | 19.9 |
| Australia | Heywood et al. 2012 [73] | 2004-2005 | 16-19 | General population | 367 | 5.4 | - | - | |
| Australia | Heywood et al. 2012 [73] | 2004-2005 | 20-29 | General population | 737 | 22.3 | - | - | |
| Australia | Heywood et al. 2012 [73] | 2004-2005 | 30-39 | General population | 810 | 23.2 | - | - | |
| Australia (Queensland) | Tranter, Grant 2018 [99] | 2013 | 19-20 | High school students | 2,206 | 14.3 | - | - | |
| Africa | Tanzania (Dar es Salaam) | Chacha, Kazaura 2015 [9] | 2014 | Mean: 23.9 (SD: 4.5) | Undergraduate medical university students | 536 | 7.5 | 6.8 | 8.6 |
| SD: standard deviation; NA: not available; §expressed in years; °the same samples involved in the studies by Mayers et al. (2002) [88] and by Meyers and Chiffriller (2008) [4] are analysed in the Meyers and Chiffriller (2007) [89] publication (not reported in the Table); Σthe study sample was extracted from the study population analysed by Kluger et al. (2019) [17]; †the same samples involved in the study by Cegolon et al. (2010) [94] are analysed in the publication by Cegolon et al. (2010) [97] (not reported in the Table); *#the two studies focus on the same sample. | |||||||||
| Study | Authorized parlour (%) | Beauty salon/piercing studio (%) | At home (%) | Other (%) |
|---|---|---|---|---|
| Balci et al. 2015 [22] | 80.4 | - | - | |
| Deschenes et al. 2006 [3] | 90.4 | - | 9.6 | |
| Gallè et al. 2021 [76] | 93.9 | 0.5 | 4.3 | 1.3 |
| Heywood et al. 2012 [73] | 90.7 | - | 3.6 | 3.2 |
| King, Vidourek 2013 [74] | 87.6 | 10.7 | 6.7 | - |
| Laumann, Derick 2006 [75] | 64 | - | 26 | |
| Oinam et al. 2019 [10] | 10.8 | - | 68.6 | 16.6 |
| Renzoni et al. 2018 [15] | 76.1 | 9.1 | 4.4 | 10.2 |
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