Body piercing and adolescent risk-taking: association or expression?

This study aimed to investigate the relationship between body piercing and risk-taking behaviors among adolescents, while assessing their knowledge and attitudes regarding piercing practices, hygiene, and potential complications. This cross-sectional descriptive study was conducted among 141 adolescents aged 12-19 years attending an adolescent health clinic between February and November 2025. Participants were divided into two groups: adolescents with at least one body piercing (n = 71) and controls without piercings (n = 70). Data on sociodemographic characteristics, risk-taking behaviors, and mental health status were collected using a structured questionnaire. Risk behaviors were defined as meeting in person with someone first met online, driving without a seat belt, getting into a stranger's vehicle, experimenting with cigarettes, alcohol, or substances, and having suicidal thoughts. Suicide risk was evaluated using the "Ask Suicide-Screening Questions." Knowledge regarding piercing procedures, hygiene, and complications was assessed through an 18-item survey, and scores were calculated on a 100-point scale. Adolescents with piercings demonstrated significantly higher engagement in risk-taking behaviors compared to controls, including smoking (73.2% vs. 11.4%), alcohol use (63.4% vs. 8.6%), substance use (11.3% vs. 0%), and non-suicidal self-injury (42.3% vs. 4.3%) (all p < 0.001). Positive suicide risk screening was also more frequent in the piercing group (45.1% vs. 7.1%, p < 0.001). Nearly half of the pierced adolescents reported local complications such as hyperemia, swelling, or pain, and only 49.3% had their procedures performed in licensed studios. The overall knowledge score was moderate (mean = 59.4 ± 14.2), with the lowest accuracy in the "Site and Setting of Application" domain. None of the participants answered all questionnaire items correctly.

Although body piercing has become a normalized form of self-expression among adolescents, it remains associated with significantly higher rates of risk-taking behaviors and psychological vulnerability. Moreover, adolescents demonstrated insufficient knowledge about safe piercing practices, sterilization, and complications, and most had not received information from health professionals. These findings highlight the need for targeted educational interventions and counseling to promote safer body modification practices and to use piercing as an opportunity for psychosocial assessment in adolescent health care.

• Body piercing is a common form of self-expression among adolescents and has been previously linked to certain risk taking behaviors like smoking and substance use. • Adolescents generally demonstrate insufficient knowledge regarding hygiene, sterilization, and health complications associated with body modifications.

• This study explicitly details a alarmingly high rate of positive suicide risk screening and non-suicidal self-injury specifically among pierced adolescents. •It quantifies a distinct gap in knowledge regarding the Site and Setting of Application, revealing that more than half of adolescents utilize unlicensed studios without professional health guidance. •Body piercing should serve as a practical, visible trigger for pediatricians to initiate comprehensive psychosocial and mental health screenings in clinical settings.