United States Military Service Members and Their Tattoos: A Descriptive Study

Transcription

1 MILITARY MEDICINE, 178, 8:921, 2013 United States Military Service Members and Their Tattoos: A Descriptive Study COL R. Gregory Lande, MC USA (Ret.); Bhagwan A. Bahroo, MD; MAJ Alyssa Soumoff, MC USA ABSTRACT To explore the characteristics of military service tattoos a descriptive study was conducted at Walter Reed Army Medical Center to collect information from a convenience sample. An investigator-developed questionnaire provided the data for this study. Over the ensuing 12 month-period the researchers collected 126 questionnaires. Typical respondents were enlisted men with at least one deployment to an area of combat operations. Among the respondents, 57% acquired their tattoos before their deployment. One-quarter of the respondents reported only one tattoo, leaving the majority with multiple tattoos. Men received their first tattoo at an earlier age than women. The most common tattoo listed a person s name. Respondents did not regret their tattoos and rarely acquired the body art under the influence of alcohol or drugs. Little evidence was found to support a connection between tattoos and deployment. Few regretted their decisions and most all approached the tattoo experience free of any mind-altering substance. All this seems to suggest that military tattoos are a well-accepted means of self-expression. INTRODUCTION Tattoos have a history vacillating broadly over time between acceptance and condemnation. It seems reasonable to include tattoos adorning the bodies of 4,000-year-old Egyptian female mummies in the acceptance category. 1 In a similar fashion, Captain Cook and his British Sailors enjoyed a small but receptive audience when they introduced the novel art form to the Western culture in Otherwise, tattoo condemnation was practiced in England. The Holy Bible, at Leviticus 19:28, seems to rather definitely preclude print[ing] any marks upon you... 3 The Catholic Pope Hadrian I banned the practice in 787 AD. 4 The British Navy launched the enduring western military tradition of tattoos through exposure to the Polynesian cultures of the 18th century. 5 These decorative Polynesian images portrayed important historical events. The Polynesian influence extended to our language. In fact, the word tattoo comes from the Tahitian word tatau. Tattoos were uncommon in America until the military intervened. War, patriotism, and graphic body art were the typical ingredients that fostered the trend in the 20th century. 6 As a consequence, the tattoos were often related to military insignia and patriotic themes. Members in the Navy were the greatest patrons of the art during World War II with approximately 65% of Navy personnel sporting tattoos. 7 The modern history of tattoos still carries remnants of disdain but the current practice is generally considered acceptable. Even so, the oscillating history of tattoos invites curiosity, the principle factor motivating the authors study. Psychiatry Continuity Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD This article was presented in poster format, American Psychiatric Association, May The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Army, or Defense, or the U.S. Government. doi: /MILMED-D What factors increase their frequency and define their theme? Individuation appears to be one factor influencing the frequency of tattoos inasmuch as the tattoo becomes a visible means to differentiate oneself. The wars in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom), if history is a guide, are propelling the positive trend too. Increasingly, researchers, tattoo artists, and historians are studying tattoos and providing insights into the incidence, motivations, meanings, and behavioral correlations among individuals choosing this very personal form of body art. In terms of incidence, a military survey found that 27% of recruits had tattoos preceding enlistment. 8 Interest in tattoos among newly enlisted Army soldiers was very high in another study, with nearly a quarter of the soldiers sporting three or more tattoos and expressing a strong desire for more. 9 This study reported that 36% of Army soldiers, surveyed during basic training and advanced individual training, possessed tattoos, most of whom obtained the tattoos before joining the service. 9 For comparison purposes, a nonmilitary study examined the prevalence of tattoos and body piercings through a national probability sample. 10 The authors of this study reported that 24% of the respondents had tattoos and 14%, mostly women, had body piercings. Researchers also examine the motivations, meanings, and behavioral correlations associated with tattoos. It appears that military recruits are well versed in body art before they join the military. As such, studies that examine adolescents and college age students might shed some light on the motivations, meanings, and behavioral correlations associated with military tattoos. In a nationally representative study among adolescents, the authors reported a 4.5% incidence of tattoos. 11 This same study found a significant relationship between adolescent tattoos, substance use, and aggression. Another study examined the relationships between body art and social deviance among college students. 12 The authors hypothesized that the popularity of tattoos forced a dichotomy. Those with a small MILITARY MEDICINE, Vol. 178, August

2 amount of tattoos reflected individuals like a nontattoo group, while when the amount of tattoos were quantified, higher amounts of four or more tattoos tended to be at higher risk for regular use of marijuana and binge drinking. 12 Strong religious beliefs among college students are not a tattoo deterrent. 13 The behavioral correlations with tattoos seem strongest with drug use and weakest with violence. Among a small group of psychiatric patients, a study reported a significant relationship between a personality disorder and substance misuse. 14 Another study found a higher incidence of tattoos among smokers. 15 Tattoos are common among gang members, prison inmates, and drug users. 16 An Australian study found the highest rates of tattoos among women in their 20s. The same study reported that tattooing was associated with higher rates of tobacco and marijuana use. 17 In a matched casecontrol study, the authors reported no association between tattoos and deaths by homicide. 18 Interest in tattoos seems to change over time, perhaps a further reflection hinting at different motivations. The authors of a study reported that women, by a two-to-one margin over men, requested tattoo removal. 19 The impulse behind the removal is interesting and would be a worthwhile avenue for further research. The authors of this study were curious. Tattoos among current active duty service members often seemed to portray combat-related themes. In some cases, the service member s tattoos honored a buddy killed in combat, while in others the meaning seemed more obscure. Perhaps in some of these cases the tattoo is a sort of good luck charm. 20 In any event, the authors of this article undertook a descriptive study to better understand the frequency and characteristics of tattoos among active duty service members. METHODS The authors collected data through a convenience sample obtained from active duty service members who completed a tattoo questionnaire. Potential respondents could access the tattoo questionnaire at four WRAMC) locations. Sites included the WRAMC Psychiatric Continuity Service. The WRAMC Psychiatric Continuity Service is an intensive outpatient treatment program that provides care for active duty service members. Predominant diagnoses included combatrelated post-traumatic stress disorder and depression. The remaining three tattoo questionnaire access sites included the WRAMC s Behavioral Health Clinic, Physical and the Occupational Therapy Clinics, and Physical Fitness Center. The tattoo questionnaire was designed by the investigators taking cues from the published literature, their clinical experience, and through consultations with WRAMC s Department of Research. Before distributing the questionnaire, the authors conducted a field test of the instrument seeking feedback and making final adjustments. The WRAMC Institutional Review Board approved the final tattoo questionnaire along with the entire study. The tattoo questionnaire asked respondents basic demographic information such as their age, gender, military branch, and pay grade. The remainder of the questionnaire focused on gathering military relevant tattoo information. To that end, the questionnaire collected deployment data, including the number of deployments and a description of the duties performed. Then, respondents were asked about their tattoo designs using a list of 39 descriptions. Some of the choices included weapons, unit symbols, meat tags, various religious images, names, dates, quotes, and abstract designs. The tattoo questionnaire also asked the service member to comment on the age when the tattoos was started, the number of tattoo sessions, the size, colors, why they chose to obtain a tattoo, whether the service member was under the influence of alcohol or drugs, was the tattoo later modified, the tattoo s relationship to a combat deployment, and whether the service member subsequently regretted the tattoo. This questionnaire allowed the service member to comment on a total of five tattoos. Participants deposited the completed questionnaires into secured collection boxes for later retrieval by the researchers. Data reported in this study were collected from July 2010 through June The authors analyzed these data using Microsoft Excel 2010, specifically the functions CHIDIST for c 2 probabilities and TDIST for Student t-test probabilities. RESULTS The researchers retrieved 126 questionnaires from the secured boxes and eliminated four because the respondents either were not military or they reported no tattoos; a total of 122 were used for data analysis. Men accounted for nearly two-thirds (80/122, 66%) of the completed questionnaires (see Table I). Slightly over half of the respondents (63/122, 52%) were between 21 and 30 years old. Army respondents completed the bulk (96/122, 79%) of the questionnaires. Nearly twothirds (80/122, 66%) of the respondents reported at least one military deployment. The vast majority of respondents (n = 100/118, 82%) reported that at least one family member had a tattoo. In terms of gender, men in the lower pay grades (E1 E4) are more likely to report tattoos than women (p = 0.02). That relationship disappears in the remaining pay grades. Most respondents in this study (n = 83/122, 68%) reported their religion as Christian. Among this religious group, significantly more men than women reported tattoos (p = 0.04). About one-quarter of the subjects reported having only one tattoo (33/122, 27%). This left the majority of respondents reporting multiple tattoos (see Table II). The researchers collected data addressing the age at which the respondents acquired their first tattoo along with the number of tattoos (see Table II). The average female respondent s age at first tattoo (n = 41/122, mean 23.2, SD 6.9) was 3.6 years later than her male counterpart s age (n = 80/122, mean 19.6, SD 4.5), a significant difference ( p = 0.00). In terms of frequency, there was no significant difference in the number of tattoos reported by men or women (p = 0.29). Among the 922 MILITARY MEDICINE, Vol. 178, August 2013

3 TABLE I. Demographic Characteristics of Service Members (n = 122) Percent (n) Gender Male 65.6 (80) Female 33.6 (41) Age (6) (31) (32) (22) (18) 41 and older 10.7 (13) Army 78.7 (96) Air Force 7.4 (9) Navy 5.7 (7) Marine Corps 4.1 (5) Guard/Reserves 4.1 (5) Military Rank E1 E (41) E5 E (62) O1 O3 9.0 (11) O4 O6 6.6 (8) Deployment Yes 65.6 (80) No 33.6 (41) Religion a Christian 68.0 (83) Jew 2.5 (3) Muslim 0.8 (1) Buddhist 0.8 (1) Atheist/Agnostic 15.6 (19) Ethnic Origin b White, Non-Hispanic 61.5 (75) Black or African American 18.0 (22) Hispanic 9.8 (12) Asian 0.8 (1) Tattooed Family Member(s) No 14.8 (18) Yes 82.0 (100) Some categories had at least 1 nonresponse. a For religion, the options that appeared in the survey were Catholic, Protestant, Jewish, Muslim, Buddhist, Hindu, Atheist/Agnostic, and Other (please indicate). In the above table, Christian includes responses indicating Catholic, Protestant, and the handwritten responses of Christian, Lutheran, Baptist, and Episcopal. b For ethnic origin, the options that appeared in the survey were White (non-hispanic), African American or Black, Hispanic, American Indian, Asian Middle-Eastern, Asian Chinese/Korean/etc., Native Hawaiian/Pacific Islander, and Other (please indicate). There were no responses in the categories of American Indian, Asian Middle-Eastern, or Native Hawaiian/Pacific Islander. service branches, Marines reported the highest average number of tattoos at 5.8 (p = 0.02). The 122 respondents described a collective total of 516 tattoos. The top choice selected by the service members (n = 40/516, 7.75%) from the 39 tattoo categories listed on the questionnaire was a person s name. Among the other descriptions, only real animals, ethnic/cultural/ tribal symbol, and Christian symbols exceeded 5% of the total tattoos described by the service members (see Table III). TABLE II. Tattoo Data by Demographic Group (n = 122) Demographic Group Age of First Tattoo Mean (SD) Number of Tattoos Mean (SD) Gender a Male 19.6 (4.5) 3.5 (2.0) Female 23.2 (6.9) 3.2 (2.2) Army 21.0 (6.2) 3.4 (2.0) Air Force 20.8 (4.1) 2.8 (1.8) Navy 18.9 (3.3) 3.0 (2.4) Marine Corps 18.2 (1.1) 5.8 (2.2) Guard/Reserves 20.6 (2.7) 3.4 (1.8) Rank E1 E (3.1) 3.7 (2.0) E5 E (4.6) 3.4 (2.0) O1 O (3.7) 3.7 (2.3) O4 O (9.1) 1.8 (1.2) Deployments b No 20.5 (6.7) 3.3 (2.1) Yes 20.9 (5.2) 3.5 (2.0) Race White, Non-Hispanic 20.7 (5.7) 3.6 (2.0) African American 21.7 (7.4) 3.1 (2.1) Hispanic 19.2 (2.5) 3.6 (1.7) a 1 Respondent did not specify his/her gender. b 1 Respondent did not specify a deployment history. TABLE III. Service Member s Description of Tattoos (n = 516) Theme n % Person s Name Real Animals Ethnic/Cultural/Tribal Symbol Christianity Symbols Skulls/Grim-Reaper/Tombstone Symbol Refers to My Interest/Hobby Message or Nonreligious Quote Trees/Flowers/Plants Weapon Moon/Sun/Planets/Stars Chinese/Japanese Characters Symbols Abstract Designs Other Patriotic Image (Besides Flag) Angels Prayer, Verse or Religious Quote Dates Devil/Demons Mythical Animals Unit Symbols or Crests Image of a Fictional Character Values less than 2% excluded. Respondents reported few regrets about acquiring the tattoos (see Table IV). In fact, of the 516 tattoos described, only ten men and eight women expressed concerns about any one of their collective tattoos. In a similar expression of clear minded intent, only three women and ten men reported acquiring any of the 516 collective tattoos, while under the influence of alcohol or an illicit drug. MILITARY MEDICINE, Vol. 178, August

4 TABLE IV. Tattoo Data by Demographic Group (n = 122) Demographic Group Tattooed Under Substance Influence %(n) Regrets Any of the Tattoos a %(n) Gender b Male 12.5 (10) 12.5 (10) Female 7.3 (3) 19.5 (8) Army 10.4 (10) 16.7 (16) Air Force 22.2 (2) 22.2 (2) Navy 0 (0) 14.3 (1) Marine Corps 20.0 (1) 0 (0) Guard/Reserves 0 (0) 0 (0) Rank E1 E4 9.8 (4) 19.5 (8) E5 E9 8.1 (5) 11.3 (7) O1 O (3) 36.4 (4) O4 O (1) 0 (0) Deployments c No 9.8 (4) 24.4 (10) Yes 10 (8) 11.2 (9) Race White, Non-Hispanic 12.0 (9) 16.0 (12) African American 4.5 (1) 22.7 (5) Hispanic 8.3 (1) 8.3 (1) a None of the tattoos were reported to be both under the influence of a substance and regretted. b 1 Respondent did not specify his/her gender. c 1 Respondent did not specify a deployment history. The 80 respondents with at least one military deployment contributed half (n = 262/516, 50.8%) of the total tattoos reported in this study. A closer examination of this group revealed that most of these tattoos were acquired before deployment (n = 150/262, 57.3%). Interestingly, a small number of the tattoos originated during the respondent s deployment (n = 18/262, 6.9%). Among the latter subgroup, the respondents acquired the tattoos mostly through local tattoo artists (n = 16/18, 88.9%) with the 2 remaining tattoos performed by a fellow service member. DISCUSSION The authors recognized that the data collected from this study suffer from several potential short comings. Perhaps chief among these is the relatively small sample size. The sample size was determined by two basic factors the ease of accessing the questionnaire and the motivation of potential respondents. Another limiting factor was the questionnaire only asked about five tattoos. On the other hand, the 122 service members who ultimately participated in this study collectively showed their interest by thoroughly completing the questionnaires. Although the overall sample size may be relatively small, the completion rate was high. As might be expected, most of the service members in this study were younger men in the U.S. Army. In terms of influence it seems reasonable to speculate, with eight in ten service members reporting family members with tattoos, that they were comfortable with tattoos and their tattoos had messages for them. Gender had a more muted influence. Men acquired tattoos at an earlier age than women. Younger enlisted men were also more likely than women to have tattoos, but that relationship faded away as the genders ascended the pay grades. Neither men nor women expressed much regret about their collective tattoos. Our study revealed an interesting dichotomy in terms of the number of tattoos service members acquired. Two groups predominated, a fairly large group of service members who reported only one tattoo versus those service members with multiple tattoos. The authors found this an interesting finding that would be a useful subject for further research. Aside from the number of tattoos, these two groups may differ in other ways. As other researchers have noted, a correlation appears to exist between the number of tattoos and various high-risk behaviors and this could be examined in future military research. The relationships between combat deployment and tattoos also produced some interesting findings. The authors initially speculated that combat deployments accounted for the bulk of tattoo acquisitions. This did not appear to be the case because more than half of the tattoos among deployed service members were acquired before they entered military service. This finding seems consistent with previously published results about service member tattoos. The age at first tattoo acquisition did not vary significantly depending on the service member s deployment history. Roughly half of all the tattoos reported in this study came from the two-thirds of service members who reported a combat deployment. That leaves the other half coming from a disproportionately smaller group of nondeployed service members. This would seem to suggest an even weaker post-combat experience influence on tattoo acquisition. The broad array of themes chosen by service members in describing their tattoos also lends little credence to a potent post-combat influence. Based on this study, most service members acquired their first tattoo before entering military service. Two groups of service members with tattoos emerged in this study service members content with one tattoo and those progressing to multiple tattoos. Few regretted their decisions and most all approached the tattoo experience free of any mind-altering substance. All this seems to suggest that military tattoos are a well-accepted means of self-expression. REFERENCES 1. 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