INTRODUCTION AND

1
IS PERCEPTION REALITY? EMPLOYERS PERSPECTIVES ON
TATTOOS AND BODY PIERCING Judy A. Fellows, Ph.D.,
CCC-SLP, Jenene Bignar, B.S., Krystal Williams,
B.S. Department of Communicative Disorders
INTRODUCTION AND REVIEW OF
LITERATURE Body art (e.g., tattoos, body
piercing) has become more predominant in
mainstream society in recent years, creating
concerns ranging from customer discomfort to
discrimination claims. One survey of 1,010
subjects found that one in seven people (over 39
million people) have at least one tattoo and 30
of those with tattoos are between the ages of 25
and 34 years (Scripts Howard News Service Ohio
University, 2005). The increasing prevalence of
this type of self expression has business and
healthcare settings examining their current
policies regarding employees appearance. In
2005, the Employment Law Alliance (ELA) found
that 39 of Americans believe employers should
have the right to deny employment based on
appearance (i.e., clothing, weight, body art, and
hair style). Some (33) believe, however, that
special legal protection should be granted to
those considered unattractive, overweight, or
unconventional in appearance. Despite these
beliefs, only 51 of employers had formal company
policies regarding employee appearance. The
lack of formal policies regarding appearance has
resulted in employees filing discrimination
suits. In Craft v. Metromedia (1985), a
co-anchor was re-assigned to reporter status
after negative comments were made about her
appearance. The court of appeals found that
reasonable appearance was critical to the
stations economic well-being. Specifically,
Metromedia was covered under the Civil Rights Act
of 1964 that says that if the position requires a
certain religion, gender, or national origin,
employers can hire based on those characteristics
as they are bona fide occupational
qualifications. In addition to concern about
appearance, employers may also be concerned about
the possible health risks of tattoos and body
piercing. Infections such as Hepatitis B, C, and
HIV can be transmitted via unsterilized
instruments. Transmission of these diseases may
be caused by the inability to sterilize
non-disposable piercing guns and tattooing
equipment due to their design (Samantha, Tweeten,
and Rickman,1998). In general, Hepatitis B is
the major threat in body art because it can be
transmitted in as little as .00004 ml of blood
and can survive on blood-contaminated surfaces,
such as instruments or counter tops, for more
than two months (Armstrong, Texas Tech School of
Nursing, 2001). An estimated four million
Americans are infected with Hepatitis C each year
and 10,000 die (Center for Disease Control,
2005). People with tattoos are nine times more
likely to be infected with Hepatitis C (Robert
Haley, M.D., Chief of Epidemiology of Texas
Southwestern Medical Center, 2001). Hepatitis C,
known for causing chronic liver disease, can be
transferred into the bloodstream via percutaneous
exposure by way of bloodbourne pathogens. These
findings are important for speech-language
pathology students to know as they prepare for
careers in healthcare. Although concerns about
personal appearance are understandable from
business and nursing perspectives, are they and
should they be concerns of speech-language
pathologists? This study examined that question.
If the answer is yes, speech-language pathology
students need to know of these issues as they
prepare for careers in healthcare.
METHODOLOGY Surveys were sent to 106 employers of
Speech-Language Pathologists in healthcare
settings to determine their perspectives on body
art. Survey questions included personal
demographics (e.g., age, if they had body art)
and their opinions of employees with body art.
RESULTS The return rate for surveys yielded a 48
response. Demographics for respondents were as
follows

RESULTS
COMMENTS The desire for a good personal
appearance has gone by the wayside. SAD! We are
selling a producthealthcare and people expect to
SEE professionalism as well as receive it. I
grew up in the era that tattoos were only worn by
bikers, servicemen, or trashy people and body
piercing were only for ladies to wear their
earrings in. Our home health has many elderly
patients who are disgusted by the sight of
tattoos or piercings. We try to make our
patients feel as comfortable as we
can. Employers should have the right to ask
employees to cover tattoos and remove body
piercing that are visible, especially if they are
offensive. Areas of piercing could be infected
and passed on to coworker/patients. Medical
positions are considered professional---The way
you look demands respect. I am a nursing
facility administrator. I will not hire anyone
with a visible tattoo or multi-piercing.


Employers' beliefs society, health risks,
socioeconomic status, and trend

QUESTIONNAIRE For purposes of this study the
following definitions were used Tattoos
permanent coloration of the second layer of the
dermis (Krakow, 1994) that are applied by
injecting pigment 50 - 3,000 times a minute to
the depth of 1/64 to 1/16 of an inch using
whisker thin needles (Armstrong and Fell, 2000).
Body piercing the practice of using needles,
rings, steel posts or other adornments that
penetrate the skin (Rickman and Tweeten, 1998),
excluding up to two piercings per ear lobe.
1. What is your employment setting?
2. Select your age range 3. What is
your gender? 4. What is your overall
view on tattoos? 5. How many tattoos
do you have? 6. Does your company
currently have a formal policy governing
visible tattoos with penalties for
violation? 7. In your opinion, tattoos
are more predominant in people
from which socioeconomic background? 8.
Do you believe that an employer should have the
right to deny employment based on visible
tattoos? 9. Do you believe that an
employee with a visible tattoo could pose a
possible health risk for co-workers and/or
clientele? 10. Does your company
currently have a formal policy
governing body piercing with penalties for
violation? 11. What is your overall view
on body piercing? 12. How many body
piercings do you have (excluding up to 2 in
each ear lobe)? 13. In
your opinion, body piercings are more predominant
in persons from which socioeconomic
background. 14. Do you believe that an
employer should have the right to
deny employment based on body piercing?
15. Do you believe that an employee with body
piercing could pose a possible health risk for
co-workers and/or clientele? 16. Do you
believe that tattoos and piercings are becoming
a part of mainstream society or only a trend?
17. Do you believe that personal appearance
impacts a patient overall perception of care?
18. Do you believe that todays society
places more of an emphasis on personal
appearance than on ability?
Most respondents reported not having any body art.
DISCUSSION This study examined the perspectives
of employers of SLPs in healthcare settings
regarding body art (visible tattoos and body
piercing) in the workplace. Findings were
similar to those found from business (ELA, 2005)
as only about half of the companies have formal
policies governing employee appearance.
Investigation of SES found that about one-half
said it did not play a role, but one-third
believed body art reflected low SES. The issue
of health risk was more of a concern for body
piercing than tattoos, despite concerns reported
by Armstrong (2001), Haley (2001), and the CDC
(2005). Despite its increased prevalence,
respondents view body art as only a trend.
Employers believe, however, that visible tattoos
and body piercing should prevent SLPs from
obtaining employment in healthcare settings since
appearance is believed to greatly impact
patients perception of care. It is believed
that since the respondents were from a relatively
conservative area in the south, these findings
reflect those viewpoints. Investigation of other
regions of the U.S. could generate different
results. Regardless, clinicians need to be aware
of possible perceptions regarding body art and
make their personal decisions accordingly.
Although society may place more emphasis on
personal appearance than ability, in a healthcare
profession such as speech-language pathology,
ultimately ability is critical.
REFERENCES Armstrong, M.L., Fell, P.R. (2000).
Body Art Regulatory Issues and the NEHA
Body Art Model Code. Environmental Health.
pp.25-30. Center for Disease Control (CDC)
(N.D.). Hepatitis C Staphylococcus aureus HIV.
Retrieved from the World Wide Web on November
10, 2005 http//www.cdc.gov/ncidod/diseases.htm
Civil Rights Act of 1964, Pub. L. 88-352. Sec.
2000e-2, Section 703, Title VII (1964). Craft
vs. Metromedia, Inc., 766 F. 2d 1205 (8th Cir.
1985). Employment Law Alliance (ELA). (2005).
America at Work (Survey). Retrieved from the
World Wide Web on November 3, 2005
http//www.ela.org. Krakow, A. (1994). The
Tattoo Book. New York. Lloyd, J.D. (2003). Body
Piercing and Tattoos Examining Pop Culture.
Greenhaven Press. Rickman, L.S. Tweeten, S.M.
(1998). Infectious Complications of Body
Piercing. Clinical Infectious Diseases. Volume
26 735-40. Scripps Howard News Service and Ohio
University. (2005). Retrieved from the World
Wide Web on November 1, 2005 http//www.newspoll
s.org.
Employers perspectives on body art were negative.

Few employers had company policies but most
believed in the right to deny employment