OBJECTIVES : To report the prevalence, demographic characteristics, perception, and health-related quality of life (HRQoL) of US adults with and without tattoos, and describe the factors influencing tattoo regret.

METHODS : Data were assessed from a 2017 cross-sectional survey of US adults. Participants were recruited using a random stratified sampling framework. Descriptive and multivariable statistical models were used to describe participants with and without tattoos. A logistic regression model was used to determine factors predictive of tattoo regret.

RESULTS : Of the 3,033 respondents, 35.3% reported having at least one tattoos. Age and sex were associated with having a tattoo (age: 37.9 years with tattoo vs 46.0 years without tattoo, p<0.001; female: 58.1% with tattoo vs 45.0% without tattoo, p<0.001). Those without tattoos perceived those with tattoos as less intelligent, professional and attractive and more rebellious. Mental health was lower for tattooed vs non-tattooed participants (MCS 43.1 [12.6] vs. 47.4 [11.9], p<0.001), and those with tattoos had higher rates of severe depression (17.8% vs 12.6%, p<0.001) and severe anxiety (13.4% vs. 8.7%, p<0.001) than participants without. Factors predictive of tattoo regret included being impaired when getting the tattoo (OR=2.98, p<0.001), a tattoo on the head or neck (OR=2.10, p<0.05), a tattoo on the hands, wrist or fingers (OR=2.00, p<0.05), peer pressure as the reason for the tattoo (3.02, p<0.05) and experiencing a tattoo related adverse event (OR=1.42, p<0.05); age (OR=0.93, <0.001) and remembrance as the reason for the tattoo (OR=0.68, p<0.05) were predictive of not having tattoo regret. Those reporting tattoo regret reported were more likely to incur health care costs to remove or cover their tattoo(s).

CONCLUSIONS : Participants with tattoos were negatively perceived by those without tattoos. Time with and an exposed tattoo location were predictive of tattoo regret and additional health care costs for tattoo removal or coverage.