Body Art: Regulatory Issues and the NEHA Body Art Model Code.

Abstract

The popularity of body art, especially of invasive tattooing and body-piercing procedures, has prompted safety concerns. The four primary areas of concern are (1) the equipment and associated materials, (2) the artists' education, (3) the physical environments where body art is performed, and (4) the pancity of regulations and enforcement associated with the procedures. (Approximately half the states in this country have tattooing regulations. A few states have regulations for body piercing.) To address these concerns, a 21-member expert committee was formed under the auspices of NEHA. This committee, which assumed a leading role by creating a Body Art Model Code, comprised environmental and public health professionals; representatives from three body art organizations; and physicians, nurses, health educators, and individuals from relevant federal agencies.

The Model Code is designed to serve as a professional advisory document for health officials who wish to regulate the body art industry in their jurisdictions. It also establishes public health criteria and recommendations for operators so that they can safely provide body art services to the general public.

Introduction

All over the social landscape, tattooing and body piercing have become popular, and body art is found on people of all ages, occupations, and social classes [1]. According to the 1996 Business Changes Report, tattooing is the fifth-fastest-growing business in the United States. One large national supplier of tattooing accessories claims more than 37,000 regular customers [2]. Pediatrician Benjamin Spock, in the seventh revision of his book Baby and Child Care, even discussed body piercing [3].

Although an increase in the popularity of body art has been observed, it remains difficult to find published information about the percentage of body art recipients in the U.S. population. Frequently only estimates are provided. One unpublished 1990 survey of 10,000 randomly selected U.S. households found that three percent of household members were tattooed and five percent of the men were tattooed [4]. Those percentages translate to between seven million and 20 million tattooed people. Armstrong and Pace Murphy have found that one in 10 adolescents are tattooed, Sperry estimates that 25 percent of all 15-to-25-year olds are tattooed, and a recent study of Army basic recruits found that over a third (37 percent) had tattoos [5-7].

Information about the prevalence of body piercing is a bit more elusive since customers can change their minds, remove their jewelry, and allow the body openings to close. At each outlet of Gauntlet, formerly one of the oldest body-piercing businesses in the United States, each of 30 piercers has in the past averaged 1,000 to 1,500 piercings per year. To calculate business volume for the entire chain, one must then multiply those figures by four; Gauntlet had four national and international locations. Recently, Gauntlet closed, in part because of intense competition from other body art studios. In Texas, state officials estimate that there are over 450 tattoo studios, with about 85 percent of the artists in tattoo shops also providing piercing [8]. In Florida, the Department of Health estimates that there are over 250 body art shops.

Despite its popularity, body art is not merely the risqu[acute{e}], carefree activity portrayed in the media. The invasive procedures of tattooing and body piercing have raised safety concerns. The four primary areas of concern are

1. the equipment and associated materials,

2. the artists' education,

3. the physical environments where body art is performed, and

4. the paucity of regulation and enforcement associated with the procedures.

Tattooing Procedure and Regulations

The tool used for tattooing in studios is an electric, vertically vibrating instrument that resembles a dentist's drill. It injects the skin with pigment 50 to 3,000 times per minute to a depth of 1/64th to 1/16th of an inch [9]. Depending on the intricacy of the tattoo design, from one to 14 solid, "whisker-thin" needles joined on a needle bar are used to transfer the tattoo pigment into the skin. While single-use needles (discarded after each tattoo) would be the preferred method for effective hygiene, most reputable tattoo artists simply sterilize their needles and the traditional tattooing equipment after each use.

Pigments used for tattooing are associated with lack of purity and identity issues [2,4]. Since 1938, the Food and Drug Administration (FDA) has considered tattoo pigments to be color additives--that is, cosmetics. Because of the cosmetics label, tattoo pigments are approved for topical use, but have never been thoroughly reviewed for interdermal use. The lack of review also means that tattoo pigments can contain nonstandardized ingredients, with exact mixtures of pigments considered to be proprietary knowledge. Many of the pigments contain elements such as cadmium, chromium, cobalt, copper, iron, selenium, titanium, or zinc. Concentrations of mercury are limited to three parts per million to prevent reactions to red pigments, although they still occur [2].

The way tattoo pigments are purchased and stored presents additional problems. Artists can purchase pigments in bulk amounts, which they may store in large containers. When artists remove more pigment than needed for a given job, they may then return the unused portion of the pigment to the large container, thus contaminating the whole batch, A safer approach would be to remove a small amount of pigment into a single-use container for each procedure, and then discard any leftovers to avoid contaminating the pigment left in the bulk container. Pigment also can be purchased in powder form. Artists who use powders must reconstitute the pigments themselves. To obtain a variety of colors, they often mix the powders with compounds such as alcohol, glycerin, and even mouthwash (Listerine(R) is favored) [10]. A lack of aseptic technique during any part of this reconstitution could lead to contamination of the pigment.

Tattooing and body piercing have been called "an artist-consumer-regulated business"-in other words, only an artist's personal commitment guarantees effective and safe body art procedures [1,11,12]. The theory is that if customers are knowledgeable about the procedures and ask specific questions to avoid potential risks, artists will be eager to please in the hope of eliciting more customers. Often, however, tattooists and piercers have limited knowledge about standard sanitation, infection control, sterilization, and skin care procedures when they establish body art businesses [2,4,13]. Some artists get started in the body art business by reading a book, viewing a video, or just obtaining the instruments. Apprenticeship positions are limited because artists don't want future competition from their proteges. "Certificates" displayed in body art studios frequently represent the artist's state business registration and merely indicate that the owner has paid a yearly licensing fee. Gauntlet, however, supported one and a half years of direct supervised training and practice with well-established, professional piercers, so that a new body artist would understand the minimum health and safety guidelines. All of the body art organizations (the Alliance of Professional Tattooists, the American Body Art Association, the Association of Professional Piercers, and the Society of Cosmetic Professionals) are strong supporters of artist education, and they conduct national and regional hygiene workshops; unfortunately their memberships represent only a minority of the nation's body artists.

The United States has no universal regulations for body art. Many people, including customers, believe that body art establishments are inspected and monitored by some regulatory health authority In many states, however, such establishments--especially body-piercing establishments--are not inspected, monitored, or regulated [14]. In 1989, three states (Mississippi, Oklahoma, and South Carolina) had banned tattooing, and 16 states were regulating tattooing in some manner (Arkansas, Arizona, Connecticut, Florida, Hawaii, Illinois, Indiana, Maine, Massachusetts, New Hampshire, North Carolina, Pennsylvania, Tennessee, Texas, Vermont, and Washington) [15]. Six years later, Tope found that seven states had banned tattooing, hut that 27 states still had no statutory regulations for tattooing [2]. Eleven states had adopted regulations against tattooing of minors, and 12 states had elected to pursue a thorough review of tattooing with a focus on artist education, infection control, and recognition of untoward activities. Most of those 12 states have conducted their evaluations just within the last 20 years. In 1996, Korn reported that five more states (Colorado, Mississippi, New Hampshire, Pennsylvania, and Wisconsin) had adopted some sort of regulation [15]. Currently, nine states (Arkansas, Arizona, Hawaii, Kansas, Maine, New Hampshire, Oregon, Rhode Island, and South Carolina) not only have regulations, but also specify an examination or educational requirements for tattoo artists.

Despite increases in the number of studios and in regulations implemented by states, safety enforcement in the body art industry remains problematic. Many body art customers who are dissatisfied--whether because they do not like the aesthetic appearances of their body art or because of medical complications such as allergic responses or infections--do not return to the original artist. In addition, customers with medical complications often do not seek medical advice in a timely manner. Research has documented that customers frequently seek out other artists to remedy their medical problems instead of approaching health providers [5,7,16]. In addition, the inspection and monitoring of body art studios may be restricted by limitations in resources. The personnel resources of health departments may be scant, funding may not be adequate, and departments may have other priorities. Usually, however, public health personnel are responsive and diligent when complaints are received. Recently, to recover more of the administration and inspection costs associated with body art studios, the state of Texas raised its licensing fee from $130 to $450 [17].

Body-Piercing Procedure and Regulations

In body piercing, an area of the body (ear, nose, eyebrow, lip, tongue, nipple, naval, or genitals) is held taut with a forceps while a needle is inserted. Alternatively, a piercing gun is used to create openings into which decorative ornaments such as jewelry may be inserted [18]. Except that no pigments are involved, the safety concerns for body piercing are the same as those for tattooing: equipment, education, environment, and enforcement. An additional concern is the type of jewelry inserted [19]. It should be made of surgical-implant-grade stainless steel, solid 14- or 18-karat white or yellow gold, niobium, titanium, platinum, or a dense, low-porosity plastic [17-19]. Jewelry with nickel or brass plating tends to produce allergic or infectious responses.

Currently, 17 states (California, Delaware, Florida, Illinois, Indiana, Iowa, Kansas, Maine, Maryland, Michigan, Missouri, New Hampshire, New Jersey, Ohio, Oregon, Texas, and Wisconsin) have specific regulations for body piercing [13,20]. Other states (Louisiana, North Dakota, and Nebraska) recently have passed legislation and are developing body-piercing regulations. New Hampshire also has regulated traditional ear lobe piercing.

Accessibility of Equipment

Most body art procedures are performed in storefront businesses. Piercing and tattooing can be portable, however, and that portability means that the procedures also are conducted in homes and at flea markets, rock concerts, and entertainment parties [18,21]. Anyone can purchase equipment by skimming specific magazines to find professional body art kits for sale. One body-piercing kit is advertised as "the perfect solution for the beginner and the professional on the move, including a custom made carrying case" [22]. The kit is very complete: It contains two pairs of forceps, (one specifically for the tongue), bead rings, alcohol swabs, latex gloves, finger cots, and piercing needles--all for $295. An instructional video and book also are included. Tattooing equipment is easily accessible as well.

Health Concerns

Any procedure that punctures the skin increases the risk of pain, bleeding, infection, and scarring. As the popularity of tattooing and body piercing continues, the medical literature documenting complications seems to be evolving. Sperry believes that any loss of serosanguineous fluid accompanying the repetitive puncturing of tattooing is associated with the potential for infections and the transmission of bloodborne diseases [23]. Puncture wounds caused by body piercing present the same kinds of risks. Organisms can be introduced at the time of the procedure if an artist uses poor technique or unsterile instruments, and they can be introduced during aftercare if the wound is not kept clean. Therefore it is important that the client receive skin care instructions before leaving the studio [19].

Two cases of HIV/AIDS in the medical literature have been thought to be linked to body art procedures, but overall there has been more concern about the transmission of hepatitis B--and now hepatitis C [21,23-27], These infections pose a potential threat to customers, body piercers, and tattooists. While this threat may be reduced as more people obtain vaccinations against hepatitis B, Tope believes that all body art artists, with their daily exposure to body fluids, should be required to receive hepatitis B vaccinations [2]. Both the U.S. Red Cross and the Canadian Red Cross refuse blood donations from body art recipients for at least one year after performance of the procedure because of the potential for hepatitis transmission [27]. Recently, three cases of hepatitis were self-reported (two with body piercings and one with tattooing) during a study that examined body art practices among college students (N = 766) [18]. The same study reported frequent infections and local skin irritations with body pierci ng.

Given this information about body art, many ask the same question as Anderson: "Why should someone who is unlicensed inject unknown compounds [or jewelry] for profit and have less public health scrutiny [than] a cook or a barber?"--or, one might add, than beauty and nail salons [4]? As the popularity of body art continues to escalate, this emerging industry poses a number of dilemmas for state, county, and local health departments.

Development of a Body Art Model Code

In October 1996, NEHA President Peter D. Thornton recognized the need for reasonable guidelines governing the body art industry. He also saw a critical need for a national public health organization, such as NEHA, to assume a leading role in developing a model code. Thus, the Body Art Model Code Committee was formed. Its task was to develop a model code that would, over time, provide a comprehensive approach to body art as well as promote consistent regulations that might be adopted throughout the nation. The nucleus of the committee was eight environmental and public health professionals. Representatives from three body art organizations (the Alliance of Professional Tattooists, the Association of Professional Piercers, and the Society of Permanent Cosmetic Professionals) were included. Also participating were interested physicians, nurses, health educators, and individuals from applicable federal agencies. The composition of the membership was, however, designed to incorporate individuals who had specific e xpertise related to body art practices, not necessarily to represent official agencies. There was a final total of 21 members.

The committee's mission was to draft guidelines that provided

1. a public health orientation,

2. a comprehensive approach to all forms of body art,

3. promotion of standardized body art regulations throughout the nation, and

4. the acknowledgement of a universal public health mission for protection against disease and improvement of citizens' health.

Initial drafts of the Body Art Model Code and Guidelines were shared frequently with the NEHA board of directors. A major presentation of the fourth draft was made to the general membership at the Annual Educational Conference (AEC) on June 30, 1997, where it was enthusiastically received. Small revisions and refinements continued into 1998, including a NEHA legal review. After undergoing a total of 13 drafts, a final Body Art Model Code was published and made available to NEHA and the public at the AEC on June 29, 1998, in Las Vegas. Both the initial concept draft and the final Model Code were enthusiastically endorsed by the four major body art organizations; their letters of support remain a permanent part of the code.

The Model Code is intended to serve as a professional advisory document. Its recommendations address health officials who wish to regulate the body art industry in their jurisdictions by establishing public health criteria, as well as operators who wish to provide safe body art services to the general public.

Basic Tenets and Provisions of the NEHA Body Art Model Code

The two-year development period involved a great deal of discussion. The discussion evolved into the following philosophical tenets and provisions of the NEHA Body Art Model Code [28]:

1. Body art is fast becoming prevalent and popular in all communities. As used in this Model Code, the term "body art" includes body piercing, tattooing, permanent cosmetics, branding, and scarification. Implants under the skin, currently known as 3-D body art, are considered a medical procedure and should not be performed in body art establishments. Injuries, infections, and occasional transmission of disease are occurring as a result of improper body art or aftercare procedures.

2. if the mission of a health authority is to prevent disease and improve the health of its citizens, it is incumbent upon health authorities to address the emerging health issues posed by body art.

3. A body art regulation should take a comprehensive rather than a piecemeal approach, addressing all forms of body art. Contrary to public opinion, body art is not a fad, and it will not quietly go away Rather, it's becoming mainstream in our society, and new forms and expressions of body art are emerging all the time, thus requiring vigilance on the part of public health officials and updates and revisions to any body art code.

4. The environmental health sections of health departments, with their public health training and regulatory functions, should promulgate rules and administer the regulatory program. If at all possible, regulations should be statewide in order to promote consistency.

5. Permitting, both of the body art establishments and of the operator(s)/technician(s), is often regarded as the most effective means of administering and regulating this program.

6. Body art operators should be required to demonstrate knowledge, skills, and ability in body art, through proof of attendance at professional courses or certifications, as well as knowledge/proficiency in subjects as anatomy universal precautions, disease transmission, skin diseases, sterilization procedures, etc.

7. Individuals under 18 years of age desiring body art should have written consent from and be accompanied by a parent or legal guardian. Many body art professionals have individual policies of not performing body art on anyone under 18 years of age, regardless of consent.

8. Body art clients should receive verbal and written health educational information from the operator so that clients can make an informed decision prior to the body art procedure, as well as written information regarding the client responsibilities for aftercare of the body art. Placards posted in all body art establishments, giving the name, address, and phone number of the local health authority, should be required so that the public can report complaints or seek additional information.

9. To protect both the client and the body art operator, certain information should be disclosed by the client to assist the operator/technician in evaluating the proper healing of the body art procedure. This disclosure should occur in such a manner that the rights of the client are not violated. The records should be kept confidential and available for review by the health department upon request. These records should include information on the body art performed, the location on the body date performed, name of operator/technician, and record of aftercare information given.

10. Knowledge and practice of universal precautions, sanitation, personal hygiene, sterilization, and aftercare requirements on the part of operators/technicians should be demonstrated to prevent the transmission of disease or injury to the client.

11. Body art establishments should meet minimum sanitary establishment requirements to assure the client and operator of a clean, hygienic environment. Health department plan reviews also should be required (e.g., an examination of an establishment's floor plan to ensure that the physical elements of a facility are in compliance with various code requirements for a new body art establishment).

12. All body art operators/technicians should be offered the hepatitis B vaccine series, with recognition of their right of refusal. Employers should be encouraged to require the vaccine series as a pre-employment consideration.

13. All body art establishments should be equipped with approved autoclaves, complete with operating instructions, and they should be monitored monthly with an appropriate biological indicator. Results should be submitted to an independent laboratory. Dry heat sterilizers may be used if approved by the local health department.

14. Permits and requirements for mobile, temporary body art establishments, as well as body art booths at demonstration projects or fairs, also are addressed.

15. Enforcement procedures are addressed in this code. Emphasis should be directed toward body art operations that do not obtain permits or that violate the regulations.

16. The Model Code does exempt the piercing of the outer perimeter and lobe of the ear from these regulations for two reasons: [1] the lack of current epidemiological evidence of disease transmission or conclusive medical evidence of cartilage injury from the use of ear-piercing guns on the outer perimeter and lobe of the ear and [2] the considerable additional work load impact upon health department staff, which could not be justified effectively in terms of a cost/benefit analysis insofar as disease or injury prevention activities are concerned. (While the Model Code does not require a training class for upper-perimeter ear and ear lobe piercers using ear-piercing guns, such a class is nonetheless advised.)

17. A body art regulatory program should be self-supported, with an appropriate fee schedule for plan reviews, as well as for establishment, operator/technician, and temporary permits.

18. Lastly but most importantly any jurisdiction considering regulating the body art profession may use all or part of this code to suit community needs and personnel capabilities. It is not an all-or-nothing situation. s the Model Code provides this committee's recommendations for what should be included in a comprehensive approach that will meet the challenges of this emerging industry.

The actual Model Code contains applicable working definitions and discusses two categories of personnel who could be exempt from its recommendations, It also provides pertinent information on

* public notification requirements;

* client records;

* records retention;

* preparation and care of the body art area;

* sanitation and sterilization procedures;

* requirements for single-use items;

* requirements for the premises;

* permit requirements, including requirements for temporary demonstrations and mobile body art;

* prohibitions;

* enforcement;

* suspension and revocation of permits;

* competency requirements for department personnel; and

* interpretation/severability issues.

The accompanying guidebook supplements the Model Code with excellent educational information designed to assist readers in understanding body art--and in understanding some of the rationale for the use of standards.

Because the body art profession and the various forms of body art are evolving and ever-changing, the committee has recommended that the Model Code be reviewed frequently. The NEHA board of directors has stated that it will continue to review and update the code.

What Should Be Done Now?

Readers may object: "I haven't seen any tattooing or body-piercing shops in my community, so we don't need a code." A glance in the telephone directory, however, is likely to turn up more establishments than might be expected.

Health departments should he proactive with respect to body art. This field is new to most environmental health personnel, so it is important that they visit the studios, learn about the operations, and ask questions. Readers of this article might want to find out what kind of regulations their city, county, and state jurisdictions currently have for body art, then obtain a copy of the Body Art Model Code and compare. (A copy of the Model Code can be obtained by phoning NEHA at 303-756-9090, e-mailing a request to [less than][e-mail][great than], or visiting NEHAs Web site at [less than]http://www.neha.org[great than].) Do the standards currently in effect fit the needs of the community? Do those standards need expansion or fine-tuning?

NEHA has taken a proactive stance, and it is the first public health organization in the nation to work on this issue. Recently, California, Florida, Ohio, and Texas have used NEHAS Model Code as a foundation or reference in implementing new body art regulations. Thus, NEHA has undertaken an important project with national, lasting implications. The Body Art Model Code can assist jurisdictions around the country in enacting comprehensive, reasonable, enforceable, public health-oriented body art regulations.

REFERENCES

(1.) Armstrong, M.L. (1991), "Career-Oriented Women with Tattoos," IMAGE: Journal of Nursing Scholarship, 23(4):215-220.

(2.) Tope, W.D. (1995), "State and Territorial Regulations of Tattooing in the United States," Journal of the American Academy of Dermatology, 32:791-799.

(3.) Spock, B., and S.J. Parker (1998), Dr. Spock's Baby and Child Care, 7th ed., New York: Dutton.

(4.) Anderson, R.R. (1992), "Tattooing Should Be Regulated," New England Journal of Medicine, 326:207.

(5.) Armstrong, M.L., and K.M. Pace Murphy (1997), "Tattooing: Another Adolescent Risk Behavior Warranting Health Education," Applied Nursing Research, 10(4):181-189.

(6.) O'Hara, D. (1995), "Risky Fashion," American Medical News, 11(December 18):12, 21, 22.

(7.) Armstrong, M.L., K.M. Pace Murphy, A.S. Sallee, and M. Watson (2000), "Tattooed Army Soldiers: Risks, Incidence, and Behavior," Military Medicine, 165(2):31-37.

(8.) Barad, M., and G. Brown (1997), "Health Hazards of Body Modification," Disease Prevention News: Texas Department of Health, 57(8):2.

(9.) Armstrong, M.L., and D.C. Gabriel (1993), "Tattoos on Women: Marks of Distinction or Abomination?" Dermatology Nursing, 5(2):107-113.

(10.) Sperry, K. (1991), "Tattoos and Tattooing, Part I: History and Methodology," American Journal of Forensic Medicine and Pathology, 12(4):313-319.

(11.) Goldstein, N. (1979), "Laws and Regulations Relating to Tattoos," Journal of Dermatologic Surgery and Oncology, 5:913-915.

(12.) Polilli, S. (1988), "Tattoo Artists of Tarrant County Are Not Answerable for Cleanliness," Fort Worth Star-Telegram, February 1, p. 45.

(13.) Fell, P.R. (1995), "Should Body Piercing Establishments Be Regulated?" Florida Public Health Advisor, 13(3):1.

(14.) Stauter, R.L. (1988), "Laws Regulating Tattooing: The Protection of the Public Health," American Journal of Public Health, 79(9):1308-1309.

(15.) Korn, K. (1996), "Body Adornment and Tattooing: Clinical Issues and State Regulations," Physician Assistant, 20(5):85-86, 89-90, 93-96, 99-100.

(16.) Armstrong, M.L., and C. McConnell (1994), "Tattooing in Adolescents, More Common Than You Think: The Phenomenon and Risks," Journal of School Nursing. 10(1): 22-29.

(17.) Gaffney, M. (1998), "Board Raises Tattoo Fees," Lubbock Avalanche-Journal [Texas], June 28, p. A10.

(18.) Grief, J., M.L. Armstrong, and W. Hewitt (1999), "Tattooing and Body Piercing: Body Art Practices Among College Students," Clinical Nursing Research, 8(4):360-377.

(19.) Armstrong, M.L. (1996), "You Pierced What?" Pediatric Nursing, 22(3):236-238.

(20.) Thomas, K. (1999), "States Take Stab at Regulating Teen Body Piercing: The Regulations for Shops, Customers," USA Today, July 7, p. 5D.

(21.) Tweeten, S.S.M., and L.S. Rickman (1998), "Infectious Complications of Body Piercing," Clinical Infectious Disease, 26(3):735-740.

(22.) "Professional Body Piercing Kit," (1996), Outlaw Biker Tattoo Revue, 52(8):43.

(23.) Sperry, K. (1992), "Tattoos and Tattooing, Part II: Gross Pathology Histopathology, Medical Complications, and Applications," American Journal of Forensic Medicine and Pathology, 13(1):7-17.

(24.) Doll, B.C. (1988), "Tattooing in Prison and HIV" [Letter] Lancet, 1(8575):66-67.

(25.) Ross, J.J., and D.S. Shapiro (1998), "Possible Transmission of Human Immunodeficiency Virus Type 1 from Body Piercing," Clinical Infectious Disease, 26(3):767-768.

(26.) Long, G.E., and L.S. Rickman (1994), "Infectious Complications of Tattooing," Clinical Infectious Disease, 18(3):610-619.

(27.) Shimokura, G.H., and P.R. Gully (1995), "Risk of Hepatitis C Virus Infection from Tattooing and Other Skin Piercing Services," Canadian Journal of Infectious Disease, 6(5):235-238.

(28.) Body Art Model Code Committee (1999), Body Art: A Comprehensive Guidebook and Model Code, Denver, Cob.: National Environmental Health Association.

Membership of the Committee that Drafted the NEHA Body Art Model Code [*]

Paul R. Fell, R.S., M.S.

Volusia County Health Department, Daytona Beach, Florida (committee chair)

Edith Coulter

Environmentalist III, Florida State Department of Health, Tallahassee, Florida 

Philippa Pointon, R.N., R.E.H.S.

Clark County Health District, Las Vegas, Nevada

Richard Zipin

Chief, Environmental Engineering, Department of Public Health, Philadelphia, Pennsylvania

Frank C. Gomez

Director of Public Health, Monterey Park, California 

Jeff Buckingham

Washoe County District Health Department, Reno, Nevada

Leisa Cook

Training Officer, Oregon Health Division, Portland, Oregon

Susan Wilson

Licensing Programs, Oregon State Health Department, Salem, Oregon 

David Vidra, L.P.N.

Medical Advisor, Association of Professional Piercers, Cleveland, Ohio 

Tom Gecewicz

Executive Health Officer, Braintree Board of Health, Braintree, Massachusetts

Kris Sperry, M.D.

Forensic Pathologist, Atlanta, Georgia

Thomas E. Wittkopf, R.S., M.P.H

Marathon County Health Dept., Wausau, Wisconsin

Myrna Armstrong, Ed.D., R.N.

Texas Tech University, Health Sciences Center, Lubbock, Texas

Bob Montagna

Past President, Alliance of Professional Tattooists, Malagna, New Jersey

A.D. Sowers

Board Member, Association of Professional Piercers, Seattle, Washington

Samantha Caruthers

Permanent Make-up, Inc., Wichita, Kansas

Susan Preston

Professional Program Insurance Brokerage, Novata, California

Jack Ward, M.D.

Orthopedic Oncologist, Shreveport, Louisiana

Allen Halper

Office of Colors and Cosmetics, FDA, Washington D.C.

Walter W. Bond, M.S.

Deputy Chief, Hospital Environmental Laboratory Branch, Hospital Infections Program, National Centers for Disease Control, Centers for Disease Control and Prevention, Atlanta, Georgia

Whitney Tope, M.D.

Department of Dermatology, University of Minnesota, Society of Permanent Cosmetic Professionals, Minneapolis, Minnesota

(*.) The membership of the committee was designed to comprise individuals with specific areas of expertise, not necessarily to represent official agencies.