Saeede Jafari - MSc student of Epidemiology, Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Ghobad Moradi - MD, MPH, PhD of Epidemiology, Associate Professor, Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
Bushra Zareie - MSc of mathematical statistics, Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
Mohammad Mehdi Gouya - Iranian Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran

Background and Objective: Tattooing in prisons is associated with the prevalence of blood borne diseases (BBD). This study aims to determine the prevalence of tattooing in lifetime and in prisons and its related factors among Iranian prisoners in 2015 and 2016.Methods: This study is a cross-sectional descriptive-analytical study. The required data was obtained from hepatitis B and C surveillance surveys in 2015-16 that was collected through face-to-face questionnaire-based interview. 12739 prisoners were selected by multi-stage random sampling from 55 prisons of 19 provinces in Iran. Weighted prevalence of tattooing in lifetime and in prison and its associated factors were determined by using Chi-square test and multivariate logistic regression respectively.Results: 11988 out of 12726 prisoners participated in the study (94.2% participation rate). The prevalence of tattooing in lifetime and tattooing in prisons was 47.1% (CI95%: 43.4 - 50.8) and 35.2% (CI95%: 30.5 - 40.3) respectively. Tattooing in lifetime was prevalent in prisoners with age less than 35 years while the tattooing in prison was higher in inmates with age 35 years and over. The prevalence of tattooing in lifetime was significantly associated with age less than 35 years (AOR): 1.69, CI95%: 1.42 - 2.02), being single (AOR: 1.35, CI95%: 1.13 - 1.62), being divorced or widowed (AOR: 1.37, CI95%: 1.03 - 1.82), illiteracy (AOR: 4.85, CI95%: 3.44 - 6.82), history of imprisonment (AOR: 1.46, CI95%: 1.22 - 1.76), history of drug use (AOR: 2.59, CI95%: 2.07 - 3.24), and history of piercing in prison (AOR: 1.61, CI95%: 1.28 - 2.02). The prevalence of tattooing in prison had a significant association with history of imprisonment (AOR: 1.69, CI95%: 1.20 - 2.39), history of piercing in prison (AOR: 1.96, CI95%: 1.24 - 3.11), and history of extramarital sex in lifetime (AOR: 1.64, CI95%: 1.22 - 2.20).Conclusion: The results of this study showed that the prevalence of tattooing in lifetime and in prison among prisoners was significantly high especially in high-risk groups such as drug users and sexually active subjects. Given the role of tattooing, drug injection and sex in the transmission of BBD, harm reduction programs are recommended to reduce these high-risk behaviors in prisons.

Prevalence, Tattooing, Prisons, Iran