Characterizing the Impact and Outcomes of Tattoo Removal on Recently Incarcerated and Gang Affiliated Individuals
by Eddie Rodriguez1*, Priscilla Garza1, Anthony Kim1, Nimish Garg1, Miguel Caballero1, Jo Marie Reilly2
1University of Southern California, Keck School of Medicine of USC, USA
2Department of Family Medicine, Keck School of Medicine of USC, USA
*Corresponding author: Eddie Rodriguez, Keck School of Medicine of USC, Los Angeles, CA, USA
Received Date: 01 September, 2024
Accepted Date: 10 September, 2024
Published Date: 13 September, 2024
Citation: Rodriguez E, Garza P, Kim A, Garg N, Caballero M, et al. (2024) Characterizing the Impact and Outcomes of Tattoo Removal on Recently Incarcerated and Gang Affiliated Individuals. J Community Med Public Health 8: 468. https://doi.org/10.29011/2577-2228.100468
Abstract
Objective: To investigate the impact of tattoo removal on recently incarcerated and gang affiliated individuals and their attainment of higher education, employment, mental health, and personal relationships. Methods: We performed a survey and semi-structured interview on clients of Homeboy Industries’ tattoo removal clinic in Los Angeles, California, from August 2022 - May 2024 with at least one tattoo removal. Analysis was conducted using descriptive statistics, paired t-test, and Chi-squared. Interviews were coded through an inductive method. Results: Following tattoo removal, clients reported improvements in their financial situation, educational pursuits, mental health, interpersonal relationships, and safety from law enforcement and gang related violence. Conclusion: Our study is an important step in understanding how tattoo removal can facilitate the societal reintegration and gang disengagement of this vulnerable population, highlighting the importance of cost-efficient tattoo removal. Affordability of and access to tattoo removal pose significant barriers to the formerly gang affiliated and carceral population who seek this service to aid in their reassimilation into society.
Keywords: Tattoos; Tattoo removal; Gang; Incarcerated
Introduction
In Western societies, tattoos have historically been viewed as symbols for the counterculture, often associated with groups in which membership has been taboo: indigenous populations, non-Judeo-Christian religions, incarcerated individuals, gang members, and other underrepresented groups [1,2]. However, recent epidemiological studies demonstrate a cultural shift in which tattoos are more accepted— expressing identity, art, cultural affiliation, and group membership [3]. A 2023 Pew research study states that in the United States, 32% of adults have tattoos, with 22% having more than one. Tattoos are also overrepresented in women, Black and Hispanic Americans, individuals under 50, those with lower income, people with up to some college education, and those who identify as LGBTQ [4]. The same study demonstrates that about one third of people with tattoos expressed feeling regret after obtaining them [4].
Negative attitudes directed towards tattoos may be in part due to the well-documented stigma that exists both interpersonally and in work and legal settings. Among Americans who don’t have tattoos, about 30% say that seeing a tattoo on someone gives them a negative impression of that person [4]. Studies also show that educators and employers view those with tattoos as less competent and professional, and believe tattoos may be a hindrance in interacting with customers in service industries, especially when visible [5-8]. Tattoo stigma is often amplified for individuals within the legal system. Tattoos are correlated with increased police profiling, and in legal court proceedings, tattooed defendants have been perceived as more threatening. Still further, those with facial tattoos were more likely to be found guilty and incarcerated [9].
The social ramifications created by tattoos have a significant impact on formerly incarcerated and formerly gang-affiliated individuals, a highly underserved population that is disproportionately represented by people of color or with low income [10]. Gang affiliated tattoos are common across the United States, with the average inmate obtaining a median of 3 tattoos by the time of their initial release [11]. In Los Angeles alone, there are over 450 active gangs with a combined membership of over 45,000 individuals [12,13]. Tattoos are often used as indicators of gang involvement and high risk behavior among adolescents, as they often represent commitment, allegiance, rank within a gang or reflect committed felonies [14]. However, when these individuals leave their past lives, their tattoos remain as a physical reminder for both themselves and others, presenting a barrier to their societal reintegration. Further, this community has had poor access to tattoo removal services and lacks the economic resources to benefit from the growing and expensive tattoo removal industry [15,16].
To our knowledge, this study represents the only effort to characterize long-term outcomes of laser tattoo removal in the formerly incarcerated and gang affiliated community. The purpose of this study is to understand if and how the tattoo removal process: (1) reduces socioeconomic barriers by increasing employment opportunities and/or educational attainment; (2) decreases law enforcement discrimination; (3) improves self-perception and social relationships; and (4) assists in the reintegration of formerly incarcerated or gang-affiliated individuals into society.
Materials and Methods
Study Design
This study employs a mixed-method design consisting of a survey and semi-structured interview to investigate clients’ perceived impact of tattoo removal on various socioemotional and socioeconomic measures. Quantitative analysis was conducted using descriptive statistics and paired t-tests of aggregate scores before and after tattoo removal. Qualitative analysis was performed through inductive coding. Surveys and interviews were conducted in English and Spanish by bilingual researchers. Homeboy Industries’ (HBI) Tattoo Removal Clinic clients were compensated for their time with a $5.00 and $15.00 gift card for the survey and interview completion, respectively. This study was conducted under a research partnership between the Keck School of Medicine (KSOM) and HBI.
Setting
This study was conducted at the HBI Ya’Stuvo Tattoo Removal Clinic. HBI is an East Los Angeles based nonprofit organization that operates a large gang intervention and rehabilitation program; the tattoo removal service is one of many, serving over 3,000 people a month without cost [17]. Previous studies using a representative sample demonstrate that the general population at HBI is mostly (75%) between the ages of 20-39 years old, over half (56%) is male, and a majority (86%) identify as Black or Latinx. Nearly half (46%) cite gang affiliation as their reason for obtaining tattoos.
Client Recruitment
Clients age 18 or older with at least one completed tattoo removal were recruited in person by healthcare professionals conducting tattoo removal at the Ya‘Stuvo tattoo removal clinic. Clients provided a phone number and once contacted by IRB approved researchers, were de-identified utilizing a randomized 4-digit code and sent copies of informed consent forms via electronic mail.
Survey
An 11-item survey instrument was prepared via Qualtrics software [19] to investigate differences in self-perception pre- and posttattoo removal, with a portion of the questions adapted from a previous retrospective chart review conducted on this population [18,20]. The survey consisted of 3 response options: (1) check all that apply; (2) “yes/no” questions; and (3) a 10-point Likert scale. Following the survey, clients were provided a $5.00 electronic gift card.
Interviews
Interviews were conducted by a 5 member KSOM student research team under the direction of the faculty PI. The PI led the interview and survey tool development and supervised research team training.
The semi-structured interview included open-ended questions to allow the interviewees to express their opinions, insights, and personal experiences about the tattoo removal process. Interviews were approximately 30 minutes, during which researchers took written notes of the clients’ responses. Following the interview, clients were provided a $15.00 electronic gift card.
Analysis
Statistical analysis was conducted using descriptive statistics, paired student’s-t test, and Chi-squared though SPSS [21]. Telephone interviews were coded through an inductive method by 2 independent researchers using Atlas [22].
Results
Data was collected between August 2022 and May 2024. 104 total clients completed the survey and 90 completed the interview.
Theme 1: Motivations for and barriers to obtaining tattoos (Table 1)
The most frequently selected reasons for obtaining tattoos on our survey were gang affiliation (61.8%), followed by decoration (40.2%) and current or ex-relationship (33.3%). Among cases where tattoos were obtained against their will (2.9%), individuals often cited abusive relationships wherein their significant other used placement of tattoos as a sign of loyalty to their partners’ gang. One in five (20.6%) cited peer pressure as a factor. Interestingly, individuals who obtained gang specific tattoos often cited peer pressure rather than force as a main factor. Other factors included being under the influence of drugs (27.5%) or alcohol (28.4%). One in ten (9.8%) of clients cited “other” reasons, which included being young and immature, experiencing depression, and believing tattoos were “cool” at the time.
Responses |
Percent of Cases |
||
N |
Percent |
||
Gang |
63 |
27.5% |
61.8% |
Current or Ex-Relationship |
34 |
14.8% |
33.3% |
Decoration |
41 |
17.9% |
40.2% |
Peer Pressure |
21 |
9.2% |
20.6% |
Under the Influence of Alcohol |
29 |
12.7% |
28.4% |
Under the Influence of Drugs |
28 |
12.2% |
27.5% |
Against My Will |
3 |
1.3% |
2.9% |
Other |
10 |
4.4% |
9.8% |
Total |
229 |
100.0% |
224.5% |
Table 1: Reasons for obtaining tattoo.
Though clients had strong motivations for removing their tattoos, many faced barriers that either delayed or hindered removal (Table 2). These included pain from the removal (75.2%), loss of memories (11.9%) and relationships (11.9%), fear of removal (8.9%), concerns about safety (8.9%), and lack of transportation (8.9%). Clients who selected “other” cited elevated cost, a long-time commitment required for complete removal, fewer appointments during the COVID-19 pandemic, and difficulty overcoming their shame, ego, or hesitation to change their life.
Responses |
Percent of Cases |
||
N |
Percent |
||
Embarrassed |
55 |
11.9% |
53.9% |
Employment |
68 |
14.7% |
66.7% |
Family |
40 |
8.7% |
39.2% |
Court order |
1 |
0.2% |
1.0% |
Maturity |
74 |
16.0% |
72.5% |
Ready to Change My Life |
71 |
15.4% |
69.6% |
Tattoos Attract Negative Attention |
75 |
16.2% |
73.5% |
Offensive |
23 |
5.0% |
22.5% |
Safety |
42 |
9.1% |
41.2% |
Military Recruitment |
1 |
0.2% |
1.0% |
Other |
12 |
2.6% |
11.8% |
Total |
100.0% |
452.9% |
Table 2: Reasons for removing tattoos.
Theme 2: Impact of tattoo removal
Five distinct categories emerged in the analysis of how tattoo removal changed the lives of clients: (1) Financial situation; (2) Education; (3) Relationships; (4) Mental Health; and (5) Safety. For each of the categories, clients described the personal experiences they perceived as being a result of their tattoos, how these contributed to their motivations for pursuing tattoo removal, as well as how the removal process has changed these experiences. Illustrative quotes are provided for these categories (Tables 3 and 4).
Theme |
Subtheme |
Quotationsillustratingexperiencesprior to tattoo removal |
Quotationsillustratingexperiencesfollowingtattoo removal |
Motivations for obtaining tattoos |
Gang affiliation |
It was my neighborhood, it was what I lived for and would have died for. I got my tattoos in the hood and I earned mine. I was going through a battle with myself and told myself I got [the tattoos] for a reason. They were all gang tattoos, which made me feel accepted amongst my gang friends. |
|
Current or ex relationship |
I was pressured to get them placed. My boyfriend was really big in the gang where he was from. We were in an abusive relationship. Every time we would fight he would threaten me. My way to make it up was to get his name or his face tattooed on me. If I didn’t, he would say I was disloyal and that was my way of proving my love or my loyalties. |
||
Peer pressure |
No, [the tattoos] were all my choice. I guess you could say I was peer pressured. Everyone had them and I knew it was the only way I would get respected by my crew. |
||
Under the influence of drugs or alcohol |
My goal was to not get any more and not go into an addiction again because I would see those tattoos as mistakes due to my addiction. I was deep into an addiction. A lot of people asked me why I even got them because I was already 38 when I first got them and I regret it a lot. |
||
Barriers to tattoo removal |
Pain |
I feel like what I did [before removal] was a huge mistake and I physically paid for it during the removal process. Yeah it was a pretty smooth process. Just hurts a lot, but it’s better than walking around with [the tattoos] in my hood. |
|
Loss of memories and relationships |
I’m not involved with the gang no more so when you get tattoos removed when it has to do with the hood it feels a little weird at first, [...] it's like a part of me is gone. |
||
Cost |
Just glad I came into contact with HBI, for a service that anyone else would have charged thousands of dollars. I couldn't afford to get these removed even spending my entire paycheck. The dermatologist charges per square inch and it's expensive. |
||
Lack of transportation |
I wish that they would expand more to the SGV area. My interpretation is that it’s great to get to LA, but if you don’t have a license and can’t drive, it’s hard to get down there. |
||
Safety |
You can’t just get rid of tattoos from jail like the ones on my neck, because it would be disrespectful. |
||
Impact of tattoo removal |
Financial situation |
Yes, when I show up to a job interview, I get dressed up nice and make sure to look presentable/professional, but when you have tattoos on your face people become weary regardless of what you are wearing. It’s a dichotomy, you can look professional but have tattoos on your face, and people will either be confused or start to judge. People see the tattoos on my face, assume I got them recently, and it doesn’t occur to them that I have had them for 15 years and got them when I was a different person in much different circumstances. I was called a freak. I was physically assaulted by a manager. Before my welding job, my only identity was my physical appearance because of my lack of experience and education. The two tattoos covered my neck. They 100% affected me in my job search and just the way people saw me. I definitely had a hard time getting jobs, so I would cover my neck when I went into interviews with button-ups, makeup, and certain hairstyles. I was discriminated against after being hired. |
Once I removed [my tattoos] I noticed my boss took me more serious. I started as a clerk and by the time I finished removal I was a supervisor and then went on to better jobs. HBI helped make me a supervisor, I felt like they accepted me more. Yes, now when I go into an interview I feel like they are looking at ME, and they even called me back for jobs which has never happened before. They don’t judge me, I was able to get my plumbing license because someone gave me a chance. That would not have happened with my tattoos looking the way they did. |
Education |
When I went to school, they told me it would be harder with visible tattoos. |
I told Troy (tattoo removal provider) the other day I started crying. I just graduated and I could never repay him for what he's done in my life. Goal right now is getting a high school diploma. I am enrolled in a Zoom program. I still have some classes left: Language 2, half of math, US history. I want to go to college. |
|
Relationships: Family |
My mom also never agreed on me having tattoos. It was always like a fight because of the way they looked. My husband's family, his mom or aunt are really old school and when they see people with tattoos they kind of frown upon it. |
I feel like it even stopped them from putting tattoos on themselves so I wanted to be an example to them. I did not want them to go through what I went through, I want another life for them. I have a good relationship with my family now. They invite me to their parties, we have conversations now. Before, I was considered trouble, but not anymore. It made me change my mentality for my kids. They don’t look at their dad and glorify him anymore because they see that. I’m changing and doing better. I think if I continued to have them on me they would have continued down that same path. |
|
Relationships: Society |
I knew myself and having tattoos on my hand and neck, I knew people would perceive me as a dangerous gang member, but I knew in my heart I knew I was not the person people perceived me to be. What I noticed right away, I would go to the bank, I wait, they start to speak to me, and then I notice if I gaze away and I look back, they’re looking at my tattoos. Sometimes it was a barrier because I’m already a tall African American, as well as tattooed. |
I no longer have to worry about taking my clothes off, shaking hands, and people focusing on the tattoos rather than looking at me in the eyes when I speak. They see me now with respect. But not the respect that we were feeling when I was gangbanging. This is the good respect–the clean, pure respect that comes from somebody’s soul. When they shake your hand, they mean it. You can feel it right away, the difference, the positivity. |
|
Mental Health |
I felt ashamed of what I had become. I felt ashamed that my kids would probably not look at me the same, seeing their mom all tatted up. I felt ashamed because as I got older and more mature, I realized [the tattoos] were not the right choices. The negative associations that came with it also contributed to it. I felt a bit worthless due to the perception people had of me and the problems that came with my tattoos, in particular possible confrontations with other gangs. |
The first thing I felt was relief. I felt that I was letting something go and that had bothered and hurt me for so long. I remember I used to ask my wife excitedly, “Can you see it?” (regarding the tattoos). Until one day, my wife said, “I can’t see it anymore.” That was the moment I was waiting for. I would say my confidence and my self-worth because those two things changing is what paved the way to go back to school and get a job. It opened up avenues and opportunities because I didn't feel beneath anyone anymore. |
|
Safety: Law enforcement profiling |
That's the first thing why they pull you over, even if you're just walking down the street. The first thing they look at is the tattoos. That was their thing. That was their excuse. If it wasn’t the tattoos they would find another reason to pull us over. It was the type of tattoos not just because we had tattoos. If I got pulled over, there was no warning. I was disrespected. I had no words, no value, like I was a criminal because of what I looked like, how I was treated because they were stereotyping me. Once I was pulled over and he put me on the floor. He put the gun to my face and I had done nothing wrong. He just saw the tattoos and I guess he was scared. |
Now I feel comfortable. I can pass by without [law enforcement] turning around and taking a second peek at me. It’s true, before they would always stop me, now it's been years. I notice a difference, like even cops say hi to me now. I would have never imagined that before. They stopped bothering me after the removal and respected me a bit more. |
|
Safety: Gang |
When you have the gang name on your face, at any given time they can just come and shoot you. I just wanted to stay alive. I endangered my daughter and my ex because of my life choices. [My] enemies would try to run her down when she was pregnant. I put myself in jeopardy. I’ve lost a lot of good friends from that lifestyle. I always had to watch where I was going. I had no freedom to go to a certain street or place because I knew that was where a rival gang was. I had to be careful with clothing even when I was going to do something like picking up food in a certain area. |
I started to notice that people looked at me differently. I could be walking and if some of them were gang members they would look for those marks, but when I had no tattoos I was perceived as the average citizen, not like I had to be watched. People would always ask what hood I was from, I'm not threatened by Blood, or people that hate the Blues. I now don't have threats or pressure about who I am or who I know. Now I could go walk in the most rundown gang infested hood and they think that I'm there for the community/social work. They don't think I'm there for the gang. It's a really good feeling. |
|
Gang separation |
- |
The tattoo removal was the main part of cutting that connection. I already did everything else (moving away, cutting contact, etc.) before the tattoo removal, and the tattoo removal was the last remaining connection I had with the gang lifestyle. I still communicate with a lot of different people, so I still communicate with them. Basically, how it works is when people know that they wanna do something positive then they'll reach out to me, I'm doing positive and constructive and if they want to do the same then reach out to me. |
Table 3: Quotations illustrating impact of tattoo removal.
Paired Differences |
t |
df |
Significance (One- tailed) |
|
Ashamed to proud |
6.51874 |
15.342 |
100 |
<.001* |
Sad to happy |
6.36633 |
16.073 |
98 |
<.001* |
Insecure to confident |
6.66652 |
16.712 |
96 |
<.001* |
Rejected to accepted |
6.31359 |
14.573 |
96 |
<.001* |
Worthless to feeling like someone |
5.78712 |
13.606 |
98 |
<.001* |
Note: p<0.05 |
Table 4: Improvements to mental health following tattoo removal.
Financial Situation
Most clients believed their tattoos negatively impacted their chances at employment, particularly if they were in visible locations such as the face, neck, and hands or if the job involved working directly with patrons. This discouraged many individuals from seeking employment. Further, after interviewing and subsequently being rejected from a job, especially if the interviewer looked questionably at client tattoos, clients believed their tattoos were the main reason they were not hired. In an attempt to improve their job prospects, clients attempted to hide their tattoos through clothing, jewellery, makeup, or hairstyles in order to appear more trustworthy or professional. Ultimately, these experiences correlated with two-thirds (66.7%) of our survey responses citing employment as a reason for tattoo removal, highlighting the economic difficulties this population faces as a result of their tattoos.
Following tattoo removal, clients believed they were taken more seriously by employers and had more opportunities to interview and be hired or promoted. Overall, 59.5% of clients believed that tattoo removal helped them acquire employment. However, not all clients believed they faced employer bias as a result of their tattoos. Some individuals specifically noted they were able to hide their tattoos effectively, or that they worked in certain industries where tattoos may be more acceptable, including HBI. Further, not all clients were actively seeking employment and some were on disability, retained their previous employment or did not directly work with customers. Of those who were working (80.6%), most reported stable employment (72.8%).
Education
The majority (80%) of clients felt more motivated to further their education or job training after tattoo removal. The most commonly cited educational pursuits included: college (28.2%), trade school (23.5%), high school diploma (11.8%), GED (10.6%), counselling (7.1%), educational services (5.9%), medical training (4.7%), and job development workshops (4.7%). Of note, only 38.8% of clients completed their training program.
Mental Health
Many clients expressed shame or regret for obtaining their tattoos, with 53.9% of clients citing embarrassment as motivation for removal. This was exacerbated when clients obtained their tattoos at a young age or under the influence of alcohol or drugs. This shame led to mental distress and negative feelings of selfperception. Emotional maturity gained over time often played a part in decisions to pursue tattoo removal. Following removal, clients felt significantly more pride, happiness, confidence, acceptance, and self-worth (P<0.001). Further, many expressed relief and gratitude for HBI and chose to remain connected to the strong support system they gained while at HBI. These changes in self-perception, especially in confidence, often empowered clients to seek education and employment and to feel safer and less judged in public.
Improved Relationships
Clients felt that tattoo removal was an important part of the process of repairing relationships both with loved ones and with society. Most clients felt judged and stigmatized by society for their tattoos, believing that they attracted negative attention (73.5%) that caused them to be stereotyped as “dangerous,” “bad” people. They felt these assumptions were most pronounced when tattoos were visible, offensive, and gang-related. About one in five (22.5%) responses demonstrated that offensive tattoos served as motivation for removal. Following tattoo removal, clients felt like “normal” “other people’’ in society– no longer obviously stared at, judged, or treated differently when in public. Many expressed being now seen for who they are on the inside and not the outside, without assumptions made about their previous lives.
Many clients described strained relationships with family prior to tattoo removal, ranging from dislike for the tattoos and lifestyle choices to fear of being seen in public with the client. 39.2% cited family as an important factor in deciding to obtain tattoo removal. Clients wanted to be a better example for their children and prevent them from making similar mistakes. After removing their tattoos, clients’ families were happy and proud of their decision, often including them in family events they had previously been excluded from. Some clients were even able to regain custody of their children. Ultimately, 91% of clients reported improvements in their relationships with loved ones, society, or both after tattoo removal.
Safety: Law enforcement profiling and gang activity
Safety was an important factor in pursuing tattoo removal (41.2%), with clients desiring to avoid profiling by law enforcement and violent retaliation from rival gangs. Gang-affiliated individuals perceived that the negative attention their tattoos attracted was a key factor (73.5%), though not the only factor, that may have led to profiling and/or violence by law enforcement specifically. Clients describe being pulled over while driving or approached on the street and harassed by law enforcement who attempted to use their tattoos as forms of identification. 91% of individuals believed they were either less profiled or no longer profiled after removing their tattoos and 87.4% felt safer. Some individuals even felt more respected by law enforcement. Clients who reported continued profiling or who were profiled without visible tattoos believed that their race (largely Hispanic), urban style of dress, neighbourhood, and association with other individuals in gangs, contributed to persistent profiling.
Additionally, clients with gang-affiliated tattoos sought to remove their tattoos due to targeted violence to themselves or their families from rival gangs. After removal of these tattoos, many now felt comfortable walking in their neighbourhoods and removing their shirts in public without fear for themselves or their loved ones.
Theme 3: Gang Separation
We asked individuals who identified as former gang members specific questions about how they separated themselves from their respective gangs. Many clients began a physical separation by moving away from their neighbourhoods or cutting contact with other gang members even before tattoo removal. Physical removal of their tattoos became symbolic of a new identity they were secure in or were in the process embracing. For some, maturity came with age, bringing with it a realization that they had new priorities, such as family, religion, work or education. Interestingly, this separation from the gang was not usually viewed with animosity or threats of violence, but rather with support and pride from individuals still active in their respective gangs.
Discussion
Our study aimed to contribute to the limited literature addressing the long-term outcomes of tattoo removal in the recently incarcerated and/or formerly gang-involved population.
For many in this community, tattoos are permanent markers, serving as employment, relationship, and safety impediments that make it harder to make positive life changes. It is well documented that tattoos, especially those with offensive language or gang affiliated symbols, lead to discrimination, stigma, and profiling by employers and law enforcement. Once individuals decide they want to make a change in their lives, removal of their tattoos is an important step towards societal reintegration.
Our study highlights this community’s journey from initial tattoo placement to removal. It describes that the former gang and recently incarcerated population often obtained their tattoos at a young age, under the influence of alcohol or drugs, or as a result of peer pressure or coercion, and that they experience regret for their placement. They describe that their tattoos lead to societal judgment, profiling by law enforcement, and decreased chances to obtain employment and further education. While most individuals reported obtaining their tattoos as symbols of allegiance to their gang, many also shared a common goal for removing their tattoos: a regret for their decisions and a desire to move on to a new, mature phase in their life with job security.
Overall, our results indicate that tattoo removal gave individuals a fresh start at a newer and safer life, with repaired relationships with family members and less judgment from society, fewer experiences of profiling with law enforcement, and improved employment prospects. They express an immense gratitude and emotional fulfilment throughout the removal process. Clients were particularly grateful for caring providers and a free service that is often difficult for individuals to access or afford.
While members from this community cite multiple improvements in their lives that result from the tattoo removal process, some also describe the process as the culmination of inner healing that began prior to their tattoo removal completion. Most describe a new life that is both mentally and physically healthier and safer. For some, there is a hope to be an example to their families and break generational cycles. Community members describe more pride in their appearance, less shame, more self-confidence and happiness, and better self-esteem. In a marginalized community that often struggles with self-acceptance, judgment, regret, and a history of substance use, removing the stigmatizing barriers of tattoos is critical to their healing, recovery, and self-efficacy.
Lastly, access to locations that provide affordable and accessible services to recently incarcerated or former gang members is often a barrier to tattoo removal completion. In fact, multiple sessions are often required due to the number and size of tattoos on their bodies. HBI services clientele from across the state and from neighbouring states, highlighting the need for these services. The barrier in access to affordable services has resulted in some individuals resorting to unsafe methods of tattoo removal. These methods include burning or applying acid to the tattooed skin which leads to scarring and permanent skin damage. This, coupled with the many benefits that have been described by this community, further highlight that providing safe, accessible, and affordable tattoo removal for the recently incarcerated or former gang members is an important public health issue.
This study examined the impact of tattoo removal in the recently incarcerated and former gang members at a single site in California. While there is a very large and diverse community in this area, results from this study may not be representative of all members from this community who reside outside of Los Angeles. Further, HBI represents the largest, most comprehensive gang rehabilitation center in the world. As such, it may be better resourced to support this community than other regions of the country. Specifically, 39% of study respondents stated that tattoo removal did not help them gain employment. We believe that this may be due to the higher rates of employment our study population has gained at HBI where tattoos are not stigmatized or discriminated against and where there are resources to help clientele find viable employment. Additionally, some clients who had removed gang-affiliated or prison-related tattoos believed they were still being profiled by law enforcement, attributing it to their “urban style” and the neighbourhood they lived in. These results suggest that tattoo removal is one of, but not the only barrier for reintegration into society. Future studies should include a multi-site study to investigate additional factors that support the reintegration of this community into the larger population and increase generalizability.
Acknowledgments
We wish to acknowledge HBI and the support of Dr. Paula Pearlman, MD, Troy Clarke, PA-C, and all the health professionals who remove tattoos for the Ya‘Stuvo Tattoo Removal clients. We appreciate their contributions to the recruitment of the study clients and for all their incredible work. We also wish to acknowledge the California Academy of Family Physicians student research grant for helping support the client incentives for this study.
Ethical Considerations
All participants in this study were provided with an informed consent document that was carefully reviewed with each participant. This study was approved by the University of Southern California Social-Behavioral Institutional Review Board (IRB) (Study ID: UP-21-00609) and conducted under a research partnership between KSOM and HBI.
Conflict of Interest
The authors have no conflicts of interest to disclose.
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