Grant Number:	5R21CA263723-02 Interpret this number
Primary Investigator:	Siconolfi, Daniel
Organization:	Rand Corporation
Project Title:	Integrating Smoking Cessation in Tattoo Aftercare
Fiscal Year:	2023

Project Summary. New tattoos are a missed opportunity to promote smoking cessation. The tattoo aftercare period is a nexus of biological, psychological, social, and structural points of leverage. Between one-fifth and one-third of Americans ages 18 to 65 have at least one tattoo, and among adults ages 25-39, nearly one in two persons have at least one tattoo. Smoking prevalence among persons with tattoos is greater than smoking prevalence in the general population. Tattoo parlors are a potential catchment and referral context for evidence-based smoking cessation interventions. There is a history of feasible, acceptable, and efficacious interventions in other aesthetic service settings, such as barbershops. Yet, no published studies have examined the feasibility, acceptability, or efficacy of smoking cessation interventions delivered in tattoo parlors or adjacent to tattoo sessions (e.g., as tattoo aftercare). There are at least 20,000 tattoo parlors in the U.S., and these sites present an opportunity to reach smokers who are not well-engaged with usual intervention settings. At the individual level, a new tattoo may represent a unique window of opportunity when smokers have a greater propensity to attempt and succeed at smoking cessation. First, quitting smoking may facilitate healing of the tattoo and reduce the risk of short-term complications such as infection, which can lead to poorer aesthetic outcomes and the need for additional corrective tattooing. The negative effects of smoking on wound healing are well- documented. Second, tattoos are highly symbolic, and the symbols often have psychological relevance to motivation, self-efficacy, and resilience. Brief motivational interventions could draw upon the tattoo's salience as a means to overcome ambivalence about quitting smoking. Third, bundling cessation support into tattoo aftercare may be more acceptable to smokers who are ambivalent about quitting. Bundling cessation supports with existing tattoo aftercare practices, which are a change to routine, may help to reinforce the quit attempt during the highly vulnerable period of withdrawal. Bundling may also buffer against implicit or explicit social pressure to abandon the quit attempt. There is significant potential for promoting smoking cessation in this setting. However, no published studies have addressed whether, why, and how stakeholders (shop owners, tattoo artists, and recently-tattooed smokers) would engage in this novel approach. We will: 1) Assess the perceptions and attitudes of tattoo parlor owners and artists as they relate to tattoo-related smoking cessation interventions and aftercare bundling; 2) Assess smokers' attitudes toward smoking cessation interventions and supports in the context of tattooing and aftercare; and, 3) Develop a preliminary evidence-based intervention and/or referral protocol that will promote smoking cessation in the context of tattooing and aftercare. This research has the potential to introduce a never-before explored channel and context for delivery of smoking cessation interventions. In doing so, the work stands to reach an underserved population with an efficient and scalable intervention.





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