"Tattoo Artist", March 4, 1944, By Norman Rockwell Investigation of Musculoskeletal Discomfort and Ergonomic Risk Factors among Practicing Tattoo Artists THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Dana Lani Keester Graduate Program in Industrial and Systems Engineering The Ohio State University 2015 Master's Examination Committee: Dr. Carolyn M. Sommerich, Advisor Dr. Blaine W. Lilly Copyright by Dana Lani Keester 2015 Abstract Introduction. Tattoo artists as a population of workers may suffer from a high prevalence of musculoskeletal discomfort. Despite this finding, no detailed analyses of the work processes required in tattooing have been published in peer reviewed literature to date. The information gathered in the course of this study provides a base of knowledge for future research and intervention with this population of workers. Methods. In Phase 1, a survey was conducted on worker and work characteristics and musculoskeletal discomfort, involving 34 professional tattoo artists. In Phase 2, workplace observations were conducted in order to gather data to perform postural analyses and assess muscle activation while performing typical tattooing tasks; 10 professional tattoo artists participated in this phase of the study. Results. The findings in the current study concerning musculoskeletal discomfort in tattoo artists are consistent with the work of Grieshaber et al. (2012). Both studies support the conclusion that musculoskeletal discomfort is highly prevalent in several regions of the body in these workers. 12-month prevalence for musculoskeletal discomfort in the 8 regions of the body included in the questionnaire ranged from 38% for the legs/feet to 94% for the lower back, while the observation and muscle activity recording portions of the study show that the occupation is marked by prolonged ii awkward postures (just under 50% of Rapid Upper Limb Assessment (RULA, McAtamney & Corlett, 1993) scores were between 5 and 6 which corresponds to action level 3 and indicates that investigation and changes are required soon) and high levels of static muscle activity (all 10 Phase 2 participants displayed 10th percentile muscle activity levels that exceeded 2-5% MVE limit recommended by Jonsson (1978) in at least one muscle or muscle group, particularly in the right and left upper trapezius muscles in which activity ranged from 3.4% to16% MVE). Conclusions. The present study found that tattoo artists experience high levels of discomfort in the neck, shoulders, elbows, hands/wrists, upper back, lower back, legs/feet, and eyes, and in many cases reported that their discomfort was made worse by performing their work tasks, primarily tattooing. Some tattoo artists may have to leave their chosen profession due to the extent of their discomfort, while many work in pain. In their experience of work-related musculoskeletal discomfort and its effects, this profession is similar to others, such as sonographers, surgeons, dentists, and dental hygienists, which have been recognized as needing attention from the ergonomics community and have begun to benefit from interventions that result in improvements to work area layout, furniture, and design of work tools. iii For my mother, who taught me that girls can be doctors, pilots, and presidents too. iv Acknowledgements I would like to take this opportunity to thank everyone who supported me throughout the course of this project as well as my graduate studies as a whole. Your heartfelt guidance, friendly advice, and constructive criticism have been invaluable to me. I am sincerely grateful for the time you spent with me over the past two years. To my advisor, Dr. Carolyn Sommerich, thank you for challenging and encouraging me in equal measure, and for accompanying me to multiple tattoo shops with a curious heart and an open mind. Thank you to Dr. Blaine Lilly for serving on my thesis committee when others refused, and to all the professors in the Department of Integrated Systems Engineering, College of Public Health, and Department of Design, without whom I would not have possessed the knowledge or experience to complete this thesis. Thank you to all of the shop owners for opening your doors to me, and to the individual tattoo artists who participated in my study and worked with me throughout the course of this project. For your privacy I’m unable to name you, but you know who you are. To my friends and family, my deepest appreciation. To Gary, for keeping me sane; Kate and Andrew, for all of the ice cream; Lindsey, for the commiseration and advice; and to my parents, for believing in me from the start and helping me to see the light at the end of the tunnel. Lastly I would like to thank my middle school principal, Mr. Mark Elliott, who once told me that if I could just make it to college I would do well. My approach was unconventional but in the end he was right. v Vita December 2004 ..............................................Maui School for Adults 2011................................................................B.A. Psychology, The Ohio State University 2012 to 2014 ..................................................NIOSH Traineeship Recipient, Department of Integrated Systems Engineering, The Ohio State University Fields of Study Major Field: Industrial and Systems Engineering Human Factors & Ergonomics vi Table of Contents Abstract ............................................................................................................................... ii Acknowledgments............................................................................................................... v Vita ..................................................................................................................................... vi List of Tables ..................................................................................................................... xi List of Figures ................................................................................................................... xii Chapter 1: Introduction ....................................................................................................... 1 1.1 Background .......................................................................................................... 2 1.2 Regulatory History of the Tattoo ......................................................................... 3 1.2.1 Needles and blood borne pathogens (BBP). ................................................. 4 1.3 Population Overview ............................................................................................ 5 1.3.1 Growing in numbers. .................................................................................... 5 1.3.2 Nature of the work. ....................................................................................... 5 1.3.3 Other occupational risks. .............................................................................. 7 1.3.4 Ergonomics. .................................................................................................. 8 vii 1.3.5 Anecdotes on being an independent contractor, workers’ compensation, and control of work environments.................................................................................... 10 1.4 The Importance of Ergonomics .......................................................................... 12 1.5 The Study of Similar Populations ...................................................................... 13 1.5.1 Assessment of musculoskeletal discomfort. ............................................... 13 1.5.2 Assessment of posture................................................................................. 14 1.5.3 Assessment of muscle activity. ................................................................... 14 1.6 Next Steps in the Study of Tattoo Artists ........................................................... 15 Chater 2: Methods ............................................................................................................. 16 2.1 Participants ......................................................................................................... 16 2.1.1 Recruitment. ................................................................................................ 16 2.1.2 Participation. ............................................................................................... 17 2.2 Materials and Methods ....................................................................................... 17 2.2.1 Questionnaire. ............................................................................................. 17 2.2.2 Electromyography (EMG). ......................................................................... 19 2.2.3 Postural observation. ................................................................................... 26 2.3 Analysis .............................................................................................................. 26 2.3.1 Questionnaire. ............................................................................................. 26 viii