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Tobacco smoking and tattooing interact in multiple ways because they are risk factors to health and share social determinants and meanings (e.g. deviance). Existing research is limited and reliant on non-generalizable samples in Europe and the United States. Addiction studies on religious Chinese are scarce. In this study, we investigated the embeddedness of smoking in tattooing and tattoo-associated contextual factors in a representative sample of Chinese Buddhist adolescents. Latent class analyses based on smoking, tattooing, and tattoo norms were conducted on survey data from 1322 Chinese Dai students (aged 15–19 years, 41.2% females) in seven middle schools in Xishuangbanna, Yunnan Province, China. Subgroup membership was subsequently examined in terms of associations with religiosity, spirituality, and traditionalist tattoo esthetics. Three subgroups with different patterns of cooccurring smoking and tattooing were detected. Tattoo norms—especially peer norms—were found to be distinguishable indicators between subgroups. Traditionalist tattoo esthetics was associated with the lowest smoking-tattooing comorbidity subgroup. Religiosity and spirituality showed sporadic associations with subgroup memberships. The results demonstrate the complexity of smoking-tattooing comorbidity and the importance of a culturally contextualized understanding of addiction. Greater smoking-tattooing comorbidity among adolescents with higher levels of religiosity and spirituality highlights the limitations of Eurocentric views of addiction. The role of tattoo esthetics suggests that body-related visual information can contribute to substance use. Further studies are needed on religious Chinese, a population overlooked in the literature.

Synergistic relationships between tobacco smoking, tattooing, religiosity, and spirituality among Chinese Buddhist adolescents