Adolescents are obtaining tattoos, yet professionals in medical and sociological fields attribute it mostly to gang affiliation. Further information about this at-risk behavior is needed so school nurses can plan and implement applicable health promotion strategies. A total of 642 adolescents from five suburban high schools and one large urban school district in Texas participated in this study. Tattooed adolescents (N = 105) described their decisions, events, and experiences before, during, and after the tattoo procedure so purchase, possession, and health-risk factors could be examined. Over one-third of the non-tattooed adolescents are considering tattooing in the future.