Anabolic Steroids and Pre-Adolescent Athletes: Prevalence, Knowledge, and Attitudes

Abstract

  The objective of this article is to determine the prevalence, knowledge, and attitudes regarding anabolic steroids among pre-adolescent athletes and to compare our findings with a similar survey done in 1989. To measure these attitudes, the researchers conducted a survey of 1,553 pre-adolescent (10 to 14 year-old) athletes from 34 states. Less than one percent (0.7%) of the study group reported current or previous anabolic steroid usage. Eighty-eight percent had heard of anabolic steroids, but only 64% had had their side effects explained to them. Only 47% stated that a parent, coach, teacher, or athletic trainer was their primary source of information. Results were compared to a 1989 baseline study completed before legislation lead to the scheduling of anabolic steroids. In 1989, 78% had heard of anabolic steroids, 50% had had the side effects explained to them, and 2% admitted to using steroids. These results suggest that anabolic steroids remain a problem among pre-adolescents. Educational programs should be instituted during junior high school to increase the knowledge of anabolic steroids in this group. Information should come from qualified individuals including coaches, teachers, trainers, and especially parents.

KEY WORDS: anabolic steroids, steroids, athletes, pre-adolescent

Introduction

Anabolic steroid usage has been recognized as a serious health and ethical problem in athletes for several decades. Numerous examples of steroid usage rules violations have been highly publicized and have lead to the suspension and stripping of medals from international athletes, as well as many American professional athletes. Elite athletes, however, are not the only population of individuals that use steroids. Recreational athletes also use steroids to enhance performance and to improve personal appearance. Furthermore, evidence indicates that steroid usage often starts during high school. (Anderson, Buckley, Friedl, Streit, Wright &Yesalis, 1988; Bahrke, Kennedy, Kpstein & Yesalis, 1993; Dumitru & WIndsor, 1989)

Several investigators have examined the prevalence of anabolic steroid usage among American adolescent students, ages 12-18 years old. To date, published reports show male prevalence ranging from 1.4% to 12% and female prevalence from 0.5% to 2.9%. (Andwerson, et al, 1988; Bahrke et al, 1993; DuMitru & Windsor, 1989; Komoroski & Rickert, 1992; Escobedo, Heath & DuRaunt, 1995; Chilag, Elliot & Whitehead, 1992; Alongi, Miller & Tanner, 1995; DuRaunt, Emans, Faulkner, MIddleman & Woods, 1995) Two-thirds of the users started by age 17 (Johnson, 1990; Broderick, Pickell &Radakovich, 1993). Sixty-five percent were involved in high school athletics. (Komoroski et al 1992)  reported that when users were questioned as to why they were using anabolic steroids, 64% stated to increase their strength; 48% to increase their size; 44% to improve their physical appearance; and 17% because their peers were users. Furthermore, anabolic steroid use has been associated with illicit drug use and high-risk behaviors. (DuRaunt, et al, 1995; Chillag, et al, 1992; DuRaunt, Emans et al, 1995;  DuRaunt et al, 1993).

Numerous studies have documented adolescent steroid usage in the high school populationAndwerson, et al, 1988; Bahrke et al, 1993; DuMitru & Windsor, 1989; Komoroski & Rickert, 1992; Escobedo, Heath & DuRaunt, 1995; Chilag, Elliot & Whitehead, 1992; Alongi, Miller & Tanner, 1995; DuRaunt, Emans, Faulkner, MIddleman & Woods, 1995) , but little work has been published on the preadolescent or junior high age population. Yesalis et al did examine a population of adolescents 12 years old and older, and reported that males had higher levels of anabolic steroid use during their lifetime than females (0.9% and 0.1% respectively). (Bahrke et al, 1993) Radakovich et al studied anabolic-androgenic steroid use among students in 7th grade, ages ranging 12 to 15 years old, and reported that 4.7% of males and 3.2% of females used anabolic steroids.10 Minimal work has been done in a population younger than 12 years old.

In a report sponsored by the National Youth Sports Research and Development Center in 1989, a baseline was established for anabolic steroid knowledge, attitudes, and usage for a population of 10-14 year-old youth sports participants. (Gray, 1990) While actual usage of anabolic steroids was only 2%, overall attitudes and knowledge about anabolic steroids, and especially their side effects, was poor. For example, 43% of the athletes felt that steroids would probably not harm them if used carefully, and 55% felt that steroid usage alone would improve muscle size and strength. Furthermore, only 50% had ever had the side effects of steroids explained to them. This study also identified a population at risk. 12% of the athletes stated that they knew where to obtain steroids, and 15% indicated that they might use steroids to enhance performance.

In 1992, a second study was undertaken to examine the changes in attitudes and knowledge of anabolic steroids over time with the increased publicity and educational sources available to youth sports participants. The purpose of this paper is to report on the results of that study and compare responses to those obtained in 1989. This study is unique, as it is the first to present results in athletes this young using a national database.

Materials and Methods

The questionnaire was modified from the one designed and used by Gray (1990) in 1989(Appendix). The twenty-question survey included 15 questions used to determine the age, sex, race, sport, prevalence of anabolic steroid use, knowledge of side effects, attitudes towards steroids, and where to obtain anabolic steroids. Five additional questions focused on the number of years that the athletes were involved in sports, information sources about steroids, and perceptions of how steroids work.

Two research assistants in each of 34 states distributed questionnaires. The states were broken down into four geographical regions, and the results were examined nationally as well as regionally, Table 1.

Table 1. States involved in survey broken down by region.


Northeast Midwest South West

Connecticut
Maine
New Hampshire
New Jersey
New York
Pennsylvania
Rhode Island
Indiana
Iowa
Kansas
Minnesota
Missouri
Nebraska
Ohio
S. Dakota
Wisconsin
Delaware
Florida
Georgia
Kentucky
Louisiana
Mississippi
N. Carolina
Oklahoma
S. Carolina
Tennessee
Texas
Virginia
Arizona
California
Montana
Oregon
Washington
Wyoming

Sixty questionnaires were distributed to each state in two separate groups of 30 each. A total of 2,040 questionnaires were given to youth sports participants, and 1,553 were returned, a response rate of 76%. Figure 1 displays the response rates according to geographical region. Where appropriate, Chi-squared tests were used to determine statistical significance.

Results

Demographics

The characteristics of the 1,553 youth sports participants who completed the survey are shown in Table 2.

 

Table 2. Characteristics of 1,553 youth sports participants completing survey


Age n %

10 248 16
11 394 25
12 484 31
13 274 18
14 199 13
15 32 2

Gender

M 1079 70
F 474 30

Males made up 70% of the respondents in this survey. In Gray’s 1989 survey, males accounted for 80% of respondents. Children ages 11 and 12 accounted for over half of the survey participants (56%), with few 15 year-old participants (2%). Table 3 describes the ethnicity of the students in the survey.

 

Table 3. Ethnicity of youth sports participants


Ethnic group
n %

Caucasian
1031 66
Black
264 17
Native American
83 5
Hispanic
76 5
Other
75 5
Asian/Pacific
12 1
No Answer
75 5

For all participants, basketball was the most common sport (78% for boys and 65% for girls). Baseball (31%), football (20%), and soccer (18%) followed respectively for the boys. Softball (24%), “other sports” (16%), and swimming (14%) followed for the girls, Table 4.

Table 4. Sport that youth sport participants currently involved in at time of survey

all athletes male female



Sport n % n % n %
Basketball 1147 74 837 78 310 65
Baseball 362 23 337 31 25 5
Soccer 248 16 190 18 58 12
Football 228 15 217 20 11 2
Softball 134 9 22 2 112 24
Swimming 121 8 54 5 67 14
Other 105 7 28 3 77 16
Wrestling 72 5 71 7 1 .2
Tennis 75 5 43 4 32 7
Ice Hockey 22 1 19 2 3 1

 

The characteristics of the survey participants, including ethnic origin and sport participation did not vary significantly between the regions.
Prevalence of Anabolic Steroid Use

Less than one percent (0.7%) of youth sports participants reported current or previous usage of anabolic steroids. The rate of usage was higher in males (0.9%) than females (0.2%). The Midwest and Northeast regions had the lowest number of admitted users, while the South had the most (p<.05) (Figure 2). Forty-nine (3%) athletes had been offered steroids at some time. Of the 49 athletes that had been offered anabolic steroids, eleven (22%) admitted to using steroids

Of the reported 11 anabolic steroid users, 3 (27%) admitted they used anabolic steroids for athletic performance; 2 (18%) used to improve personal appearance; 2 (18%) used for bodybuilding; 2 (18%) took due to peer pressure; and two did not respond. Twelve percent of all athletes said that they personally know someone who was using or had used steroids.

Two percent of the youth sports participants agreed that they might use anabolic steroids to increase their size or improve their strength, with males three times as likely as females (3% to 1%) (p<.05). 11% admitted to knowing where to obtain steroids if they decided to use them.

Knowledge of Anabolic Steroids

Several questions in the survey were directed towards the youth sports participant’s knowledge of anabolic steroids and their side effects. Most of the survey’s participants (88%) had heard of anabolic steroids. Only 64% however, answered that they had had the side effects of steroids explained to them, with males (68%) significantly more frequently than females (57%) (p<.05). Less than half (47%) of the youth sports participants correctly answered that they did not believe that steroids alone, without proper nutrition and exercise, would improve muscle size and strength. Males were twice as likely as females (17% to 10%) (p<.05) to believe that steroids alone will improve muscle size and strength. Likewise, only 60% of the athletes disagreed with the statement that if used carefully, anabolic steroids would not harm the athlete.

Sixty-six percent of the athletes believed that steroids would not improve performance in their sport, and 90% stated that they did not need to take anabolic steroids to improve their chances for athletic success.

Males twice as commonly believed that anabolic steroids would improve performance in their sport, 17% to 10% for females (p<.05). Three percent of males also believed that they needed to take anabolic steroids to improve chances for athletic success. Only 0.4% of females held this belief (p<.05). When questioned if they believed that Olympic athletes used anabolic steroids to make the team, 30% answered yes, 35% no, and 28% not sure. Likewise, when asked if high school athletes used steroids to make their team, 25% said yes, 40% no, and 34% not sure. 65% of the youth sports participants surveyed stated that they believed that using anabolic steroids is the same as having a drug problem.

Sources of Information

The youth sports participants were given ten choices regarding their primary source of information about anabolic steroids, Table 5.

Table 5. Primary source of information about anabolic steroids.


No. of youth sports
participants (n=1,553)

Source n %

Book/Magazine 433 28
Parent 322 21
Coach 267 17
Friend/Teammate 113 7
Gym Personnel 112 7
Athletic Trainer 89 6
Teacher 47 3
Television 29 2
Dealer 17 1
Sibling 15 1

The most common source listed was books and magazines (28%). Parents (21%), coaches (17%), trainers (6%), and teachers (3%) accounted for less than half of all primary sources of information.

Discussion

This study was undertaken to examine the knowledge and attitudes of 10 to 14 year-old youth sports participants toward anabolic steroids. Very little attention has been paid to the pre-adolescent population in comparison to the high school age and older populations. This is the first study to examine this young of a population and thus has initiated questions about the knowledge, or lack thereof, and the educational processes directed towards this age group. This survey is also one of the first to look exclusively at a population of athletes before they enter high school.

The study was conducted in 34 states, and involved 1,553 youth sports participants. Prevalence of anabolic steroid usage was 0.7% in this study, lower than the previous study in 1989 at 2% (NS), and lower than the reported prevalence of usage among the studies that examined high school age students. Consistent with other studies1-8, more males (0.9%) than females (0.2%) took anabolic steroids (NS).

Although males had more commonly had steroid side effects explained to them than females (68% to 57%), they still had incorrect beliefs about steroids. Significantly more males (17%) than females (10%) believed that steroids would enhance performance, but also that steroids alone would improve performance (17% to 10%). Most importantly, however was that significantly more males (3%) than females (.4%) thought that they needed steroids to improve their chances of athletic success and would consider steroid usage (3% to 1%). This appears to show a tendency toward greater risk-taking behaviors in the males in this population.

The decrease in prevalence of anabolic steroid use among this age population may have several explanations. Since 1990, subsequent to the first survey, anabolic steroids have been classified as a Schedule III drug in the United States. This has resulted in decreased legal availability of anabolic steroids to potential users.

Increased educational resources are available to at least certain age groups and are now reaching larger numbers of children. The percentage of pre-adolescent athletes who have heard of steroids has increased significantly from 78% in 1989 to 88% in the current survey (p<.05). In 1989, only 50% of respondents had had steroid side effects explained to them. This significantly increased to 64% in the current study (p<.05). Currently, 60% of respondents felt that steroids, even if used carefully, would still harm the athlete compared to 56% in 1989 (p<.05). Furthermore, 65% currently consider steroid use a drug problem compared to 57% in 1989 (p<.05).

There is still pressure to take steroids and availability is still common. In the current survey, over 2% of athletes felt the need to take steroids to improve performance and would consider taking them. In 1989, 4% of athletes felt that way (p<.05). Furthermore, these athletes stated that they know where to obtain steroids (88% currently versus 87% in 1989). More importantly, athletes are still being offered steroids (3% currently compared to 4% in 1989). Most distressingly of all though is that those who are offered steroids often accept (11/49, 22%).

Unlike other studies where the sample population included athletes and non-athletes, this study involved only athletes. Prevalence of anabolic steroid use has historically been higher in athletes than non-athletes. For example, Tanner et al (1995) reported that 2.9% of athletes and 2.2% of non-athletes used anabolic steroids. Since athletes use steroids more often than non-athletes being exposed to anabolic steroids. A study including both higher risk (athletes) and lower risk (non-athletes) individuals may show prevalence rates lower than described here.

The most common primary source of information about anabolic steroids was printed material (28%). The sources that would seem most appropriate: parents, coaches, teachers, and athletic trainers totaled less than do those persons involved in sports appear to be at high risk for fifty percent of all primary information sources.

Parents, coaches, teachers, and health-care providers need to take a more active role in educating adolescents about the effects of anabolic steroids. Too often adolescents are left to compile information on anabolic steroids from inappropriate sources and so do not fully understand the effects associated with steroids. Children are more likely to experiment with something that they don’t understand as opposed to a subject about which they have sufficient knowledge.

According to published data (DuRaunt et al, 1995; DuRaunt, Emons et al, 1995; Ashworth et al, 1993) adolescents who use anabolic steroids are more likely to exhibit other high-risk behaviors such as multiple illicit drug use, unprotected sex, and illegal behaviors. Educational programs must not include just the direct negative effects of anabolic steroids to an individual, but they must also provide information about behavioral modification strategies, risk avoidance and reduction of peer pressure.

Conclusion

Approximately one percent of 10 to 14 year-old youth sports participants are using or have used anabolic steroids. Even though usage has decreased by over 50% since 1989, steroid use is still a serious problem. Insufficient knowledge and inappropriate attitudes regarding the benefits and risks of using anabolic steroids is also a major concern. Less than two-thirds of the athletes had the effects of anabolic steroids explained to them, and less than half of them have received their knowledge from an adult (parent, coach, teacher, athletic trainer, etc.). Over a quarter of youth sports participants have received their knowledge of anabolic steroids from magazines or books.

Educational programs have shown to be effective against other forms of drug use. New educational and intervention efforts against anabolic steroids likewise should be instituted. These programs should start before junior high and continue through high school. Informational sources about steroids should come from qualified individuals including teachers, coaches, and trainers. Parents should also be involved and educated to help inform their children about anabolic steroids.

Acknowledgement

This study was funded in part by the National Youth Sports Research and Development Center.

APPENDIX

Please answer every question on the appropriate line.

  1. Age: _____
  2. Sex: _____ Male _____ Female
  3. Ethnic Origin:_____ Caucasian _____ Native American _____ Hispanic

    _____ Black _____ Asian/Pacific _____ Other

  4. How many years have you played in organized youth league sports?_____
  5. What youth league sport do you now play?_____ Basketball _____ Football _____ Baseball _____ Softball

    _____ Soccer _____ Tennis _____ Swimming _____ Ice Hockey

    _____ Wrestling _____ Other: ___________________

  6. Have you ever heard of anabolic steroids (a drug taken to increase muscle
    size and/or strength)?_____ Yes _____ No
  7. What is your primary source of information about anabolic steroids ?
    (one answer only)_____ Coach _____ Athletic Trainer _____Friend/Teammate

    _____ Parent _____ Sibling _____ Gym Personnel

    _____ Dealer _____Books/Magazines

    _____ Teacher _____ Television

  8. Have the side effects of anabolic steroid use ever been explained to you?

    _____ Yes _____ No

  9. Do you feel that anabolic steroids without proper nutrition and exercise
    will improve muscle size and strength?_____ Yes _____ No _____ Not Sure
  10. Would you ever use anabolic steroids to increase your size or improve
    your strength?_____ Yes _____ No _____ Not Sure
  11. Do you think using anabolic steroids will improve your performance in your sport?_____ Yes _____ No _____ Not Sure
  12. Do you feel that you need to take anabolic steroids to improve your chances for athletic
    success (college scholarships, world championships, professional contracts, etc.)?_____ Yes _____ No _____ Not Sure
  13. Do you feel that Olympic athletes use anabolic steroids to make the team?_____ Yes _____ No _____ Not Sure
  14. Do you feel that High School athletes use anabolic steroids to make the team?_____ Yes _____ No _____ Not Sure
  15. Do you feel that, if used carefully, anabolic steroids will not harm an athlete?_____ Yes _____ No _____ Not Sure
  16. Do you personally know someone who is using or has used anabolic steroids?_____ Yes _____ No
  17. Have you ever been offered anabolic steroids?_____ Yes _____ No
  18. Have you ever used anabolic steroids?

    _____ Yes _____ No

    If yes, what was the main reason for use? (one answer only)

    _____ Personal Appearance _____ Athletic Performance

    _____ Body Building _____ Pressure From Others

  19. Do you consider regular anabolic steroid usage the same as having a drug problem? (e.g. cocaine, marijuana, heroin, etc.)_____ Yes _____ No _____ Not Sure
  20. If you decided to use anabolic steroids today, do you know where to obtain them?_____ Yes _____ No

References

Anderson, W.A.; W.E. Buckley K.E. Friedl,  A.L. Streit, J.E. Wright, and C.E. Yesalis (1988) Estimated prevalence of anabolic steroid use among high school seniors. Journal of the American Medical Association, 260, 3441-3445

Bahrke, M.S.; N.J. Kennedy, A.N. Kopstein and C.E. Yesalis (1993) Anabolic-androgenic steroid use in the United States. Journal of the American Medical Association, 270, 1217-1221.

Windsor, R. and D. Dumitru (1989)  Prevalence of anabolic steroid use by male and female
adolescents. Med Sci Sports Exerc., 270, 494-497.

Dumitru, D.; E.M. Komoroski, V.I. Rickert and R. Windsor (1992). Adolescent body image and attitudes to anabolic steroid use. AJDC, 146, 823-828.

DuRaunt,  R.H.; L.G. Escobedo and G.W. Heath. Anabolic-steroid use, strength training, and multiple drug use among adolescents in the United States. Pediatrics, 96, 23-28.

Chillag, S.; D. Elliot and R. Whitehead (1992).  Anabolic steroid use among adolescents in a rural state. J Family Practice. 1992; 35, 401-405.

Alongi, C.; D.W. Miller and S.M. Tanner (1995). C. Anabolic steroid use by adolescents: prevalence, motives, and knowledge of risks. Cl J Sports Med., 5, 108-115

DuRaunt, R.H.; S.J. Emans, A.H. Faulkner, A.B. Middleman and E.R. Woods (1995). High-risk
behaviors among high school students in Massachusetts who use anabolic steroids. Pediatrics, 96, 268-272

Johnson, M.D. (1990). Anabolic steroid use in adolescent athletes. Ped Cl North Amer.
,37, 1111-1123.

Broderick, P; G. Pickell & J. Radakovich (1993). Rate of anabolic-androgenic steroid use among students in junior high school. JABFP. 6, 341-345.

Ashworth, C.S.; R.H. DuRaunt, C. Newman, V.Il. Rickert & G. Slavens (1993). Use of multiple
drugs among adolescents who use anabolic steroids. NE J Med. ,328, 922-926

Gray M. (May, 1990)  Anabolic Steroid Survey: Study Group – 10 to 14 year-old youth sports participants. Sponsored by NYSCA Nat R & D Center. Presented at American College of Sports Medicine in Salt Lake City, Utah.

 

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