Nutritional Supplementation and Anabolic Steroid Use in Adolescents

Jay R. Hoffman; Avery D. Faigenbaum; Nicholas A. Ratamess; Ryan Ross; Jie Kang; Gershon Tenenbaum

Disclosures

Med Sci Sports Exerc. 2007;40(1):15-24. 

In This Article

Abstract and Introduction

Abstract

Purpose: To examine nutritional supplementation and anabolic steroid (AS) use in adolescent males and females in a multistate, cross-regional study. A secondary purpose of the study was to investigate the knowledge, beliefs, and sources of education on nutritional supplementation and AS in these students.
Methods: A confidential self-report survey was administered to 3248 students representing grades 8-12 in 12 states in the continental United States by their teachers during homeroom or physical education class.
Results: Use of at least one supplement was reported by 71.2% of the adolescents surveyed. The most popular supplements used were multivitamins and high-energy drinks. The use of supplements to increase body mass and strength, and to reduce body fat or mass, increased across grade and was more prevalent in males than females. The number of students that self-reported AS use was 1.6% (2.4% males and 0.8% females). The number of supplements used was related to AS use among adolescents, and this effect was greater among males. Adolescents also seemed willing to take more risks with supplements to achieve their fitness or athletic goals, even if these risks reduced health or caused premature death.
Conclusion: This study demonstrates that reliance on nutritional supplements increases as adolescents mature. The apparent willingness of adolescents to use a supplement that may harm their health or shorten their life highlights the need for greater involvement of teachers, coaches, and physicians to provide continued education on the risks and benefits associated with nutritional supplementation and AS use.

Introduction

For the past 50 yr, the use of nutritional supplements and anabolic steroids (AS) by athletes has increased the media's scrutiny and the medical and scientific focus on the efficacy and dangers of these substances. The medical risks associated with many of these ergogenic aids, as well as ethical considerations, have led the major sport governing bodies to initiate measures to combat their use. Many of these organizations have defined lists of drugs and methods that are banned from use by their athletes, and whose detection would result in suspension from competition. In addition, sports medicine and sport science organizations have begun to develop educational and awareness programs for their membership on AS and other performance-enhancing substances. Despite known side effects and potential risks associated with many of these ergogenic aids, including the risk of being barred from competition, athletes still continue to use these substances and search for ways to mask their use to avoid detection.

Recent surveys have suggested that AS use and other banned performance-enhancing drugs commonly used by athletes may be declining compared with use patterns of two to three decades ago. In a survey of almost 14,000 NCAA student athletes, the NCAA has reported that the prevalence of AS and amphetamine use has declined in the past 12 yr.[13] According to their results, AS use among athletes surveyed has actually decreased from 4.9% in 1989 to 1.4% in 2001, and additional reports have indicated that AS use among NCAA football players has decreased by almost 50% from 1985 to 1991.[11] Similar trends have also been reported in high school students. Early studies examining adolescent steroid use reported that AS use at the secondary level ranged from 6%[5] to 11% in males.[18] In the past 10 yr, however, the use of AS at the high school level seems to be lower, with ranges varying from 3%[8] to 5.4%.[17] Despite the apparent decline in AS use, NCAA surveys have shown that initial AS use in collegiate athletes is occurring earlier in the athlete' s career, with the majority (> 40%) of these athletes first using AS during high school.[13] In addition, a greater number of nonathletic males and females (2.9%) seem to be using AS,[8] and recent reports suggest that AS use has also trickled into the middle schools.[9] These trends suggest that the educational process of combating AS use may not have successfully targeted the adolescent population.

The apparent decrease in the use of AS and other banned drugs does not seem to have reduced the use of performance-enhancing substances. Recent reports indicate that between 65 and 89% of intercollegiate athletes are using some type of nutritional supplement,[11,15] and similar use patterns may also be occurring at the scholastic level. A recent study of high school football players has reported that 31% of the athletes surveyed use some performance-enhancing supplement, with 13% of the athletes admitting to taking more than one supplement.[25] Performance-enhancing substances can be generally divided into two categories: hormones and the drugs that mimic their effects (these are generally banned by sports governing bodies), and dietary or nutritional supplements. Whether the prevalence of nutritional supplementation in a high school student will lead to the use of banned substances is not known, but a pressing issue is whether these students are receiving the proper information concerning nutritional supplementation.

Despite an apparent decline in reported AS use, recent media exposure involving tragic cases of high school students dying from AS, congressional hearings on AS testing in professional sports, and allegations of current widespread use in Major League Baseball have led the validity of these claims to be questioned. A major concern for many is the apparent abuse of AS in the adolescent population for both athletic and aesthetic reasons. The medical issues associated with AS use may be much greater in this population than in an adult population.[16] The knowledge base of these adolescents may also be lower than the adult population, lessening the ability of these individuals to make educated decisions. In addition, the alleged abuse of AS by professional athletes has raised issues concerning the influence that these athletes may have on the adolescent population, who often idolize these athletes. However, the scientific literature concerning the impact that professional athletes have on adolescent steroid or nutritional supplementation use is limited. The debate on AS abuse in athletes raises issues concerning perceptions of whether adolescents believe that AS can help achieve athletic goals, and whether professional athletes need or have the right to use AS. Thus, the purposes of this study were threefold. The primary objective was to examine the nutritional supplementation and AS habits in high school (8th-12th grade) students. Additional objectives were to investigate the knowledge, beliefs (regarding self-administered AS use, AS use among peers, and AS use in professional athletes), and sources of education on nutritional supplementation and AS of these students, and to compare beliefs and sources of education between AS users and nonusers.

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