© 2013 John Wiley & Sons A/S.
Scand J Med Sci Sports 2015: 25: 116–124 doi: 10.1111/sms.12168
Published by John Wiley & Sons Ltd
Doping in sports: Knowledge and attitudes among parents of Austrian junior athletes C. Blank1, V. Leichtfried1, R. Schaiter1, C. Fürhapter1, D. Müller2, W. Schobersberger1,3 Institute for Sports Medicine, Alpine Medicine & Health Tourism, UMIT, Hall, Innsbruck, Austria, 2National Anti-Doping Agency (NADA) Austria, Vienna, Austria, 3Institute for Sports Medicine, Alpine Medicine & Health Tourism, TILAK, Innsbruck, Austria Corresponding author: Cornelia Blank, MSc, Department for Medical Sciences and Health Systems Management, Institute for Sports Medicine, Alpine Medicine & Health Tourism, UMIT, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria. Tel: +43 (0) 50 8648 3840, Fax: +43 (0) 50 8648 67 3840, E-mail: [email protected]
1
Accepted for publication 26 November 2013
Strategies for doping prevention are based on prior identification of opportunities for intervention. There is no current research focusing on the potential role in doping prevention, which might be played by the parents of junior elite athletes. The purpose of this study was to evaluate the knowledge and attitudes toward doping among parents of Austrian junior athletes and to analyze factors potentially influencing these beliefs. In this study, two questionnaires were distributed to 1818 student athletes, each with instructions that these surveys were to be completed by their parents (ntotal = 3636). Parents filled in questionnaires at home without observation. Responses
from 883 parents were included in this analysis. Compared to female parents, male parents demonstrated significantly better knowledge about doping and its side effects and were more likely to be influenced by their own sporting careers and amounts of sports activities per week. Parental sex did not demonstrate a significant influence on responses reflecting attitudes toward doping. Additional research is needed to compare these results with young athletes’ knowledge and attitudes to determine if and to what degree parental attitudes and beliefs influence the behavior and attitudes of their children.
Doping is an issue the sports world has faced for decades. Doping is generally accepted as being against the spirit of sport and is believed to create unfair advantages that may enable an athlete to win in competition although the latter argument has been discussed at length in the literature (Savulescu et al., 2004; Kayser et al., 2007; Kayser & Smith, 2008). In recent years, research in doping has shifted away from detection and secondary prevention. Instead, more recent research has been directed toward primary prevention of doping through education (Mazanov et al., 2011). Essential components of these primary prevention strategies are the identification of target groups, the evaluation of their knowledge and attitudes with respect to doping, and the determination of effective starting points for interventions (Fürhapter et al., 2013). Increasingly, research in doping has particularly expanded in the search for such potential intervention points. These studies have mainly focused on athletes, who may directly benefit from doping (Bloodworth et al., 2012; Fürhapter et al., 2013), coaches, whose job security is directly linked with their athletes’ successes (Laure et al., 2001; Peters et al., 2009), and team physicians, whose medical advice may influence athletes’ knowledge and attitudes regarding doping (Greenway & Greenway, 1997; Laure et al., 2003; Bundy, 2009). Most
commonly, these studies focus on the prevalence of substance misuse with regard to anabolic steroids (Kondric et al., 2010; Lentillon-Kaestner & Carstairs, 2010; Thorlindsson & Halldorsson, 2010) as well as growth hormones (Holt, 2011). Additional research has been conducted on the knowledge and the attitudes of athletes (Bloodworth et al., 2012), coaches (Laure et al., 2001), and physicians and pharmacists (Greenway & Greenway, 1997; Ambrose, 2011; Auersperger et al., 2012). Results of these studies demonstrate some consistent findings with respect to knowledge and attitudes. Groups questioned in these studies generally endorse statements that characterize the use of prohibited substances as ethically and morally reprehensible. In addition, in all of these studies, knowledge about prohibited substances and especially about their medical side effects showed the need for improvement. However, no available literature has yet focused on the knowledge and attitudes toward doping among the parents of competitive junior athletes. Nevertheless, numerous research studies exist that are establishing the role of parental influence in modulating behavior and attitudes with respect to preventing high-risk sexual and smoking behaviors (Harris et al., 2013; Mercken et al., 2013). For doping, such studies do not exist yet. It can be assumed that parents might also be able to modulate
116
Doping knowledge of athletes’ parents other high-risk behavior, such as doping. Parental influence may provide an important target point for early interventions to prevent doping. Therefore, the purpose of this study was to assess the knowledge and attitudes of the parents of junior athletes as a first step toward proposing educational and preventive interventions. In this study, the parents of Austrian junior athletes, aged 14 to 19, were surveyed regarding their attitudes toward doping and their knowledge of doping substances, methods, and side effects. Information was also collected from these surveys regarding factors potentially influencing the parents’ knowledge and attitudes, including parental sex and past or current sports involvement. Materials and methods
ited substances during their professional sporting career (“Have you ever been tempted to take prohibited substances yourself during your active sporting career?”). With respect to doping, parents’ current kind of sports activity as well as kind of former professional sports activity was classified into “high-risk” and “non-high-risk” sport. “High-risk” sports included at least one of the following (parents could indicate more than one kind of sport practice): running, swimming, bodybuilding, cross-country skiing, biathlon, biking, athletics, and triathlon. Next to that, information about the parents’ attitudes toward doping in sport, and their knowledge about prohibited substances and the side effects of these substances were retrieved. To analyze the main research questions, we separated the answers into three categories: (a) knowledge about doping substances and methods; (b) knowledge about health-affecting side effects of doping; and (c) attitudes toward doping. The assignment group for each question was not labeled in the questionnaires. Examples of the main research questions are outlined in Table 1.
Study design Prior to the collection of data, this cross-sectional survey study was reviewed for human subjects’ protection and approved by the ethics committee of the medical universities of Innsbruck, Graz, Vienna, and Lower Austria (St. Pölten) (Innsbruck: AN3854, 284/ 4.1., Graz: 23–206 ex 10/11, Vienna: 1096/2010, St. Pölten: GS4EK-4/121–2011). The study was also approved and supported by the Austrian Ministry for Sport and the National Anti-Doping Agency (NADA) Austria. Survey data were collected over a period of 1 year between April 2010 and April 2011. Surveys were distributed to Austrian junior athletes between the ages of 14 and 19 years at 12 Austrian elite sport schools and 2 training centers in 5 Austrian counties (Tyrol, Salzburg, Vienna, Styria, Lower Austria, and Vorarlberg). In total, there are 27 recognized elite sport schools in Austria. Elite sport schools were selected based on convenience sampling, writing an invitation letter to all schools to take part in the study, and including all who responded to this request (44.4%). The two training centers were included based on personal invitation to take part in the study, as the best Tyrolean soccer and football athletes are training at these institutions and were matching the American age criteria. Athletes, meeting the age-defined inclusion criteria, received two copies of the questionnaire and were asked to bring them home to their parents, asking both parents to complete and return the forms. Parents were not observed while filling the questionnaires, which could be returned either back to the study site by the athlete or athlete’s parent or mailed using a stamped return envelope with the cost covered by the study. To ensure anonymity, data collection was performed with randomly encoded case report forms. Participation in the study was voluntary. All participants provided written informed consent along with completing the survey. These written informed consent forms were removed from the survey form by administrative staff, not involved in the study, immediately after opening the envelopes. The researchers only received the surveys of those parents who priorly signed the written informed consent.
Questionnaire structure A questionnaire with closed-ended questions was used. The design of the questionnaire was adapted from published questionnaires used to evaluate doping knowledge and attitudes among athletes (Laure et al., 2004; Wanjek et al., 2007; Peters et al., 2009). The survey collected socio-demographic data (e.g., age, sex, highest educational level, profession), information about the sports activity levels (times of sporting activity per week and what kind of sport), own former sports careers of the athletes’ parents (whether parents pursued a professional sporting career and if so, what kind of sport and for how many years), and temptation to take prohib-
Statistical analysis Data were analyzed using SPSS 17.0 (SPSS, Inc., Chicago, Illinois, USA). Even though data were not normally distributed (Kolmogorov–Smirnov test, P < 0.001 for all metric variables), the investigators used parametric methods of testing, allowing the results to be generalized, which is possible when analyzing samples of more than 30 respondents (Bortz & Döhring, 2006). As a supplementary statistical analysis, the authors performed the corresponding no-parametric tests (Mann-Whitney U-test and Spearman correlation coefficients). Where results differed between analyses, values were considered as being nonsignificant to exclude a possible statistical significance by mistake. To evaluate differences between sex and age with respect to the level of sporting activities, as well as with respect to parental professional sporting career, chi-square tests (sex) and unpaired t-tests (age) were used. Relative risk (RR) was indicated with the corresponding 95% confidence interval (CI95%). For calculation, responses for questions regarding general doping knowledge, knowledge about side effects, and attitudes were measured as a cumulative score (Table 1). The cutoff point for “good knowledge” was set at 80% of questions answered correctly (Auersperger et al., 2012). Unpaired t-tests were used to analyze the influences of dichotomous variables: sex, membership in a sporting club, child’s membership in a squad that is part of a sporting federation, parental participation in a sports championship, former parental professional sporting career, and taking part in “high-risk” classified sport. Correlation analysis (Pearson correlation coefficient) was used for metric variables: own temptation to dope, age, knowledge of doping, knowledge of side effects, attitudes, subjective estimation of own sporting activity, amount of sport per week, duration of own professional sporting career, and number of children. In case of a significant influence of sex, data were analyzed for men and women separately. To reduce potential confounding due to significant relationships between the independent variables, a linear, stepwise regression analysis was performed. Results were displayed with the respective mean ± standard deviation (SD), and two-sided significance level was set at a P ≤ 0.05.
Results Demographic data and own level of sporting activity A total of 921 respondents returned the questionnaires. After eliminating questionnaires, which were not filled in completely, 883 remaining data sets entered analysis. About one fifth (21.4%) of the returned questionnaires were filled in by only one parent (67.2% mothers);
117
Blank et al. Table 1. Scoring system main research questions
Items
Scores
Scores I + II
Correct = 1, Incorrect = 0
Item scale
Yes
(I) General doping knowledge Which of the following substances are listed on the WADA prohibited list Caffeine Anabolic steroids Carbohydrates Protein Marihuana Stimulants Alcohol (in general) None Do not know Doping substances/doping methods are. . . Generally prohibited Prohibited only for elite athletes Prohibited only for amateur athletes Prohibited only for bodybuilders Not health threatening Only to be taken with permission from a physician Do not know Maximum score (II) Knowledge of side effects Taking anabolic steroids may lead to. . . Myocardial infarction Accelerated growth of individual parts of the body Liver damage Increased aggression Impotence Weight loss Do not know Taking anabolic steroids. . . Endangers your health Increases self-confidence Only shows effects for professional elite athletes Serves as a performance enhancer Do not know By taking anabolic steroids. . . Subcutaneous tissue increases Subcutaneous tissue decreases Drive to win increases One becomes tired faster Do not know Taking stimulants. . . Calms you down Leads to psychological dependency Serves as a performance enhancement Endangers your health Only shows effects for professional elite athletes Do not know Maximum score
0 1 0 0 1 1 0 0 0 1 0 0 0 0 0 0 16 points (all answers correct)
No
1 0 1 1 0 0 1 1 1 0 1 1 1 1 1 1
1 1 1 1 1 0 0
0 0 0 0 0 1 1
1 0 0 1 0
0 1 1 0 1
1 0 0 0 0
0 1 1 1 1
0 1 1 1 0 0 23 Points (all answers correct)
1 0 0 0 1 1
Scores III
Contra doping = 2, “Do not know” = 1, Pro doping = 0
Item scale
Yes
No
Do not know
(III) Attitudes Doping in sport is reprehensible Doping in sport destroys its moral concepts Blood doping is unethical Doping should be rejected Doping should be prohibited Doping should be legalized Athletes should be punished if they dope Sport clubs should be punished if their athletes dope Sport federations should be punished if their athletes dope Doping controls should be increased Maximum score
2 2 1 2 2 0 2 2 2 2 19 Points (totally contra doping)
0 0 0 0 0 2 0 0 0 0
1 1
WADA, World Anti-Doping Agency.
118
1 1 1 1 1 1 1
Doping knowledge of athletes’ parents 78.6% (n = 2 × 347) were filled in by both parents. A total of 1818 students were given questionnaires addressed to both of their parents. A number of 3636 responses from parents were possible. The theoretical response rate was therefore 24.3%. Exact response rate could not be calculated because in some cases, only one parent returned the questionnaire and some potentially live in divorce or have more than one child. Of the respondents, 409 (46.3%) were men and 474 (53.7%) were women. The mean age of the sample was 45.98 (±4.98). Regarding the highest educational level, most of the subjects finished an apprenticeship (40.7%), 19.6% finished their A-levels (“Matura” in Austria), and 19.1% had a university degree. There was no significant educational difference between men and women. Of these respondents, 90% reported having between one and three children, and 81.7% indicated that their child was a member of a sports federation squad. Male parents were significantly more likely themselves to be a member in a sporting club than female parents, (66.3% men vs 44.8% women, P < 0.001). The mean frequency of parental sports activity per week was 2.6 ± 1.5 times (no significant differences between male and female parents), with 5.1% reporting daily sports activities. Skiing was mentioned most often (73.5%), followed by biking (69.3%) and swimming (41.9%). In total, 19.3% still took part in sport competition with 76.5% participating in a “high-risk” sport. Compared with female parents, a significantly greater percentage of male parents were still participating in competitive athletics themselves (30.3% male vs 9.7% female, P < 0.001, χ2 = 60.1) and had their own professional sporting career in their past (35.4% male vs 13.1% female, P < 0.001, χ2 = 60.5, ntotal = 206). Five percent of those participated in a “high-risk” kind of sport. Soccer was named most often (25.2%), followed by alpine skiing (9%) and athletics (7%). The mean duration of reported professional sports careers (±SD) in this survey population was 14.5 ± 8.8 years for men and 9.2 ± 5.3 years for women (P < 0.001). Notably, among parents who had a professional sporting career, 7.8% were tempted to take prohibited substances, 92.2% were never tempted, and 0.5% did not indicate an answer. Men more often reported being tempted to take prohibited substances compared with women [P = 0.01, RR = 5.3 CI95% (1.3;22.3)]. Knowledge about doping and side effects When asked to rate their knowledge about doping, 18.8% of the parents surveyed reported feeling poorly informed, 45.5% reported feeling moderately well informed, and 31.4% reported feeling well informed to very well informed. Most parents reported seeking information about doping from the Internet (51.6%). Another 23.7% reported that they had used the World AntiDoping Agency (WADA)/NADA hotlines for informa-
tion on doping. The percentage of parents who sought information from physicians, including general practitioners, school physicians, and/or sport physician was relatively low (1.5–12%, depending on the physician). No sex differences were found for the frequency or methods of information-seeking behavior with regard to doping. Among all parents surveyed, the mean score out of 16 possible points for general doping knowledge was 13.1 ± 1.6 (range 6–15) and out of 23 possible points for knowledge about health-threatening side effects, the mean score was 16.6 ± 3.5 (range 0–22). “Good knowledge,” defined as a score of 80% or greater correct answers, was demonstrated by 68.2% of parents in general doping knowledge and 34.4% of parents in knowledge of the side effects of doping. With regard to side effects, it should be noted that 82.3% answered more than 60% of the questions correctly. The general knowledge score of parents who both returned the questionnaire was significantly better (13.2 ± 1.6 vs 12.9 ± 1.8, P = 0.042), whereas knowledge about side effects did not show any marked differences between the groups. Additionally, parental sex was found to influence general doping knowledge (P = 0.008) and knowledge about side effects (P = 0.009). Therefore, analyses for these two items were additionally performed separately for male and female. Male parents reported greater self-assessed knowledge of doping (38.6% reported being well informed to very well informed) compared with female parents (25.4% reported being well informed to very well informed) (P < 0.001), which is confirmed by the measured knowledge about doping and side effects with higher scores in men than in women (P = 0.01 for both). The educational status of the parents showed a significant but low positive association with knowledge about side effects (r = 0.15, P < 0.001). Whether parents still take part in competitions of a “high-risk” classified sport with respect to doping did not show any significant differences in general knowledge and knowledge about side effects. Different additional factors (e.g., own former sporting career, own sporting activity, own temptation to use doping substances during former sporting career, etc.) possibly found to influence general doping knowledge and knowledge about side effects are outlined in Tables 2 (entire sample), 3, and 4 (for men and women separately). Two items of the correlation analysis did not show significant results when using the Spearman correlation coefficient (Pattitudes = 0.18 and Psubjective sporting level = 0.17). Notably, whether parents were tempted to use doping substances during former sporting career did not show marked associations with their doping knowledge. The subgroup of males who admitted to have been tempted though showed a significantly better knowledge about side effects (17.9 ± 1.7) than the subgroup of women (13.5 ± 2.1) (P < 0.01).
119
Blank et al. Table 2. Influences on doping knowledge and knowledge about side effects
Item
Doping knowledge
Member of a sporting club
Yes No Children members of a sport federations’ squad Yes No Participation in competitions Yes No Own temptation to use prohibited substances Yes No Own professional sporting career Yes No Knowledge about side effects of doping Knowledge about doping Age Attitudes toward doping Subjective sporting activity level Amount of sport per week Length of own sporting career Number of children
Knowledge about side effects P Pearson correlation coefficient
Mean (±SD)
P
13.26 (1.5) 12.92 (1.7) 13.1 (1.6) 12.9 (1.8) 13.1 (1.6) 13.1 (1.6) 13.1 (1.6) 13 (1.7) 13.1 (1.6) 13.1 (1.6)
0.003* 0.14 0.82 0.91 0.87 0.28
Scand J Med Sci Sports 2015: 25: 116–124 doi: 10.1111/sms.12168
Published by John Wiley & Sons Ltd
Doping in sports: Knowledge and attitudes among parents of Austrian junior athletes C. Blank1, V. Leichtfried1, R. Schaiter1, C. Fürhapter1, D. Müller2, W. Schobersberger1,3 Institute for Sports Medicine, Alpine Medicine & Health Tourism, UMIT, Hall, Innsbruck, Austria, 2National Anti-Doping Agency (NADA) Austria, Vienna, Austria, 3Institute for Sports Medicine, Alpine Medicine & Health Tourism, TILAK, Innsbruck, Austria Corresponding author: Cornelia Blank, MSc, Department for Medical Sciences and Health Systems Management, Institute for Sports Medicine, Alpine Medicine & Health Tourism, UMIT, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria. Tel: +43 (0) 50 8648 3840, Fax: +43 (0) 50 8648 67 3840, E-mail: [email protected]
1
Accepted for publication 26 November 2013
Strategies for doping prevention are based on prior identification of opportunities for intervention. There is no current research focusing on the potential role in doping prevention, which might be played by the parents of junior elite athletes. The purpose of this study was to evaluate the knowledge and attitudes toward doping among parents of Austrian junior athletes and to analyze factors potentially influencing these beliefs. In this study, two questionnaires were distributed to 1818 student athletes, each with instructions that these surveys were to be completed by their parents (ntotal = 3636). Parents filled in questionnaires at home without observation. Responses
from 883 parents were included in this analysis. Compared to female parents, male parents demonstrated significantly better knowledge about doping and its side effects and were more likely to be influenced by their own sporting careers and amounts of sports activities per week. Parental sex did not demonstrate a significant influence on responses reflecting attitudes toward doping. Additional research is needed to compare these results with young athletes’ knowledge and attitudes to determine if and to what degree parental attitudes and beliefs influence the behavior and attitudes of their children.
Doping is an issue the sports world has faced for decades. Doping is generally accepted as being against the spirit of sport and is believed to create unfair advantages that may enable an athlete to win in competition although the latter argument has been discussed at length in the literature (Savulescu et al., 2004; Kayser et al., 2007; Kayser & Smith, 2008). In recent years, research in doping has shifted away from detection and secondary prevention. Instead, more recent research has been directed toward primary prevention of doping through education (Mazanov et al., 2011). Essential components of these primary prevention strategies are the identification of target groups, the evaluation of their knowledge and attitudes with respect to doping, and the determination of effective starting points for interventions (Fürhapter et al., 2013). Increasingly, research in doping has particularly expanded in the search for such potential intervention points. These studies have mainly focused on athletes, who may directly benefit from doping (Bloodworth et al., 2012; Fürhapter et al., 2013), coaches, whose job security is directly linked with their athletes’ successes (Laure et al., 2001; Peters et al., 2009), and team physicians, whose medical advice may influence athletes’ knowledge and attitudes regarding doping (Greenway & Greenway, 1997; Laure et al., 2003; Bundy, 2009). Most
commonly, these studies focus on the prevalence of substance misuse with regard to anabolic steroids (Kondric et al., 2010; Lentillon-Kaestner & Carstairs, 2010; Thorlindsson & Halldorsson, 2010) as well as growth hormones (Holt, 2011). Additional research has been conducted on the knowledge and the attitudes of athletes (Bloodworth et al., 2012), coaches (Laure et al., 2001), and physicians and pharmacists (Greenway & Greenway, 1997; Ambrose, 2011; Auersperger et al., 2012). Results of these studies demonstrate some consistent findings with respect to knowledge and attitudes. Groups questioned in these studies generally endorse statements that characterize the use of prohibited substances as ethically and morally reprehensible. In addition, in all of these studies, knowledge about prohibited substances and especially about their medical side effects showed the need for improvement. However, no available literature has yet focused on the knowledge and attitudes toward doping among the parents of competitive junior athletes. Nevertheless, numerous research studies exist that are establishing the role of parental influence in modulating behavior and attitudes with respect to preventing high-risk sexual and smoking behaviors (Harris et al., 2013; Mercken et al., 2013). For doping, such studies do not exist yet. It can be assumed that parents might also be able to modulate
116
Doping knowledge of athletes’ parents other high-risk behavior, such as doping. Parental influence may provide an important target point for early interventions to prevent doping. Therefore, the purpose of this study was to assess the knowledge and attitudes of the parents of junior athletes as a first step toward proposing educational and preventive interventions. In this study, the parents of Austrian junior athletes, aged 14 to 19, were surveyed regarding their attitudes toward doping and their knowledge of doping substances, methods, and side effects. Information was also collected from these surveys regarding factors potentially influencing the parents’ knowledge and attitudes, including parental sex and past or current sports involvement. Materials and methods
ited substances during their professional sporting career (“Have you ever been tempted to take prohibited substances yourself during your active sporting career?”). With respect to doping, parents’ current kind of sports activity as well as kind of former professional sports activity was classified into “high-risk” and “non-high-risk” sport. “High-risk” sports included at least one of the following (parents could indicate more than one kind of sport practice): running, swimming, bodybuilding, cross-country skiing, biathlon, biking, athletics, and triathlon. Next to that, information about the parents’ attitudes toward doping in sport, and their knowledge about prohibited substances and the side effects of these substances were retrieved. To analyze the main research questions, we separated the answers into three categories: (a) knowledge about doping substances and methods; (b) knowledge about health-affecting side effects of doping; and (c) attitudes toward doping. The assignment group for each question was not labeled in the questionnaires. Examples of the main research questions are outlined in Table 1.
Study design Prior to the collection of data, this cross-sectional survey study was reviewed for human subjects’ protection and approved by the ethics committee of the medical universities of Innsbruck, Graz, Vienna, and Lower Austria (St. Pölten) (Innsbruck: AN3854, 284/ 4.1., Graz: 23–206 ex 10/11, Vienna: 1096/2010, St. Pölten: GS4EK-4/121–2011). The study was also approved and supported by the Austrian Ministry for Sport and the National Anti-Doping Agency (NADA) Austria. Survey data were collected over a period of 1 year between April 2010 and April 2011. Surveys were distributed to Austrian junior athletes between the ages of 14 and 19 years at 12 Austrian elite sport schools and 2 training centers in 5 Austrian counties (Tyrol, Salzburg, Vienna, Styria, Lower Austria, and Vorarlberg). In total, there are 27 recognized elite sport schools in Austria. Elite sport schools were selected based on convenience sampling, writing an invitation letter to all schools to take part in the study, and including all who responded to this request (44.4%). The two training centers were included based on personal invitation to take part in the study, as the best Tyrolean soccer and football athletes are training at these institutions and were matching the American age criteria. Athletes, meeting the age-defined inclusion criteria, received two copies of the questionnaire and were asked to bring them home to their parents, asking both parents to complete and return the forms. Parents were not observed while filling the questionnaires, which could be returned either back to the study site by the athlete or athlete’s parent or mailed using a stamped return envelope with the cost covered by the study. To ensure anonymity, data collection was performed with randomly encoded case report forms. Participation in the study was voluntary. All participants provided written informed consent along with completing the survey. These written informed consent forms were removed from the survey form by administrative staff, not involved in the study, immediately after opening the envelopes. The researchers only received the surveys of those parents who priorly signed the written informed consent.
Questionnaire structure A questionnaire with closed-ended questions was used. The design of the questionnaire was adapted from published questionnaires used to evaluate doping knowledge and attitudes among athletes (Laure et al., 2004; Wanjek et al., 2007; Peters et al., 2009). The survey collected socio-demographic data (e.g., age, sex, highest educational level, profession), information about the sports activity levels (times of sporting activity per week and what kind of sport), own former sports careers of the athletes’ parents (whether parents pursued a professional sporting career and if so, what kind of sport and for how many years), and temptation to take prohib-
Statistical analysis Data were analyzed using SPSS 17.0 (SPSS, Inc., Chicago, Illinois, USA). Even though data were not normally distributed (Kolmogorov–Smirnov test, P < 0.001 for all metric variables), the investigators used parametric methods of testing, allowing the results to be generalized, which is possible when analyzing samples of more than 30 respondents (Bortz & Döhring, 2006). As a supplementary statistical analysis, the authors performed the corresponding no-parametric tests (Mann-Whitney U-test and Spearman correlation coefficients). Where results differed between analyses, values were considered as being nonsignificant to exclude a possible statistical significance by mistake. To evaluate differences between sex and age with respect to the level of sporting activities, as well as with respect to parental professional sporting career, chi-square tests (sex) and unpaired t-tests (age) were used. Relative risk (RR) was indicated with the corresponding 95% confidence interval (CI95%). For calculation, responses for questions regarding general doping knowledge, knowledge about side effects, and attitudes were measured as a cumulative score (Table 1). The cutoff point for “good knowledge” was set at 80% of questions answered correctly (Auersperger et al., 2012). Unpaired t-tests were used to analyze the influences of dichotomous variables: sex, membership in a sporting club, child’s membership in a squad that is part of a sporting federation, parental participation in a sports championship, former parental professional sporting career, and taking part in “high-risk” classified sport. Correlation analysis (Pearson correlation coefficient) was used for metric variables: own temptation to dope, age, knowledge of doping, knowledge of side effects, attitudes, subjective estimation of own sporting activity, amount of sport per week, duration of own professional sporting career, and number of children. In case of a significant influence of sex, data were analyzed for men and women separately. To reduce potential confounding due to significant relationships between the independent variables, a linear, stepwise regression analysis was performed. Results were displayed with the respective mean ± standard deviation (SD), and two-sided significance level was set at a P ≤ 0.05.
Results Demographic data and own level of sporting activity A total of 921 respondents returned the questionnaires. After eliminating questionnaires, which were not filled in completely, 883 remaining data sets entered analysis. About one fifth (21.4%) of the returned questionnaires were filled in by only one parent (67.2% mothers);
117
Blank et al. Table 1. Scoring system main research questions
Items
Scores
Scores I + II
Correct = 1, Incorrect = 0
Item scale
Yes
(I) General doping knowledge Which of the following substances are listed on the WADA prohibited list Caffeine Anabolic steroids Carbohydrates Protein Marihuana Stimulants Alcohol (in general) None Do not know Doping substances/doping methods are. . . Generally prohibited Prohibited only for elite athletes Prohibited only for amateur athletes Prohibited only for bodybuilders Not health threatening Only to be taken with permission from a physician Do not know Maximum score (II) Knowledge of side effects Taking anabolic steroids may lead to. . . Myocardial infarction Accelerated growth of individual parts of the body Liver damage Increased aggression Impotence Weight loss Do not know Taking anabolic steroids. . . Endangers your health Increases self-confidence Only shows effects for professional elite athletes Serves as a performance enhancer Do not know By taking anabolic steroids. . . Subcutaneous tissue increases Subcutaneous tissue decreases Drive to win increases One becomes tired faster Do not know Taking stimulants. . . Calms you down Leads to psychological dependency Serves as a performance enhancement Endangers your health Only shows effects for professional elite athletes Do not know Maximum score
0 1 0 0 1 1 0 0 0 1 0 0 0 0 0 0 16 points (all answers correct)
No
1 0 1 1 0 0 1 1 1 0 1 1 1 1 1 1
1 1 1 1 1 0 0
0 0 0 0 0 1 1
1 0 0 1 0
0 1 1 0 1
1 0 0 0 0
0 1 1 1 1
0 1 1 1 0 0 23 Points (all answers correct)
1 0 0 0 1 1
Scores III
Contra doping = 2, “Do not know” = 1, Pro doping = 0
Item scale
Yes
No
Do not know
(III) Attitudes Doping in sport is reprehensible Doping in sport destroys its moral concepts Blood doping is unethical Doping should be rejected Doping should be prohibited Doping should be legalized Athletes should be punished if they dope Sport clubs should be punished if their athletes dope Sport federations should be punished if their athletes dope Doping controls should be increased Maximum score
2 2 1 2 2 0 2 2 2 2 19 Points (totally contra doping)
0 0 0 0 0 2 0 0 0 0
1 1
WADA, World Anti-Doping Agency.
118
1 1 1 1 1 1 1
Doping knowledge of athletes’ parents 78.6% (n = 2 × 347) were filled in by both parents. A total of 1818 students were given questionnaires addressed to both of their parents. A number of 3636 responses from parents were possible. The theoretical response rate was therefore 24.3%. Exact response rate could not be calculated because in some cases, only one parent returned the questionnaire and some potentially live in divorce or have more than one child. Of the respondents, 409 (46.3%) were men and 474 (53.7%) were women. The mean age of the sample was 45.98 (±4.98). Regarding the highest educational level, most of the subjects finished an apprenticeship (40.7%), 19.6% finished their A-levels (“Matura” in Austria), and 19.1% had a university degree. There was no significant educational difference between men and women. Of these respondents, 90% reported having between one and three children, and 81.7% indicated that their child was a member of a sports federation squad. Male parents were significantly more likely themselves to be a member in a sporting club than female parents, (66.3% men vs 44.8% women, P < 0.001). The mean frequency of parental sports activity per week was 2.6 ± 1.5 times (no significant differences between male and female parents), with 5.1% reporting daily sports activities. Skiing was mentioned most often (73.5%), followed by biking (69.3%) and swimming (41.9%). In total, 19.3% still took part in sport competition with 76.5% participating in a “high-risk” sport. Compared with female parents, a significantly greater percentage of male parents were still participating in competitive athletics themselves (30.3% male vs 9.7% female, P < 0.001, χ2 = 60.1) and had their own professional sporting career in their past (35.4% male vs 13.1% female, P < 0.001, χ2 = 60.5, ntotal = 206). Five percent of those participated in a “high-risk” kind of sport. Soccer was named most often (25.2%), followed by alpine skiing (9%) and athletics (7%). The mean duration of reported professional sports careers (±SD) in this survey population was 14.5 ± 8.8 years for men and 9.2 ± 5.3 years for women (P < 0.001). Notably, among parents who had a professional sporting career, 7.8% were tempted to take prohibited substances, 92.2% were never tempted, and 0.5% did not indicate an answer. Men more often reported being tempted to take prohibited substances compared with women [P = 0.01, RR = 5.3 CI95% (1.3;22.3)]. Knowledge about doping and side effects When asked to rate their knowledge about doping, 18.8% of the parents surveyed reported feeling poorly informed, 45.5% reported feeling moderately well informed, and 31.4% reported feeling well informed to very well informed. Most parents reported seeking information about doping from the Internet (51.6%). Another 23.7% reported that they had used the World AntiDoping Agency (WADA)/NADA hotlines for informa-
tion on doping. The percentage of parents who sought information from physicians, including general practitioners, school physicians, and/or sport physician was relatively low (1.5–12%, depending on the physician). No sex differences were found for the frequency or methods of information-seeking behavior with regard to doping. Among all parents surveyed, the mean score out of 16 possible points for general doping knowledge was 13.1 ± 1.6 (range 6–15) and out of 23 possible points for knowledge about health-threatening side effects, the mean score was 16.6 ± 3.5 (range 0–22). “Good knowledge,” defined as a score of 80% or greater correct answers, was demonstrated by 68.2% of parents in general doping knowledge and 34.4% of parents in knowledge of the side effects of doping. With regard to side effects, it should be noted that 82.3% answered more than 60% of the questions correctly. The general knowledge score of parents who both returned the questionnaire was significantly better (13.2 ± 1.6 vs 12.9 ± 1.8, P = 0.042), whereas knowledge about side effects did not show any marked differences between the groups. Additionally, parental sex was found to influence general doping knowledge (P = 0.008) and knowledge about side effects (P = 0.009). Therefore, analyses for these two items were additionally performed separately for male and female. Male parents reported greater self-assessed knowledge of doping (38.6% reported being well informed to very well informed) compared with female parents (25.4% reported being well informed to very well informed) (P < 0.001), which is confirmed by the measured knowledge about doping and side effects with higher scores in men than in women (P = 0.01 for both). The educational status of the parents showed a significant but low positive association with knowledge about side effects (r = 0.15, P < 0.001). Whether parents still take part in competitions of a “high-risk” classified sport with respect to doping did not show any significant differences in general knowledge and knowledge about side effects. Different additional factors (e.g., own former sporting career, own sporting activity, own temptation to use doping substances during former sporting career, etc.) possibly found to influence general doping knowledge and knowledge about side effects are outlined in Tables 2 (entire sample), 3, and 4 (for men and women separately). Two items of the correlation analysis did not show significant results when using the Spearman correlation coefficient (Pattitudes = 0.18 and Psubjective sporting level = 0.17). Notably, whether parents were tempted to use doping substances during former sporting career did not show marked associations with their doping knowledge. The subgroup of males who admitted to have been tempted though showed a significantly better knowledge about side effects (17.9 ± 1.7) than the subgroup of women (13.5 ± 2.1) (P < 0.01).
119
Blank et al. Table 2. Influences on doping knowledge and knowledge about side effects
Item
Doping knowledge
Member of a sporting club
Yes No Children members of a sport federations’ squad Yes No Participation in competitions Yes No Own temptation to use prohibited substances Yes No Own professional sporting career Yes No Knowledge about side effects of doping Knowledge about doping Age Attitudes toward doping Subjective sporting activity level Amount of sport per week Length of own sporting career Number of children
Knowledge about side effects P Pearson correlation coefficient
Mean (±SD)
P
13.26 (1.5) 12.92 (1.7) 13.1 (1.6) 12.9 (1.8) 13.1 (1.6) 13.1 (1.6) 13.1 (1.6) 13 (1.7) 13.1 (1.6) 13.1 (1.6)
0.003* 0.14 0.82 0.91 0.87 0.28
