JOURNAL OF ADOLESCENT HEALTH CARE 1990;11:210-214
Effect of an An olic Steroi Program on Knowledge and Attitu High School Football Players LINN
GOLDBERG,
M.D.,
LOUIS TREVISAN,
M. D.
ERIC E. BOSWORTH,
Six varsity high schocalfootball teams were assessed by confidential questionnaire regarding anabolic steroids, before and 2 weeks after an education intervention. The education program used the American College of Sports Medicine’s position on the “use of anabolic androgenic steroids in sports. ” Two teams received a lecture and a four-page handout, two teams were given the handout only, and two teams were controls. Selfreport of current use was 1.1% but 38.8% claimed availability of these agents. Although increased awareness of the adverse effects of anabolic steroid was found after the education program, no differences in attitudes toward the use of anabolic steroids occurred as compared to controls. Strategies designed to dissuade adolescent athletes from considering these drugs
need to be developed. RBY WORDS
Adolescent athletes Anabolic steroids
Anabolic steroid (AS) use was introduced to competitive athletics in the early 1950s [l]. Various oral and parenteral synthetic agents have been developed because of the rapid degradation of exogenously administered testosterone [2,3]. Although there are legitimate medical uses for these drugs From theHuman Perfornmce L&oratory, Division of GeneralMedicine. School of Medicine, Oregon Health Sciences University, Portland, Oregon. Address reprint requests to: Linu Goldberg, M.D., L47.5. Oregon Health Sciences University, 3181 SW Sam lackson Park Road, Portland, OR 97201. Manuscript accepted August 29, 1989.
M.D.,
o
fiblished
by Elsevier
AND
[4,5], they are also used in sports because of their potential to enhance muscle strength [6,7]. Serious medical and psychologic complications may be associated with the use of anabolic steroids [8,9]. Despite existing sanctions [lo], athletes continue to use these agents [ll]. Reports of their use by high school athletes is a more recent phenomena [12,13]. Adolescent attitudes and knowledge of potential benefits and risks associated with anabolic steroids have not previously been assessed. The American Medical Association Council on Scientific Affairs suggests that education should be considered because of the known abuse of these drugs by athletes [14]. The “potential” teaching strategies include 1) “preparation and drstribution of education pamphlets on drug abuse in athletes, emphasizing the adverse effects and limited benefits of such use” and 2) presentations by health care, professional:: who would be available to discuss the consequences of these agents. The effect of this form of education intervention directed toward high school athletes has not been evaluated. The American College of Sports Medicine’s (ACSM) position on the use of anabolic androgenic steroids in sports is a compilation of previous and current research concerning AS [ 151. The ACSM review discusses the potential benefits to the athlete, such as increased strength and muscle size, as well as the adverse effects, including an increased risk for premature cardiovascular disease, sterility, early epiphyseal closure, and potential psychological changes. The purpose of our investigation was twofold: I) to measure AS use and availability among Portland,
210 01974lIm9o/3.50
ROBERT T. BENTS,
Science Publishing
LINN GOLDBERG, M.D., 1990 Co., Inc., 655 Avenue of the Americas, New York, NY 10010
May 1990
ANABOLIC STEROID EDUCATION AND ADOLESCENT ATHLETES
Table 1. W-Education Knowledge Scan (All Groups Combined)
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Knowledge statement
Likert scale score k SEM (pre-test)
Steroids can cause: Acne Aggressive behavior Blood pressure elevation Certain cancers Cholesterol elevation Growth stunting Gynecomastia Heart disease Increased size Increased weight Liver damage Qerility Strength increase
4.220.2 6.6-cO.3 7.O-cO.2 5.7kO.4 5.420.2 5.6~0.3 7.120.2 6.3kO.3 7.920.2 7.920.2 5.820.2 6.4kO.3 8.4-cO.2
n = 105. Liiert score: 0 = strongly disagree; 10 = strongly agree.
Oregon varsity high school football players and 2) to compare changes in knowledge and attitudes concerning AS among these athletes before and after an education intervention.
211
lay terms with slides, reflecting the ACSM position. This was followed by a brief question an6 answer session. Group I participants also received a four-page, typewritten handout summariig the ACSM position in lay language. Group I1 (two teams) received the education handout only. Group III (two teams) participants were used as controls and did not receive either oral or written information during the study. All teams were informed that a follow-up questionnaire wculd be distributed to them in 2 weeks. They were retested using an identical questionnaire. Intergroup comparisons were assessed by AIUOVA. Significant score changes were compared by Bonferroni analysis.
Results
One hundred-ninety athletes, mean dge fi SD 17 + 1 years, completed the initial questionnaire before the education intervention. Respondents reported 38.8% availability of AS, although 1.1% (two students) claimed current use of AS.
Methods Six varsity high school football teams were assessed.
Pre- to Post-Intervention
Results
They were randomly assigned to three groups. Before any intervention, a confidential questionnaire was distributed to all athletes. The initial portion of the questionnaire included inquiries about availability and use of anabolic steroids. The second part dealt with knowledge and attitude assessment. It consisted of a Likert (visual analog) scale (0. . . strongly disagree to 10. . . strongly agree). Thirteen questions included the effect of AS on increasing muscle size and weight, as well as their potential to result in sterility, growth stunting, acne, heart disease, and other known adverse effects (Table 1). Two questions were included that dealt with consequences not attributabje to steroid use: 1) AS use results in kidney disease and 2) AS improves endurance (aerobic) capacity. The attitude statements that were used considered the use of AS if 1) AS could assist in obtaining a college athletic scholarship or 2) a professional sports contract, and whether 3) the student athlete would consider using AS steroids even if there was a 50% chance of his being killed by them in 20 to 30 years. Of the three groups assessed, group I (two teams) received a 20-minute oral Bresentation in
Although nearly all athletes completed the followup questionnaire, because of confidentiality, only 105 matched pairs of pre- to post-intc:rvention questionnaires could be clearly identified. II&al knowledge scores (Likert scale of agreemerrf) are shown in Table 1. Similar responses regardirzg the effects of AS were present between the three groups before presentation of the ACSM pcsition. After the education interventions, knowledge of 7 of the 13 potential effects induced by AF, was not different between groups; mean values are pre-
sented (Table 2). Two statements not related to steroid use were evaluated. The statements-l) AS result in improved endurance and 2) AS cause kidney diseas-had pre-intervention Likert scale scores r SEM of 6.1 + 0.2 and 6.4 + 0.2, respectively. There was no significant change postintervention. Significant Likert score knowledge changes OCcurriztg after the education program!; are shown in Figure 1. The oral presentation combined with the distribution of the written education material (group I) enhanced scores on six steroid effects as compared with controls. Distribution of the handout alone (group II) altered Likert scale scores concerning the
212
GOLDBERGET AL
JOURNAL OF ADOLESCENTHEALTH CARE Vol. 11, No. 3
Table 2. Mean L,ikert Score Before and After Intervention” Group 1 (n=36): lecture + handout
1. 2. 3. 4. 5. 6. 7. 8.
Steroids cause: Growth stunting Heart disease Gynecomastia Elevated blood pressure Increased size Increased weight Increased strength Increased confidence
Group 2 (n = 49): handout
Group 3 (n = 20); control
Before
After
Before
After
Before
After
5.8 6.4 7.1 7.0 8.0 7.9 8.4 5.5
7.9
5.4 6.5 6.0 7.0 7.3 7.0 7.1 6.6
6.1 7.4 7.0 7.3 8.1 8.2 7.4 6.7
5.3 5.9 7.1 7.5 8.1 8.0 8.3 5.0
5.3 6.0 6.5 6.4 7.3 7.8 6.6 4.8
7.7 8.7 7.8 7.6 7.0 7.1 6.6
“No changes were significant
risks of AS use compared to controls (group III) in three areas. The lecture and handout program (group I) resulted in improvement in scores for two adverse effects as compared to the “handout only” intervention (group II). Although all groups had higher mean values on the three attitude questions, the intervention group scores were not different from controls, before or after the ACSM presentation (Table 3).
Discussion Anabolic steroids are used at all levels of athletic activity [11,13,15,16]. However, the prevalence has been difficult to accurately assess, especially among high school athletes. In 1934, it was reported to the National College Athletic Association that more than 50% of college athletes who used AS said they began taking them in high Figure 1. Likert scale scare of knowledge changes + SEA4after education inktventions for group I (lecture and handout), group 11(handout only) and gmup Ill (omtml). * pqO.05, **p-zO.005,***p
Effect of an An olic Steroi Program on Knowledge and Attitu High School Football Players LINN
GOLDBERG,
M.D.,
LOUIS TREVISAN,
M. D.
ERIC E. BOSWORTH,
Six varsity high schocalfootball teams were assessed by confidential questionnaire regarding anabolic steroids, before and 2 weeks after an education intervention. The education program used the American College of Sports Medicine’s position on the “use of anabolic androgenic steroids in sports. ” Two teams received a lecture and a four-page handout, two teams were given the handout only, and two teams were controls. Selfreport of current use was 1.1% but 38.8% claimed availability of these agents. Although increased awareness of the adverse effects of anabolic steroid was found after the education program, no differences in attitudes toward the use of anabolic steroids occurred as compared to controls. Strategies designed to dissuade adolescent athletes from considering these drugs
need to be developed. RBY WORDS
Adolescent athletes Anabolic steroids
Anabolic steroid (AS) use was introduced to competitive athletics in the early 1950s [l]. Various oral and parenteral synthetic agents have been developed because of the rapid degradation of exogenously administered testosterone [2,3]. Although there are legitimate medical uses for these drugs From theHuman Perfornmce L&oratory, Division of GeneralMedicine. School of Medicine, Oregon Health Sciences University, Portland, Oregon. Address reprint requests to: Linu Goldberg, M.D., L47.5. Oregon Health Sciences University, 3181 SW Sam lackson Park Road, Portland, OR 97201. Manuscript accepted August 29, 1989.
M.D.,
o
fiblished
by Elsevier
AND
[4,5], they are also used in sports because of their potential to enhance muscle strength [6,7]. Serious medical and psychologic complications may be associated with the use of anabolic steroids [8,9]. Despite existing sanctions [lo], athletes continue to use these agents [ll]. Reports of their use by high school athletes is a more recent phenomena [12,13]. Adolescent attitudes and knowledge of potential benefits and risks associated with anabolic steroids have not previously been assessed. The American Medical Association Council on Scientific Affairs suggests that education should be considered because of the known abuse of these drugs by athletes [14]. The “potential” teaching strategies include 1) “preparation and drstribution of education pamphlets on drug abuse in athletes, emphasizing the adverse effects and limited benefits of such use” and 2) presentations by health care, professional:: who would be available to discuss the consequences of these agents. The effect of this form of education intervention directed toward high school athletes has not been evaluated. The American College of Sports Medicine’s (ACSM) position on the use of anabolic androgenic steroids in sports is a compilation of previous and current research concerning AS [ 151. The ACSM review discusses the potential benefits to the athlete, such as increased strength and muscle size, as well as the adverse effects, including an increased risk for premature cardiovascular disease, sterility, early epiphyseal closure, and potential psychological changes. The purpose of our investigation was twofold: I) to measure AS use and availability among Portland,
210 01974lIm9o/3.50
ROBERT T. BENTS,
Science Publishing
LINN GOLDBERG, M.D., 1990 Co., Inc., 655 Avenue of the Americas, New York, NY 10010
May 1990
ANABOLIC STEROID EDUCATION AND ADOLESCENT ATHLETES
Table 1. W-Education Knowledge Scan (All Groups Combined)
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Knowledge statement
Likert scale score k SEM (pre-test)
Steroids can cause: Acne Aggressive behavior Blood pressure elevation Certain cancers Cholesterol elevation Growth stunting Gynecomastia Heart disease Increased size Increased weight Liver damage Qerility Strength increase
4.220.2 6.6-cO.3 7.O-cO.2 5.7kO.4 5.420.2 5.6~0.3 7.120.2 6.3kO.3 7.920.2 7.920.2 5.820.2 6.4kO.3 8.4-cO.2
n = 105. Liiert score: 0 = strongly disagree; 10 = strongly agree.
Oregon varsity high school football players and 2) to compare changes in knowledge and attitudes concerning AS among these athletes before and after an education intervention.
211
lay terms with slides, reflecting the ACSM position. This was followed by a brief question an6 answer session. Group I participants also received a four-page, typewritten handout summariig the ACSM position in lay language. Group I1 (two teams) received the education handout only. Group III (two teams) participants were used as controls and did not receive either oral or written information during the study. All teams were informed that a follow-up questionnaire wculd be distributed to them in 2 weeks. They were retested using an identical questionnaire. Intergroup comparisons were assessed by AIUOVA. Significant score changes were compared by Bonferroni analysis.
Results
One hundred-ninety athletes, mean dge fi SD 17 + 1 years, completed the initial questionnaire before the education intervention. Respondents reported 38.8% availability of AS, although 1.1% (two students) claimed current use of AS.
Methods Six varsity high school football teams were assessed.
Pre- to Post-Intervention
Results
They were randomly assigned to three groups. Before any intervention, a confidential questionnaire was distributed to all athletes. The initial portion of the questionnaire included inquiries about availability and use of anabolic steroids. The second part dealt with knowledge and attitude assessment. It consisted of a Likert (visual analog) scale (0. . . strongly disagree to 10. . . strongly agree). Thirteen questions included the effect of AS on increasing muscle size and weight, as well as their potential to result in sterility, growth stunting, acne, heart disease, and other known adverse effects (Table 1). Two questions were included that dealt with consequences not attributabje to steroid use: 1) AS use results in kidney disease and 2) AS improves endurance (aerobic) capacity. The attitude statements that were used considered the use of AS if 1) AS could assist in obtaining a college athletic scholarship or 2) a professional sports contract, and whether 3) the student athlete would consider using AS steroids even if there was a 50% chance of his being killed by them in 20 to 30 years. Of the three groups assessed, group I (two teams) received a 20-minute oral Bresentation in
Although nearly all athletes completed the followup questionnaire, because of confidentiality, only 105 matched pairs of pre- to post-intc:rvention questionnaires could be clearly identified. II&al knowledge scores (Likert scale of agreemerrf) are shown in Table 1. Similar responses regardirzg the effects of AS were present between the three groups before presentation of the ACSM pcsition. After the education interventions, knowledge of 7 of the 13 potential effects induced by AF, was not different between groups; mean values are pre-
sented (Table 2). Two statements not related to steroid use were evaluated. The statements-l) AS result in improved endurance and 2) AS cause kidney diseas-had pre-intervention Likert scale scores r SEM of 6.1 + 0.2 and 6.4 + 0.2, respectively. There was no significant change postintervention. Significant Likert score knowledge changes OCcurriztg after the education program!; are shown in Figure 1. The oral presentation combined with the distribution of the written education material (group I) enhanced scores on six steroid effects as compared with controls. Distribution of the handout alone (group II) altered Likert scale scores concerning the
212
GOLDBERGET AL
JOURNAL OF ADOLESCENTHEALTH CARE Vol. 11, No. 3
Table 2. Mean L,ikert Score Before and After Intervention” Group 1 (n=36): lecture + handout
1. 2. 3. 4. 5. 6. 7. 8.
Steroids cause: Growth stunting Heart disease Gynecomastia Elevated blood pressure Increased size Increased weight Increased strength Increased confidence
Group 2 (n = 49): handout
Group 3 (n = 20); control
Before
After
Before
After
Before
After
5.8 6.4 7.1 7.0 8.0 7.9 8.4 5.5
7.9
5.4 6.5 6.0 7.0 7.3 7.0 7.1 6.6
6.1 7.4 7.0 7.3 8.1 8.2 7.4 6.7
5.3 5.9 7.1 7.5 8.1 8.0 8.3 5.0
5.3 6.0 6.5 6.4 7.3 7.8 6.6 4.8
7.7 8.7 7.8 7.6 7.0 7.1 6.6
“No changes were significant
risks of AS use compared to controls (group III) in three areas. The lecture and handout program (group I) resulted in improvement in scores for two adverse effects as compared to the “handout only” intervention (group II). Although all groups had higher mean values on the three attitude questions, the intervention group scores were not different from controls, before or after the ACSM presentation (Table 3).
Discussion Anabolic steroids are used at all levels of athletic activity [11,13,15,16]. However, the prevalence has been difficult to accurately assess, especially among high school athletes. In 1934, it was reported to the National College Athletic Association that more than 50% of college athletes who used AS said they began taking them in high Figure 1. Likert scale scare of knowledge changes + SEA4after education inktventions for group I (lecture and handout), group 11(handout only) and gmup Ill (omtml). * pqO.05, **p-zO.005,***p
