Trends in Anabolic-Androgenic Steroid Use Among AdolescentsThis study assessed the prevalence, trends, and student- and college-level characteristics associated with the non-medical use of anabolic steroids NMAS among U. Data were collected through self-administered mail surveys, from anabolic steroid trends, 14, 13, and 10, randomly selected college students steroid hormones are synthesized from the same nationally representative colleges in, andrespectively. Multiple logistic regression analyses revealed that lifetime and past-year NMAS were associated with student-level characteristics such as being male and participation in intercollegiate athletics. Lifetime and past-year NMAS were stroid positively associated with several risky behaviors, including cigarette smoking, illicit drug use, drinking and driving, and DSM-IV alcohol use disorders. Nearly 7 out of every 10 lifetime non-medical users of anabolic steroids met past-year criteria for a DSM-IV anabollc use disorder. Although the overall prevalence of NMAS remained low between andfindings suggest that continued monitoring is necessary because male student-athletes are at heightened risk for NMAS and this behavior anabolic steroid trends associated with a wide range of risky health behaviors. The anabolic steroid trends associated with NMAS have important implications for future practice and research.
Trends in Anabolic-Androgenic Steroid Use Among Adolescents | JAMA Pediatrics | JAMA Network
This study assessed the prevalence, trends, and student- and college-level characteristics associated with the non-medical use of anabolic steroids NMAS among U.
Data were collected through self-administered mail surveys, from 15,, 14,, 13,, and 10, randomly selected college students at the same nationally representative colleges in , , and , respectively.
Multiple logistic regression analyses revealed that lifetime and past-year NMAS were associated with student-level characteristics such as being male and participation in intercollegiate athletics.
Lifetime and past-year NMAS were also positively associated with several risky behaviors, including cigarette smoking, illicit drug use, drinking and driving, and DSM-IV alcohol use disorders.
Nearly 7 out of every 10 lifetime non-medical users of anabolic steroids met past-year criteria for a DSM-IV alcohol use disorder. Although the overall prevalence of NMAS remained low between and , findings suggest that continued monitoring is necessary because male student-athletes are at heightened risk for NMAS and this behavior is associated with a wide range of risky health behaviors.
The characteristics associated with NMAS have important implications for future practice and research. Anabolic—androgenic steroids, including synthetic testosterone, are controlled substances that have selected therapeutic uses such as treating male hypogonadism Bhasin et al. Anabolic—androgenic steroids also have been used in clinical research trials for muscle wasting and weight loss due to chronic diseases Johns et al.
The non-medical use of anabolic steroids NMAS is most prevalent among adolescents and young adults in the U. NMAS among adolescents and young adults is also documented in several other countries Melia et al. Although NMAS has been associated with adverse health effects on the liver, reproductive, musculoskeletal, cardiovascular, and psychological systems Bahrke and Yesalis, ; Hartgens and Kuipers, ; Pope and Brower, ; Thiblin and Petersson, , U.
Studies over the past three decades have reported a wide variation in the lifetime prevalence of NMAS among U. Yesalis reviewed college-based studies conducted before and found higher prevalence rates of NMAS than investigations conducted in the mid-to-late s and s.
The lower prevalence rates in recent studies could be the result of actual decreases in NMAS or methodological limitations, including non-random sampling, small homogeneous samples and low response rates. Although recent national studies have improved methodology, there remains a limited understanding regarding the trends and correlates associated with NMAS among U.
According to previous college-based investigations, individual characteristics associated with NMAS include male gender and intercollegiate athletic participation Berning et al.
NMAS is also associated with substance use, poor academic performance and other problem behaviors among adolescents and college students DuRant et al. Despite the evidence for higher rates of substance use, there remains limited information regarding the association between NMAS, substance use disorders based on DSM-IV criteria, and other adverse health outcomes to test whether NMAS is part of a larger cluster of problem behaviors Biglan et al.
Most evidence indicates that intercollegiate student-athletes are more likely than non-athletes to use anabolic steroids for non-medical purposes Dezelsky et al. To date, there have been no nationally representative studies comparing intercollegiate student-athletes and other college students.
Few studies have examined the association between college-level characteristics and NMAS. At least three national studies in the U. More research is needed to examine possible college-level characteristics associated with NMAS.
The main objective of this study was to assess the prevalence, trends, and student- and college-level characteristics associated with NMAS among U. The present study used data from four-year U.
Student responses to the survey were voluntary and anonymous, and students were told that they did not have to answer any question that made them uncomfortable.
There were no statistically significant associations between response rates and the estimated month or lifetime prevalence rates of NMAS at the college level in any of the four study years. We also incorporated sampling weights adjusting for non-response in all statistical analyses. Additional information regarding sampling methods, inclusion criteria, and weighting for the CAS are described in more detail elsewhere e.
Nonmedical use of anabolic steroids NMAS was measured with the following item: The response scale was 1 never used to 4 used in the past 30 days. In , a list of examples was also included as follows: Responses to this item were coded into a binary indicator of any participation in intercollegiate athletics in each study year. Binge drinking was defined as the consumption of at least five drinks in a row for men and at least four drinks in a row for women during the 2 weeks preceding completion of the questionnaire, and frequent binge drinking was defined as having three or more binge drinking episodes in the past 2 weeks Wechsler et al.
Drinking and driving behaviors were measured with the following item: Age of first intoxication was measured with the following item: Mental health was assessed in and using a five-item subscale of the Short Form 36 SF that provides an indication but not diagnosis of depression Ware et al.
Consistent with previous research Weitzman, , a score of on the SF was considered the best mental health and 0 was considered the worst mental health, with scores between 0 and 38 considered to have clinical significance. Sampling weights were applied to the student-level data to make sure that estimates at a given school reflected the baseline demographic composition of full-time students at the school in terms of gender, race and age.
Statistical analyses accounting for the clustered designs were performed using the SAS statistical software package Release 9. A Taylor Series Linearization approach e. Hierarchical generalized linear models HGLMs that provide robust standard error estimates based on multilevel and clustered sampling designs and incorporate sampling weights were fitted using the HLM software package Raudenbush et al. To examine the changing prevalence rates of NMAS over time, both overall and for the male and female subpopulations, we first estimated weighted prevalence rates for each sample year, in addition to design-based standard errors for the estimated rates.
The estimated lifetime, past-year, and past-month prevalence rates of NMAS were compared between , , and using multiple pair-wise comparisons Altman and Bland, A Bonferroni correction was applied to reduce the likelihood of making a Type I error when performing the multiple comparisons e.
In addition to pairwise comparisons, linear trends in the prevalence of each type of NMAS were evaluated both overall and separately by gender using logistic regression adjusting for the clustering of students by year within the sampled schools. Based on the investigative nature of this study and previous research that has examined correlates associated with NMAS among college students, we considered the following student-level characteristics as predictors: The models also considered the following college-level characteristics: Ninety-five percent confidence intervals CI were calculated in HLM for the adjusted odds ratios AORs associated with one-unit changes in the predictors.
The mean age of each sample was approximately 21 years old. Although there was some slight variation between the study years, the CAS samples tended to be nationally representative cross-sections of students enrolled at 4-year colleges in the U. Department of Education, , The estimated lifetime prevalence rate of NMAS was approximately 1. Based on multiple pair-wise comparisons, there were no significant differences in the rates, with the exception of the increase in past-year NMAS between and Prevalence and trends in non-medical use of anabolic steroids among U.
College students who played or participated in intercollegiate athletics had increased odds as compared to non-athletes of reporting lifetime NMAS in all four survey years AORs ranged from 1. Married students had higher odds of reporting lifetime NMAS as compared to students who were never married in and Finally, students older than 23 years of age had greater odds of lifetime NMAS as compared to students under 21 years of age in and Multivariate HGLM analyses of lifetime non-medical use of anabolic steroids weighted estimates.
Many of the same associations were present for past-year NMAS. Age was not associated with past-year NMAS. Lifetime NMAS was significantly more prevalent at commuter colleges and , but urbanicity, geographical region, size of student enrollment, NCAA athletic division, admission criteria and type of college public versus private were not associated with either lifetime or past-year NMAS in at least two years.
Finally, we found no consistent associations of college-level factors in the models predicting past-year NMAS. Lifetime NMAS was significantly associated with cigarette smoking, binge drinking, marijuana use, other illicit drug use, DSM-IV alcohol use disorders and other risky health behaviors Table 3.
Associations between lifetime non-medical use of anabolic steroids and other risky behaviors, weighted estimates. These same associations held true for past-year NMAS. Finally, the results presented in Table 3 are primarily from the survey only, but similar associations were observed in previous survey years , , and These findings are consistent with other national studies of U.
The present study found that approximately 20 in every college men and about 2 in every college women reported NMAS in their lifetime.
While the lower prevalence rates in the present study could be the result of actual differences in NMAS between high school and college students, some of the differences could be attributed to methodological factors such as survey mode effects, non-random sampling, differences in question wording, and response rates Fendrich and Johnson, There are also important developmental differences and selection effects between high school and college student populations.
For example, high school students who do not intend to complete college report considerably higher rates of NMAS than individuals who intend to complete college Johnston et al. Our findings were consistent with previous investigations which found increased risk for NMAS among men Johnston et al. The present study provides new evidence that lifetime and past-year NMAS is higher among married college students.
This finding deserves more attention in future research because marriage is typically protective against most forms of substance abuse Bachman et al. The multivariate findings also add a new dimension because college-level characteristics were examined and were not found to be significantly associated with NMAS, with the exception of commuter status. The findings of the present study were consistent with past studies demonstrating that intercollegiate student-athletes were more likely to report NMAS than non-athletes Dezelsky et al.
Indeed, the respective prevalence rates of lifetime and past-year NMAS were about 3. If the results from the present study were extrapolated to the total population of , NCAA male student-athletes in NCAA, c , more than male student-athletes used anabolic steroids for non-medical purposes in their lifetime and male student-athletes did so in the past 12 months.
The higher prevalence rate among student-athletes could be motivated by a desire to improve athletic performance and treat sports injuries NCAA, We found that non-medical steroid users were more likely to engage in other substance use, abuse, and risky health behaviors. These findings complement evidence that adolescent and collegiate anabolic steroid users are more likely to use alcohol and other drugs in the U. First, the study featured data from four large nationally representative samples of students attending four-year colleges and universities.
The large sample sizes allowed for in-depth and multivariate analyses of several individual-level and college-level characteristics. Second, the study included clinically relevant substance abuse and other health measures e. Third, the study examined prevalence rates by lifetime, past-year, and past-month timeframes. Lifetime prevalence of NMAS is especially relevant because some of the gains in muscle size and strength that motivate athletes to use are initially attainable only with NMAS, but sustainable in part with rigorous training alone Yesalis et al.
The present study also had some limitations. First, the survey did not assess the frequency, duration, or quantity of anabolic steroid use, which is limiting because adverse effects are most likely to occur with prolonged, high-dose use Thiblin and Petersson, Second, the low prevalence rates limited some statistical analyses, such as comparing NMAS across individual college campuses.
Third, the study relied solely on self-reported substance use. Although self-report for substance use is generally valid when special conditions such as anonymity are operative, validity of self-report specifically for NMAS is poorly studied Yesalis et al.
Furthermore, non-response may have introduced bias. We tried to minimize this impact by incorporating sampling weights in the statistical analyses to ensure that the demographic distribution of the sample was roughly equivalent to the total student population. Finally, because the sample consisted of full-time students attending 4-year U. The findings of the present study have implications for clinical work and prevention efforts.
Thus, detection of NMAS may be more difficult, expertise among health professionals may be comparatively lacking, and the priority of NMAS as a college health concern may be minimized. Given that steroid use disproportionately impacts student-athletes, intercollegiate student athletic programs may be best poised to impact the problem NCAA, a , b.