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Background: Concurrent use of e-cigarettes, cigarettes, and cannabis is common among adolescents, while illicit anabolic-androgenic steroid (AAS) use has recently been on the rise. Today, no known research has investigated the patterns of concurrent substance use and AAS use among adolescents in the United States., Objective: To determine the association between concurrent lifetime use of e-cigarettes, cigarettes, and cannabis and illicit AAS use among adolescents., Methods: Cross-sectional data from the 2019 Youth Risk Behavior Survey ( N  = 13,677) were analyzed in 2021. Four mutually exclusive categories of concurrent substance use (no use, any single use, any dual use, and triple use) were constructed, along with any lifetime AAS use. One logistic regression model was estimated to determine the association between concurrent substance use and lifetime AAS use., Results: Compared to no use, lifetime triple use (adjusted odds ratio 3.95, 95% confidence interval 1.73-8.95) was associated with lifetime AAS use while adjusting for potential confounders., Conclusions: Findings underscore an overlapping pattern of problematic substance use that may be harmful for adolescents. Health care professionals should be aware of these patterns to improve substance use assessment protocols.

The author argues that drug testing of U.S. high school students for performance-enhancing substance misuse is invasive, expensive, and the low number of positive test results do not justify the costs, especially in financially strapped school districts where this money would be better spent on injury prevention for athletes and the education of all students.

Previous research has revealed a significant bivariate relationship between anabolic-androgenic steroid (AAS) use and reduced condom use among adolescent boys. However, to date, no known studies have explored the psychological mechanisms that may explain this relationship. Thus, the current study sought to examine two possible mediators in the association between AAS and condom use: depressive symptoms and substance use. Data were extracted from a nationally representative sample of U.S. adolescents. Participants were 3,780 U.S. high school boys who responded to self-report items assessing a number of health behaviors, including symptoms of depression, substance use, AAS use, and use of condoms during their most recent act of intercourse. Both depression and substance use were significant mediators in the relationship between AAS and condom use. However, when these effects were contrasted, the indirect effect of substance use was significantly stronger in magnitude than the effect of depression. Although AAS use was associated with sexual risk behaviors among adolescent boys, significant variance in this relationship was accounted for by elevated levels of depression and substance use, with substance use demonstrating a particularly salient pathway.

This study assessed the prevalence, trends, and student- and college-level characteristics associated with the non-medical use of anabolic steroids (NMAS) among U.S. college students. Data were collected through self-administered mail surveys, from 15,282, 14,428, 13,953, and 10,904 randomly selected college students at the same 119 nationally representative colleges in 1993, 1997, 1999 and 2001, respectively. The prevalence of lifetime, past-year and past-month NMAS was 1% or less and generally did not change significantly between 1993 and 2001, with one exception: past-year NMAS increased significantly among men from 1993 (0.36%) to 2001 (0.90%). 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 1993 and 2001, 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.

Adolescents may regard the use of performance-enhancing substances as an easy means to gain self-esteem through improved body appearance and athletic performance. The use of performance-enhancing substances by adolescents is particularly troubling because safety data are largely lacking. This poses a dilemma for the pediatrician who needs correct information, including the potential efficacy and negative health effects of such substances, to identify the patients in need of counseling and to find the best way to help adolescent patients make informed decisions to promote healthy behaviors. This article is intended to assist pediatricians by providing a summary of the current state of knowledge regarding the prevalence of use of performance-enhancing substances by United States adolescents.

Objective: To determine the characteristics of female US high school students reporting anabolic steroid use., Design: Cross-sectional assessment using the 2003 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey database., Setting: Nationally representative sample of US high schools., Participants: Female students in grades 9 through 12 (n = 7544)., Main Outcome Measures: Participants' self-reported anabolic steroid use was compared with other health-related behaviors and with sports participation., Results: Prior or ongoing anabolic steroid use was reported by 5.3% of female high school students. Those adolescent girls had a marked increase in other health-compromising behaviors, including past 30-day use of alcohol (odds ratio [OR], 8.83; 95% confidence interval [CI], 5.49-14.20]), cigarettes (OR, 5.14; 95% CI, 3.14-8.42), marijuana (OR, 7.91; 95% CI, 5.20-12.04), cocaine (OR, 10.78; 95% CI, 6.18-18.81), and diet pills (OR, 4.86; 95% CI, 2.98-7.93). They were more likely to carry a weapon (OR, 7.54; 95% CI, 4.83-11.76), have had sexual intercourse before age 13 years (OR, 2.90; 95% CI, 1.58-5.33), and have had feelings of sadness or hopelessness almost every day for at least 2 consecutive weeks (OR, 4.13; 95% CI, 2.57-7.22). They were less likely to play school-sponsored team sports (OR, 0.52; 95% CI 0.34-0.80). Steroid users participating in sports shared the same problem behaviors as steroid users not participating in team athletics., Conclusion: Self-reported anabolic steroid use is not confined to adolescent girls in competitive athletics and is an indicator of adolescent girls with a marked increase in a cluster of other health-harming behaviors.

Objective: We examined the prevalence, persistence, secular and longitudinal trends, and predictors of steroid use in a diverse sample of adolescents., Participants and Methods: Data are from Project EAT-II (Eating Among Teens), a 5-year longitudinal study of eating, activity, weight, and related variables in 2516 middle and high school students. Data were collected in 1999 (time 1) and 2004 (time 2)., Results: Approximately 1.5% of adolescents reported steroid use at time 2. Use differed by ethnicity but not socioeconomic status. Steroid use was not stable across time, although the risk of use at time 2 was higher for girls and (marginally) for boys who used steroids at time 1. No secular trends were noted in middle adolescents' steroid use between 1999 and 2004. Developmentally, steroid use decreased as adolescents grew older. Predictors of use for male adolescents included wanting to weigh more and reporting higher use of healthy weight-control behaviors. Female time 2 steroid users had higher BMIs and were less satisfied with their weight, had poorer nutrition knowledge and concern for health, and were marginally more likely to have participated in weight-related sports at time 1., Conclusions: The prevalence of steroid use in adolescents was low but of concern. Although use was not persistent over 5 years, time 1 use was a risk factor for time 2 use in female adolescents. There was no change in the prevalence of steroid use by middle adolescents between 1999 and 2004 despite a great deal of public interest in steroids during this time period. Steroid use decreased as adolescents grew older. Weight-related variables predicted adolescents' steroid use 5 years later, and health and nutrition knowledge and concern and (marginally) participation in weight-related sports further predicted use in female adolescents. These findings suggest that early preventive efforts may be most useful.

This article examines the processes by which the Anabolic Steroid Control Act of 2004, an act that added steroid precursors such as androstenedione to the list of Schedule III Controlled Substances in the United States, came to pass in both the House of Representatives and the Senate. Grounded theoretically in political economy, the article addresses, in the abstract, how the interplay of political pressures and economic influences stands to affect the actions of public officials, and how "tougher" drug policies-those touted to be more substantive and efficacious than existing regulations-often fail to effect change. The article concludes with implications for those involved in the regulation of anabolic steroids and steroid precursors.

Athletes use substances to produce pleasure, relieve pain and stress, improve socialization, recover from injury, and enhance performance. Therefore, they use some substances in substantially higher rates that nonathletes. Despite these higher rates of use, rates of addiction may in fact be lower in athletes. This article reviews the prevalence and patterns of use, health and performance effects, and preventive and treatment interventions for alcohol, tobacco, stimulants, and steroids. Each substance is considered from the differing perspectives of abuse/addiction and performance enhancement models. Similarities and differences between college and professional athletes are discussed. Finally, suggestions for future research are made.

Performance-enhancing substances include dietary supplements, prescription medications, and illicit drugs. Virtually no data are available on the efficacy and safety in children and adolescents of widely used performance-enhancing substances. This statement is intended to provide a generalized but functional definition of performance-enhancing substances. The American Academy of Pediatrics strongly condemns the use of performance-enhancing substances and vigorously endorses efforts to eliminate their use among children and adolescents.

Abuse of anabolic-androgenic steroids (AAS) is reportedly increasing in prevalence and spreading from sportsmen to cosmetic and recreational use, though there are few accurate estimates of the extent of AAS use outside North America. In order to identify the prevalence of, and risk factors for, 'ever' (lifetime) or 'recent' (within last month) use of AAS among Australian high school students, 13,355 students (51.3% male, median age 13.8 years) in 203 schools constituting a stratified random sample of all high schools in New South Wales and Victoria completed a self-report questionnaire about drug use. Lifetime ('ever') use of AAS was reported by 213 boys (3.2%; 95% CI, 2.7-3.6%) and 74 girls (1.2%; 95% CI, 0.9-1.5%). Factors associated with 'ever' use were truancy [odds ratio (OR) 17.7 (95% CI, 9.4-31.6) for 7 or more truant days compared with no trauncy over the last fortnight], unsupervised recreation [OR 8.4 (5.9-11.9) for 6 or more compared with 2 or fewer nights per week], speaking only a non-English language at home [OR 7.75 (4.4-13.1)], Aboriginality [OR 3.4 (2.0-5.5)], male gender [OR 2.8 (2.1-3.7)], higher student income [OR 2.3 (1.7-3.0)], overseas born [OR 2.2 (1.6-3.0)] and low level of social support [OR 2.5 (1.7-3.5)]. Use of AAS within the last month ('recent') was reported by 113 boys (1.7%; 95% CI, 1.4-2.0%) and 28 girls (0.4%; 95% CI, 0.3-0.6%) and virtually identical risk factor patterns except ORs were uniformly higher. We conclude that AAS abuse is relatively uncommon among Australian high school students but has distinctive and strong socio-economic and cultural predictors. Further studies of the behavioural epidemiology of AAS abuse are required to clarify the origins and significance of our findings and to identify potentially effective interventions.

Theories related to planned behavior and reasoned action have included an individual's attitude as an important factor in the formation of behavioral intentions and behaviors. Research on this topic suggests that salient beliefs affect intentions and subsequent behaviors, either through attitudes or subjective norms, or the degree of (perceived) control that an individual feels he/she has over the behavior. This study was designed to examine the relative importance of selected attitude variables in describing a profile of athletes who were at risk for using anabolic steroids, human grown hormone, amphetamines, cocaine, and marijuana. Responses from 563 student athletes at two Division One NCAA universities were used in the study. The results of this study suggest that subjective norms, based on the influence of drug testing, peer influence, and a fear of detection are significant factors that influence the decisions of student athletes related to using banned substances. In this article characteristics of at-risk athletes are presented with recommendations for drug education programs for student athletes.

Androgenic-anabolic steroid use is a significant problem among young people. The abuse of steroids may cause significant medical problems. Adolescent steroid users have also been found to be more likely than non-users to be engaging in other high risk behaviours including multiple drug use, cigarette and smokeless tobacco use, suicidal behaviours, high risk sexual behaviours, carrying a weapon, and fighting behaviours. It is critical that clinicians and athletic coaches and trainers are aware of these associations in order to more carefully screen and advise adolescents for health risk behaviours.

The extremely low prevalence of steroid use among college students makes it virtually impossible to conduct analyses on any single college campus. By studying a cohort of 58,625 college students from 78 institutions that administered the Core Alcohol and Drug Survey in 1990 and 1991, a critical mass of 175 users on which it was possible to conduct statistical analyses was identified. Compared with a randomly selected group of nonusers, the steroid users reported consuming dramatically more alcohol and demonstrated higher rates of binge drinking. In addition, a significantly higher percentage of steroid users reported using tobacco, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opiates, inhalants, and designer drugs. A higher percentage of steroid users than nonusers also reported experiencing negative consequences as a result of substance abuse, and a greater percentage of the steroid users reported family histories of abuse of alcohol and other drugs. Implications from the standpoint of student development are discussed.

This cross-sectional survey study examined body image, dieting and exercise variables, and steroid use in 2,088 high-school graduates aged 18 years. In contrast to women, more men wished to gain (46%) rather than loose weight (32%). Men who wished to gain weight were more satisfied with their body shape, showed no fear of fatness, and dieted and exercised less frequently than did men who wished to lose weight. The prevalence of dieting was low (4%), even among men who wished to lose weight (9%), and physical exercise was more likely to be used for both weight loss and weight gain. Contrary to expectations, anabolic steroid use was rare (0.6%) and was not associated with a desire for weight gain. Steroid users were more likely to engage in running and swimming than football. The data did not support the notion that anabolic steroid use is widespread among high-school males.

An examination of the heights and weights of members of the Parade Magazine's High School All-American Football Teams from 1963-1971 indicates no significant changes in the Body Mass Index of these elite athletes whereas an increased pattern in Body Mass Index was noted within this group from 1972-1989. The large increases in Body Mass Index after 1971 among the All-American high school football players raise interesting research questions; in particular, what portion of these gains can be attributed to improved nutrition and training techniques and what portion is the result of use of performance enhancing drugs such as anabolic steroids?

Background: Increasing illicit use of anabolic steroids in adolescent and young adult populations has been reported. To determine the scope of this problem and its relationship to psychoactive substance abuse, we evaluated the prevalence of anabolic steroid use among individuals seeking inpatient treatment for substance abuse., Method: A randomized mail survey of 175 inpatient substance abuse treatment directors elicited information regarding the prevalence of anabolic steroid use for inpatients treated in 1989 and the first half of 1990. Additionally, directors were surveyed for experience with DSM-III-R psychoactive substance dependence criteria for anabolic steroid use., Results: Only 19% of centers responding had treated at least one individual using anabolic steroids. Facilities encountering anabolic steroid users reported a prevalence of less than 1% among all admissions. Anabolic steroid users were seen more commonly in privately funded facilities. Directors reported a majority of anabolic steroid users had at least three DSM-III-R psychoactive substance dependence criteria for anabolic steroid use. Treatment directors rarely found anabolic steroid use acknowledged as a problem by users and rarely found anabolic steroid use a primary reason for treatment., Conclusion: Users of illicit anabolic steroids may have significant clinical differences compared with users of other psychoactive substances of abuse and dependence.

A survey carried out in 1970, 1973, 1976, 1980 and 1984 by means of a questionnaire at five American universities, which involved a total of 4,171 students, showed an increase in the use of cocaine, cannabis, hallucinogens, sedatives, amphetamines and alcohol. Cocaine use increased from 2.7 per cent in 1970 to 30 per cent in 1984, while cannabis use almost doubled during that period. The survey found that intercollegiate athletes used significantly more anabolic steroids than non-athletes, but with regard to the use of other substances the athletic students did not differ significantly from non-athletic students.

Use of androgenic-anabolic steroids is increasing in the adolescent population. Information necessary for the health care professional to deal effectively with this problem is reviewed. Clinical effects, both positive and negative, as well as methods for recognition of the androgen-anabolic steroid user, are presented. Discussion of various forms of intervention is included.

Recent proposals to punish athletes for taking drugs or to impose mandatory drug testing cannot be defended in ethical terms. Nor is it possible to distinguish consistently between ethical and unethical uses of restorative drugs, additive drugs, painkillers, and recreational drugs. We oppose drugs in sports because they violate the majority notion of acceptable behavior. But such opposition has more to do with defending the ideals of the community than with creating policies that are ethically sound.

Self-medication with anabolic steroids by athletes, particularly in the sports of weight lifting and track and field, has become increasingly popular. In the 1983 Pan American Games, 15 athletes were disqualified for taking anabolic steroids. Athletes take steroids believing the steroids will allow increased periods of intensive training and will increase muscle strength with proper weight training. The athletes assume this increased strength and training will translate into better athletic performance. Most athletes taking anabolic steroids are taking very large doses with no thought as to the potential adverse side effects. They ignore the possibility of long-term problems relating to hypertension, liver dysfunction, and atherosclerosis for what they see as the immediate performance benefits. In an attempt to keep sports competition "clean" and to help protect athletes from harmful drugs, the International Olympic Committee (IOC) and the United States Olympic Committee have rules stating that the use of anabolic steroids is illegal. Drug testing is performed in Olympic and in many international competitions. Those people found using anabolic steroids are disqualified. This use of anabolic steroids indicates that for some athletes the need to win or to maximize performance supersedes any worries about future health.

The use of anabolic-androgenic steroids (AS) is perceived by the media, by segments of the sports medicine and athletic communities, and by the public to have grown to epidemic proportions. Unfortunately, the incidence and prevalence of AS use among elite, amateur, and recreational athletes is poorly documented. This study was designed to help identify AS use patterns among the male portion of the general adolescent population. The overall participation rate on a schoolwide basis was 68.7% and on an individual basis reached 50.3%. Participants in this investigation were 12th-grade male students (N = 3403) in 46 private and public high schools across the nation who completed a questionnaire that established current or previous use of AS as well as user and nonuser characteristics. Results indicate that 6.6% of 12th grade male students use or have used AS and that over two thirds of the user group initiated use when they were 16 years of age or younger. Approximately 21% of users reported that a health professional was their primary source. The evidence indicates that educational intervention strategies should begin as early as junior high school; the intervention should not be directed only toward those individuals who participate in school-based athletics.