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Fortifying students against steroid use

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 12 - DECEMBER 96


The antisteroid message can be a tough sell among high school football players, but researchers in Oregon are getting promising results with a new approach that involves peer counseling, strength training, and sports nutrition education. Positive results from the first year of the Adolescents Training and Learning to Avoid Steroids (ATLAS) program were scheduled to be reported in the November 20 Journal of the American Medical Association (1). The JAMA report confirms the group's preliminary findings (2).

The study included 1,506 football players from 31 high schools—802 in the experimental group and 704 in the control group. The ATLAS program consists of seven weekly 50-minute classroom sessions led by coaches and player team leaders and eight weight-room sessions led by research staff. Classroom topics include nutrition, strength training, drug-refusal role playing, creation of media campaigns, and antisteroid information.

In the experimental group, the ATLAS program positively influenced 77% of the risk factors for steroid use, and these effects persisted for 1 year. Risk factors and behaviors measured by confidential questionnaire included the ability to turn down drugs; belief in coaches' intolerance of steroid use; belief in personal vulnerability to the adverse effects of steroids; self-confidence; belief in parental intolerance of steroid use; and intention to use steroids. "That's remarkable for an intervention study to remain positive for 1 year. Now we're trying to figure out what parts of the program were most effective," says Linn Goldberg, MD, lead author of the study and professor of medicine and section chief of health promotion and sports medicine at Oregon Health Sciences University in Portland. Researchers noted a 50% reduction in new anabolic steroid use, but Goldberg says it will take 1 to 2 years for this finding to reach statistical significance.

The traditional approach physicians use—emphasizing harmful effects—doesn't work, Goldberg says. Results from the ATLAS program suggest that the antisteroid message is much more powerful when it comes from other kids. "People remember what their friends on the team say, and coaches are influential; during the season they often have as much contact with the kids as their parents do," he says. Peer counselors were chosen by coaches.

Goldberg believes another reason why the ATLAS program has been effective is that it provides strength training and sports nutrition alternatives for "bulking up" without denying that steroids work. And the program has had desirable side effects, he says. "Teams participating in the ATLAS program improved their win-loss records. Kids are eating better, exercising more efficiently, and decreasing hostility."

Goldberg says that in Oregon and Washington, the ATLAS program is the only deterrent to student steroid use other than drug testing, which school districts can do under last year's US Supreme Court decision.3 (See "Drugs and High School Athletes," October 1995, page 25.)

Charles Yesalis, MPH, ScD, an epidemiologist and professor of health and human development at Penn State University in University Park, Pennsylvania, says the ATLAS program stands apart from videos, posters, and one-time talks because it gives a variety of consistent messages from a range of people: coaches, peers, and parents. "And it's the only intervention that has been evaluated in a scholarly way," Yesalis says.

National estimates of steroid use in high school seniors range from 4% to11% for boys and 0.5% to 2% for girls, Yesalis says. Part of the difficulty of designing any antisteroid intervention, he says, is that steroid use is consistent with two societal values: winning and improved physical appearance. "We have to give kids a clear message that taking steroids is cheating and harmful," Yesalis says. "Kids have to stand up and make some value judgments."

Yesalis thinks physicians should continue to discuss the negative effects of steroids, "especially when they see an extremely muscled individual gain a lot of lean mass in a short time," he says. However, it's important to give accurate information: "Don't embellish and don't get into the realm of Reefer Madness [a 1936 movie that overdramatized illegal drug use]." Physicians can also warn of psychological dependence, Yesalis says. "When kids say, 'One cycle won't hurt me,' the physician can respond, 'But I bet you can't eat just one.' "

ATLAS researchers would like to determine how long the program benefits last, Goldberg says. "We've developed booster sessions that take place as we enroll new students," he says. The group hopes to present its 2-year findings in May 1997 in Denver at the American College of Sports Medicine annual meeting. The 5-year project was funded by a grant from the National Institute on Drug Abuse in Rockville, Maryland.

Encouraged by the success of the ATLAS program, Goldberg and his colleagues are developing a theoretical model for a program to combat drug use and eating disorders in active adolescent girls. That program also has a catchy name: Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA). The program will address the risk factors for eating disorders that are unique to girls, but it's likely to follow the same type of peer-counseling approach used in the ATLAS program. "It's not just the message, it's the messenger," Goldberg says.

References

  1. Goldberg L, Elliot DL, Clarke GN, et al: Effects of a multidimensional anabolic steroid prevention intervention: the Adolescents Training and Learning to Avoid Steroids (ATLAS) program. JAMA 1996;276(19):1555-1562
  2. Goldberg L, Elliot DL, Clarke GN, et al: The Adolescents Training and Learning to Avoid Steroids (ATLAS) prevention program: background and results of a model intervention. Arch Pediatr Adolesc Med 1996;150(7):713-721
  3. Veronia School District v. Acton, 115 S.Ct. 2386 (1995)

Lisa Schnirring
Minneapolis


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