Legal Performance-enhancing Substances Research Articles

Sport-Related Injury and Performance Enhancing Substance Use by Young Athletes.

Legal performance enhancing substance (PES) use is increasing in young athletes and may lead to banned PES use. This study examines legal PES use and consideration of banned PES use in young athletes with a season-ending injury (SEI) compared to young athletes with non-SEI/no previous injury. Young athletes sustaining SEI or concussions have increased odds of reporting legal PES use and consideration of banned PES use compared with non-SEI or no injury. Cross-sectional study. Level 4. Cross-sectional study from 2013 to 2020 of athletes aged 6 to 25 years. No association was found between reporting legal PES use or consideration of banned PES use and young athletes with SEI or concussion compared with no injury/non-SEI. 14% of athletes reported legal PES use and 3% reported consideration of banned PES use. In adjusted analysis, athletes who were male (odds ratio [OR], 1.38; 95% CI, 1.16-1.73; P = 0.03), have history of depression (OR, 3.01; 95% CI, 1.26-7.18; P = 0.01), weight train (OR, 1.66; 95% CI, 1.04-2.65; P = 0.03), and believe that athletic ability is influenced by weight (OR, 1.75; 95% CI, 1.08-2.83; P = 0.02) had increased odds of reporting legal PES use. Older (OR, 1.18; 95% CI, 1.03-1.36; P = 0.02) and male (OR, 1.57; 95% CI, 1.02-1.81; P < 0.04) athletes had increased odds of consideration of banned PES use. This study found no increased odds of reported PES use in young athletes with sports-related injury or concussion regardless of injury type or severity. Factors associated with PES use were male sex, age, history of depression, weight training, and belief that weight affects athletic performance. Risk factors associated with PES use in young athletes are essentially unknown. This study can inform pertinent clinical care, education, and policy implementation.

Does seeking the brawns impact the brain?: An investigation of muscularity-oriented disordered behaviors and cognitive function

Shifts in body-image ideals over the past 30 years towards leaner, muscular bodies have revealed new health behaviors that may be related to cognitive function. This study objective was to investigate prospective associations between a drive for muscularity and/or muscularity-oriented disordered behaviors (MODBs) with cognition. Data were drawn from Add Health, a nationally representative longitudinal cohort dataset. Drive for muscularity and MODB engagement were assessed in emerging adulthood (ages 18–26). Cognition was measured via immediate word recall, delayed-word recall, and number recall at 7-years later (ages 24–32). Analyzes were conducted in 1976 participants with available data. A one-way ANCOVA revealed that those with a drive for muscularity had lower immediate word recall (F(3, 12,819) = 3.845, p = .009) and delayed word recall (F(3, 12,807) = 5.933, p < .001) scores than other weight goal groups adjusting for covariates. Hierarchical linear regressions between individual MODBs and cognitive outcomes showed that legal performance-enhancing substance use (βs = 0.06–0.07, p < .05) and exercise (β = 0.06, p < .05) were positively associated with some cognition scores. Conversely, lifting weights (β = − 0.06, p < .05) and eating different foods than usual (β = − 0.05, p < .05) exhibited negative associations with some of the cognitive outcomes. Future research should be conducted to examine other potential outcomes related to the drive for muscularity and associated MODBs.

Performance-Enhancing Substance Use and Intimate Partner Violence: A Prospective Cohort Study.

Research has shown that performance-enhancing substance (PES) use, including anabolic-androgenic steroids (AAS), is associated with interpersonal violence (e.g., fighting). This study aimed to determine whether legal PES use and AAS use are associated with intimate partner violence (IPV) involvement cross-sectionally and over seven-year follow-up in a nationally representative prospective cohort study. Data from the National Longitudinal Study of Adolescent to Adult Health (N = 12,288) were analyzed (2021). Logistic regression analyses were conducted to determine the associations between legal PES use and AAS use at Wave III (2001-2002; ages 18-26) and IPV victimization (five variables) and IPV perpetration (five variables) at Wave III and Wave IV (2008-2009; ages 24-32), adjusting for relevant demographic and confounding variables. Results from cross-sectional analyses showed that legal PES use and AAS use were associated with higher odds of both any IPV victimization and sexual IPV victimization, and both any IPV perpetration and physical IPV perpetration by pushing or shoving a partner. Results from prospective analyses showed that AAS use, but not legal PES use, was associated with higher odds of all five IPV victimization variables (any IPV victimization: adjusted odds ratio [AOR] 1.72, 95% confidence interval [CI]1.04-2.84; two forms of physical abuse: 1: AOR 2.01, 95% CI 1.15-3.50; 2: AOR 2.11, 95% CI 1.06-4.21; incurring an injury from IPV victimization: AOR 4.90, 95% CI 1.71-14.01; and sexual IPV victimization AOR 2.44, 95% CI 1.05-5.65), as well as three IPV perpetration variables (any IPV perpetration: AOR 2.11, 95% CI 105-4.23; one form of physical abuse perpetration: AOR 2.58, 95% CI 1.06-6.27; and sexual IPV perpetration: AOR 3.80, 95% CI 1.44-10.02). These results emphasize the adverse social and interpersonal risks associated with PES use. Continued research, health care, and public health prevention and intervention efforts to reduce the use of PES and occurrence of IPV are warranted.

Performance-enhancing substance use and criminal offending: A 15-year prospective cohort study

BackgroundResearch has documented an association between anabolic-androgenic steroid (AAS) use and criminal offending. Still, whether legal performance-enhancing substance (e.g., creatine; PES) use is similarly associated with criminal offending is unknown. The aim of the present study was to determine the prospective associations between legal PES use and AAS use and criminal offending among U.S. adults. MethodsData from three waves over 15 years of the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study, were analyzed. Legal PES use and AAS use were assessed at Wave III (ages 18−26) and criminal offending was assessed at Wave IV (ages 24−32; N = 10,861) and Wave V (ages 33–43; N = 9,451). Criminal offending was measured using a summed score of six items (range 0–6). Multiple negative binominal regressions were conducted, transformed to incident rate ratios (IRR), adjusting for biological sex, age, race/ethnicity, household income, body mass index, depression, smoking, alcohol, and prior victimization and offending. Main FindingsAmong the sample (51.3 % male; 68.8 % White), legal PES use (Wave IV: IRR 1.46, 95 % confidence interval [CI] 1.15−1.85; Wave V: IRR 1.52, 95 % CI 1.02−2.27) and AAS use (Wave IV: IRR 1.73, 95 % CI 1.09−2.76; Wave V: IRR 2.36, 95 % CI 1.33−4.19) were prospectively associated with criminal offending during young and middle adulthood, while adjusting for demographic and behavioral factors. ConclusionsThese results confirm and expand upon prior research by describing the prospective associations between both legal PES use and AAS use and criminal offending among a nationally representative sample of U.S. adults.

Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study.

BackgroundLegal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their long-term safety and health outcomes. Preliminary studies have demonstrated associations between PES use and severe medical events, including hospitalizations and death. PES could be linked to cardiovascular disease (CVD), the most common cause of mortality in the US, by altering the myocardium, vasculature, or metabolism. The objective of this study was to examine prospective associations between the use of legal PES in young adulthood and CVD risk factors at seven-year follow-up.Materials and methodsNationally representative longitudinal cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves III (2001–2002) and IV (2008), were analyzed. Regression models determined the prospective association between the use of legal PES (e.g. creatine monohydrate) and CVD risk factors (e.g. body mass index, diabetes, hypertension, hyperlipidemia), adjusting for relevant covariates.ResultsAmong the diverse sample of 11,996 male and female participants, no significant differences by PES use in body mass index, diabetes, hypertension, or hyperlipidemia were noted at Wave III. In unadjusted comparisons, legal PES users (versus non-users) were more likely to be White, be male, be college educated, drink alcohol, and engage in weightlifting, exercise, individual sports, team sports, and other strength training. There were no significant prospective associations between legal PES use at Wave III and body mass index, hemoglobin A1c, systolic and diastolic blood pressure, and cholesterol (total, HDL, LDL, triglycerides) deciles at seven-year follow-up (Wave IV), adjusting for demographics, health behaviors, and Wave III CVD risk factors. Similarly, there were no significant prospective associations between legal PES use and diabetes, hypertension, or hyperlipidemia based on objective measures or self-reported medications and diagnoses, adjusting for demographics, health behaviors, and Wave III CVD risk.ConclusionsWe do not find evidence for a prospective association between legal PES use and CVD risk factors in young adults over seven years of follow-up, including BMI, diabetes, hypertension, or hyperlipidemia. It should be noted that legal PES use was operationalized dichotomously and as one broad category, which did not account for frequency, amount, or duration of use. Given the lack of regulation and clinical trials data, observational studies can provide much needed data to inform the safety and long-term health associations of legal PES use and, in turn, inform clinical guidance and policy.

Legal Performance-Enhancing Substances and Substance Use Problems Among Young Adults.

Legal performance-enhancing substance(s) (PES) (eg, creatine) are widely used among adolescent boys and young men; however, little is known about their temporal associations with substance use behaviors. We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I to IV (1994-2008). Logistic regressions were used to first assess adolescent substance use (Wave I) and use of legal PES (Wave III) and second to assess use of legal PES (Wave III) and subsequent substance use-associated risk behaviors (Wave IV), adjusting for potential confounders. Among the sample of 12 133 young adults aged 18 to 26 years, 16.1% of young men and 1.2% of young women reported using legal PES in the past year. Adolescent alcohol use was prospectively associated with legal PES use in young men (odds ratio 1.39; 95% confidence interval [CI] 1.13-1.70). Among young men, legal PES use was prospectively associated with higher odds of problematic alcohol use and drinking-related risk behaviors, including binge drinking (adjusted odds ratio [aOR] 1.35; 95% CI 1.07-1.71), injurious and risky behaviors (aOR 1.78; 95% CI 1.43-2.21), legal problems (aOR 1.52; 95% CI 1.08-2.13), cutting down on activities and socialization (aOR 1.91; 95% CI 1.36-2.78), and emotional or physical health problems (aOR 1.44; 95% CI 1.04-1.99). Among young women, legal PES use was prospectively associated with higher odds of emotional or physical health problems (aOR 3.00; 95% CI 1.20-7.44). Use of legal PES should be considered a gateway to future problematic alcohol use and drinking-related risk behaviors, particularly among young men.

Legal Performance-Enhancing Substances in Children and Adolescents: Why Should We Care?

* Abbreviation: PES — : performance-enhancing substance The use of legal performance-enhancing substances (PESs) is common among adolescents, particularly boys.1 Approximately one-third of all youth use creatine, protein powders, or dietary supplements,2–4 and an even greater proportion of athletes and college students do so.5,6 Although previous studies have correlated legal PES use with future use of illegal PESs,7,8 in a study in this issue of Pediatrics , Ganson et al9 explore a broader role for PESs as a gateway to alcohol and other substance use. There are 2 key points to recognize when addressing this topic: 1. “PES” is a misleading term. Most legal supplements marketed for athletic performance enhancement are ineffective at increasing muscle mass or athletic performance beyond what can be achieved through appropriate nutrition and training.1,10 They are not truly performance enhancing. 2. Many adolescents, both athletes and nonathletes, are using PESs primarily in pursuit of a more muscular appearance, rather than for performance-oriented goals. This recognition has spurred an evolution of terminology, with increasing use of “appearance and PESs” in place of the … Address correspondence to Steven Cuff, MD, FAAP, Division of Sports Medicine, Nationwide Children’s Hospital, 584 County Line Rd West, Westerville, OH 43082. E-mail: steven.cuff{at}nationwidechildrens.org

Association Between Legal Performance-Enhancing Substances and Use of Anabolic-Androgenic Steroids in Young Adults

This cohort study uses data from the National Longitudinal Study of Adolescent to Adult Health database to describe the association between anabolic-androgenic steroid use and legal performance-enhancing substances in young adults.

The Prevalence of Legal Performance-Enhancing Substance Use and Potential Cognitive and or Physical Doping in German Recreational Triathletes, Assessed via the Randomised Response Technique.

This study investigated the use of performance-enhancing substances in recreational triathletes who were competing in German races at distances ranging from super-sprint to long-distance, as per the International Triathlon Union. The use of legal drugs and over-the-counter supplements over the previous year, painkillers over the previous 3 months, and the potential three-month prevalence of physical doping and or cognitive doping in this group were assessed via an anonymous questionnaire. The Randomised Response Technique (RRT) was implemented for sensitive questions regarding “prescription drugs […] for the purpose of performance enhancement […] only available at a pharmacy or on the black market”. The survey did not directly state the word “doping,” but included examples of substances that could later be classed as physical and or cognitive doping. The subjects were not required to detail what they were taking. Overall, 1953 completed questionnaires were received from 3134 registered starters at six regional events—themselves involving 17 separate races—in 2017. Of the respondents, 31.8% and 11.3% admitted to the use of dietary supplements, and of painkillers during the previous three months, respectively. Potential physical doping and cognitive doping over the preceding year were reported by 7.0% (Confidence Interval CI: 4.2–9.8) and 9.4% (CI: 6.6–12.3) of triathletes. Gender, age, experience in endurance sports, and number of weekly triathlon training hours were linked to potential physical or cognitive doping. Given the potentially relevant side effects of painkiller use and physical and or cognitive doping, we recommend that educational and preventative measures for them be implemented within amateur triathlons.

Cross-sectional associations between gender-linked personality traits and use of weight-loss and muscle-building products among U.S. young adults

ABSTRACTThis study examined the cross-sectional associations between gender-linked personality traits and use of products for weight loss and muscle building using data from young adults participating in Wave III of the National Longitudinal Study of Adolescent to Adult Health who completed the short-form Bem Sex-Role Inventory (n = 3,343). Among men, a higher score on the masculinity scale was associated with greater odds of diet pill use, legal performance-enhancing substance (PES) use, and illicit PES use, while a higher score on the femininity scale was associated with lower odds of illicit PES use. These findings can inform interventions for men with weight/shape concerns.

Doping Attitudes and the Use of Legal and Illegal Performance-Enhancing Substances Among Italian Adolescents

Using retrospective self-reporting, rates of illegal and legal performance-enhancing substance (PES) use in the past three months among more than 3,400 Italian high school adolescents were obtained and estimated. The study focused on the extent to which these sociodemographic characteristics and illegal PES use were associated with adolescents' positive attitudes toward illegal PES use. Results showed that it is relatively rare for youths to report use of illegal performance-enhancing substances in the past three months, and that male, relatively older, and athlete students were significantly more likely to use illegal PES than their respective counterparts. The results also showed that illegal PES users and male, older, and athlete students held stronger attitudes favoring illegal PES use. Finally, results showed that those student athletes who reported having used legal PES in the past three months were 10 times more likely to also have used illegal PES than those student athletes who did not report having used legal PES.

Judgments about illegal performance-enhancing substances: Reasoned, reactive, or both?

This study applied aspects of the Theory of Reasoned Action and the Prototype/Willingness model to understand cognitions associated with the use of illegal performance-enhancing substances. There were two study objectives. One was to investigate whether the illegal-is-effective heuristic (i.e. belief that illegal performance-enhancing substances are more effective than legal performance-enhancing substances) affects willingness to use illegal performance-enhancing substances. The second was to examine whether attitudes, norms, and prototypes influence the willingness and intentions to use illegal performance-enhancing substances. The illegal-is-effective heuristic was a significant predictor of willingness but was not a significant predictor of intentions. Implications for future research and prevention efforts are discussed.

Contextual influences and athlete attitudes to drugs in sport

This article reports on 11 narrative-based case histories which sought to: (1) uncover the attitudes of players and athletes to drugs in sport, and (2) explore contextual factors influencing the formation of those attitudes as informed by social ecology theory. Overall, participants viewed the use of banned performance-enhancing substances as cheating, ‘hard’ non-performance-enhancing recreational or illicit substances as unwise, legal non-performance-enhancing substances as acceptable, and legal performance-enhancing substances as essential. In short, attitudes were sometimes quite libertarian, and contingent upon first, the legality of the substance, and second, its performance impact. Results also indicated that athletes’ attitudes about drugs were fundamentally shaped by sport's culture. Other significant factors included its commercial scale, closely identifiable others, early experiences and critical incidents of players and athletes, and their level of performance.

Drive for Muscularity and Beliefs about Legal Performance Enhancing Substances as Predictors of Current Use and Willingness to Use

Using a sample of college-aged male athletes (n = 56) and nonathletes (n = 43), negative and positive beliefs were tested as mediators of the relationship between Drive for Muscularity (DM) and use of performance enhancing substances (PES). Results showed that the Muscularity Behavior (MB) and Muscularity-oriented Body Image (MBI) subscales of the DM scale differentially predicted PES use. Results also showed that negative and positive beliefs are mediators MB-PES use relationship. Neither the MB nor MBI subscales predicted willingness to use a new performance enhancing drug.

Is Abstinence an Alternative?

The present study incorporated the behavioral alternative of abstinence into the Theory of Reasoned Action to test whether abstinence contributed to the prediction of intentions to use performance enhancing substances (PES). Adolescent athletes (N = 241) completed a questionnaire about the use of legal and illegal PES. Approximately 2.5 percent of adolescents reported having tried an illegal PES and 17 percent reported having tried a legal PES. Results showed that attitudes and norms associated with abstinence contribute to the prediction of behavioral intentions over and above that of attitudes and norms associated with using both legal and illegal PES.