Media images of men and women have become increasingly muscular, and muscle-enhancing techniques are available to youth. Identifying populations at risk for unhealthy muscle-enhancingbehaviors is of considerable public health importance. The current study uses a large and diverse population-based sample of adolescents to examine the prevalence of muscle-enhancing behaviors and differences across demographic characteristics, weight status, and sports team involvement.
Survey data from 2793 diverse adolescents (mean age = 14.4) were collected at 20 urban middle and high schools. Use of 5 muscle-enhancing behaviors was assessed (changing eating, exercising, protein powders, steroids and other muscle-enhancing substances), and a summary score reflecting use of 3 or more behaviors was created. Logistic regression was used to test for differences in each behavior across age group, race/ethnicity, socioeconomic status, BMI category, and sports team participation.
Muscle-enhancing behaviors were common in this sample for both boys and girls. For example, 34.7% used protein powders or shakes and 5.9% reported steroid use. Most behaviors were significantly more common among boys. In models mutually adjusted for all covariates, grade level, Asian race, BMI category, and sports team participation were significantly associated with the use of muscle-enhancing behaviors. For example, overweight (odds ratio = 1.45) and obese (odds ratio = 1.90) girls had significantly greater odds of using protein powders or shakes than girls of average BMI.
The use of muscle-enhancing behaviors is substantially higher than has been previously reported and is cause for concern. Pediatricians and other health care providers should ask their adolescent patients about muscle-enhancing behaviors.
Comments
Evidence-based Programs to Deter these Behaviors
We read with interest the article concerning adolescents' use of muscle-enhancing behaviors (1). Although these unhealthy behaviors were prevalent among all students, they were greatest among sport participants. The authors stated in their conclusions that prevention programs are needed for both boys and girls to deter those unhealthy behaviors. The ATLAS (2) and ATHENA (3,4) programs for both boys' and girls' sport teams, respectively, have been used for much of the past decade and implemented in 45 states with more than 80,000 participants, through major sponsorship from the National Football League and Sports Illustrated (5). The programs were proven effective in randomized controlled trials funded by the National Institute on Drug Abuse and are listed in the U.S. Department of Health and Human Services' National Registry of Evidence-Based Programs and Practices. They were named as the model educational programs in the 2005 federal legislation, "The Anabolic Steroid Control Act," and the World Anti-Doping Agency sponsored evaluation of prevention programs (6) found ATLAS and ATHENA "provide the only high quality evidence available on the best way to 'educate' adolescents about doping," and noted that they "are the only programmes that have been systematically monitored over an extended follow-up period."
These easily implemented, peer-led programs are designed to be incorporated into a sport team's usual in-season training activities. Along with performance-enhancing supplement and body-shaping drug use deterrence, they also were found to reduce other harmful behaviors, including alcohol and other substance use, while improving the diet of teen athletes (2, 3). Because the authors appear to be unaware of these prevention efforts, we thought readers may be interested in learning about their availability.
1. Eisenberg ME, Wall M, Neumark-Sztainer D. Muscle-enhancing behaviors among adolescent girls and boys. Pediatrics. 2012;130(6):1019- 1026.
2. Goldberg L, MacKinnon DP, Elliot DL, Moe EL, Clarke G, Cheong J. The adolescents training and learning to avoid steroids program: preventing drug use and promoting healthy behaviors. Arch Pediatrics Adolesc Med. 2000;154(4):332-338.
3. Elliot DL, Goldberg L, Moe EL, DeFrancesco CA, Durham MB, Hix- Small H. Preventing substance use and disordered eating: initial outcomes of the ATHENA (athletes targeting healthy exercise and nutrition alternatives) program. Arch Pediatr Adolesc Med. 2004;158(11):1043-9.
4. Elliot DL, Goldberg L, Moe EL, DeFrancesco CA, Durham MB, McGinnis W, Lockwood C. Long-term outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) program for female high school athletes. J Alcohol & Drug Educ. 2008;52(2):73-92.
5. Kuehn BM. Teen steroid, supplement use targeted: officials look to prevention and better oversight. JAMA. 2009;302(21):2301-2303.
6. Backhouse S, McKenna J, Patterson L. Prevention through education: a review of current international social science literature. Leeds, England: Carnegie Research Institute, 2009. Accessed January 22, 2013.
Conflict of Interest:
ATLAS and ATHENA are programs on the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-based Programs and Practices and distributed through the Center for Health Promotion Research at Oregon Health & Science University (OHSU). OHSU and Drs. Elliot and Goldberg have a financial interest from the commercial sale of technologies used in this research. This potential conflict of interest has been reviewed and managed by the OHSU Conflict of Interest in Research Committee.
Causal relationship between protein use and steroid use?
Hello,
Could the author(s) please elaborate on how protein use could lead to steroid use? Has there been a study performed that explores this possibility?
And could the author(s) please explain the reasoning behind why protein powders are considered bad and therefore grouped with steroids? Considering that most protein powders on the market today are created from whey (milk), it is not immediately obvious as to how protein powders would negatively affect one's health.
Thank you,
Albert Chen
Conflict of Interest:
None declared