Doping among adolescent athletes.

The use of drugs to enhance physical performance and appearance has been observed for thousands of years. Today individuals, including adolescents, continue to employ a wide variety of drugs in the hope of improving their athletic performance and looking better. Unfortunately, beyond the assessment of anabolic-androgenic steroid (AAS) use, very little is known regarding the use, safety and efficacy of other performance-enhancing drugs and nutritional supplements among adolescents. Most studies report that 3-12% of adolescent males admit to using an AAS at some time during their life. Among adolescent females, studies find that 1-2% report having used steroids. The current strategy for dealing with performance-enhancing drug use by adolescents is multi-faceted and primarily involves education and prevention strategies, interdiction and drug testing programmes. However, the demand for performance-enhancing drugs has been created by our societal fixation on winning and physical appearance. In order to alter the current use of performance-enhancing drugs by adolescents, we as a society must come to grips with our addiction to sport and the importance we place on winning and appearance. We must change our values.

Risk factors associated with anabolic-androgenic steroid use among adolescents.

To identify risk factors associated with anabolic-androgenic steroid (AAS) use among adolescents, computerised and manual literature searches were performed and the resultant local, state, national and international reports of illicit AAS use by adolescents that referenced risk factors were reviewed. Results indicate that adolescent AAS users are significantly more likely to be males and to use other illicit drugs, alcohol and tobacco. Student athletes are also more likely than non-athletes to use AAS, and football players, wrestlers, weightlifters and bodybuilders have significantly higher prevalence rates than students not engaged in these activities. Currently, only a partial profile can be created to characterise the adolescent AAS user. Further research will be needed before associations can be made with a reasonable degree of confidence regarding risk factors such as athletic participation, ethnicity, socioeconomic status and educational level. More importantly, to improve prevention and intervention strategies, a better understanding of the process involved in initiating AAS use is needed, including vulnerability factors, age of initiation and the use of other illicit drugs.

Evaluation of the ergogenic properties of ginseng: an update.

Ginseng has been used in the Orient for several thousand years as an 'adaptogenic' as well as a 'restorative' agent. It has been used to treat nervous disorders, anaemia, wakefulness, dyspnoea, forgetfulness and confusion, prolonged thirst, decreased libido, chronic fatigue, angina and nausea. Although the mechanisms underlying the alleged effects of ginseng remain to be elucidated, there is an extensive animal literature dealing with the effects of ginseng on the cardiovascular system, central nervous system, endocrine system, metabolism, and immune system. In our previous review dealing with the efficacy of ginseng, we concluded that while studies with animals show that ginseng, or its active components, may prolong survival to physical or chemical stress, there is generally a lack of controlled research demonstrating the ability of ginseng to improve or prolong performance in fatigued humans. In this review, we extend our earlier analysis on the potential efficacy of ginseng use in the enhancement of physical performance and modification of fatigue states. Our analysis reveals that published literature appearing since our earlier review has not resolved the equivocal nature of research evidence involving animals or humans. Also, the lack of unanimity in this research can be explained on the basis of various methodological problems such as inadequate sample size and lack of double-blind, control and placebo paradigms. In addition, the absence of acceptable approaches to the problem of 'sourcing', in concert with an absence of compliance data in human research, further complicates the interpretation of this research literature. Nevertheless, the use of ginseng continues to grow, and current sales are estimated to be over $US300 million annually. There is clearly a need for systematic research dealing with the efficacy of ginseng, and this research needs to take into account basic, fundamental design considerations if there is to be any hope of establishing whether or not ginseng possesses efficacy.

Anabolic-androgenic steroid abuse and performance-enhancing drugs among adolescents.

Adolescents use a wide variety of drugs and supplements, including anabolic steroids, to improve their sports performance and physical appearance. Prevalence rates for steroid use generally range between 4% and 12% among male adolescents and between 0.5% and 2% for female adolescents. Although the short-term health effects of anabolic steroids such as effects on the liver, serum lipids, reproductive and cardiovascular systems, and moods and behavior have been increasingly studied, the long-term health effects are not well known. Steroid users are more likely to be boys, participate in strength-related sports, and use other illicit drugs. The effects of many other potential risk factors have not been fully elucidated, however. Assessment of anabolic steroid abuse includes physical and mental status and laboratory examinations. Steroid cessation, supportive therapy, and adjunctive pharmacotherapies are all employed in treating steroid abuse and dependence.

Trends in anabolic-androgenic steroid use among adolescents.

OBJECTIVE: To examine the trends in anabolic steroid use among adolescents in the United States between 1988 and 1996. DESIGN: Computerized and manual literature searches were performed, and the resultant local, state, and national cross-sectional surveys of illicit anabolic steroid use by adolescents were reviewed. Trends in steroid use were evaluated using state and national studies administered in multiple periods. Various sampling procedures were employed, and all surveys used anonymous questionnaires. The national studies used for this analysis included the Monitoring the Future (MTF) study, the national component of the Youth Risk and Behavior Surveillance System, and the National Household Survey on Drug Abuse. SETTING: Most of the surveys described were self-administered in school classrooms. The National Household Survey on Drug Abuse was administered in the respondent's home. PARTICIPANTS: Most survey respondents were junior high an high school male and female students aged 12 to 18 years. RESULTS: Individual state studies (ie, a single point in time) provide evidence of continued steroid use throughout the United States despite educational and legal interventions. The findings of multiyear state-level studies show a decrease in lifetime steroid use rates between 1988 and 1994 for male and female adolescents, although no tests of statistical significance were conducted. At the national level, a significant decline (P < .01) in lifetime steroid use has taken place from 1989 to 1996 for male and female students (MTF data). However, since 1991, lifetime steroid use by male students, as measured by 2 of the 3 national surveys, has been generally stable. The third survey, MTF, shows a significant decrease (P < .05) in use from 1991 to 1996. Likewise, from 1991-1996 use of anabolic steroids during the past year (MTF data) was stable for 10th and 12th grade males; use among eighth grade males decreased significantly (P < .01). Since 1991, data from the 3 national surveys indicate an increase in lifetime anabolic steroid use among adolescent females, although only 1 of these increases is statistically significant. Furthermore, past year use of steroids (MTF data) increased for females in the 8th (P < .05), 10th (P < .05), and 12th (ns) grades. CONCLUSIONS: A long-term comparison of anabolic steroid use (from 1989-1996) indicates that use among adolescent males and females has decreased significantly (P < .05). However, for females the low point in lifetime steroid use was reached in 1991, with subsequent significant (P < .05) increases in use being reported in several national data sets. For adolescent males, after declining sharply between 1989 and 1991, steroid use has generally been stable since 1991. Moreover, based on the 1995 estimates of high school students and Youth Risk and Behavior Surveillance System data, approximately 375,000 adolescent males and 175,000 adolescent females in public and private schools in the United States used anabolic steroids at least once in their lives. These results suggest that prevention, intervention, and regulatory efforts to reduce steroid use at the local, state, and national levels should be reassessed, especially those efforts that focus on adolescent female steroid use.

Psychological and behavioural effects of endogenous testosterone and anabolic-androgenic steroids. An update.

Endogenous testosterone levels have been linked to aggressive behaviour in both animals and humans. Studies administering moderate doses of exogenous testosterone for contraceptive and clinical purposes reveal essentially no adverse effects on male sexual and aggressive behaviour. However, investigations and case reports of athletes, usually involving higher doses, demonstrate an association between anabolic-androgenic steroid use and affective and psychotic syndromes and psychological dependence. Efforts to study the psychological and behavioural effects of anabolic-androgenic steroids are complicated by a variety of methodological limitations. Only 3 prospective, blinded studies demonstrating aggression or adverse overt behaviour resulting from anabolic-androgenic steroid use have been reported. With estimates of over 1 million past or current users in the US, an extremely small percentage of individuals using anabolic-androgenic steroids appear to experience mental disturbances severe enough to result in clinical treatment and medical case reports. Even among those so affected, the roles of previous psychiatric history, genetic susceptibility to addictions or mental disorders, environmental and peer influences, and individual expectations remain unclear.

Influence of age and physical training on measures of cardiorespiratory and muscle endurance.

This study describes associations between age, physical training and measures of muscle and cardiorespiratory endurance. The subjects were 5079 healthy male soldiers aged 18-53 years from 14 Army installations in the United States. The subjects completed as many push-ups as possible in 2 min, as many sit-ups as possible in 2 min, and performed a timed 3.2-km run. The training level was assessed by asking the subjects two questions about the frequency (times each week) and duration (hours each week) of their physical training. For all three performance events there were significant declines with age, but at a given age, groups that trained more demonstrated higher performance levels than groups that trained less. For the 3.2-km run, the age-associated rate of performance decline was less in the groups that trained more, and greater amounts of training resulted in progressively less performance decline with age. For push-ups and sit-ups, the training level did not systematically influence the age-related rate of performance decline. The results suggest that tasks involving different physiological systems may be influenced differentially by age and training. Training may slow age-associated performance declines in tasks requiring cardiorespiratory endurance but not in tasks requiring muscle endurance.

Anabolic-androgenic steroids. Current issues.

The use of drugs to enhance physical performance has been observed for thousands of years. Today, individuals continue to use a variety of substances, including anabolic-androgenic steroids, in the hope of enhancing their performance and appearance. Rumours persist regarding the incidence of the nonmedical use of anabolic steroids by athletes and nonathletes: however, true estimates are now available based on the results of systematic surveys. Although the vast majority of the athletic community accepts that anabolic steroids enhance performance and appearance, the extent to which this occurs and the factors influencing such effects remain incompletely understood and documented. Refinement of our knowledge of the ergogenic effects of anabolic steroids is not without merit; however, the existing scientific evidence coupled with an overwhelming number of anecdotal accounts argues against devoting significant resources to this area of investigation at present. The short term health effects of anabolic steroids have been increasingly studied and reviewed, and while anabolic steroid use has been associated with several adverse and even fatal effects, the incidence of serious effects thus far reported has been extremely low. The long term effects of anabolic steroid use are generally unknown. Unfortunately, the lack of scientific information on long term health effects has impeded, if not precluded, the formation of effective health education and drug abuse prevention strategies. Consequently, efforts should be expanded in the areas of prevention and education.

Weight training. A potential confounding factor in examining the psychological and behavioural effects of anabolic-androgenic steroids.

Psychological and behavioural changes are associated with anabolic-androgenic steroid (AAS) use. Changes in personality, moods and self-esteem following weight training have also been reported. The fact that nearly all AAS users are also dedicated weight trainers has often been overlooked in studies examining the relationship between AAS use and behavioural change. A triad may exist between AAS use, weight training and behavioural change (including dependence). It is also possible that changes frequently attributed to AAS use may also reflect changes resulting from the concurrent use of other substances such as alcohol, and from dietary manipulation including food supplements. Weight training and related practices should be considered potential confounding factors in future studies designed to examine the psychological and behavioural effects of AAS.

Evaluation of the ergogenic properties of ginseng.

Ginseng has been used for several thousand years in the Orient as a tonic, prophylactic agent and 'restorative'. However, its efficacy has been established primarily through clinical experience as opposed to scientific verification of its pharmacological effects. Ginseng has been used by athletes as an ergogenic aid for many years, but there is an absence of compelling research evidence in support of its use for this purpose. Indeed, most of the support favouring the use of ginseng to enhance physical performance is of a testimonial nature. While studies with animals show that ginseng or its active components may prolong survival to physical or chemical stress, there is, generally, a lack of controlled research demonstrating the ability of ginseng to improve or prolong performance in fatigued humans.

Anabolic-androgenic steroid use in the United States.

OBJECTIVE: To estimate the size of the anabolic-androgenic steroid (AAS) user population in the United States, to examine characteristics of AAS users, and to explore the association between AAS use and the use of other illicit drugs as well as self-reported aggressive behaviors. DESIGN: A cross-sectional study using data from the 1991 National Household Survey on Drug Abuse. STUDY POPULATION: The survey covered the population aged 12 years and older living in households in the United States. The results of the survey were based on personal interviews combined with self-administered questionnaires from 32,594 respondents. These respondents were randomly selected by means of a stratified multistage area sample of the household population. RESULTS: Estimates based on data from the National Household Survey on Drug Abuse indicated that there are more than 1 million current or former AAS users in this country, with more than half of the lifetime user population being 26 years of age or older. More than 300,000 individuals used AAS in the past year. Males had higher levels of AAS use during their lifetime than females (0.9% and 0.1%, respectively; P < .01). The median age of first use of AAS for the study population was 18 years; for 12- to 17-year-olds, the median age of initiation was 15 years. Among 12- to 34-year-olds, AAS use was significantly and positively associated with the use of other illicit drugs (P < .05), cigarettes (12- to 17-year-olds only; P < .01), and alcohol (P < .01). Furthermore, AAS use is highly correlated with self-reported aggressive behavior (P < .01) and crimes against property (P < .01). CONCLUSIONS: These results indicate that AAS use impacts a large number of men and women from various racial and age groups across the nation. While causal inferences cannot be made regarding the associations between AAS use and use of other drugs as well as antisocial behavior, these findings should enhance our ability to profile the typical AAS user.

Effects of altitude on mood, behaviour and cognitive functioning. A review.

Alterations in psychological mood, personality, behaviour and cognitive functioning associated with altitude have been recognised for many years. Psychological and behavioural changes resulting from the effects of hypoxia often include increases in euphoria, irritability, hostility and impairment of neuropsychological functions such as vision and memory. There is limited research to indicate that some decrements may persist for up to a year, or longer, after return to lower elevation. However, generalisations of the effects of altitude on mood, behaviour and cognitive function are complicated by differences between studies including the specific tasks or dimensions measured, methods of measurement, degree of altitude, duration of exposure and types of participants. There also appear to be wide individual differences in the response to altitude sojourns. Investigations designed to measure symptoms and mood changes during actual mountain climbs are needed, since most of the systematic research has been conducted in altitude chambers. The extent to which these simulations can be generalised to actual altitude settings remains to be documented.

Psychological moods and subjectively perceived behavioral and somatic changes accompanying anabolic-androgenic steroid use.

To assess physiological and psychological states accompanying anabolic-androgenic steroid use, male weight lifters 1) were interviewed regarding their physical training and the patterns and effects of any drug use; 2) completed a written physical and medical history questionnaire, a Profile of Mood States questionnaire, and the Buss-Durkee Hostility Inventory; and 3) were physically examined, including a blood sample and urinalysis. Subjects were divided into current anabolic-androgenic steroid users (N = 12), previous users (N = 14), and nonusers (N = 24). Current and previous users reported the following changes associated with anabolic-androgenic steroid use: increases in enthusiasm, aggression, and irritability; changes in insomnia, muscle size, muscle strength and density; faster recovery from workouts and injuries; and changes in libido. We were unable to confirm these interview and physical and medical history questionnaire responses using standardized and well-accepted psychological inventories. There were no significant differences among groups for any Profile of Moods factor, total mood disturbance, total Buss-Durkee Hostility Inventory score, or any subscale. For current users, there were no significant correlations between either total weekly drug dose or length of time on the current cycle of anabolic-androgenic steroids and any individual scale of the Profile of Mood States, Buss-Durkee Hostility Inventory, Profile of Mood States total mood disturbance, or composite Buss-Durkee Hostility Inventory score. Furthermore, anabolic-androgenic steroid users did not differ in their responses on these inventories from nonusers or from general population norms.(ABSTRACT TRUNCATED AT 250 WORDS)

1988 active Army physical fitness survey.

The U.S. Army Physical Fitness School (USAPFS) at Ft. Benjamin Harrison, IN was tasked with measuring the physical fitness of the active Army. Performance on the Army Physical Fitness Test (APFT) was used to determine fitness levels. Data were collected at 14 U.S. Army installations CONUS-wide between October 1 and November 30, 1988. Five thousand three hundred forty-six male and 676 female active Army soldiers (N = 6.022) between the ages of 17-52 and in 60 military occupational specialties (MOSs) participated in the study. Generally, the results were favorable. Senior age groups performed well overall, especially females. Improvement in muscular strength and endurance conditioning since 1984 was also observed. However, concern was raised about poor performance in the youngest age group (17-21), where 16.6% of the males failed the 2-mile run event and 29.0% failed overall. Likewise, for females in the 17-21 year age group, 28.8% failed the 2-mile run and 36.0% failed overall. Several reasons are suggested for the poor performance of the younger age groups, including inadequate leadership in fitness training and low levels of self-motivation. This study suggest that many soldiers, especially young soldiers, may not possess sufficient levels of physical fitness to meet the physical demands of war.

Psychological and behavioural effects of endogenous testosterone levels and anabolic-androgenic steroids among males. A review.

The psychological and behavioural effects of endogenous testosterone levels and anabolic-androgenic steroids in males have been investigated for over 50 years in both clinical and nonmedical uses, including the influence of anabolic-androgenic steroids on the nervous system and neuromuscular expression as a mechanism for behavioural and ergogenic effects. The relationship between moods, behaviour and endogenous plasma testosterone levels, as well as anabolic steroids and corticosteroid administration has been studied, including psychological dependence, withdrawal effects, and major methodological issues. While a relationship between endogenous testosterone levels and aggressive behaviour has been observed in various animal species, it is less consistent in humans. It can be concluded that, although the use of exogenous anabolic-androgenic steroids may have psychological and behavioural effects in some patients and athletes, the effects are variable, transient upon discontinuation of the drugs, and appear to be related to type (17 alpha-alkalated rather than 17 beta-esterified), but not dose, of anabolic-androgenic steroids administered. The roles of genetic factors, medical history, environmental and peer influences, and individual expectations are likewise unclear. In general, the evidence at present is limited and much additional research will be necessary for a complete understanding of this relationship.