Beyond antidoping and harm minimisation: a stakeholder-corporate social responsibility approach to drug control for sport.

Debate about the ethics of drug control in sport has largely focused on arguing the relative merits of the existing antidoping policy or the adoption of a health-based harm minimisation approach. A number of ethical challenges arising from antidoping have been identified, and a number of, as yet, unanswered questions remain for the maturing ethics of applying harm minimisation principles to drug control for sport. This paper introduces a 'third approach' to the debate, examining some implications of applying a stakeholder theory of corporate social responsibility (CSR) to the issue of doping in sport. The introduction of the stakeholder-CSR model creates an opportunity to challenge the two dominant schools by enabling a different perspective to contribute to the development of an ethically robust drug control for sport.

Would they dope? Revisiting the Goldman dilemma.

BACKGROUND/AIM: Discussions of doping often report Goldman's sensational results that half of the elite athletes asked would take a drug that guaranteed sporting success which would also result in their death in 5 years' time. There has never been any effort to assess the properties of the 'Goldman dilemma' or replicate the results in the post World Anti-Doping Agency context. This research evaluated the dilemma with contemporary elite athletes. METHODS: Participants at an elite-level track and field meet in North America were segregated into an interview or online response. After basic demographics, participants were presented with three variant 'Goldman' dilemmas counter-balanced for presentation order. RESULTS: Only 2 out of 212 samples  (119 men, 93 women, mean age 20.89) reported that they would take the Faustian bargain offered by the original Goldman dilemma. However, if there were no consequences to the (illegal) drug use, then 25/212 indicated that they would take the substance (no death condition). Legality also changes the acceptance rate to 13/212 even with death as a consequence. Regression modelling showed that no other variable was significant (gender, competitive level, type of sport) and there was no statistical difference between the interview and online collection method. CONCLUSIONS: Goldman's results do not match our sample. A subset of athletes is willing to dope and another subset is willing to sacrifice their life to achieve success, although to a much lesser degree than that observed by Goldman. A larger scale online survey is now viable to answer important questions such as variation across sports.

Prioritising health in anti-doping: what Australians think.

OBJECTIVES: There is debate concerning whether the guiding paradigm for anti-doping policy should be the current legalistic approach or a "harm minimisation" approach prioritising athlete health. This study sought to determine whether a representative sample of Australians prioritises health above other concerns using the World Anti-Doping Code's Spirit of Sport statement which lists the 11 attributes that define the moral basis for anti-doping. DESIGN: A Best-Worst Scaling (BWS) Balanced Incomplete Block Design experiment using 11 choice sets of five Spirit attributes from the set of 11, with the attributes within each choice set in a random order. METHODS: A representative sample of n=168 Australians responded to an on-line survey. The BWS scores defined the relative ranking of each attribute to define an aggregate model and demographically defined models (gender, education, sports participation and sports following). RESULTS: Health was ranked as 7/11 in the aggregate model. Only those who did not follow sport prioritised health (2/11), with other demographic models failing to show a meaningful departure from the aggregate model. CONCLUSIONS: Australians ranked health below other attributes in the Spirit of Sport, appearing to prioritise "rule following" consistent with the legalistic approach. This challenges the harm minimisation approach to managing the role of drugs in sport and suggests that rule-following and legalistic approaches to drug use should take precedence over health messages.

Inside athletes' minds: preliminary results from a pilot study on mental representation of doping and potential implications for anti-doping.

BACKGROUND: Despite the growing body of literature and putative links between the use of ergogenic nutritional supplements, doping and illicit drugs, it remains unclear whether, in athletes' minds, doping aligns with illicit behaviour or with functional use of chemical or natural preparations. To date, no attempt has been made to quantitatively explore athletes' mental representation of doping in relation to illegality and functionality. METHODS: A convenience sample of student athletes from a large South-Eastern Australian university responded to an on-line survey. Competitive athletes (n = 46) were grouped based on self-reported use as follows: i) none used (30%), ii) supplement only (22%), iii) illicit only (26%) and iv) both supplements and illicit drug use (22%). Whereas no athlete reported doping, data provided on projected supplement-, doping- and drug use by the four user groups allowed evaluation of doping-related cognition in the context of self-reported supplement- and illicit drug taking behaviour; and comparison between these substances. RESULTS: A significantly higher prevalence estimation was found for illicit drug use and a trend towards a biased social projection emerged for supplement use. Doping estimates by user groups showed mixed results, suggesting that doping had more in common with the ergogenic nutritional supplement domain than the illicit drug domain. CONCLUSIONS: Assessing the behavioural domain to which doping belongs to in athletes' mind would greatly advance doping behaviour research toward prevention and intervention. Further investigation refining the peculiarity of the mental representation of doping with a larger study sample, controlling for knowledge of doping and other factors, is warranted.

Qualitative evidence of a primary intervention point for elite athlete doping.

Anti-doping activities in sport have shifted from secondary prevention (intervening after athletes have used) to educational strategies focused on primary prevention through promoting abstinence. There is no empirical evidence to guide targeting of anti-doping education initiatives. In this paper, a heuristic to guide education initiatives was derived by re-analysing a series of interviews (n=20) with athletes, coaches, sports managers, physiotherapists and sports nutritionists. The findings indicate primary prevention of doping may be enhanced by timing it around periods of career instability where athlete vulnerability to doping may increase as a function of winning or losing sponsorship. Sponsorship is broadly defined as financial (e.g. salary stipend) and non-financial support (e.g. training facilities). This provides a basis for targeting education interventions to promote abstinence. Two options are offered to mitigate the need to time prevention activity around career instability by lessening the effect of sponsorship on athlete doping. The first is liberalising access to legitimate performance enhancing technologies (e.g. training techniques or nutritional supplements). The second is to delay access to financial sponsorship (beyond living expenses) until retirement, with monetary gains (e.g. prize money) deposited into an account where penalties are debited if the athlete is caught doping.

Adolescent stress: evaluation of the factor structure of the Adolescent Stress Questionnaire (ASQ-N).

The present study reports an evaluation of the factor structure of the Norwegian version of the Adolescent Stress Questionnaire (ASQ-N) among 723 students. Principal components analysis (PCA) revealed nine internally consistent dimensions of adolescent stress. Scales constructed from this PCA correlated positively with measures of depression and anxiety and negatively with self-esteem. Girls reported higher stress levels than boys in seven of the nine scales and age was also positively correlated with the scale scores of adolescent stress. The results revealed that the instrument has potential for measuring adolescent stress. The stability of the ASQ-N needs to be tested repeatedly, across cohorts and over time, to establish the adequacy for use in Norwegian adolescent studies.

Predicting future anabolic-androgenic steroid use intentions with current substance use: findings from an internet-based survey.

OBJECTIVE: To explore how current substance use, including the use of sports supplements and illicit drugs, may impact upon a person's future intentions to use anabolic-androgenic steroids (AAS). DESIGN: Web-based survey. PARTICIPANTS: Two hundred fourteen exercising males (mean age, 30 years; range, 17-61 years) recruited from 5 gymnasia in Sydney, Australia, completed a web-based survey. The survey contained questions relating to sport supplement use, illicit substance use, reasons for currently not using AAS, and reasons for intending to use AAS in the future. INTERVENTIONS: Participants completed a structured interview schedule that included questions regarding licit and illicit substance use, reasons for non-AAS use, and, where appropriate, reasons for intended future AAS use. MAIN OUTCOME MEASURES: The planned main outcome measure was positive intention to use AAS. RESULTS: Sixteen percent of the sample indicated that they would use AAS in the future. Reasons for future AAS use included increasing muscle size (80%), improving appearance (74%), and increasing strength (57%). Four-fifths (80%) of the sample reported use of sports supplements, with vitamins and protein supplements commonly reported (83% and 67%, respectively); more than one-third (36%) reported use of creatine in the past 6 months. Half (52%) of the sample reported use of illicit substances in the preceding 6 months, with amphetamines and cannabis commonly reported (66% and 62%, respectively). Significant predictors of intending to use AAS included past 6-month use of creatine and knowing AAS users. CONCLUSIONS: The use of sport supplements and/or illicit substances may remove barriers for the future use of such drugs as AAS. Future research is necessary to explore in depth whether such substances may act as a "gateway" to future AAS use.

Comfort in big numbers: Does over-estimation of doping prevalence in others indicate self-involvement?

BACKGROUND: The 'False Consensus Effect' (FCE), by which people perceive their own actions as relatively common behaviour, might be exploited to gauge whether a person engages in controversial behaviour, such as performance enhancing drug (PED) use. HYPOTHESIS: It is assumed that people's own behaviour, owing to the FCE, affects their estimation of the prevalence of that behaviour. It is further hypothesised that a person's estimate of PED population use is a reliable indicator of the doping behaviour of that person, in lieu of self-reports. TESTING THE HYPOTHESIS: Over- or underestimation is calculated from investigating known groups (i.e. users vs. non-users), using a short questionnaire, and a known prevalence rate from official reports or sample evidence. It is proposed that sample evidence from self-reported behaviour should be verified using objective biochemical analyses.In order to find proofs of concept for the existence of false consensus, a pilot study was conducted. Data were collected among competitive UK student-athletes (n = 124) using a web-based anonymous questionnaire. User (n = 9) vs. non-user (n = 76) groups were established using self-reported information on doping use and intention to use PEDs in hypothetical situations. Observed differences in the mean estimation of doping made by the user group exceeded the estimation made by the non-user group (35.11% vs. 15.34% for general doping and 34.25% vs. 26.30% in hypothetical situations, respectively), thus providing preliminary evidence in support of the FCE concept in relation to doping. IMPLICATIONS OF THE HYPOTHESIS: The presence of the FCE in estimating doping prevalence or behaviour in others suggests that the FCE based approach may be an avenue for developing an indirect self-report mechanism for PED use behaviour. The method may be successfully adapted to the estimation of prevalence of behaviours where direct self-reports are assumed to be distorted by socially desirable responding. Thus this method can enhance available information on socially undesirable, health compromising behaviour (i.e. PED use) for policy makers and healthcare professionals. The importance of the method lies in its usefulness in epidemiological studies, not in individual assessments.

Limited agreement exists between rationale and practice in athletes' supplement use for maintenance of health: a retrospective study.

BACKGROUND: The widespread use of nutritional supplements among athletes is poorly understood. The prevalence of supplement intake and users' knowledge have been researched independently leading to useful, but disconnected, information on supplement use. METHODS: The 'UK Sport 2005 Drug Free Survey' data (n = 874) were re-analysed using association [chi2] and 'strength of association' tests [phi], to discover observed incongruencies between self-reported supplement use and the underlying motives. Results are given for test pairs between 'motive for use' [doctor's advice, avoiding sickness, overcoming injuries and enhancement of diet] and each supplement used and these were categorized as strong (phi > .7), intermediate (7 < phi > .3) and weak (phi < .3). RESULTS: The use of selected supplements varied widely as follows: multivitamin (72.7%), vitamin C (70.4%), echinacea (30.8%), iron (29.8%), magnesium (11.0%) and ginseng (8.3%). Associations with motive were found in 8 of the 10 test pairs which were expected from literature precedents, however only weak associations exist. Of these, four were associated with avoidance of sickness [iron (chi2 = 11.94, p < .001; phi = .15, p = .001), multivitamin (chi2 = 6.43, p < .001; phi = .11, p = .011), vitamin C (chi2 = 54.67, p < .001; phi = .32, p < .001) and echinacea (chi2 = 40.34, p < .001; phi = .28, p < .001)]. The remaining 4 associations were: no time to prepare meals with ginseng (chi2 = 7.64, p = .006; phi = .12, p = .006) and multivitamin (chi2 = 9.103, p = .003; phi = .13, p = .003); overcoming injuries with magnesium (chi2 = 6.99, p = .008; phi = .11, p = .008); doctors' advice and iron (chi2 = 35.00, p < .001; phi = .25, p = .001). CONCLUSION: These results suggest a lack of understanding regarding supplements and health maintenance, except for vitamin C and echinacea. Furthermore, supplement use is apparently independent of physicians/dieticians' advice, except for iron. This may suggest a widespread circumvention of expert advice in the growing area of supplement use and therefore should be addressed to underscore potential health risks.

Performance enhancement with supplements: incongruence between rationale and practice.

BACKGROUND: Athletes are expected to consider multiple factors when making informed decision about nutritional supplement use. Besides rules, regulations and potential health hazards, the efficacy of different nutritional supplements in performance enhancement is a key issue. The aim of this paper was to find evidence for informed decision making by investigating the relationship between specific performance-related reasons for supplement use and the reported use of nutritional supplements. METHODS: The 'UK Sport 2005 Drug Free Survey' data (n = 874) were re-analysed using association [chi2] and 'strength of association' tests [varphi] to show the proportion of informed choices and to unveil incongruencies between self-reported supplement use and the underlying motives. RESULTS: Participants (n = 520) reported supplement use in the pattern of: vitamin C (70.4%), creatine (36.1%), whey protein (30.6%), iron (29.8%), caffeine (23.8%), and ginseng (8.3%) for the following reasons: strength maintenance (38.1%), doctors' advice (24.2%), enhancing endurance (20.0%), ability to train longer (13.3%), and provided by the governing body (3.8%). Of thirty possible associations between the above supplements and reasons, 11 were predictable from literature precedents and only 8 were evidenced and these were not strong (varphi < .7). The best associations were for the ability to train longer with creatine (reported by 73.9%, chi2 = 49.14, p < .001; varphi = .307, p < .001), and maintaining strength with creatine (reported by 62.6%, chi2 = 97.08, p < .001; varphi = .432, p < .001) and whey protein (reported by 56.1%, chi2 = 97.82, p < .001; varphi = .434, p < .001). CONCLUSION: This study provided a platform for assessing congruence between athletes' reasons for supplement use and their actual use. These results suggest that a lack of understanding exists in supplement use. There is an urgent need to provide accurate information which will help athletes make informed choices about the use of supplements.

A cusp catastrophe model analysis of changes in adolescent substance use: assessment of behavioural intention as a bifurcation variable.

Behavioural intention was advanced as an alternative bifurcation variable to peer pressure in the context of a cusp catastrophe model of changes in adolescent substance use (Clair, 1998; Byrne, Mazanov & Gregson, 2001). Three sets of models were tested using data from a 12 month longitudinal study of adolescent smoking in Australia: the first with peer pressure only as the bifurcation term, the second with behavioural intention only and the third with both. In isolation both bifurcation variables performed similarly (adjusted-R2 and beta). In the third model, peer pressure edged out behavioural intention as an indicator of catastrophic change. Post hoc analysis revealed the polynomial and simple terms of initial conditions were more important than the bifurcation variable to explain change in smoking behaviour. This provoked a call for more work on finding an appropriately complex (non-straight line), theoretically justifiable mathematical model of adolescent substance use. Overall, behavioural intention was considered equivalent to peer pressure as a bifurcation variable although further research is needed to confirm this result.