Development of Reference Point of Doping Attitude and Dispositions for Anti-Doping Education Notification of Athletes: Application of Reference Group Model.

Background: We developed a reference point by applying a doping attitude and propensity tool to prevent doping in sports athletes. Methods: Performance Enhancement Attitude Scale (PEAS) was investigated on 768 registered athletes with the Korea Sports Association. Independent sample t-test and ANOVA were applied to confirm the doping attitude and propensity according to anti-doping education and event type. To establish the criteria for PEAS, the intersection was confirmed through the group comparison method, and EasyOZ by Excel was applied at this time. In addition, accuracy, sensitivity, and specificity were calculated to confirm the validity of the reference point. Results: First, in the case of anti-doping education, it was confirmed that more than 90% of the anti-doping education was completed in all sports. Second, there was no statistically significant difference in PEAS according to the type of sport, and there was only a difference in the PEAS according to whether or not anti-doping education was provided and whether or not there was anti-doping education. Third, the point of contact established in the group comparison method was 29.5 points, and as a result of validating the validity based on this, 30 points were found to be the most suitable index. Conclusion: This study could be used as important information in that it suggests a different method for evaluating PEAS and establishes a reference point that can be used more effectively in the actual field.

Barriers and enablers in doping, anti-doping, and clean sport: A qualitative meta-synthesis informed by the theoretical domains framework and COM-B model.

To protect the integrity of sport, and the health of athletes, global anti-doping programmes seek to prevent doping, and elicit anti-doping and clean sport behaviours, through education, deterrence, detection, enforcement, and rules. To guide programme development, this meta-synthesis of qualitative research applied a behavioural science framework to identify barriers and enablers to doping, anti-doping, and clean sport. A systematic search of electronic databases up to May 2022, followed by critical appraisal, resulted in 73 included articles. Fifty-two articles reported the athlete perspective, thirteen included athletes, athlete support personnel (ASP), and other experts, and eight focused on ASP only. Rigorous methods of thematic synthesis were drawn upon to construct analytical themes in line with the theoretical domains framework (TDF) and the capability, opportunity, and motivation model of behaviour (COM-B). A wide range of barriers and enablers were identified which influenced capability, opportunity, and motivation to participate in a clean sport environment. The weight of evidence pointed to limitations in the current anti-doping education system in providing athletes and ASP with the knowledge and skills to protect against doping, as well as the significant influence of social and cultural norms in shaping doping and clean sport behaviours through a shared social identity, and risky contexts leading to moments of vulnerability to doping. We identified a need for anti-doping programmes to move beyond the current focus on athlete capability, and address the opportunity and motivation components of clean sport behaviours through a targeted and tailored focus on education, training, persuasion, modelling and environmental restructuring interventions.

The association between subjective anti-doping knowledge and objective knowledge among Japanese university athletes: a cross-sectional study.

Introduction: This study aimed to assess the association between subjective anti-doping knowledge (subjective ADK) and objective anti-doping knowledge (objective ADK) among Japanese university athletes, framed within the context of the Theory of Planned Behavior (TPB). Methods: Eligible participants were 486 university athletes [320 men (65.8%), 166 women; mean age of 18.9 ± 1.0 years]. The participants categorized themselves in terms of the quality of their anti-doping knowledge. This assessment resulted in an independent variable coded as "(1) substantial lack of adequate knowledge," "(2) some lack of adequate knowledge," "(3) fair amount of knowledge" or "(4) good amount of knowledge." Objective ADK was assessed using the Athlete Learning Program about Health and Anti-Doping (ALPHA) test, a set of questions derived from the ALPHA-a former World Anti-Doping Agency e-learning program. The test comprises 12 questions (four choices each; passing index: ≧10 points or 80% correct answer rate). ANCOVA was conducted using subjective ADK as an independent variable and ALPHA scores as a dependent variable, adjusting for confounding factors (anti-doping experience). Results: The ALPHA corrected answer rate across subjective ADK levels for the group were 73.10% for "(1) substantial lack of adequate knowledge," 71.97% for "(2) some lack of adequate knowledge," 75.18% for "(3) fair amount of knowledge" and 72.86% for "(4) good amount of knowledge." Comparison between different levels of subjective ADK revealed no significant differences in ALPHA score considering the main effects or any of their interactions. Discussion: The present results revealed that Japanese university athletes' subjective ADK did not match their objective ADK. In the context of the TPB, there may be limitations in the perceived behavioral control in anti-doping knowledge. Even if athletes view doping as a wrongful act and have formed attitudes and subjective norms to comply with the rules, the results suggest that errors may occur in the composition of behavioral intentions due to a lack of knowledge. This could lead to the possibility of facing the risk of unintentional anti-doping rule violations. It highlights the need for targeted educational interventions to align subjective ADK of athletes with their objective ADK.

Doping in Paralympic sport: perceptions, responsibility and anti-doping education experiences from the perspective of Paralympic athletes and parasport coaches.

Introduction: Limited effort has been invested in understanding doping in Paralympic sport. The limited evidence that exists suggests that factors influencing doping in parasport are similar to Olympic sport. However, based on the design and nature of the previous studies, where methods have been mostly limited to qualitative data and prevalence numbers, further research is warranted to extend previous findings. Methods: Informed by current evidence from Paralympic and Olympic sport, we aimed to investigate (1) para-athletes' perceptions of Anti-Doping Rule Violations (ADRVs) and responsibility for them, (2) descriptive norms for doping in parasport (3) perceptions of anti-doping education and legitimacy of anti-doping authorities, and (4) coach engagement in doping prevention and levels of doping confrontation efficacy using a quantitative survey approach. Results: In total, valid survey responses from 126 Paralympic athletes and 35 coaches from four countries (Germany, Austria, Switzerland, UK) were analysed for experience with anti-doping, descriptive norms, anti-doping education, perceived legitimacy, knowledge, and doping confrontation efficacy (coaches only). Across both athletes and coaches, the level of education was generally good and doping willingness was low. Classification cheating was considered a form of doping and seems to be an important issue for athletes and coaches, especially within the UK sample. For 33.3% of the athletes, doping control was their first experience with anti-doping. Coaches' engagement with doping prevention activities and their perceived efficacy to confront doping-related matters appears to be higher compared to Olympic coaches' samples. Discussion: Sport organisations/NADOs in Paralympic sport could use synergies with those organisations in Olympic sport, adopting similar approaches to anti-doping education, also focusing on a balanced communication of doping prevalence numbers and testing figures. Efforts to ensure athletes are educated about anti-doping before they are tested should be upheld. It seems that in para sport, different compared to able-bodied coaches, anti-doping organizations do not have to convince the coaches about their roles (i.e., being responsible for anti-doping education) anymore but can directly build on these resources. Overall, it seems that there are few differences between parasport and able-bodied sports and thus responsible organisations could use the existing programmes in Olympic sport and only adapt special content (e.g., boosting) which is unique to Paralympic athletes.

Relationship between the level of willingness to learn about anti-doping and objective knowledge among Japanese university athletes: A cross-sectional study.

Previous studies have indicated that athletes' anti-doping knowledge is inadequate. Athletes' willingness to learn about anti-doping (willingness to learn) may influence their anti-doping knowledge, but the actual situation is unclear. This study aimed to determine the relationship between athletes' willingness to learn about anti-doping and their objective measurement knowledge and explore directions for educational interventions. The eligible participants were 971 male and 802 female university athletes. We used the ALPHA test (12 questions/four choices; passing index: ≥10 points/80% correct answer rate) to assess objective anti-doping knowledge. The willingness to learn question was, "Would you like to learn more about anti-doping?" Responses were given on a 4-point scale ranging from 1: strongly disagree to 4: strongly agree. An ANCOVA was conducted with four levels of willingness to learn as the independent variable and ALPHA correct answer rate as the dependent variable, adjusting for confounding factors (years of athletic experience and anti-doping education experience). The percentage of athletes (%) and each ALPHA correct answer rate (%) by the level of willingness to learn was 1: strongly disagree, n = 1.64%, 61.78%; 2: somewhat disagree, n = 13.14%, 62.38%; 3: somewhat agree, n = 62.94%, 64.08%; 4: strongly agree, n = 22.28%, 67.11%. The ALPHA correct answer rates showed significant differences in the main effect by the level of willingness to learn [F (3, 1767) = 2.873, p < 0.05, η2 = 0.01], although the effect size was small, and multiple comparisons showed no significant differences between the levels. The results indicated that the ALPHA correct answer rate did not reach 80% even for the "strongly agree" level of willingness to learn, suggesting that information on anti-doping may be inadequate. The need to provide sufficient educational content to improve knowledge was evident.

Every Young Athlete Counts: Are Tailored Doping Prevention Programs Necessary in Young Elite Sports?

Conclusions from doping prevention literature recommend tailored anti-doping education for athletes' specific needs. Newer approaches like the International Standard for Education of the World Anti-Doping Agency recommend a needs assessment before implementing measures. The International Standard for Education refers to the type of sports and its associated risk for doping. Following this idea, elite athletes from different types of sports should differ in their prerequisites for doping prevention. Consequently, the guiding research question focused on exploring the doping-prevention-related background of young athletes as a particular group for prevention efforts. Sixty young elite athletes (58.3% male) took part in a cross-sectional online survey, which was quantitatively analyzed. Participants included 26 athletes from a sport with low doping prevalence (sailing) and 34 athletes from a sport associated with high doping prevalence (wrestling). Sailors and wrestlers differed concerning the perceived resistance against doping temptations (p = 0.031, r = 0.31) and the estimated actual doping prevalence regarding sports in general (national frame: p < 0.001, r = 0.60; international frame: p = 0.013, r = 0.43). No differences between the two types of sports occurred, referring to doping attitudes, tendency to disengage morally, or topics athletes wish to learn about during doping prevention measures. All results indicated a good baseline for doping prevention with young elite athletes at the beginning of their careers. There is no sport-specific needs profile that could be used as a base for tailored measures. However, the data suggest that a differentiated consideration of gender could be helpful in the planning of doping prevention measures.

Knowledge and experience of Kazakhstan athletes in anti-doping and the impact of past educational intervention.

BACKGROUND: Although Kazakhstan National Anti-Doping Organization (KazNADO) exists since 2013, but little is yet known about anti-doping (AD) knowledge of Kazakhstan athletes. The aim of this study was to assess the AD education knowledge level and experience among Kazakhstan athletes, as well as the impact of any past AD educational program on them. METHODS: Altogether, 590 athletes (the median was age 17 years (interquartile range 8)), representing various sports, participated in the web-based study and completed the questionnaire, which consisted of socio-demographic part and ALPHA test. We assessed the association of any past AD education and experience with anti-doping knowledge using adjusted regression models. RESULTS: A total of 54.6% participants underwent doping control and 82,7% of athletes received AD education at least once. More than 300 participants (50.8%) provided correct answers for 10 questions. Age and years in sports (competition duration) were significantly associated with the ALPHA scores of athletes. Athletes who received AD education more than once in the past had significantly higher ALPHA scores than non-AD educated athletes in most questions. CONCLUSION: AD education was associated with AD knowledge. Further research is needed to identify the adherence to anti-doping knowledge.

Effectiveness of the world anti-doping agency's e-learning programme for anti-doping education on knowledge of, explicit and implicit attitudes towards, and likelihood of doping among Chinese college athletes and non-athletes.

BACKGROUND: This study aimed to evaluate the effects of the World Anti-Doping Agency's e-learning programme for anti-doping education on knowledge of, explicit and implicit attitudes towards, and likelihood of doping among Chinese college athletes and non-athletes. METHOD: Thirty-two young adults (including 16 college athletes) were recruited to receive the Athlete Learning Program about Health and Anti-Doping (ALPHA) intervention (Zh-hans version). Another 32 young adults were recruited for no-treatment control purposes. Before and immediately after the intervention, the ALPHA test, performance enhancement attitude scale, doping likelihood scale, and brief implicit association test (BIAT) were performed. Cortical activity during the BIAT test was monitored using a functional near-infrared spectroscopy instrument. RESULTS: Significant intervention effects were observed for knowledge (p < 0.01, η2 = 0.21) and explicit attitude (p < 0.05, η2 = 0.12) but not for doping likelihood (p > 0.05; benefit situation: η2 = 0.04; cost situation: η2 = 0.02). Compared with the non-athletes, the college athletes reported lower doping likelihood scores in benefit situations (e.g., financial gain, p < 0.05, η2 = 0.10). Regarding the BIAT task, the experimental effect was successfully induced by different semantic associations between the concepts and the attitude (doping + like vs. doping + dislike). The mean reaction times (p < 0.01, η2 = 0.36) and error rate (p < 0.01, η2 = 0.34) in the doping-like block were higher than those in the doping-dislike block. Moreover, oxygenated haemoglobin (oxy-Hb) in response to BIAT interference in the temporoparietal junction-related channels was increased during the post-intervention test (p < 0.05, η2 varied from 0.09 to 0.16). CONCLUSIONS: The findings suggest that the online anti-doping education programme is partially effective among Chinese college athletes and non-athletes. Furthermore, our findings reflect enhanced cognitive control after the education intervention to suppress a prepotent implicit attitude towards doping.

GRADE IT-A Literacy-Based Assessment Tool for Generating Research-Based Assessment Data to Evidence the ImpacT of Anti-doping Education via Athletes' Capability to Make the Right Decision.

The International Standard for Education (ISE) mandates Code Signatories to plan, deliver, and evaluate anti-doping education. Performance-based evaluation of anti-doping education requires alignment between educational goals, content, and defined outcomes. Based on an existentialist teaching and learning philosophy, we aimed to develop and test an anti-doping impact evaluation tool, to assess the impact of anti-doping education on doping awareness, literacy (DAL), perceived trust, and legitimacy. We propose that the impact of anti-doping education is best captured through assessment of situation-specific (social) cognitive mediators of actions that influence athletes' choices in the context of sport-related goals. In phase one, we aimed to develop and test the Generating Research-based Assessment Data to Evidence the ImpacT of anti-doping education (GRADE IT) evaluation tool that comprised a set of social cognitive components: anti-doping knowledge, DAL, perceived trust, and legitimacy of anti-doping (organizations). In phase two we assessed whether anti-doping education impacts knowledge, the three DAL stages (functional, interactive, and critical literacy), perceived trust and legitimacy. Phase one enrolled 986 junior elite athletes, and we showed that all GRADE IT components performed well. After revision of the tool for phase two, we validated the assumption that anti-doping education impacts the likelihood that athletes will make the "right" choice (based on a new set of data from 1,255 junior elite athletes). Comprehensive education was associated with higher scores for all stages of DAL, as well as perceived trust and legitimacy. Even athletes reporting no education had positive scores for all included outcomes, supporting the assumption that most athletes wish to engage in clean sport behaviors and might need anti-doping education not to prevent them from doping, but rather to reinforce their commitment to clean sport. In conclusion, GRADE IT, which is available in 23 languages, is a suitable tool for application to young, emerging athletes to satisfy the ISE requirement for evaluating anti-doping education programs. Researchers and practitioners alike are advised to collect additional data to further validate the tool for adult athletes, and to apply it longitudinally to identify if changes in doping prevention policies have a delayed effect on DAL, perceived trust, and legitimacy.

Efficient Ways to Combat Doping in a Sports Education Context!? A Systematic Review on Doping Prevention Measures Focusing on Young Age Groups.

Youth is characterized by testing and crossing natural boundaries, sometimes with the help of performance-enhancing substances. In this context, doping prevention measures play a crucial role to protect individuals both within and outside the context of elite sport. Based on the PRISMA guidelines, a systematic literature search was conducted in the databases ProQuest (ERIC), Scopus, PSYNDEX/PsychInfo, PubMed, and Web of Science Core Collection to provide an overview of the impact of doping prevention measures, with particular attention to the underlying understanding of learning. As a result of the screening process, 30 of the initial 5,591 articles met the previously defined and recorded eligibility criteria. The analysis led to heterogeneous results regarding content, implementation, target group, or outcome variables considered relevant. Two-thirds of the studies related to the competitive sports context. Nevertheless, there has been a growing interest in studying doping prevention and its effects on non-elite athlete target groups in recent years. In terms of effectiveness, many measures did not achieve long-term changes or did not collect any follow-up data. This contrasts with understanding learning as sustained change and reduces the intended long-term protection of prevention measures, especially for adolescent target groups. Even young age groups from 10 years upwards benefited from doping prevention measures, and almost all doping prevention measures enabled their participants to increase their physical and health literacy. No conclusion can be drawn as to whether doping prevention measures based on constructivist ideas are superior to cognitivist approaches or a combination of both. Nevertheless, programs that actively engage their participants appear superior to lecture-based knowledge transfer. Most of the prevention measures offered a benefit-orientation so that participants can achieve added value, besides trying to initiate health-promoting change through rejection. Because of the lack of sustained changes, a further modification in doping prevention seems necessary. The review results support the value of primary prevention. Doping prevention measures should enable tailored learning and development options in the sense of more meaningful differentiation to individual needs. The implementation in a school context or an online setting is promising and sees doping as a problem for society. The review highlights the importance of accompanying evaluation measures to identify efficient prevention components that promote health and protect young people.

Reporting doping in sport: national level athletes' perceptions of their role in doping prevention.

This paper qualitatively explores national level athletes' willingness to report doping in sport. Following ethical approval, semi-structured interviews were conducted with nine national level athletes from rugby league (n = 5) and track and field athletics (n = 4). Thematic analysis established the main themes within the data. Contextual differences existed around the role that athletes perceived they would play if they became aware of doping. Specifically, track and field athletes would adopt the role of a whistle-blower and report individuals who were doping in their sport. In comparison, the rugby league players highlighted a moral dilemma. Despite disagreeing with their teammates' actions, the players would adhere to a code of silence and refrain from reporting doping. Taking these findings into account, prevention programs might focus on changing broader group and community norms around doping. In doing so, community members' receptivity to prevention messages may increase. Moreover, developing skills to intervene (e.g., speaking out against social norms that support doping behavior) or increasing awareness of reporting lines could enhance community responsibility for doping prevention. In sum, the findings highlight the need to consider the context of sport and emphasize that a one-size-fits-all approach to anti-doping is problematic.

Anti-doping education and dietary supplementation practice in Korean elite university athletes.

This study was conducted to investigate relationships and gender differences in dietary supplement (DS) and oriental supplement (OS) prevalence as well as anti-doping awareness during training and the game period. Korea National Sport University athletes (343 male and 136 female) participated in this study and completed DS and OS practice and anti-doping awareness questionnaires. Forty-six percent of athletes used DS during the training period, and there was significantly higher DS use in females (53%) compared to males (43%) (P < 0.05). Twenty-eight percent of athletes used OS, and there was significantly higher OS use in females (35%) than males (26%) (P < 0.05) during the training period. The primary reason of DS use was to supply energy both in males (36%) and females (28%). The main reason for male athletes' OS use was to supply energy (41%). Meanwhile, the reasons for female athletes' OS use were to supply energy (23%), to maintain health (19%), and to improve recovery ability (20%), which showed a significant gender difference (P < 0.05). Athletes rated their perceived degree of satisfaction, perceived importance, and beliefs in efficacy of DS and OS use all over 50% during the training period, and no gender differences were detected. In a comparison between athletes educated about anti-doping (at least more than one time) and non-received athletes, DS and OS use during the training period was 2.30 (1.47-3.60) and 1.71 (1.03-2.82), respectively. DS and OS use immediately before the game period was 2.38 (1.50-3.80) and 3.99 (1.20-13.28), respectively. Elite athletes' anti-doping education was highly related to increased DS use during the training period and immediately before the game. Although elite athletes use various DS and OS during the training period and before the game period, doping education for elite athletes is related with DS and OS use during the training period and before the game.

Anti-doping education and dietary supplementation practice in Korean elite university athletes

This study was conducted to investigate relationships and gender differences in dietary supplement (DS) and oriental supplement (OS) prevalence as well as anti-doping awareness during training and the game period. Korea National Sport University athletes (343 male and 136 female) participated in this study and completed DS and OS practice and anti-doping awareness questionnaires. Forty-six percent of athletes used DS during the training period, and there was significantly higher DS use in females (53%) compared to males (43%) (P < 0.05). Twenty-eight percent of athletes used OS, and there was significantly higher OS use in females (35%) than males (26%) (P < 0.05) during the training period. The primary reason of DS use was to supply energy both in males (36%) and females (28%). The main reason for male athletes' OS use was to supply energy (41%). Meanwhile, the reasons for female athletes' OS use were to supply energy (23%), to maintain health (19%), and to improve recovery ability (20%), which showed a significant gender difference (P < 0.05). Athletes rated their perceived degree of satisfaction, perceived importance, and beliefs in efficacy of DS and OS use all over 50% during the training period, and no gender differences were detected. In a comparison between athletes educated about anti-doping (at least more than one time) and non-received athletes, DS and OS use during the training period was 2.30 (1.47-3.60) and 1.71 (1.03-2.82), respectively. DS and OS use immediately before the game period was 2.38 (1.50-3.80) and 3.99 (1.20-13.28), respectively. Elite athletes' anti-doping education was highly related to increased DS use during the training period and immediately before the game. Although elite athletes use various DS and OS during the training period and before the game period, doping education for elite athletes is related with DS and OS use during the training period and before the game.