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CORK Bibliography: Athletes

121 citations. January 2004 to present

Prepared: January 2008

Abrams RI. Professional sports and collective bargaining: Alcohol, drugs and the national pastime. University of Pennsylvania Journal of Labor and Employment Law 8(Summer): 861-881, 2006. (17 refs.)

Summary: The author recounts the history of performance-enhancing drug use among professional athletes. In the mid-1800s pro swimmers in Amsterdam's canal races and cyclists later in the century were accused of using drugs to enhance their performance. French cyclists in 1879 were found to have used a simple caffeine stimulant, and a Belgian team used ether-laced sugar cubes. Sprint cyclists tried nitroglycerine. A British cyclist died in 1886 after using ephedrine. Athletes in various sports used concoctions to dull pain. For example, boxers used a potent combination of alcohol and strychnine to reduce pain during midday matches that would last for hours. The Boston Globe asked the most famous athlete of the day, heavyweight champion John L. Sullivan, about the Brown-Sequard elixir. This was the first known manufactured steroid, created by Dr. Brown-Sequard, derived from the testicles of guinea pigs and a dogs. Other recreational drugs, like cocaine and marijuana, have been the bane of numerous baseball superstars. The problems of alcohol and drugs among major sports figures are discussed as well as their impact on the sport.

Alaranta A; Alaranta H; Holmila J; Palmu P; Pietila K; Helenius I. Self-reported attitudes of elite athletes towards doping: Differences between type of sport. International Journal of Sports Medicine 27(10): 842-846, 2006. (21 refs.)

Although athletes' beliefs and values are known to influence whether or not an athlete will use banned drugs, little is known about the athletes' beliefs and attitudes in different sports. The aim of this study was to clarify the beliefs and attitudes of elite athletes towards banned substances and methods in sports. A total of 446 athletes (response rate 90.3%; 446/494) financially supported by the National Finnish Olympic Committee completed a structured questionnaire during their national team camps in 2002. More than 90% of the athletes reported to believe that banned substances and methods have performance enhancing effects, and 30% reported that they personally know an athlete who uses banned substances. Of the male athletes 35%, and 23% of females reported they personally know an athlete using banned substances. A total of 15% of the athletes reported that they had been offered banned substances: 21% of the speed and power athletes, 14% of the team sport athletes and of the athletes in motor skills demanding events, and 10% of the endurance athletes. Stimulants were the most often offered substance group (to 7% of all the athletes) followed by anabolic steroids (4%). Subjects who regarded doping as a minor health risk seemed to be more often associated with doping users than those regarding doping as a significant health risk. Athletes in different sports have a different approach to doping. Risk of doping appears to be highest in speed and power sports and lowest in motor skills demanding sports. Males are at higher risk than females. Controlling doping only by tests is not sufficient. A profound change in the attitudes is needed, which should be monitored repeatedly.

Antonio J. Caffeine: The forgotten ergogenic aid. (editorial). Strength and Conditioning Journal 26(6): 50-51, 2004. (10 refs.)

Caffeine is a safe and effective ergogenic aid for endurance and strength-power athletes; moreover, its thermogenic properties make it an oft-used tool for altering body composition.

Astorino TA; Marrocco AC; Gross SM; Johnson DL; Brazil CM; Icenhower ME et al. Is running performance enhanced with creatine serum ingestion? Journal of Strength and Conditioning Research 19(4): 730-734, 2005. (27 refs.)

Runners Advantage (RA) creatine (Cr) serum has been marketed to increase running performance. To test this claim, cross-country runners completed baseline testing (BASE), an outdoor 5,000-m run followed by treadmill (V)over dot O-2,max testing on the same day. Subjects repeated testing after ingesting 5 ml of RA (n = 13) containing 2.5 g of Cr or placebo (n = 11). Heart rate (HR), rating of perceived exertion (RPE), and run time were recorded. With RA (56.48 +/- 8.93 ml(.)kg(.)min(-1)), (V)over dot O(2)max was higher (p = 0.01) vs. BASE (54.07 +/- 9.36 ml(.)kg(-1) min(-1)), yet the magnitude of the increase was within the coefficient of variation of (V)over dot O(2)max. No effect of RA on maximal HR was exhibited, Yet (V)over dot CO(2)max and duration of incremental exercise were significantly higher (p < 0.025) vs. BASE. (V)over dot O(2)max was similar in PL (58.85 +/- 6.67 ml(.)kg(-1) min(-1)) and BASE (57.28 +/- 7.22 ml(.)kg(-1) min(-1)). With RA, the 5,000-m time was unchanged, and RPE was lower (p < 0.025) vs. BASE. These data do not support the ergogenic claims of RA in its current form and dose.

Avois L; Robinson N; Saudan C; Baume N; Mangin P; Saugy M. Central nervous system stimulants and sport practice. British Journal of Sports Medicine 40(Supplement 1): 16-20, 2006. (17 refs.)

BACKGROUND AND OBJECTIVES: Central nervous system (CNS) stimulants may be used to reduce tiredness and increase alertness, competitiveness, and aggression. They are more likely to be used in competition but may be used during training to increase the intensity of the training session. There are several potential dangers involving their misuse in contact sports. This paper reviews the three main CNS stimulants, ephedrine, amfetamine, and cocaine, in relation to misuse in sport. METHODS: Description of the pharmacology, actions, and side effects of amfetamine, cocaine, and ephedrine. RESULTS: CNS stimulants have psychotropic effects that may be perceived to be ergogenic. Some are prescription drugs, such as Ephedra alkaloids, and there are issues regarding their appropriate therapeutic use. Recently attention has been given to their widespread use by athletes, despite the lack of evidence regarding any ergogenic or real performance benefit, and their potentially serious side effects. Recreational drugs, some of which are illegal (cocaine, amfetamines), are commonly used by athletes and cause potential ergolytic effects. Overall, these drugs are important for their frequent use and mention in anti-doping laboratories statistics and the media, and their potentially serious adverse effects. CONCLUSIONS: Doping with CNS stimulants is a real public health problem and all sports authorities should participate in its prevention. Dissemination of information is essential to prevent doping in sport and to provide alternatives. Adequate training and education in this domain should be introduced.

Baron DA; Baron DA; Baron SH. Laboratory testing for substances of abuse. IN: Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. pp. 63-71. (7 refs.)

This chapter reviews testing methodologies and the fundamental aspects of planning effective testing procedures in both clinical and consulting settings. It outlines the most common testing technologies and their limitations. Also significant issues such as the lack of a standard cut-off point for positive outcome are noted, as well as techniques to avoid a positive test results. The mechanisms of drug testing programs are also reviewed, such as chain of evidence, testing of athletes, and testing in occupational settings.

Beck TW; Housh TJ; School ofmidt RJ; Johnson GO; Housh DJ; Coburn JW et al. The acute effects of a caffeine-containing supplement on strength, muscular endurance, and anaerobic capabilities. Journal of Strength and Conditioning Research 20(3): 506-510, 2006. (25 refs.)

The purpose of this study was to examine the acute effects of a caffeine-containing supplement on upper- and lower-body strength and muscular endurance as well as anaerobic capabilities. Thirty-seven resistance-trained men (mean SD, age: 21 +/- 2 years) volunteered to participate in this study. On the first laboratory visit, the subjects performed 2 Wingate Anaerobic Tests (WAnTs) to determine peak power (PP) and mean power (MP), as well as tests for 1 repetition maximum (1RM), dynamic constant external resistance strength, and muscular endurance (TOTV; total volume of weight lifted during an endurance test with 80% of the 1RM) on the bilateral leg extension (LE) and free-weight bench press (BP) exercises. Following a minimum of 48 hours of rest, the subjects returned to the laboratory for the second testing session and were randomly assigned to 1 of 2 groups: a supplement group (SUPP; n = 17), which ingested a caffeine-containing supplement, or a placebo group (PLAC; n = 20), which ingested a cellulose placebo. One hour after ingesting either the caffeine-containing supplement or the placebo, the subjects performed 2 WAnTs and were tested for 1RM strength and muscular endurance on the LE and BP exercises. The results indicated that there was a significant (p < 0.05) increase in BP 1RM for the SUPP group, but not for the PLAC group. The caffeine-containing supplement had no effect, however, on LE 1RM, LE TOTV, BP TOTV, PP, and MP. Thus, the caffeine-containing supplement may be an effective supplement for increasing upper-body strength and, therefore, could be useful for competitive and recreational athletes who perform resistance training.

Bents RT; Tokish JM; Goldberg L. Ephedrine, pseudoephedrine, and amphetamine prevalence in college hockey players: Most report performance-enhancing use. Physician and Sportsmedicine 32(9): 30-34, 2004. (20 refs.)

BACKGROUND: Performance-enhancing drugs are used by some athletes, even though the substances may be potentially dangerous and some are banned. OBJECTIVE: To assess the use of metabolic stimulants among collegiate hockey players. METHODS: Surveys were administered to college hockey players on five teams. Participation was voluntary, and respondents remained anonymous. The survey included questions regarding use of specific stimulants (eg, ephedrine, amphetamines, pseudoephedrine), awareness of potential side effects, and knowledge of National Collegiate Athletic Association (NCAA) rules. RESULTS: More than half (58%) of the 122 college hockey players who completed the survey reported past or present use of the specific stimulants. Almost half (46%) reported pseudoephedrine use to enhance performance, including 24% who indicated current use, and 38% reported ephedrine use, including 11% who admitted current use. Stimulant users had good knowledge about the potential side effects of ephedrine, including sudden death, hypertension, and insomnia. Nearly all (92%) stimulant users were aware of the current NCAA ban of ephedrine. Over 33% stated they would use a banned substance if it would help them get to the National Hockey League. CONCLUSION: A large number of collegiate hockey players admit to using metabolic stimulants despite knowledge of side effects and the NCAA ban on two of these substances. More effective educational interventions, perhaps coupled with a stronger testing policy, may be necessary to curb this potentially dangerous practice.

Blum A. Tobacco in sport: an endless addiction? (editorial). Tobacco Control 14(1): 1-2, 2005. (7 refs.)

Bouroncle A. Sports, substances and politics: A brief historical approach. IN: Bouroncle A; Rauhamaki S, eds. Sport and Substance Use in the Nordic Countries. NAD Monograph No. 45. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 17-38. (17 refs.)

This is one of two chapters providing a historical perspective of the relationship between sports and substance use, from the classic Greek period to the modern Olympic movement.

Bouroncle A. The good, the bad and the ugly: Sports and substances in contemporary society. IN: Bouroncle A; Rauhamaki S, eds. Sport and Substance Use in the Nordic Countries. NAD Monograph No. 45. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 177-196. (19 refs.)

This is one of two chapters which deal with sport, prevention and culture. The common wisdom is that sport builds character among youth, and promotes physical health as well as psychological and social skills. However, the author holds that a closer examination reveals a more complex picture. Historically the athletic body was a mark of the king or leader, and considered at the national level, sports is viewed as a mark of national prestige, as witnessed in the Olympic movement, with the national count of medels. Sports have also been commercialized as well as increasingly enshrined, as in "Halls of Fame", as well as the transformation of spectators into fans, whose behavior too has symbolic behavior. In looking beyond the image of 'fair play, loyalty, and health', the author looks at the role of alcohol consumption, doping in sports, violence in sports, and the limits of sports as a formative force. it is noted that the goal to "be number one" can lead to a tendency to never feel satisfied, and the good personality features attributed to athletes may be a sacrifice later.

2005, Nordic Council for Alcohol and Drug Research

Bridge CA; Jones MA. The effect of caffeine ingestion on 8 km run performance in a field setting. Journal of Sports Sciences 24(4): 433-439, 2006. (40 refs.)

The aim of this study was to assess the effect of caffeine ingestion on 8 km run performance using an ecologically valid test protocol. A randomized double-blind crossover study was conducted involving eight male distance runners. The participants ran an 8 km race 1 h after ingesting a placebo capsule, a caffeine capsule (3 mg . kg(-1) body mass) or no supplement. Heart rate was recorded at 5 s intervals throughout the race. Blood lactate concentration and ratings of perceived exertion were recorded after exercise. A repeated-measures analysis of variance ( ANOVA) identified a significant treatment effect for 8 km performance time (P<0.05); caffeine resulted in a mean improvement of 23.8 s (95% confidence interval [CI] 13.1 to 34.5 s) in 8 km performance time (1.2% improvement, 95% CI 0.7 to 1.8%). In addition, a two-way (time x condition) repeated-measures ANOVA identified a significantly higher blood lactate concentration 3 min after exercise during the caffeine trial ( P<0.05). We conclude that ingestion of 3 mg . kg(-1) body mass of caffeine can improve absolute 8 km run performance in an ecologically valid race setting.

Calfee R; Fadale P. Popular ergogenic drugs and supplements in young athletes. (review). Pediatrics 117(3): E577-E589, 2006. (102 refs.)

Ergogenic drugs are substances that are used to enhance athletic performance. These drugs include illicit substances as well as compounds that are marketed as nutritional supplements. Many such drugs have been used widely by professional and elite athletes for several decades. However, in recent years, research indicates that younger athletes are increasingly experimenting with these drugs to improve both appearance and athletic abilities. Ergogenic drugs that are commonly used by youths today include anabolic-androgenic steroids, steroid precursors (androstenedione and dehydroepiandrosterone), growth hormone, creatine, and ephedra alkaloids. Reviewing the literature to date, it is clear that children are exposed to these substances at younger ages than in years past, with use starting as early as middle school. Anabolic steroids and creatine do offer potential gains in body mass and strength but risk adverse effects to multiple organ systems. Steroid precursors, growth hormone, and ephedra alkaloids have not been proven to enhance any athletic measures, whereas they do impart many risks to their users. To combat this drug abuse, there have been recent changes in the legal status of several substances, changes in the rules of youth athletics including drug testing of high school students, and educational initiatives designed for the young athlete. This article summarizes the current literature regarding these ergogenic substances and details their use, effects, risks, and legal standing.

Camacho A; Matthews SC; Dimsdale JE. Use of GHB compounds by HIV-positive individuals. American Journal on Addictions 13(2): 120-127, 2004. (29 refs.)

Gamma hydroxybutyrate (GHB) has been used by body-builders to enhance performance and by young adults in rave parties. Warnings have been posted about its addictive potential. The use of these dietary compounds is currently banned by the Food and Drug Administration, but they are widely available through the Internet and in certain communities. The purpose of the study was to examine the use of these compounds by HIV-positive individuals and to investigate their knowledge of the addictive potential of GHB and its related dietary compounds. One hundred HIV-positive individuals from the UCSD outpatient HIV clinic responded to an anonymous survey that inquired about their knowledge, use, and effects produced by GHB containing dietary compounds. The most common reported dietary compound beside GHB was Growth Hormone Release Extract (GHRE). Fifty-two percent of individuals reported using at least one GHB containing dietary compound. Gay subjects reported the highest use of GHB compounds (76.9%; p less than or equal to 0.001). The most common effect reported by users was increased energy (71%). Only 24% of the total responders knew about GHB's addictive potential. Among reported users of GHB containing compounds, fourteen (27%) knew about its addictive potential and nine (17%) knew that the compound is illegal. This study shows that HIV-positive gay individuals attending our clinic are using GHB compounds. Reported GHB users have limited knowledge about its addictive potential and serious adverse effects. More controlled studies are needed to evaluate long-term effects of dietary compounds containing GHB, especially among HIV-positive individuals who are actively receiving antiretroviral treatment.

Castrucci BC; Gerlach KK; Kaufman NJ; Orleans CT. Tobacco use and cessation behavior among adolescents participating in organized sports. American Journal of Health Behavior 28(1): 63-71, 2004. (24 refs.)

Objectives: To examine the difference in tobacco use between adolescents who participate in organized sports and those who do not. Methods: Using a cross-sectional study design, this study uses data from a nationally representative sample of adolescents enrolled in public high schools in the United States. Results. Those participating in organized sports were 25% less likely to be current cigarette smokers. However, smokeless tobacco use was found to be associated with participation in organized sports. Conclusions: Given the large proportion of students involved in organized sports, intervening through this venue to address tobacco use has the potential to reach significant numbers of adolescents.

Collins T. Symposium: From grand slams to grand juries. Performance-enhanicng drug use in sport. Changing the Game: The Congressional response to sports doping via the anabolic steroid control Act. New England Law Review 40: 753-763, 2006. (41 legal refs.)

This article focuses on the use of anabolic steroids and steroid precursors by sports competitors and how federal legislators have responded by subjecting possessors of steroid precursor products - which were openly sold in health food stores until January 2005 - to arrest and prosecution. In the mid 1980s, reports of increasing use of anabolic steroids in organized sports came to the attention of Congress. Between 1988 and 1990, congressional hearings were held to determine whether the Controlled Substances Act should be amended to include anabolic steroids. (Significantly, medical professionals and representatives of regulatory agencies (including the Food and Drug Administration, the Drug Enforcement Administration, and the National Institute on Drug Abuse) testified against the proposed amendment to the law. The majority of witnesses at the hearings, consistent with Congress's apparent main concern, focused on the purported need for legislative action to solve an athletic "cheating" problem. Congress consequently passed the Anabolic Steroid Control Act of 1990, criminalizing the possession of anabolic steroids without a valid prescription. The law placed steroids in the same legal class as barbiturates, ketamine, LSD precursors, and narcotic painkillers such as Vicodin, the only hormones in the schedules. The 1990 law only listed twenty-seven compounds, along with their muscle-promoting salts, esters, and isomers. However, there are in theory hundreds or even thousands of anabolic steroidal compounds - many of which might enhance athletic performance - which could be created in laboratories and offered for human use. By the early part of the current decade, some of these substances were being openly marketed as performance-enhancing dietary supplements. Called "pro-hormones" or in some cases "pro-steroids," these products were frequently metabolic precursors to testosterone or other listed anabolic steroids. The Anabolic Steroid Control Act of 2004 was passed to deal with this. The new law also changes the general requisite elements of an anabolic steroid. Ironically, there is no longer any requirement for evidence that an anabolic steroid is "anabolic," i.e., that it promotes muscle growth. The ramifications for the criminal justice system are outlined. The approach to combat steroid and steroid precursor use in competitive athletics has been two-fold: the imposition of administrative penalties by the sports agencies for those who test positive for the drugs, and the imposition of sanctions to criminalize those who possess them unlawfully, regardless of sports involvement. The focus in both instances is on the drugs or substances themselves. Neither approach is free of problems. Drug testing continues to be a game of cat-and-mouse as new performance-enhancing compounds and masking techniques emerge; catching up to the cheaters can take decades. Criminal laws and sanctions may be largely irrelevant to athletic steroid use, at least at commercialized levels, based upon the lack of enforcement efforts targeting competetive athletes to date. Steroid use in sports is not so much a drug crisis as an ethics crisis. If that is the true heart of the problem, we need to look beyond drug testing and new criminal laws. We need to ask the tough questions about what drives the "winning at all costs" attitude.

Curry LA; Maniar SD. Academic course for enhancing student-athlete performance in sport. Sport Psychologist 18(3): 297-316, 2004. (51 refs.)

The purpose of this paper is to describe content and methods of an academic course offered twice annually at an NCAA Division I University. With empirical support to the effectiveness of this academic approach to psychological skills training presented elsewhere (Curry & Maniar, 2003), the focus of this paper is on the type and extent of each intervention treatment during the 15-week semester course (Vealey, 1994). Course content includes applied strategies for best performance targeting, arousal/affect control, identifying purpose, goal setting, imagery, sport confidence, trust, flow, sport nutrition, on-/off-field problem solving, self-esteem, and life skills education on eating disorders and drug/alcohol abuse. Teaching methods include narrative story telling, small group activities, journal writing, cognitive-behavioral homework, brainteasers, and active learning demonstrations.

Danaher S. Drug abuse in major league baseball: A look at drug testing in the past, in the present, and steps for the future. Journal of Sports and Entertainment Law 14: 305-334, 2004. (192 legal refs.)

Over the past few years in Major League Baseball ("MLB"), there erupted a growing concern amongst the league, owners, and lawmakers that players were using steroids and other muscle enhancing supplements to boost production. Whether or not there actually is a correlation between drug or supplement use and the increase in hitter statistics has yet to be determined, regardless, steroids are still illegal and harmful to the body of adults, and children more so. Finally, thirty-four years after the inaugural collective bargaining agreement in MLB and professional sports , the owners and players agreed to implement a policy for testing steroid use as a part of the 2002 collective bargaining agreement. This comment will focus on: (I) why the issue of drug testing (including illegal drugs and all supplements) is an important topic; (II) pre-2002 collective bargaining agreements and attempts at drug testing; (III) an explanation of the 2002 collective bargaining agreement and its criticisms; (IV) an overview of drug testing in other major sports; and (V) steps for future collective bargaining agreements in major league baseball. In 1986, Ueberroth again tried to institute a drug-testing program for all major league players by inserting clauses into player contracts that required mandatory drug testing. However, drug testing is a mandatory subject of collective bargaining, therefore, any program that is instituted must be agreed to by both MLB and the MLBPA.

Dhar R; Stout CW; Link MS; Homoud MK; Weinstock J; Estes NAM. Cardiovascular toxicities of performance-enhancing substances in sports. (review). Mayo Clinic Proceedings 80(10): 1307-1315, 2005. (91 refs.)

Athletes commonly use drugs and dietary supplements to improve athletic performance or to assist with weight loss. Some of these substances are obtainable by prescription or by illegal means; others are marketed as supplements, vitamins, or minerals. Nutritional supplements are protected from Food and Drug Administration regulation by the 1994 US Dietary Supplement Health and Education Act, and manufacturers are not required to demonstrate proof of efficacy or safety. Furthermore, the Food and Drug Administration lacks a regulatory body to evaluate such products for purity. Existing scientific data, which consist of case reports and clinical observations, describe serious cardiovascular adverse effects from use of performance-enhancing substances, including sudden death. Although mounting evidence led to the recent ban of ephedra (ma huang), other performance-enhancing substances continue to be used frequently at all levels, from elementary school children to professional athletes. Thus, although the potential for cardiovascular injury is great, few appropriately designed studies have been conducted to assess the benefits and risks of using performance-enhancing substances. We performed an exhaustive OVID MEDLINE search to identify all existing scientific data, review articles, case reports, and clinical observations that address this subject. In this review, we examine the current evidence regarding cardiovascular risk for persons using anabolic-androgenic steroids including 2 synthetic substances, tetrahydrogestrinone and androstenedione (andro), stimulants such as ephedra, and nonsteroidal agents such as recombinant human erythropoietin, human growth hormone, creatine, and beta-hydroxy-beta-methylbutyrate.

Dvorak J; Graf-Baumann T; D'Hooghe M; Kirkendall D; Taennler H; Saugy M. FIFA's approach to doping in football. British Journal of Sports Medicine 40(Supplement 1): 3-12, 2006. (3 refs.)

BACKGROUND AND OBJECTIVES: FIFA's anti-doping strategy relies on education and prevention. A worldwide network of physicians guarantees doping control procedures that are straightforward and leave no place for cheating. FIFA actively acknowledges its responsibility to protect players from harm and ensure equal chances for all competitors by stringent doping control regulations, data collection of positive samples, support of research, and collaboration with other organisations. This article aims to outline FIFA's approach to doping in football. Method: Description of FIFA's doping control regulations and procedures, statistical analysis of FIFA database on doping control, and comparison with data obtained by WADA accredited laboratories as for 2004. RESULTS: Data on positive doping samples per substance and confederation/nation documented at the FIFA medical office from 1994 to 2005 are provided. According to the FIFA database, the incidence of positive cases over the past 11 years was 0.12%, with about 0.42% in 2004 (based on the assumption of 20 750 samples per year) and 0.37% in 2005. Especially important in this regard is the extremely low incidence of the true performance enhancing drugs such as anabolic steroids and stimulants. However, there is a need for more consistent data collection and cross checks among international anti-doping agencies as well as for further studies on specific substances, methods, and procedures. With regard to general health impairments in players, FIFA suggests that principles of occupational medicine should be considered and treatment with banned substances for purely medical reasons should be permitted to enable players to carry out their profession. At the same time, a firm stand has to be taken against suppression of symptoms by medication with the aim of meeting the ever increasing demands on football players. CONCLUSION: Incidence of doping in football seems to be low, but much closer collaboration and further investigation is needed with regard to banned substances, detection methods, and data collection worldwide.

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. Archives of Pediatrics & Adolescent Medicine 158(11): 1043-1049, 2004. (54 refs.)

Objectives: To implement and to assess the efficacy of a school-based, sport team-centered program to prevent young female high school athletes' disordered eating and body-shaping drug use. Design and Setting: Prospective controlled trial in 18 high schools, with balanced random assignment by school to the intervention and usual-care control conditions. Participants: We enrolled 928 students from 40 participating sport teams. Mean age was 15.4 years, 92.2% were white, and follow-up retention was 72%. Intervention: The ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternative) curriculum's 8 weekly 45-minute sessions were incorporated into a team's usual practice activities. Content was gender-specific, peer led, and explicitly scripted. Topics included healthy sport nutrition, effective exercise training, drug use and other unhealthy behaviors' effects on sport performance, media images of females, and depression prevention. Main Outcome Measures: We assessed participants by confidential questionnaire prior to and following their sport season. We determined program effects using an analysis of covariance-based approach within the Generalized Estimating Equation framework. Results: Experimental athletes reported significantly less ongoing and new use of diet pills and less new use of athletic-enhancing substances (amphetamines, anabolic steroids, and sport supplements) (P<.05 for each). Other health-harming actions also were reduced (less riding with an alcohol-consuming driver [P=.051, more seat belt use [P<.05], and less new sexual activity [P<.05]). The ATHENA athletes had coincident positive changes in strength-training self-efficacy (P<.005) and healthy eating behaviors (P<.001). Reductions occurred in intentions toward future use of diet pills (P<.05), vomiting to lose weight (P<.05), and use of tobacco (P<.05) and muscle-building supplements (P<.005). The program's curriculum components were altered appropriately (controlling mood [P<.005], refusal skills [P=.051, belief in the media [P<.0051, and perceptions of closest friends' body-shaping drug use [P<.001]). Conclusions: Sport teams are effective natural vehicles for gender-specific, peer-led curricula to promote healthy lifestyles and to deter disordered eating, athletic-enhancing substance use, and other health-harming behaviors.

Fortenberry PA; Hoffman BE. Illegal muscle: A comparative analysis of proposed steroid legislation and the policies in professional sports' CBAs that led to the steroid controversy. Virginia Sports and Entertainment Law Journal 5(121-147), 2006. (161 refs.)

The purpose of this paper is to compare, contrast, and evaluate the steroid clauses within the collective bargaining agreements (CBA) of the four major sports, to look at the steroid policies in the various CBAs prior to the recent steroids controversy, to examine the current steroids policy of the four major sports due to changes made as a result of public pressure and congressional scrutiny, and to discuss the possible future steroid policy that would be mandated by proposed legislation. The respective CBA language concerning steroids and other league steroid policies will be reviewed, specifically looking at (1) their prohibitions, (2) their testing procedures and (3) their disciplinary remedies for steroid violations. A review of the changes voluntarily agreed to by the subject professional sports organizations and the respective unions will be conducted and an analysis of proposed legislation in the Senate and House will also be undertaken.

Fritz MS; MacKinnon DP; Williams J; Goldberg L; Moe EL; Elliot DL. Analysis of baseline by treatment interactions in a drug prevention and health promotion program for high school male athletes (rapid communication). Addictive Behaviors 30(5): 1001-1005, 2005. (6 refs.)

This paper investigates baseline by treatment interactions (BTI) of a randomized anabolic steroid prevention program delivered to high school football players. Baseline by treatment interactions occur when a participant's score on an outcome variable is associated with both their pretreatment standing on the outcome variable and the treatment itself. The program was delivered to 31 high school football teams (Control=16, Treatment=15) in Oregon and Washington over the course of 3 years (Total N=3207). Although most interactions were nonsignificant, consistent baseline by treatment interactions were obtained for knowledge of the effects of steroid use and intentions to use steroids. Both of these interactions were beneficial in that they increased the effectiveness of the program for participants lower in knowledge and higher in intentions at baseline.

Gansky SA; Ellison JA; Rudy D; Bergert N; Letendre MA; Nelson L et al. Cluster-randomized controlled trial of an athletic trainer-directed spit (smokeless) tobacco intervention for collegiate baseball athletes: Results after 1 year. Journal of Athletic Training 40(2): 76-87, 2005. (46 refs.)

Context: Athletes in the United States are at high risk for using spit (smokeless) tobacco (ST) and incurring its associated adverse health effects. Objective: To examine whether an athletic trainer-directed ST intervention could decrease initiation and promote cessation of ST use among male collegiate baseball athletes. Design: Stratified, cluster-randomized controlled trial. Setting: Fifty-two California colleges. Patients or Other Participant(s): A total of 883 subjects in 27 intervention colleges and 702 subjects in 25 control colleges participated, as did 48 certified athletic trainers. Intervention(s): For college athletic trainers and associated dental professionals, a 3-hour video conference, and for collegiate athletes, an oral cancer screening with feedback and brief counseling during the preseason health screenings, athletic trainer support for cessation, and a peer-led educational baseball team meeting. Main Outcome Measure(s): The subjects' ST use over 1 year was assessed by self-report. At the end of the study, the certified athletic trainers were mailed a survey assessing their tobacco use and perceptions and behavior related to tobacco control in the athletic environment. We used multivariable logistic regression models for clustered responses (generalized estimating equations) to test the difference between groups in ST- use initiation and cessation and to identify significant overall predictors of noninitiation and cessation of ST use. Results: Of the 1585 athletes recruited, 1248 (78.7%) were followed up at 12 months. In addition, 48 of the 52 athletic trainers (92%) responded to the 1-year follow-up survey. The ST-use initiation (incidence) was 5.1% in intervention colleges and 8.4% in control colleges (generalized estimating equation odds ratio = 0.58, 95% confidence interval = 0.35-0.99). Predictors of ST noninitiation were low lifetime tobacco and monthly alcohol use (odds ratio = 1.98, 95% confidence interval = 1.40-2.82) and athletic trainers' report that the baseball coach supported ST-use prevention activities (odds ratio = 1.43, 95% confidence interval = 1.11-1.83). Although at 1 year, cessation of ST use was relatively high in both groups (36%), we noted no significant difference between the groups (odd ratio = 0.94, 95% confidence interval = 0.70-1.27). Conclusions: The intervention was significantly effective in preventing incident ST use but did not significantly increase cessation beyond that seen in the control group. The latter finding is inconsistent with previous studies and may be explained by spillover of the intervention to control colleges, other anti-tobacco activity in control colleges, and/or the small sample of dependent ST users enrolled in the study.

Garibaldi DA. Symposium: From grand slams to grand juries. Performance-enhanicng drug use in sport. The challenge and the tragedy. New England Law Review 40: 717-727, 2006. (35 legal refs.)

This article provides a personal perspective on the dangers of the use of performance-enhancing drugs among student athletes. It is authored by a mother whose son committed suicide after a several year period of steroid use, sparked by his desire to become a professional athlete. The complicacy of trainers are coaches are described, as well as the sources of the drugs, and the physical and behavioral changes which occurred with long term use.

Green GA. Doping control for the team physician: A review of drug testing procedures in sport. American Journal of Sports Medicine 34(10): 1690-1698, 2006. (28 refs.)

Drug testing is now ubiquitous in sport, and it often falls to the team physician to perform a variety of roles including interpreting test results, designing drug-testing programs, acting as medical review officer, and providing therapeutic use exemptions, education, and counseling. Proper understanding of current testing methods for drugs such as anabolic-androgenic steroids, erythropoietin, and growth hormone is essential if the team physician is going to assume these positions. This article outlines the basics of athletic drug testing from the collection process through the interpretation of results to assist the team physician in this field.

Haagen PH. Symposium: From grand slams to grand juries. Performance-enhanicng drug use in sport. The players have lost that argument: Doping, drug testing, and collective bargaining. New England Law Review 40(831-849), 2006. (95 legal refs.)

This article addresses the use of performance-enhancing drugs in professional sports, and legal efforts to address doping is professional sports which can have an impact for collective bargaining in the US. This article describes several legislative efforts to address the issue. In one hearing it was made clear that Congress now regarded performance-enhancing drugs in sports as a "transcendent issue." In the face of such transcendence, a matter affecting the terms of conditions of work, drug testing, and thus a mandatory subject of collective bargaining, would not be permitted to go through the normal process of collective bargaining. The Union was informed that its obligation to protect all of its members did not extend to "cheaters." Comprehensive drug testing, including out of competition, random, unannounced testing was characterized as "not about privacy." Among the topics considered is the perceived need to control doping, and the response in Olympic and professional sports. The issue of whether drug testing works is also considered as well as the nature of penalties and due process.

Haukkala A; Vartiainen E; de Vries H. Progression of oral snuff use among Finnish 13-16-year-old students and its relation to smoking behaviour. Addiction 101(4): 581-589, 2006. (40 refs.)

Aims: To examine the progression of oral moist snuff use among adolescents and its relation to smoking behaviour and nicotine addiction. Design and Setting: A 3-year smoking prevention study in 27 schools of Helsinki, Finland, starting with the seventh grade to the ninth grade. Participants and measurements: Pupils (n = 2816) completed questionnaires four times, which included information on smoking behaviour, snuff experiments, nicotine addiction (Fagerstrom Tolerance Questionnaire) and other activities. Findings: The prevalence of snuff experimentation rose among boys from 7% in the seventh grade to 43% 3 years later in the ninth grade, and among girls from 2% to 13% for the corresponding period. Among boys, smoking predicted later snuff use in all assessments and snuff experimentation predicted later weekly smoking. The impact of snuff experimentation upon later smoking experimentation was smaller than vice versa. Among boys active in sports, smoking was less common but snuff use was more common. Combined use was common; by the end of the follow-up only 10% of weekly smokers had not tried oral snuff. Nicotine dependence scores increased linearly with snuff use among weekly smokers. Conclusions: Despite the European Union sales ban on oral snuff products since 1995, in Finland snuff use is common among boys. Although combined use of snuff and cigarettes is associated with higher levels of nicotine dependence among adolescent boys, the direction of causality is not known. Unlike cigarette smoking, oral snuff use was tried among boys who spent their free time with sports-related activities.

Heinonen H. Alcohol and the transformation of sports spectating in Finland. IN: Bouroncle A; Rauhamaki S, eds. Sport and Substance Use in the Nordic Countries. NAD Monograph No. 45. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 63-80. (34 refs.)

This is one of three chapters dealing with alcohol in relation to modern sports. Historically the temperance movement has had a major impact in Finnish culture. Paradoxically, excessive drinking of spirits, to the point of intoxication, particularly over weekends, has long been a dominant drinking patterns. With increasing Europeanisation, alcohol has become more a factor of everyday life, rather than sequestered away. In 1995 promoters and sports organizers gained permission to sell and advertise alcohol at sporting events, just at the same time as the rest of Europe was moving in the opposite direction. This has begun to raise concerns about the impact on attitudes and values associated with sports. This chapter reports the results of a large national survey conducted in 2000, to ascertain the drinking patterns at sports events. Contrary to the media's presentation of drinking spectators, the minority of people consume alcohol, slightly under 40% for men and about 15% for women. Drinking at different type of sports events was determined, as well as respondants' views of drinking's impact on their enjoyment of an event.

Hellandsjo Bu ET. Alcohol debut and consumption among Norwegian athletes: The impact of environmental and personal factors. IN: Bouroncle A; Rauhamaki S, eds. Sport and Substance Use in the Nordic Countries. NAD Monograph No. 45. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 111-132. (53 refs.)

This is one of three chapters dealing with alcohol in relation to modern sports. In Norway nearly 50% of children and young people aged 8 and 24 are actively engaged in organized sports. This chapter examines the initiation of drinking and intoxication among Norwegian teenagers. Research has shown that participation in organized sports delayed drinking and intoxication. This is of importance as later use of alcohol is related to fewer alcohol problems later. Data is presented here on the use of alcohol among athletes, and the relationship to the type of sport and level of performance, places for drinking, and motives for drinking. Consumption is lower among athletes at the national, than at the local level, and even lowest at the international level. There is also discussion of environmental factors: parents, peers, and coaches as role models; goal-oriented environment; the role of cohesion in sports clubs; pressures to achieve. Personal factors such as win orientation, goal orientation, reactive and proactive negatives, self-esteem, and physical self are also discussed. The author concludes that athletes drink less than non-athletes, within certain sports groups, and the difference is marked. The age of initiation and intoxication is higher among athletes. There are gender differences as well as differences by type of sport and level of participation. Also important, environmental factors are significant as are personal factors. Support and structure from family and sports club, good role models by family and coaches are associated with less alcohol use.

2006, Project Cork

Hespel P; Maughan RJ; Greenhaff PL. Dietary supplements for football. Journal of Sports Sciences 24(7): 749-761, 2006. (116 refs.)

Physical training and competition in football markedly increase the need for macro- and micronutrient intake. This requirement can generally be met by dietary management without the need for dietary supplemens. In fact, the efficacy of most supplements available on the market is unproven. In addition, players must be cautious of inadequate product labelling and supplement impurities that may cause a positive drug test. Nonetheless, a number of dietary supplements may beneficially affect football performance. A high endurance capacity is a prerequisite for optimal match performance, particularly if extra time is played. In this context, the potential of low-dose caffeine ingestion (2 - 5 mg (.) kg body mass(-1)) to enhance endurance performance is well established. However, in the case of football, care must be taken not to overdose because visual information processing might be impaired. Scoring and preventing goals as a rule requires production of high power output. Dietary creatine supplementation (loading dose: 15 - 20 g (.) day(-1), 4 - 5 days; maintenance dose: 2 - 5 g g (.) day(-1)) has been found to increase muscle power output, especially during intermittent sprint exercises. Furthermore, creatine intake can augment muscle adaptations to resistance training. Team success and performance also depend on player availability, and thus injury prevention and health maintenance. Glucosamine or chondroitin may be useful in the treatment of joint pain and osteoarthritis, but there is no evidence to support the view that the administration of these supplements will be preventative. Ephedra-containing weight-loss cocktails should certainly be avoided due to reported adverse health effects and positive doping outcomes. Finally, the efficacy of antioxidant or vitamin C intake in excess of the normal recommended dietary dose is equivocal. Responses to dietary supplements can vary substantially between individuals, and therefore the ingestion of any supplement must be assessed in training before being used in competition. It is recommended that dietary supplements are only used based on the advice of a qualified sports nutrition professional.

Hodges K; Hancock S; Currell K; Hamilton B; Jeukendrup AE. Pseudoephedrine enhances performance in 1500-m runners. Medicine and Science in Sports and Exercise 38(2): 329-333, 2006. (20 refs.)

Pseudoephedrine is an over-the-counter drug to relieve nasal and sinus congestion. Although it has been suggested that pseudoephedrine could be a stimulant and ergogenic aid, pseudoephedrine was recently removed front the banned Substance list by the International Olympic Committee and placed on the monitoring program (front January 2004). It was felt that evidence was lacking for an ergogenic effect, although few studies have investigated the effects of pseudoephedrine on exercise performance. This study, therefore, aimed to investigate the effects of pseudoephedrine on 1500-m running performance. Methods: In a double-blind, randomized crossover design, seven male athletes completed two 1500-m running trials on an outdoor track after having completed a familiarization trial. All trials were 7 d apart. After a 12-h overnight fast, subjects reported to the laboratory and received a standardized breakfast (energy approximate to 500 kcal 50% CHO). Subjects were given either 2.5 mg center dot kg(-1) bw pseudoephedrine or 2.5 mg center dot kg(-1) bw maltodextrins (placebo) in gelatin capsules 70 min before the start of the warm-up, which started 20 ruin before the), ran 1500 in all-out. Pre- and postexercise blood samples were collected and analyzed for lactate and glucose concentrations, partial pressure of oxygen (PO2) and carbon dioxide (PCO2). and percent oxygen saturation. Results: Pseudoephedrine significantly decreased time to completion of 1500-m time trials in the present study by 2.1% (from 279.65 +/- 4.36 s with placebo to 273.86 +/- 4.36 s with pseudoephedrine) with no reported side effects. No changes in the measured blood parameters were found, suggesting a central effect of pseudoephedrine rather than a metabolic effect. Conclusion: The finding was that 2.5 bw pseudoephedrine ingested 90 preexercise improves 1500-m running performance.

Johnson R. The unique ethics of sports medicine. Clinics in Sports Medicine 23(2): 175+, 2004. (15 refs.)

The ethical code by which physicians traditionally conduct themselves is based on the relationship between the physician and the patient. Both the patient and physician work toward the common goal of improving or maintaining health. Constraints on this relationship may take the form of illness behaviors of patient choice (tobacco use, excessive alcohol use, sedentary behavior, and so on). The athlete-physician relationship is ethically different. Influences such as the physician's employer (the team or the school), the athlete's desire to play with pain and injury, and the economic consequences of playing or not playing complicate medical decisions. This perspective, then, suggests something different and even unique about the ethics of the sports medicine practitioner. This article explores the differences fostering the ethical tightropes that sports physicians walk in their sports medicine practices.

Karila T; Hovatta O; Seppala T. Concomitant abuse of anabolic androgenic steroids and human chorionic gonadotrophin impairs spermatogenesis in power athletes. International Journal of Sports Medicine 25(4): 257-263, 2004. (24 refs.)

Abuse of anabolic androgenic steroids (AASs) may be an aetiological factor in male infertility among recreational power athletes. They try to avoid AAS-induced deterioration in spermatogenesis by combining doses of human chorionic gonadotrophin (HCG) and/or antiestrogens with their AAS abuse. Eighteen healthy male power athletes using massive doses of AASs were recruited for the study. Semen samples were collected during AAS abuse and 1.5 and 6 months after cessation of the abuse. They were also asked about their reproductive activity six years after the study. At the end of the AAS cycle, the sperm count was 33 49 x 10(6)/ml (mean +/- SD), and only one subject had azoospermia. At 1.5 months after cessation of the AAS cycles, the mean sperm concentration was 30 42 x 10(6)/ml, and after six months 77 +/- 70 x 10(6)/ml. There were significant differences between the sample drawn six months after cessation of AAS abuse and both samples drawn during and 1.5 months after the abuse (p less than or equal to 0.05, repeated measures of ANOVA). There was a significant positive correlation between HCG dose during the cycle and the relative amount of morphologically abnormal spermatozoa (r = 0.60, p < 0.01). The concomitant abuse of HCG and supra-physiological AAS dose cause transient impairment on semen quality in males, although spermatogenesis is maintained with this regimen despite prolonged abuse of massive doses of AAS.

Koski P. Alcohol in the web of meanings: A cultural perspective on youth, sport and alcohol. IN: Bouroncle A; Rauhamaki S, eds. Sport and Substance Use in the Nordic Countries. NAD Monograph No. 45. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 161-176. (30 refs.)

This is one of two chapters which deal with sport, prevention and culture. A preliminary report of the Adolescent Health and Lifestyle Survey (Finland) found that 47% of boys who took part in sport club activites used to get heavily drunk at least once a month, while the corresponding portion among non-sporting boys was 38%. Of note, in the 1980s, the opposite was true, with involvement in club sports being protective. This chapter focuses on alcohol consumption as a cultural phenomenon. it reviews the drinking patterns among adults, the tendency toward intoxication, even though the per capita consumption is not among the highest in Europe. Drinking practices of school-aged children are also described, and the increases over the past 20 years. The role of culture, expectations, norms, and values are considered.

2005, Nordic Council for Alcohol and Drug Research

Koski P. Nordic sport around the bottle. IN: Bouroncle A; Rauhamaki S, eds. Sport and Substance Use in the Nordic Countries. NAD Monograph No. 45. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 5-16. (19 refs.)

This main focus of this introductory chapter is with substances and sports, both of which are prominent features of social life in Nordic countries as they are in many cultures. For many social interaction is an important aspect of both alcohol use and sport or physical exercise and both are rooted in masculine hegemony. It summarizes the major themes of the volume, which consider both athletes and spectators. It is noted that role of alcohol in culture and the connections with sport is not new in Nordic countries, but have their roots in Viking tradition. Modern sports and its capitulation into the world of entertainment has found alcohol becoming a target of marketing and alcohol a part of the fan culture and carnivalesque behavior of sporting events. While hooliganism is an issue in other countries and is intertwined with alcohol use, it is not a significant factor in Nordic countries, with the greater concerns being the impact upon health, values, and models for young people.

Kristiansen M; Levu-Milne R; Barr S; Flint A. Dietary supplement use by varsity athletes at a Canadian university. International Journal of Sport Nutrition and Exercise Metabolism 15(2): 195-210, 2005. (31 refs.)

The purpose of this study was to assess reasons for and prevalence of supplement use among varsity athletes and nonvarsity athlete students (controls) at a Canadian university. A questionnaire, distributed to 247 varsity athletes and 204 controls, included variables regarding sports participation, supplements used, reasons for usage, perceived effects, and areas of interest about supplements. Response rates were 85.5% among varsity athletes and 44.6% among controls. Supplements were used by 98.6% of varsity athletes and 94.3% of controls. Varsity men most often reported using sports drinks, and used these (and carbohydrate gels, protein powder, and creatine) more than varsity women. Caffeine products were most often reported by other groups. Health professionals and the Internet were the most reported information sources, while friends most often recommended supplements. Many subjects indicated knowing little about supplements and wanting to learn more. Results indicate a need for nutrition education among both varsity athletes and university students.

Kucharson MC. Please report to the principal's office, urine trouble: The effect of Board of Education v. Earls+ on America's schoolchildren. Akron Law Review 37: 131-179, 2004. (167 refs.)

Drug abuse among high school students is a serious problem that school officials confront everyday. ... Each student wishing to participate in any extracurricular activity was required to sign a written consent agreeing to submit to random drug testing prior to participating in the extracurricular activity, to submit to random drug testing while participating in that activity, and to agree to be tested at any time while participating upon reasonable suspicion. ... The plaintiffs further alleged that the school district failed to identify a special need for testing students who participated in non-athletic extracurricular activities, and that the drug testing Policy neither addressed a proven drug problem in the Tecumseh school district nor assured the Policy would benefit the students or the school. ... Using the Vernonia balancing test, the majority concluded that the Tecumseh School District's legitimate concern of preventing drug use among its students outweighed the privacy expectations of students wishing to participate in extracurricular activities. [Note: See Earls v. Bd. of Educ. of Tecumseh Public Sch. Dist. Earls I, 115 F. Supp.2d 1281 (W.D. Okla. 2000) (allowing the school district to drug test students wishing to participate in extracurricular activities), rev'd sub nom, Earls v. Bd. of Educ. of Tecumseh Public Sch. Dist. No. 92 of Pottawatomie County Earls II, 242 F.3d 1264 (10th Cir. 2001) (finding it unconstitutional under the Fourth Amendment to require students wishing to participate in extracurricular activities to submit to suspicionless drug test), rev'd sub nom, Bd. of Educ. of Indep. Sch. Dist. No. 92 of Pottawatomie County v. Earls Earls III, 536 U.S. 822 (2002) (holding public high school policy of suspicionless drug testing of students participating in extracurricular activities was reasonable and did not violate the Fourth Amendment)].

Kurzthaler I; Wambacher M; Golser K; Sperner G; Sperner-Unterweger B; Haidekker A et al. Alcohol and/or benzodiazepine use: Different accidents - different impacts? Human Psychopharmacology 20(8): 583-589, 2005. (23 refs.)

1611 patients were included in this investigation. 16.7% of the patients were involved in traffic accidents, 38.2% were injured by a sudden fall, 3.5% were involved in an act of violence, 22.8% were injured by a sports related accident and 18.9% were hurt within a work-related accident. 19.5% of the patients tested positive for alcohol, 5.2% tested positive for benzodiazepines and 1.4% tested positive for both substances. Blood samples were positive for alcohol in 27% males and 7.7% females and for benzodiazepines in 6.3% males and in 3.5% females. The mean blood alcohol concentration (BAC) as well as the mean benzodiazepine plasma level were higher in patients injured in violent accidents compared to the other injury groups. This study provides epidemiologic information about the relationship between specific kinds of accidents and alcohol and/ or benzodiazepine use in a large probability sample of emergency room patients. We found a high number of patients using alcohol, and a lower but still relavant number of benzodiazepine users in this large and unselected traumatology ER sample. This study adds evidence to the existing literature about the co-occurance of alcohol and/or benzodiazepine consumption and accident-related injuries.

Laure P; Lecerf T; Friser A; Binsinger C. Drugs, recreational drug use and attitudes towards doping of high school athletes. International Journal of Sports Medicine 25(2): 133-138, 2004. (26 refs.)

The purpose of this investigation was to determine the substances used, and the attitudes towards doping of high school athletes. A four-page, self-completed questionnaire was designed to determine the drugs used (licit, illicit and doping substances) along with beliefs about doping and the psychosociological factors associated with their consumption. The questionnaire was distributed to all the high school students enrolled in a school sports association in the Lorraine region in Eastern France. The completed forms were received from 1459 athletes: 4% stated that they had used doping agents at least once in their life (their main source of supply being peers and health professionals). Thirty-four percent of the sample smoked some tobacco, 66% used alcohol, 19% cannabis, 4% ecstasy, 10% tranquillizers, 9% hypnotics, 4% creatine and 41% used vitamins against fatigue. Beliefs about doping did not differ among doping agent users and non-users, except for the associated health risks which were minimized by users. Users of doping agents stated that the quality of the relations that they maintain with their parents is sharply degraded, and they reported that they are susceptible to influence and difficult to live with. More often than non-doping agent users, these adolescents are neither happy, nor healthy, while paradoxically, they seem less anxious and they are more self-confident. Our findings suggest that doping prevention among young athletes cannot be limited uniquely to the list of banned drugs.

Lorente FO; Peretti-Watel P; Grelot L. Cannabis use to enhance sportive and non-sportive performances among French sport students. Addictive Behaviors 30(7): 1382-1391, 2005. (30 refs.)

Purpose: Despite a large public health interest in substance use among athletes, only a few works have addressed illicit drug use in relation with sport practice. We have studied cannabis use to enhance both sportive and non-sportive performance among French sport university students. Methods: An anonymous self-reported questionnaire was administered to a sample of students from six Sport Science Universities from Southern France. Information on sport practice and cannabis use (frequency, quantity, motives) was collected. Results: Males were more prone to have already used cannabis to enhance non-sportive performance as well as sportive performance. The simultaneous equation model indicated that both kinds of enhancing-substance use were endogenous: cannabis use to enhance sportive performance leads to cannabis use to enhance non-sportive performance and reciprocally. Moreover, the relaxing properties of cannabis may be frequently used to enhance performance. Cannabis use to enhance sportive performance was positively related to the competitive level and to sliding sports. Conclusions: The present study helps to improve understanding on an empirical paradox about the relationship between doping agents use and so-called 'recreational' drug use among athletes. Indeed, people who use doping agents may also use 'recreational' drugs for a 'non-recreational' purpose.

Lorente FO; Souville M; Griffet J; Grelot L. Participation in sports and alcohol consumption among French adolescents. Addictive Behaviors 29(5): 941-946, 2004. (7 refs.)

Using an anonymous self-report questionnaire (N=816 participants), we examined the relation between participation in sports and alcohol consumption and identified the risk factors associated with alcohol consumption among French high-school students. Univariate analysis showed that sport involvement was related to higher alcohol use (P<.05). Participants who participated in group sports drank significantly more than those who participated as individuals (P<.01). Multivariate analysis underlined factors associated with alcohol consumption, but these varied considerably according to the level of alcohol consumption. Three factors were associated with weekly and daily alcohol use: male gender, daily cigarette use, and perception of poor health.

Magkos F; Kavouras SA. Caffeine use in sports, pharmacokinetics in man, and cellular mechanisms of action. (review). Critical Reviews in Food Science and Nutrition 45(7): 535-562, 2005. (390 refs.)

Caffeine is the most widely consumed psychoactive 'drug' in the world and probably one of the most commonly used stimulants in sports. This is not surprising, since it is one of the few ergogenic aids with documented efficiency and minimal side effects. Caffeine is rapidly and completely absorbed by the gastrointestinal tract and is readily distributed throughout all tissues of the body. Peak plasma concentrations after normal consumption are usually around 50 muM, and half-lives for elimination range between 2.5-10 h. The parent compound is extensively metabolized in the liver microsomes to more than 25 derivatives, while considerably less than 5% of the ingested dose is excreted unchanged in the urine. There is, however, considerable inter-individual variability in the handling of caffeine by the body, due to both environmental and genetic factors. Evidence from in vitro studies provides a wealth of different cellular actions that could potentially contribute to the observed effects of caffeine in humans in vivo. These include potentiation of muscle contractility via induction of sarcoplasmic reticulum calcium release, inhibition of phosphodiesterase isoenzymes and concomitant cyclic monophosphate accumulation, inhibition of glycogen phosphorylase enzymes in liver and muscle, non-selective adenosine receptor antagonism, stimulation of the cellular membrane sodium/potassium pump, impairment of phosphoinositide metabolism, as well as other, less thoroughly characterized actions. Not all, however, seem to account for the observed effects in vivo, although a variable degree of contribution cannot be readily discounted on the basis of experimental data. The most physiologically relevant mechanism of action is probably the blockade of adenosine receptors, but evidence suggests that, at least under certain conditions, other biochemical mechanisms may also be operational.

Maher A; Wilson N; Signal L; Thomson G. Patterns of sports sponsorship by gambling, alcohol and food companies: An Internet survey. BMC Public Health 6: article 95, 2006. (18 refs.)

Background: Sports sponsorship is a significant marketing tool. As such, it can promote products that pose risks to health (eg, high fat and high sugar foods) or it can promote health-supporting products ( eg, sporting equipment and services). However, there is a lack of data on the proportion of sponsorship associated with "unhealthy" and "healthy" products and no methodology for systematically assessing it. This research aimed to explore this proportion with an Internet survey of sports sponsorship in the New Zealand setting. Methods: A search methodology was developed to identify Internet-based evidence of sports sponsorship at the national level and at the regional and club level in one specific region ( Wellington). The top eight sports for 5-17-year-olds were selected and products and services of sponsors were classified in terms of potential public health impact ( using a conservative approach). Results: Sponsorship of these popular sports was common at the national, regional and club levels ( 640 sponsors listed on 107 websites overall). Sports sponsorship associated with sponsors' products classified as "unhealthy" ( eg, food high in fat and sugar, gambling and alcohol) were over twice as common as sponsorship associated with sponsors' products classified as "healthy" (32.7% (95% CI = 29.1, 36.5) versus 15.5% ( 95% CI = 12.8, 18.6) respectively). "Gambling" was the most common specific type of sponsorship (18.8%) followed by alcohol (11.3%). There were significantly more "alcohol" sponsors for rugby, compared to all the other sports collectively ( rate ratio (RR) = 2.47; 95% CI = 1.60, 3.79), and for top male sports compared to female ( RR = 1.83; 95% CI = 1.05, 3.18). Also there was significantly more "unhealthy food" sponsorship for touch rugby and for "junior" teams/clubs compared to other sports collectively ( RR = 6.54; 95% CI = 2.07, 20.69; and RR = 14.72, 95% CI = 6.22, 34.8; respectively). A validation study gave an inter-rater reliability for number of sponsors of 95% (n = 87 sponsors), and an inter-rater reliability of classification and categorisation of 100%. Conclusion: This study found that the sponsorship of popular sports for young people is dominated by "unhealthy" sponsorship ( ie, predominantly gambling, alcohol and unhealthy food) relative to "healthy" sponsorship. Governments may need to consider regulations that limit unhealthy sponsorship and/or adopt alternative funding mechanisms for supporting popular sports.

Martens MP; Dams-O'Connor K; Duffy-Paiement C; Gibson JT. Perceived alcohol use among friends and alcohol consumption among college athletes. Psychology of Addictive Behaviors 20(2): 178-184, 2006. (43 refs.)

Intercollegiate athletes have been identified as an at-risk group for heavy alcohol consumption (e.g., T. F. Nelson & H. Wechsler, 2001). The purpose of this study was to assess the relationship between descriptive drinking norms among one's closest friends and personal alcohol consumption among athletes. Specifically, the authors sought to determine whether perceptions of alcohol consumption among one's closest friend who was an athlete (athlete norms) demonstrated a stronger relationship with personal alcohol use than normative perceptions among one's closest friend who was not an athlete (nonathlete norms). Data were collected on 165 athletes competing at the National Collegiate Athletic Association Division I level. Results indicated that the athlete norms demonstrated a stronger main effect with personal alcohol use than the nonathlete norms, although both norms demonstrated strong effects. However, an interaction effect indicated that the athlete norms demonstrated a stronger relationship with personal consumption among men, whereas the nonathlete norms demonstrated a stronger relationship among women. Implications for alcohol prevention programs among college athletes are discussed.

Martens MP; Dams-O'Connor K; Beck NC. A systematic review of college student-athlete drinking: Prevalence rates, sport-related factors, and interventions. (review). Journal of Substance Abuse Treatment 31(3): 305-316, 2006. (84 refs.)

Alcohol use among college students has become a considerable public health problem. Among this group, intercollegiate athletes are at a particularly high risk for excessive alcohol consumption and resulting negative alcohol-related consequences. The purpose of our review was to systematically examine three main issues related to alcohol consumption among intercollegiate athletes: (a) the prevalence rates and alcohol consumption patterns of this group, especially in comparison with those of collegiate nonathletes; (b) the various factors that might motivate or encourage alcohol use among intercollegiate athletes, primarily sport-related individual and environmental variables; and (c) considerations for conducting alcohol-related interventions with intercollegiate athletes.

Martens MP; Watson JC; Royland EA; Beck NC. Development of the Athlete Drinking Scale. Psychology of Addictive Behaviors 19(2): 158-164, 2005. (40 refs.)

Prior research has found that intercollegiate athletes consume more alcohol and experience more negative alcohol-related consequences than nonathletes, but no measure of sport-related reasons for alcohol use currently exists. The purpose of this study was to develop such a measure, which the authors termed the Athlete Drinking Scale (ADS). An exploratory factor analysis supported the existence of 3 subscales: Positive Reinforcement, Team/Group, and Sport-Related Stress. Additional analyses supported the internal consistency and construct validity of the subscales, and hierarchical multiple regression analyses indicated that the ADS accounted for a significant amount of variance in both alcohol consumption and alcohol-related problems among intercollegiate athletes. The ADS appears to be a promising tool for measuring sport-related reasons for intercollegiate athlete alcohol use.

Martens MP; Watson JC; Beck NC. Sport-type differences in alcohol use among intercollegiate athletes. Journal of Applied Sport Psychology 18(2): 136-150, 2006. (42 refs.)

Prior research has found that (a) intercollegiate athletes are especially "at-risk for excessive alcohol consumption (e.g., Nelson & Wechsler, 2001), and (b) sport-type differences exist among college athletes in terms of yearly drinking prevalence rates (National Collegiate Athletic Association, 2001). No studies, however, have examined sport-type differences on more specific measures of alcohol consumption (e.g., drinks per week), or examined potential mediators of the relationship between sport type and alcohol consumption. In the present study, data were analyzed on 298 intercollegiate athletes from two different universities. Resuls indicated significant sport type differences on alcohol consumption variables, with athletes from the sports of swimming and diving reporting the highest levels of alcohol consumption. Results provided partial support for the role of positively reinforcing drinking motives in mediating the sport type-alcohol consumption relationship. Findings are discussed in light of prior research in the area of college student-athlete alcohol consumption.

Martin GA Jr. Symposium: From grand slams to grand juries. Performance-enhanicng drug use in sport. Introductory remarks: How it all began, the move to drug testing. New England Law Review 40: 705-707, 2006. (21 legal refs.)

Summary: This article serves as an introduction to a series of articles on performance-enhancing drug use among athletes. It also sets forth the recent history of drug testing.

McCaul K; Baker J; Yardley JK. Predicting substance use from physical activity intensity in adolescents. Pediatric Exercise Science 16(3): 277-289, 2004. (30 refs.)

Adolescence is characterized as a period of change and adaptation typically marked by a decline in physical activity participation accompanied by an increase in substance use. The purpose of this study was to examine the relationships among the type (team and individual activity) and intensity (high, medium, and low intensity) of physical activity and substance use (tobacco, marijuana, alcohol use, and binge drinking) in a sample of 738 adolescents. Results indicated differing relationships among study variables depending on the type and intensity of physical activity and the type of substance used. For instance, a positive relationship was found for physical activity intensity and alcohol use, but negative relationships were found for physical activity and tobacco and marijuana use. Collectively, the results reveal that the relationships between physical activity type and intensity and substance use are more complex than previously believed.

McDuff DR; Baron D. Substance use in athletics: A sports psychiatry perspective. (review). Clinics in Sports Medicine 24(4): 885-+, 2005. (55 refs.)

Athletes use substances to produce pleasure, relieve pain and stress, improve socialization, recover from injury, and enhance performance. Therefore, they use some substances in substantially higher rates than nonathletes. Despite these higher rates of use, rates of addiction may in fact be lower in athletes. This article reviews the prevalence and patterns of use, health and performance effects, and preventive and treatment interventions for alcohol, tobacco, stimulants, and steroids. Each substance is considered from the differing perspectives of abuse/addiction and performance enhancement models. Similarities and differences between college an professional athletes are discussed. Finally, suggestions for future research are made.

McDuff DR; Morse ED; White RK. Professional and collegiate team assistance programs: Services and utilization patterns. Clinics in Sports Medicine 24(4): 943+, 2005. (48 refs.)

Elite professional and collegiate athletes under-use stress control, mental health, and substance abuse treatment services. Behavioral health services use can be increased by establishing on-site, sports-specific services. Like Employee Assistance Programs of industry and government, Team Assistance Programs (TAPs) address critical issues such as substance abuse prevention, tobacco cessation, stress recognition, mental illness management, injury rehabilitation, performance enhancement, and cultural support. Strong links with the team's medical and conditioning staff can ensure a steady stream of TAP referrals and build trust with players and team staff. This article describes nine years of operation for two professional TAPs and three years for one college TAP. Use patterns and linkage strategies with team physicians, trainers, strength staff, chiropractors, and nutritionists are discussed.

McHale JP; Vinden PG; Bush L; Richer D; Shaw D; Smith B. Patterns of personal and social adjustment among sport-involved and noninvolved urban middle-school children. Sociology of Sport Journal 22(2): 119-136, 2005. (76 refs.)

This article examines patterns of adjustment among urban middle-school children as a function of involvement in organized team sports. Four hundred twenty-three seventh-grade students (216 boys and 207 girls) reported on their involvement in sport, self-esteem, delinquent activity, and drug use during the year preceding the survey. Physical Education teachers rated social competence, shyness/withdrawal, and disinhibition/aggression. Compared with noninvolved children, sport-involved youth reported higher self-esteem and were rated by teachers as more socially competent and less shy and withdrawn. Sport-involved youth, including those in contact sports, were not rated as more aggressive than noninvolved children. And though sport-involved youth reported a slightly broader range of delinquent activities than noninvolved youth, sport-involved boys were actually less likely than noninvolved boys to have experimented with marijuana.

Moore MJ; Werch CEC. Sport and physical activity participation and substance use among adolescents. Journal of Adolescent Health 36(6): 486-493, 2005. (31 refs.)

Purpose: To examine the association between participation in specific school-sponsored sports and out-of-school sports/physical activities and substance use. Methods: Subjects consisted of 891 8th grade youth from three schools. Baseline data were collected using the Youth Alcohol & Drug Survey (2000) and following standardized protocols. Logistic regressions were conducted to identify associations between the independent variables of school-sponsored sports, and out-of-school sports/physical activities, and each of the four substance use dependent variables, while controlling for race. Additionally, logistic regressions were run separately for males and females to examine gender differences. Results: Participation in any one of seven specific sports/physical activities was associated with increased substance use for one or both genders, whereas participation in any one of four other specific sports/physical activities was associated with decreased use for one or both genders. Those sports associated with increased use differed for males and females, as did those associated with decreased use. Females in school-sponsored dance/cheerleading/gymnastics were at decreased risk of alcohol use, whereas those in out-of-school dance/cheerleading /gymnastics, skateboarding or surfing were at increased risk for using at least one substance. Males in out-of-school swimming were at decreased risk of heavy alcohol use, whereas those in school-sponsored football, swimming, wrestling or out-of-school tennis were at increased risk for using at least one substance. Conclusions: Educators cannot assume all sports/physical activities have a positive relationship with youth substance use. School-sponsored, male-dominated sports appeared to be associated with an increased substance use risk for males, whereas out-of-school, mixed-gender sports appeared to be for females.

Neal DJ; Sugarman DE; Hustad JTP; Caska CM; Carey KB. It's all fun and games...or is it? Collegiate sporting events and celebratory drinking. Journal of Studies on Alcohol 66(2): 291-294, 2005. (17 refs.)

Objective: Heavy drinking is prevalent on college campuses, and collegiate sporting events may precipitate heavy drinking. Despite this, relatively few studies have examined student drinking on the days of sporting events. In 2003, Syracuse University won the men's National College Athletic Association basketball championship; ongoing data collection allowed an investigation of alcohol consumption at Syracuse University during the two Final Four game days, when the semifinals and championship games are played. The goals of the study were to examine the level of alcohol use on these days and to examine factors related to game-day consumption. Method: As a part of an ongoing study, 206 undergraduate students completed several questionnaires, then returned daily drinking diaries at 1-week intervals for 4 consecutive weeks. Results: Alcohol consumption levels on the two game days exceeded what is typical on campus. Further analyses conducted using zero-inflated negative binomial regression modeling demonstrated that heavier drinkers were more likely to drink alcohol, and drink alcohol heavily, on both game days. Furthermore, lack of impulse control was independently associated with an increased likelihood of drinking on both days. Conclusions: Although results from this study should be considered preliminary, these data document heavier drinking associated with high-profile athletic events. Sporting events may be a particularly opportune time and venue for collegiate risk-reduction programs.

Nilsson S; Spak F; Marklund B; Baigi A; Allebeck P. Attitudes and behaviors with regards to androgenic anabolic steroids among male adolescents in a county of Sweden. Substance Use & Misuse 40(1): 1-12, 2005. (32 refs.)

Aims. The aim of this study was to investigate attitudes towards androgenic anabolic steroids among male adolescents who have used anabolics compared to those who have not. Design and Setting. A cross-sectional survey was performed in the year 2000 in all secondary schools in the county of Halland on the west coast of Sweden. Participants and Measurements. An anonymous multiple-choice questionnaire was distributed to all classes with 14-, 16-, and 18-year-old male, adolescents. The response rate was 92.7% (n = 4049). Findings. Those who admitted having used androgenic anabolic steroids differed in several ways from those who had not. Fewer believed androgenic anabolic steroids to be harmful [odds ratio (OR) = 0.15, 95% CI 0.08-0.30] and more believed that girls preferred boys with large muscles (OR = 6.1, 95% CI 3.4-11.0). They trained more often at gyms (OR = 5.6, 95% CI 3.0-10.6), drank more alcohol (OR = 4.2, 95% CI 2.0-9.1), and had used narcotic drugs more often (OR = 15.3, 95% CI 8.5-27.5) than the other male adolescents. More immigrants than native-born adolescents had used anabolics (OR=4.2, 95% CI 2.2-7.9). Conclusion. Attitudes towards anabolics differ between users and nonusers. These aspects may be beneficial to focus on as one part of a more complex intervention program in order to change these attitudes and decrease the misuse of androgenic anabolic steroids.

O'Brien KS; Blackie JM; Hunter JA. Hazardous drinking in elite New Zealand sportspeople. Alcohol and Alcoholism 40(3): 239-241, 2005. (16 refs.)

Aims: To examine the link between hazardous drinking and level of sport participation in New Zealand. Methods: Sports science and general university students (n = 427) completed a sporting profile questionnaire that included the Alcohol Use Disorders Identification Test (AUDIT). Results: Elite sportspeople (both provincial and international/country level) reported higher rates of hazardous drinking than non-sportspeople and non-elite sportspeople. Similar differences were observed in AUDIT subscale scores, with international/country level sportspeople reporting greater symptoms of dependence than other groups.

Olrich TW; Vassallo MJ. Symposium: From grand slams to grand juries. Performance-enhanicng drug use in sport. Running Head: Psychological dependency to anabolic-androgenic tteroids: Exploring the role of social mediation. New England Law Review 40: 735-746, 2006. (28 legal refs.)

This article summarizes the findings of two studies to explore the nature of a possible psychological dependence to steroids, based on interviews with males who had used them. They spoke of a dependency not only to the chemicals themselves, but also to the secondary reinforcers found in their environment.

Ozdemir L; Nur N; Bagcivan I; Bulut O; Sumer H; Tezeren G. Doping and performance enhancing drug use in athletes living in Sivas, mid-Anatolia: A brief report. Journal of Sports Science and Medicine 4(3): 248-252, 2005. (15 refs.)

The aim of this study was to determine the rate of doping and performance enhancing drug use in athletes in Sivas, Turkey, and to analyze the main reasons for the use. This was a cross-sectional study based on a self-report questionnaire. The subjects filled the questionnaires under the supervision of the investigators during interviews. This questionnaire included 24 items describing the population in terms of demographics, sport practice, doping in sport and substance use. Moreover, we assessed the frequency of doping drug use. The number of respondents was 883, of which 433 athletes and 450 healthy non-athletes (control group). The mean age of the total volunteers was 21.8 +/- 3.7 yrs. The male and female ratios were 78.2% and 21.8% respectively. Doping and performance enhancing drug usage rate was 8.0% (71 cases in 883 subjects). Doping drug use among the athletes was significantly (p < 0.05) higher (14.5%) compared with the non-athletes (1.8%). The agents used were anabolic steroids in 60.5%, l-carnitene in 12.7%, erythropoietin in 5.4%, Na-bicarbonate in 11.3% and creatinine in 14.1% of 71 cases. The reasons for doping use were to have a better body condition in 34 cases (47.9%) and to solve weight (gaining or loosing) problems in 8 (11.3%) cases. Since the potential side effects of doping drugs are not satisfactorily familiar to the most users, the education of athletes on the matter must be a top priority.

Page RM; Roland M. Misperceptions of the prevalence of marijuana use among college students: Athletes and non-athletes. Journal of Child & Adolescent Substance Abuse 14(1): 61-75, 2004. (23 refs.)

The prevalence of marijuana use and perceptions of the prevalence of marijuana use was assessed in a sample of intercollegiate athletes and a separate sample of primarily first-year non-athlete students at a northwestern public university. Marijuana use prevalence in the non-athlete sample was higher than the prevalence found in nationwide surveys of drug use on college campuses. Current use of marijuana was greater in non-athletes than athletes, however, lifetime use was equivalent. The perceptions of prevalence of marijuana use among both athletes and non-athletes exceeded self-reported use in these groups. Students who used marijuana held higher perceptions of the prevalence of marijuana use among their campus peers and those believing that marijuana use was normative on campus were more likely to be current marijuana users themselves. The findings from this study, have important implications for designing college drug prevention programs.

Papaioannou A; Karastogiannidou C; Theodorakis Y. Sport involvement, sport violence and health behaviours of Greek adolescents. European Journal of Public Health 14(2): 168-172, 2004. (26 refs.)

Background: Within the context of problem-behaviour theory, this study investigated the intra-relationship between attitudes and behaviours towards exercise, sport involvement, violence in sport-related events, eating fruits, smoking and hashish or ecstasy use in a sample of Greek adolescents. Age and gender patterns are considered. Methods: Participants were 5991 Greek school pupils who responded to questionnaires assessing behaviour and attitudes towards health-related behaviours. Results: Positive associations were found between pupils' reports of violence in sport-related events, smoking and hashish or ecstasy use on the one hand, and eating fruits and participation in sport and exercise on the other. In contrast, small positive association was observed between sport involvement and violence in sport-related events. Attitudes towards health risk behaviours were inversely related to attitudes towards health-promoting behaviours, and attitudes were positively related to corresponding behaviours. Sport involvement and regular exercise decreased but smoking and use of hashish or ecstasy increased with age. More males than females participated in organized sport and violent acts in sport-related events. Males' involvement in sport violence increased with age. Conclusion: Sport is a suitable context for the promotion of several health-related behaviours apart from exercise. Nevertheless, the present sport structure excludes most young people and is positively linked with sport violence. A less demanding sport context should be provided for the majority of young people, particularly for females. Sport programmes designed to promote health behaviours should be encouraged. More concentrated actions to combat sport violence are required.

Peretti-Watel P; Guagliardo V; Verger P; Mignon P; Pruvost J; Obadia Y. Attitudes toward doping and recreational drug use among French elite student-athletes. Sociology of Sport Journal 21(1): 1-17, 2004. (45 refs.)

This study examined attitudes toward doping among 458 French elite student-athletes (ESAs) ages 16-24, their correlates, and their relationship with cigarette, alcohol, and cannabis use. We found a consensus among ESAs concerning negative aspects of doping. A cluster analysis showed, however, that statements dealing with benefits of doping were endorsed by two significant minorities of respondents. These ESAs were more frequently older males with a lower parental academic achievement and no sporting history in their family. Recreational drug use depended on whether or not ESAs endorsed statements related to nonsporting benefits of doping. Using an analytical framework from the sociology of deviance, our findings suggest that athletes who dope themselves pursue legitimate goals with illegitimate means but justify their behavior with a legitimate rationale. Further research is needed on the nonrecreational use of recreational drugs.

Peretti-Watel P; Lorente FO. Cannabis use, sport practice and other leisure activities at the end of adolescence. Drug and Alcohol Dependence 73(3): 251-257, 2004. (39 refs.)

Purpose: To study the relationship between cannabis use, sports practice and other leisure activities during adolescence, as a test for the sociological theory of deviant opportunities. Methods: A sample of 12,512 French adolescents aged 18 responded to an anonymous self-reported questionnaire in March 2001. Three logistic models (for occasional, recent and regular cannabis use) were estimated for girls and boys separately. Results: Outings and other peer-oriented activities were strongly correlated with cannabis use but this relationship depended on which levels of use were considered. Occasional use was more common among respondents who participated in many different outdoor activities. Regular use was associated with a more selective lifestyle, focusing on music-oriented outings and time spent at a friend's home in the evening. Conclusions: Our results provided empirical support for the theory of deviant opportunities. Changing patterns of lifestyle associated with transition from initiation to higher levels of use may reveal a shift from opportunities of cannabis use provided by a wide range of activities to specific activities chosen for their convenience to cannabis use. Further research will need to investigate how drug use is shaped by lifestyle, and conversely, how drug use reshapes lifestyle.

Perkins HW; Craig DW. A successful social norms campaign to reduce alcohol misuse among college student-athletes. Journal of Studies on Alcohol 67(6): 880-889, 2006. (35 refs.)

Objective: This study examines the impact of a social norms intervention to reduce alcohol misuse among student-athletes. The intervention was designed to reduce harmful misperceptions of peer norms and, in turn, reduce personal risk. Method: A comprehensive set of interventions communicating accurate local norms regarding alcohol use targeted student-athletes at an undergraduate college. An anonymous survey of all student-athletes was conducted annually for 3 years (2001: n = 414, 86% response; 2002: n = 373, 85% response; and 2003: n = 353, 79% response). A pre/post comparison of student-athletes was conducted separately for new and ongoing athletes at each time point to isolate any general time period effects from intervention effects. A cross-sectional analysis of student-athletes with varying degrees of program exposure was also performed. Results: The intervention substantially reduced misperceptions of frequent alcohol consumption and high-quantity social drinking as the norm among student-athlete peers. During this same time period, frequent personal consumption, high-quantity consumption, high estimated peak blood alcohol concentrations during social drinking, and negative consequences all declined by 30% or more among ongoing student-athletes after program exposure. In contrast, no significant differences across time were seen for new student-athletes each year with low program exposure. Among student-athletes with the highest level of program exposure, indications of personal misuse were at least 50% less likely on each measure when compared with student-athletes with the lowest level of program exposure. Conclusions: This social norms intervention was highly effective in reducing alcohol misuse in this high-risk collegiate subpopulation by intensively delivering data-based messages about actual peer norms through multiple communication venues.

Perry PJ; Lund BC; Deninger MJ; Kutscher EC; Schneider J. Anabolic steroid use in weightlifters and bodybuilders: An internet survey of drug utilization. Clinical Journal of Sport Medicine 15(5): 326-330, 2005. (10 refs.)

Purpose: Dietary supplements and ergogenic agents, including anabolic steroids, are common components of present-day bodybuilder and weightlifter training regimens. Prior reports of anabolic steroid use suggest polypharmacy and high doses of injectable agents. Hypothesis: To provide an updated description of anabolic steroid regimens employed by weightlifters and bodybuilders and to determine the extent to which anabolic steroid associated behaviors are consistent with substance dependence. Study Design: Web-based survey. Methods: Links to the Web-based survey instrument were established from leading bodybuilding and fitness web pages. The questionnaire included demographic information, anabolic drug use history, adverse effects, information sources, and steroid use behavior consistent with criteria for a substance dependence disorder. Results: A total of 207 subjects provided a detailed anabolic steroid drug history. Steroid regimens included a mean of 11 agents, involved cycles ranging from 5 to 10 weeks, and often included doses 5 to 29 times greater than physiologic replacement doses. Behavior consistent with a substance dependence disorder was endorsed by 33% of respondents. Conclusions: These findings suggest that anabolic steroid use among weightlifters and bodybuilders continues, generally involving multiple steroids and additional dietary supplementary agents. The adverse effects, polypharmacy, large dosages, and risk of substance abuse are all major health care concerns that require further study. Clinical Relevance: The survey findings provide sports medicine practitioners a reasonable estimate of the expected drug history among bodybuilders and weightlifters for the use of performance-enhancing agents.

Peters RJ; Adams LF; Barnes JB; Hines LA; Jones DE; Krebs KMA et al. Beliefs and social norms about ephedra onset and perceived addiction among college male and female athletes. Substance Use & Misuse 40(1): 125-135, 2005. (31 refs.)

In Spring 2003, a qualitative approach was used to investigate relevant beliefs and norms associated with ephedra initiation and perceived addiction to the drug among 43 primarily minority athletes, attending a historically Black university in the southwestern region of the United States, who self-identified as past users. In general, participants stated that their second ephedra use event occurred on the same day as or the day after initiation. The majority of participants perceived that addiction was established by routine and eccentric behavior. Male athletes stated they used ephedra for improved athletic performance while females stated they used the drug for weight loss. Male participants stated it is difficult to quit ephedra use because of the resulting decrease in athletic performance, sickness, and weight gain. Female athletes were more concerned with their appearance. These findings are important in determining the early extent to which addiction is self-identified.

Pope HG; Kanayama G; Ionescu-Pioggia M; Hudson JI. Anabolic steroid users' attitudes towards physicians. Addiction 99(9): 1189-1194, 2004. (31 refs.)

Aims:To assess anabolic-androgenic steroid (AAS) users' trust in the knowledge and advice of physicians. Design: Interviews of AAS users and non-users. Setting: Research offices. Participants: Eighty weight-lifters (43 AAS users, 37 non-users) recruited by advertisement in Massachusetts and Florida, USA. Measurements: Personal interviews and questionnaire responses, including subjects' ratings of physicians' knowledge regarding various health- and drug-related topics. AAS users also rated their level of trust in various sources of information about AAS. Findings: Both groups of subjects gave physicians high ratings on knowledge about general health, cigarette smoking, alcohol, and conventional illicit drugs, but gave physicians markedly and significantly lower ratings on knowledge about AAS. When rating sources of information on AAS, users scored physicians as no more reliable than their friends, Internet sites, or the person(s) who sold them the steroids. Forty percent of users trusted information on AAS from their drug dealers at least as much as information from any physician that they had seen, and 56% had never revealed their AAS use to any physician. Conclusion: AAS users show little trust in physicians' knowledge about AAS, and often do not disclose their AAS use to physicians. These attitudes compromise physicians' ability to educate or treat AAS users. Physicians can respond to these problems by learning more about AAS and by maintaining a high index of suspicion when evaluating athletic male patients.

Rockafellow BD; Saules KK. Substance use by college students: The role of intrinsic versus extrinsic motivation for athletic involvement. Psychology of Addictive Behaviors 20(3): 279-287, 2006. (31 refs.)

Certain types of athletic involvement may confer risk for substance use by college students. This study investigated whether motivational factors play a role in the relationship between athletic involvement and substance use. Intercollegiate athletes (n = 98) and exercisers (n = 120) were surveyed about substance use and motivation for athletic involvement. Athletes and exercisers who were extrinsically motivated had significantly higher rates of alcohol use than their intrinsically motivated counterparts. Results suggest that college students who are extrinsically motivated for involvement in physical activity /athletics-particularly those involved in team sports-may be in need of targeted prevention efforts.

Rodriguez D; Audrain-McGovern J. Team sport participation and smoking: Analysis with general growth mixture modeling. Journal of Pediatric Psychology 29(4): 299-308, 2004. (42 refs.)

Objective: To assess the likelihood of smoking among adolescents with different patterns of team sport participation, grades 9-11. Methods Adolescents (N = 1,098) participating in a longitudinal study of the biobehavioral predictors of smoking adoption completed items assessing various health-related behaviors, including team sport participation and smoking practices. General growth mixture modeling (GGMM) was used to analyze the data. Results Four patterns of team sport participation were found. Adolescents with decreasing or erratic participation were nearly three times more likely than adolescents with high participation to be current smokers in eleventh grade. Nonwhites were at particular risk for decreasing and erratic patterns of participation, and later smoking. Females were at high risk for low team participation. Conclusion: Results suggest that multiple patterns of team sport participation can be identified with GGMM and that these patterns may be useful in characterizing individuals at particular risk for future smoking.

Rolandsson M; Hallberg LRM; Hugoson A. Influence of the ice-hockey environment on taking up snuff: An interview study among young males. (editorial). Acta Odontologica Scandinavica 64(1): 47-54, 2006. (40 refs.)

In Sweden, snuff-use is an established and accepted phenomenon in society, especially in connection with certain sports. The aim of this qualitative study was to analyze and describe the psychosocial environment influencing young male ice-hockey players into starting to use snuff. The study sample comprised 16 male participants between 15 and 32 years of age strategically selected for being active or having been active as ice-hockey players-snuff-users and non-users alike. A grounded theory design, including in-depth interviews, was used to generate a theory from data and thereby create theoretical concepts explaining social phenomena, human behavior, and process. An interview guide containing different themes was used to cover the study area. Five higher-order categories were developed and labeled: having a role model, residing in a consenting environment, experiencing performance demands, experiencing a sense of community and creating an image. Socialization in and through psychosocial norms of the ice-hockey environment was identified as a core category describing the central meaning of the informants' experiences of snuff in the ice-hockey environment. In the present study, the identified categories that integrate within the environment in which the young people reside and pursue their sports activities have been interpreted as factors enhancing the commencement of snuff-use. We suggest health promotion activities within the ice-hockey environment based on a health psychology model of planned behavior.

Saugy M; Avois L; Saudan C; Robinson N; Giroud C; Mangin P; Dvorak J. Cannabis and sport. British Journal of Sports Medicine 40(Supplement 1): 13-15, 2006. (17 refs.)

Background and objectives: Cannabis is on the list of prohibited substances in the practice of sport, although its performance enhancing effect has not yet been proved. Its popularity among the younger generations as a social drug puts cannabis at the top of the list of compounds detected by the anti-doping laboratories accredited by the World Anti-Doping Agency worldwide. The management of the results of urine analysis is quite difficult for the medical and disciplinary committees not only because of the social use of the substance, but also because of the interpretation of the analytical data from urine samples. This paper gives an overview of what is presently known about cannabis in relation with the practice of sport. Methods: Review of literature on the cannabis and exercise, its effect in the body, and the problems with interpretation of results when it is detected in urine. Results: The paper outlines the major effects of cannabis in the context of its social use and its use for sport activities. The difficulties in the interpretation of urine sample analysis results because of the protracted excretion time of the main metabolite, long after the intake, are described. Conclusions: There is an urgent need for sport authorities to take measures necessary to avoid players misusing cannabis.

School ofaefer MP; Smith J; Dahm DL; Sorenson MC. Ephedra use in a select group of adolescent athletes. Journal of Sports Science and Medicine 5(3): 407-414, 2006. (25 refs.)

Ephedra-containing dietary supplements are consumed to improve sports performace, but may carry risks of cardiac and neurological adverse events. Little is known of their use by young athletes. Our aim was to determine the prevalence and patterns of ephedra use among high school athletes. An anonymous survey was performed in Rochester, Minnesota on high school athletes who participated in fall sports during 2003-04. Parental consent was obtained for athletes under age 18 years. Surveys were distributed at preparticipation examinations and in-school survey stations. The response rate to the survey was 68.2%, or 311 respondents out of a possible 456 with consent (or 26% of all 1197 athletes eligible prior to the consent process). Seven of 311 (2.3%) respondents used dietary supplements containing ephedra. Only one of seven users (14.3%) knew that the supplements they used contained ephedra. Ephedra use was more common in boys (five) than girls (two). Ephedra use was only found in 17 and 18-year-olds. The most common sports among ephedra users were football, track and field, and weightlifting. This study suggests that Ephedra use was infrequent among the young athletes in this population. However, ephedra users were generally unaware that the dietary supplements they consumed contained ephedra. Users were more likely to participate in football, track and field, and weightlifting. Ephedra users were likely to obtain supplements from their peers, and were largely uninformed of the content of their supplements.

Severson HH; Klein K; Lichtensein E; Kaufman N; Orleans CT. Smokeless tobacco use among professional baseball players: Survey results, 1998 to 2003. Tobacco Control 14(1): 31-36, 2005. (24 refs.)

Objective: The use of smokeless tobacco (ST) (snuff and chewing tobacco) has long been associated with baseball in the USA. This article reviews six years of survey data from major and minor league baseball players to evaluate trends in tobacco use and quitting patterns over time in order to gain insight into the effects of past interventions and to document continued intervention needs. Method: Surveys were distributed by athletic trainers to major and minor league professional baseball players during spring training session in the six years from 1998 to 2003. The surveys were anonymous and identified only by team, level of league, and other self reported demographic data. Results: ST use among professional baseball players remains much higher than among young males in the general population, and use is most prevalent among white non-Hispanic players. There was a significant decrease in ST use among minor league players from 1998 to 2003, with seven day self reported use declining from 31.7% in 1998 to 24.8% in 2003. No significant year to year changes were observed for major league players. Major league players' self reported past week use rates, estimated at 35.9% in 1998 and at 36% in 2003, were consistently higher than those of minor league players. Self reported prevalence of past month cigarette and cigar smoking was much lower than ST use for both major and minor league players. Conclusions: Six years of survey data confirm a continuing high use of ST among professional baseball players. Results suggest that the effects of the broad spectrum ST control efforts launched over the past decade may have been stronger among minor than major league players. Stronger policy interventions at the major league level and multi-level efforts, including programmes to increase the use of effective quitting aids and assistance, at both levels of play are needed. Future research is needed to further clarify changes in ST practices among professional players and set policy intervention directions.

Shirazi A; Tricker R. Current drug education policies in NCAA institutions: Perceptions of head athletic trainers. Journal of Drug Education 35(1): 29-46, 2005. (25 refs.)

This study compared the perceptions of head athletic trainers (HATS) from NCAA member Divisions I, II, and III regarding current athletic department drug education policies in their institutions. A Web-based questionnaire collected responses from 353 HATS. Drug education programs focused more on providing information about the negative consequences of drugs than changing the attitudes and behaviors of students in relation to drug use. More Division I and II schools offered comprehensive ATOD education programs to their athletes compared to Division III schools; however, the majority of these programs were not scheduled on a regular basis. HATS in all divisions reported that the abuse of alcohol and other drugs by student athletes during and after athletic and social events was a significant concern and indicated the importance of scheduling drug education programs closer to such events. Majority of HATS did not view participating in the drug education programs as part of their professional duties; however, they expressed an interest to increase their involvement in these activities.

Simon P; Striegel H; Aust F; Dietz K; Ulrich R. Doping in fitness sports: Estimated number of unreported cases and individual probability of doping. Addiction 101(11): 1640-1644, 2006. (20 refs.)

Aims: Recent studies have suggested that the use of doping substances and particularly of anabolic androgenic steroids (AAS) is often practised by fitness centre visitors. These studies employed direct interview techniques and questionnaires to assess the estimated number of unreported cases of doping. Because people hesitate to provide compromising information about themselves, these techniques are subject to response errors. In this study we applied an alternative interview technique to assess more accurately unreported cases of doping in fitness centres. Design and participants: The present investigation employed the randomized response technique (RRT) to reduce response errors. A cohort of 500 people from 49 fitness centres participated in this study. Finding The RRT revealed a high prevalence of doping (12.5%). In addition, and most importantly, the present RRT study revealed an alarmingly high prevalence of illicit drug use, specifically of cocaine use, that has been severely underestimated by previous studies. Conclusions: The RRT confirmed previously estimated rates of AAS use assessed by direct interview techniques and voluntary questionnaires, but uncovered a much higher usage rate of illicit drugs among fitness centre visitors. This outcome enabled us to construct a 'probability' rating for the use of doping substances in fitness centre visitors. Given its high prevalence and the predominant use of AAS, doping among fitness centre visitors is an issue of extreme relevance for the health care system. Our study may help to characterize further doping substance users and to develop and apply prevention and intervention programmes specifically to individuals at high risk.

Simpson JJ. Review of selected 2005 California Legislation. Addressing the use of steroids ond performance enhancing dietary supplements by high school athletes. University of the Pacific McGeorge Law Review 37: 239-250, 2006. (105 legal refs.)

This article examines the impact of legislation in California on efforts to reduce and prevent the use of steroids and enhancing-performance drugs by student, high school athletes. The author provides a review of perinent federal and California laws. There is consideration of figures with potential to influence student athlete drug use, from coaches to parents. The role of drug testing is also described, including its limitations.

Striegel H; Rossner D; Simon P; Niess AM. The World Anti-Doping Code 2003. Consequences for physicians associated with elite athletes. International Journal of Sports Medicine 26(3): 238-243, 2005. (9 refs.)

The purpose of the World Anti-Doping Code 2003 and the 2004 Prohibited List is to create a universal international standard to fight doping in competitive sports. The result of this is a whole series of changes for doctors with regard to their work with competitive athletes. The revised definition of doping now includes physicians in the group of persons who can fulfill the elements of a doping offence. Moreover, the mere possession of substances appearing on the Prohibited List represents a violation of anti-doping regulations. The 2004 Prohibited List includes several changes to the Olympic Movement List from 2003. Caffeine, for example, was removed from the list. Cannabinoids, on the other hand, are now prohibited in competition for all sports. The same is true for all forms of glucocorticosteroids. Therapeutic use exemptions in an abbreviated process are possible for the administration of glucocorticosteroids by non-systemic routes, as well as inhalative therapy with the beta-2-agonists formoterol, salbutamol, salmeterol, and termbutalin. In other cases, a therapeutic use exemption is possible using a standard application process. Further changes will become effective in the 2005 Prohibited List. In 2005, it is essential that beta-2-agonists are prohibited in and out of competition. HCG and LH are prohibited for all athletes. Dermatological preparations of glucocorticosteroids are no longer prohibited, and intravenous infusions will be a prohibited method in 2005, except as a legitimate acute medical treatment. In cases of violations of anti-doping regulations where it is permissible for the affected person to furnish proof of exoneration, the burden of proof is not higher than that required to prove the violation. The sanctions provided for in the World Anti-Doping Code follow a principle of rules and exceptions which at first glance seems difficult to understand. In the case of doping violations by physicians, the anti-doping code provides - as a general rule - for exclusion from sports associations for at least four years. Since several of the changes are questionable under constitutional aspects, it remains to be seen whether the World Anti-Doping Code 2003 will allow the achievement of a universal standard to combat doping.

Striegel H; Simon P; Frisch S; Roecker K; Dietz K; Dickhuth HH et al. Anabolic ergogenic substance users in fitness-sports: A distinct group supported by the health care system. Drug and Alcohol Dependence 81(1): 11-19, 2006. (28 refs.)

Background: Anabolic ergogenic substance use, in particular the use of anabolic androgenic steroids, is a serious problem in general. Nevertheless, it is subject to debate whether ergogenic substance users exhibit similar features as multiple substance users or whether they constitute a discrete group. Methods; One thousand eight hundred and two standardized, anonymous questionnaires were distributed among visitors of 113 fitness centers. Questions were asked concerning biometric parameters, social indicators, physical fitness, use of natural stimulants, general illicit drugs and ergogenic substances. With logistic regression analysis, multivariate odds ratios were estimated to investigate the association of anabolic ergogenic substance or general illicit drug use with other parameters. Results; 13.5% of all participants confessed to having used anabolic ergogenic substances at some point in time. Anabolic ergogenic substance use was positively related with cocaine use, training years, training frequency, negatively related to the level of education, alcohol intake and less frequently used by Germans than by non-Germans. General illicit drug use. however, was positively related with alcohol intake, smoking and a university degree and negatively with having children. In addition, anabolic ergogenic substance use was significantly related with the use of general illicit drugs based on the strong relation with the use of cocaine, which is an ergogenic substance itself. The health care system supplies 48.1% of the anaolic ergogenic substance users with their substances and 32.1% are even monitored by a physician. Conclusions; The results of this study strengthen the notion that anabolic ergogenic substance users constitute a specific body-oriented substance user group. Uncommon for general illicit drug use, the health care system is a major sponsor of anabolic ergogenic substance users. These findings suggest the need for alternative approaches for successful prevention and intervention programs.

Striegel H; Simon P; Wurster C; Niess AM; Ulrich R. The use of nutritional supplements among master athletes. International Journal of Sports Medicine 27(3): 236-241, 2006. (25 refs.)

We assessed the use of nutritional supplements among master athletes focusing on their source of information and source of supply of nutritional supplements. 1560 standardized, anonymous questionnaires were distributed among participants of the World Masters Athletics Championships Indoors 2004. These questions were related to biometric parameters, social indicators, training parameters, illicit drugs, and nutritional supplements. chi(2)-tests were computed to reveal meaningful associations between basic information (age, gender, family Status, children, education, country of origin, disciplines, training years, smoking, and the use of alcohol, illicit drugs, and doping) and the intake of nutritional supplements. Descriptive information on the history of their use of nutritional supplements was also provided. 60.5% of all participants reported the actual use of nutritional supplements. We found no significant differences between nutritional supplement users and non-users with regard to basic information. The substances predominantly used were vitamins (35.4%) and minerals (29.9%). In contrast to elite athletes who use nutritional supplements to increase their athletic performance, master athletes use these substances predominantly for health reasons and, thus, have a closer contact to the health care system. Physicians are their preferred source of information about nutritional supplements. More than half of the interviewed athletes obtain their nutritional supplements from pharmacies or physicians. The results of this study indicate that nutritional supplement users in master athletics show no specific user profile. Since it is not rare for nutritional supplements to contain trace contaminations of anabolic androgenic steroids or pro-hormones, physicians should also inform master competitive athletes of the clances of testing positive for doping substances due to their intake of nutritional supplements and advise them accordingly.

Stuart GR; Hopkins WG; Cook C; Cairns SP. Multiple effects of caffeine on simulated high-intensity team-sport performance. Medicine and Science in Sports and Exercise 37(11): 1998-2005, 2005. (33 refs.)

Introduction: Caffeine enhances performance of single bouts of endurance exercise, but its effects on repeated bouts typical of those in high-intensity team sports are unclear. Purpose: To investigate effects of caffeine in a performance test simulating physical and skill demands of a rugby union game. Methods: The study was a double-blind, randomized, crossover design in which nine competitive male rugby players ingested either caffeine (6 mg(.)kg(-1) body mass) or placebo (dextrose) 70 min before performing a rugby test. Each test consisted of seven circuits in each of two 40-min halves with a 10-min half-time rest. Each circuit included stations for