Anabolic Steroid Abuse
Federal Efforts to Prevent and Reduce Anabolic Steroid Abuse among Teenagers Gao ID: GAO-08-15 October 31, 2007The abuse of anabolic steroids by teenagers--that is, their use without a prescription--is a health concern. Anabolic steroids are synthetic forms of the hormone testosterone that can be taken orally, injected, or rubbed on the skin. Although a 2006 survey funded by the National Institute on Drug Abuse (NIDA) found that less than 3 percent of 12th graders had abused anabolic steroids, it also found that about 40 percent of 12th graders described anabolic steroids as "fairly easy" or "very easy" to get. The abuse of anabolic steroids can cause serious health effects and behavioral changes in teenagers. GAO was asked to examine federally funded efforts to address the abuse of anabolic steroids among teenagers and to review available research on this issue. This report describes (1) federally funded efforts that address teenage abuse of anabolic steroids, (2) available research on teenage abuse of anabolic steroids, and (3) gaps or areas in need of improvement that federal officials and other experts identify in research that addresses teenage anabolic steroid abuse. To do this work, GAO reviewed federal agency materials and published studies identified through a literature review and interviewed federal officials and other experts.
There are two categories of federally funded efforts that address teenage abuse of anabolic steroids. Efforts are either designed to focus on preventing the abuse of anabolic steroids among teenagers or are broader and designed to prevent substance abuse in general--which can include abuse of anabolic steroids among teenagers. Two programs that received federal funding during their development and testing, Athletes Training and Learning to Avoid Steroids (ATLAS) and Athletes Targeting Healthy Exercise & Nutrition Alternatives (ATHENA), are designed to focus on preventing or reducing teen abuse of anabolic steroids through use of gender-specific student-led curricula. In addition, there are various research efforts and education and outreach activities that focus on this issue. Two federal grant programs--the Office of National Drug Control Policy's Drug-Free Communities Support program and the Department of Education's School-Based Student Drug Testing program--are designed to support state and local efforts to prevent substance abuse in general and may include anabolic steroid abuse among teenagers as part of the programs' substance abuse prevention efforts. In 2007, about one-quarter of more than 700 Drug-Free Communities Support program grantees reported that they were addressing steroid abuse as one of their program's objectives. Almost half of the 16 studies GAO reviewed identified certain risk factors and behaviors linked to the abuse of anabolic steroids among teenagers. Several of these studies found connections between anabolic steroid abuse and risk factors such as use of other drugs, risky sexual behaviors, and aggressive behaviors. Most of the other studies were assessments of the ATLAS and ATHENA prevention programs and in general suggested that the programs may reduce abuse of anabolic steroids and other drugs among high school athletes immediately following participation in the programs. Experts identified gaps in the research addressing teenage abuse of anabolic steroids. Experts identified a lack of conclusive evidence of the sustained effectiveness over time of available prevention programs, for example at 1 year following participants' completion of the programs. Experts also identified gaps in the research on the long-term health effects of initiating anabolic steroid abuse as a teenager--including research on effects that may be particularly harmful in teens--and in research on psychological effects of anabolic steroid abuse.
GAO-08-15, Anabolic Steroid Abuse: Federal Efforts to Prevent and Reduce Anabolic Steroid Abuse among Teenagers
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Report to the Committee on Oversight and Government Reform, House of
Representatives:
United States Government Accountability Office:
GAO:
October 2007:
Anabolic Steroid Abuse:
Federal Efforts to Prevent and Reduce Anabolic Steroid Abuse among
Teenagers:
Teenage Abuse of Anabolic Steroids:
GAO-08-15:
GAO Highlights:
Highlights of GAO-08-15, a report to the Committee on Oversight and
Government Reform, House of Representatives.
Why GAO Did This Study:
The abuse of anabolic steroids by teenagers”that is, their use without
a prescription”is a health concern. Anabolic steroids are synthetic
forms of the hormone testosterone that can be taken orally, injected,
or rubbed on the skin. Although a 2006 survey funded by the National
Institute on Drug Abuse (NIDA) found that less than 3 percent of 12th
graders had abused anabolic steroids, it also found that about 40
percent of 12th graders described anabolic steroids as ’fairly easy“ or
’very easy“ to get. The abuse of anabolic steroids can cause serious
health effects and behavioral changes in teenagers.
GAO was asked to examine federally funded efforts to address the abuse
of anabolic steroids among teenagers and to review available research
on this issue. This report describes (1) federally funded efforts that
address teenage abuse of anabolic steroids, (2) available research on
teenage abuse of anabolic steroids, and (3) gaps or areas in need of
improvement that federal officials and other experts identify in
research that addresses teenage anabolic steroid abuse. To do this
work, GAO reviewed federal agency materials and published studies
identified through a literature review and interviewed federal
officials and other experts.
What GAO Found:
There are two categories of federally funded efforts that address
teenage abuse of anabolic steroids. Efforts are either designed to
focus on preventing the abuse of anabolic steroids among teenagers or
are broader and designed to prevent substance abuse in general”which
can include abuse of anabolic steroids among teenagers. Two programs
that received federal funding during their development and testing,
Athletes Training and Learning to Avoid Steroids (ATLAS) and Athletes
Targeting Healthy Exercise & Nutrition Alternatives (ATHENA), are
designed to focus on preventing or reducing teen abuse of anabolic
steroids through use of gender-specific student-led curricula. In
addition, there are various research efforts and education and outreach
activities that focus on this issue. Two federal grant programs”the
Office of National Drug Control Policy‘s Drug-Free Communities Support
program and the Department of Education‘s School-Based Student Drug
Testing program”are designed to support state and local efforts to
prevent substance abuse in general and may include anabolic steroid
abuse among teenagers as part of the programs‘ substance abuse
prevention efforts. In 2007, about one-quarter of more than 700 Drug-
Free Communities Support program grantees reported that they were
addressing steroid abuse as one of their program‘s objectives.
Almost half of the 16 studies GAO reviewed identified certain risk
factors and behaviors linked to the abuse of anabolic steroids among
teenagers. Several of these studies found connections between anabolic
steroid abuse and risk factors such as use of other drugs, risky sexual
behaviors, and aggressive behaviors. Most of the other studies were
assessments of the ATLAS and ATHENA prevention programs and in general
suggested that the programs may reduce abuse of anabolic steroids and
other drugs among high school athletes immediately following
participation in the programs.
Experts identified gaps in the research addressing teenage abuse of
anabolic steroids. Experts identified a lack of conclusive evidence of
the sustained effectiveness over time of available prevention programs,
for example at 1 year following participants‘ completion of the
programs. Experts also identified gaps in the research on the long-term
health effects of initiating anabolic steroid abuse as a
teenager”including research on effects that may be particularly harmful
in teens”and in research on psychological effects of anabolic steroid
abuse.
To view the full product, including the scope and methodology, click on
[hyperlink, http://wwww.GAO-08-15]. For more information, contact
Laurie E. Ekstrand at (202) 512-7114 or ekstrandl@gao.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Some Federally Funded Efforts Are Designed to Focus on Preventing
Teenage Steroid Abuse, While Other Efforts Designed to Address
Substance Abuse in General May Include Teenagers:
Research Shows Teenage Anabolic Steroid Abuse Is Linked to Certain Risk
Factors and That Prevention Programs May Have Some Short-term
Effectiveness:
Experts Find There Are Gaps in Research on the Sustained Effectiveness
of Prevention Programs and on the Long-term Health Effects for
Teenagers:
Agency Comments:
Appendix I: Selected Federally Funded Efforts That Address or Can
Address Anabolic Steroid Abuse among Teenagers:
Appendix II Articles Included in GAO's Review:
Appendix III: GAO Contact and Staff Acknowledgments:
Table:
Table 1: Selected Federally Funded Efforts That Address or Can Address
Anabolic Steroid Abuse among Teenagers:
Figures:
Figure 1: Reported Lifetime Anabolic Steroid Abuse among 12TH Graders,
1991-2006:
Figure 2: Reported Past Year Anabolic Steroid Abuse by Male and Female
Adolescents, 2002-2006:
Abbreviations:
ATHENA: Athletes Targeting Healthy Exercise & Nutrition Alternatives:
ATLAS: Athletes Training and Learning to Avoid Steroids:
CDC: Centers for Disease Control and Prevention:
HHS: Department of Health and Human Services:
MTF: Monitoring the Future:
NIDA: National Institute on Drug Abuse:
NIH: National Institutes of Health:
ONDCP: Office of National Drug Control Policy:
SAMHSA: Substance Abuse and Mental Health Services Administration:
USADA: United States Anti-Doping Agency:
YRBS: Youth Risk Behavior Survey:
United States Government Accountability Office:
Washington, DC 20548:
October 31, 2007:
The Honorable Henry A. Waxman:
Chairman:
The Honorable Tom Davis:
Ranking Member:
Committee on Oversight and Government Reform:
House of Representatives:
The abuse of anabolic steroids[Footnote 1] by teenagers--that is, their
use without a prescription--is a health concern. Anabolic steroids are
synthetic forms of the hormone testosterone that can be taken orally,
injected, or rubbed on the skin. Although a 2006 survey funded by the
National Institute on Drug Abuse (NIDA) showed that less than 3 percent
of 12TH graders had abused anabolic steroids, the survey also showed
that about 40 percent of 12TH graders described anabolic steroids as
"fairly easy" or "very easy" to get. The abuse of anabolic steroids can
cause serious health effects and behavioral changes in teenagers. Under
U.S. law, anabolic steroids are controlled substances whose
manufacture, possession, and use are regulated by the federal
government;[Footnote 2] they also cannot be sold legally without a
prescription.
You asked us to examine federally funded efforts to address the abuse
of anabolic steroids among teenagers and to review available research
on this issue. In this report, we:
1. describe major, federally funded efforts that address teenage abuse
of anabolic steroids,
2. describe the available research on teenage abuse of anabolic
steroids, and:
3. describe gaps or areas in need of improvement that federal officials
and other experts identify in research that addresses anabolic steroid
abuse among teenagers.
We focused our review on the abuse of anabolic steroids by teenagers in
grades 8 through 12. To describe federally funded efforts to address
anabolic steroid abuse among teenagers, we reviewed databases of
federal grant programs.[Footnote 3] We also obtained and reviewed
pertinent reports and information from the Web sites of agencies within
the Department of Health and Human Services (HHS)--the Centers for
Disease Control and Prevention (CDC), the National Institutes of Health
(NIH), and the Substance Abuse and Mental Health Services
Administration (SAMHSA)--as well as the Web sites of the Department of
Education (Education) and the Office of National Drug Control Policy
(ONDCP). We used these resources to identify federally funded
programs,[Footnote 4] research, and education and outreach activities
that address--through efforts to either prevent or reduce--anabolic
steroid abuse among teenagers. After identifying these efforts, we
interviewed and collected information from federal officials to confirm
that these efforts are intended to prevent or reduce anabolic steroid
abuse among teenagers. Where available, we requested funding
information on the federal efforts that we identified.[Footnote 5]
To describe the available research on teenage abuse of anabolic
steroids, we conducted a systematic review of the published literature
on this topic. We identified 16 articles that related to teenage abuse
of anabolic steroids and were published from January 1995 through June
2007. To select the articles, we conducted a keyword search using the
Dialog Database System,[Footnote 6] a system that searches numerous
database files, and reviewed the resulting article titles and abstracts
to identify whether the articles focused on teenage abuse of anabolic
steroids. We did not select articles that were international works,
based on reviews of other articles or research, position papers, policy
statements, or federal agency program documents. The references we make
to articles refer strictly to those that we reviewed.
To describe the gaps or areas in need of improvement in research that
addresses teenage abuse of anabolic steroids as identified by experts,
we interviewed experts in anabolic steroid abuse and reviewed relevant
literature. We interviewed federal officials from CDC, NIDA, SAMHSA,
and Education, as well as other experts from universities and
professional associations. We reviewed research articles identifying
gaps or areas in need of improvement as part of our systematic review
of the literature. We conducted the work for our review from January
2007 through September 2007 in accordance with generally accepted
government auditing standards.
Results in Brief:
There are two categories of federally funded efforts that address
teenage abuse of anabolic steroids. Efforts are either designed to
focus on preventing the abuse of anabolic steroids among teenagers or
are broader and designed to prevent substance abuse in general--which
can include abuse of anabolic steroids among teenagers. Two programs
that received federal funding during their development and testing,
Athletes Training and Learning to Avoid Steroids (ATLAS)[Footnote 7]
and Athletes Targeting Healthy Exercise & Nutrition Alternatives
(ATHENA), are designed to focus on preventing or reducing teen abuse of
anabolic steroids. In addition, there are various research efforts and
education and outreach activities that focus on this issue. For
example, in addition to steroid-related research, since 2000 NIDA has
provided nearly $500,000 in funding for a variety of education and
outreach activities including a multimedia educational initiative
intended to prevent anabolic steroid abuse among teenagers. Two federal
grant programs--ONDCP's Drug-Free Communities Support program and
Education's School-Based Student Drug Testing program--are designed to
support state and local efforts to prevent substance abuse in general
and may include anabolic steroid abuse among teenagers as part of the
programs' substance abuse prevention efforts. In 2007, about one-
quarter of more than 700 Drug-Free Communities Support program grantees
reported that they were addressing steroid abuse as one of their
program's objectives.
Almost half of the 16 studies we reviewed identified certain risk
factors and behaviors linked to the abuse of anabolic steroids among
teenagers. Several of these studies found connections between anabolic
steroid abuse and risk factors such as use of other drugs, risky sexual
behaviors, and aggressive behaviors. Most of the other studies we
reviewed were assessments of the ATLAS and ATHENA prevention programs.
In general, these studies suggested that the programs may reduce abuse
of anabolic steroids and other drugs among high school athletes
immediately following participation in the programs.
Experts identified gaps in the research that addresses anabolic steroid
abuse among teenagers. Experts identified a lack of conclusive evidence
of sustained effectiveness over time of available prevention programs,
for example at 1 year following participants' completion of the
programs. Experts also identified gaps in the research on the long-term
heath effects of initiating anabolic steroid abuse as a teenager--
including research on effects that may be particularly harmful in
teenagers--and in the research on psychological effects.
HHS and Education provided technical comments only, which we
incorporated into the report as appropriate.
Background:
The abuse of anabolic steroids differs from the abuse of other illicit
substances. When users initially begin to abuse anabolic steroids, they
typically are not driven by a desire to achieve an immediate euphoria
like that which accompanies most abused drugs such as cocaine, heroin,
and marijuana. The abuse of anabolic steroids is typically driven by
the desire of users to improve their athletic performance and
appearance--characteristics that are important to many teenagers.
Anabolic steroids can increase strength and boost confidence, leading
users to overlook the potential serious and long-term damage to their
health that these substances can cause. In addition, the methods and
patterns of use for anabolic steroids differ from those of other drugs.
Anabolic steroids are most often taken orally or injected, typically in
cycles of weeks or months (referred to as "cycling"), rather than
continuously. Cycling involves taking multiple doses of anabolic
steroids over a specific period of time, stopping for a period, and
starting again. In addition, users often combine several different
types of anabolic steroids to maximize their effectiveness (referred to
as "stacking").
While anabolic steroids can enhance certain types of performance or
appearance, when used inappropriately they can cause a host of severe,
long-term, and in some cases, irreversible health consequences. The
abuse of anabolic steroids can lead to heart attacks, strokes, liver
tumors, and kidney failure. In addition, because anabolic steroids are
often injected, users who share needles or use nonsterile injection
techniques are at risk for contracting dangerous infections, such as
HIV/AIDS and hepatitis B and C. There are also numerous side effects
that are gender-specific, including reduced sperm count, infertility,
baldness, and development of breasts among men; and growth of facial
hair, male-pattern baldness, changes in or cessation of the menstrual
cycle, and deepened voice among women. There is also concern that
teenagers who abuse anabolic steroids may face the additional risk of
halted growth resulting from premature skeletal maturation and
accelerated puberty changes.
The abuse of anabolic steroids may also lead to aggressive behavior and
other psychological side effects. Many users report feeling good about
themselves while on anabolic steroids, but for some users extreme mood
swings also can occur, including manic-like symptoms leading to
violence. Some users also may experience depression when the drugs are
stopped, which may contribute to dependence on anabolic steroids. Users
may also suffer from paranoia, jealousy, extreme irritability,
delusions, and impaired judgment stemming from feelings of
invincibility.
Two national surveys showed increasing prevalence in teenage abuse of
steroids throughout the 1990s until about 2002 and a decline since then
(see fig. 1). One of these two national surveys, the Monitoring the
Future (MTF) survey, is an annual survey conducted by the University of
Michigan and supported by NIDA funding.[Footnote 8] The MTF survey
measures drug use and attitudes among students in grades 8, 10, and 12,
and asks several questions about the use of and attitudes towards
anabolic steroids, such as perceived risk, disapproval, and
availability of anabolic steroids. The survey's questions are designed
to assess respondents' use of steroids in the last 30 days, the past
year, and over the course of the respondent's lifetime. Questions about
steroid use were added to the study beginning in 1989. The most recent
results from this survey showed that in 2006, 2.7 percent of 12TH
graders said they had used anabolic steroids without a prescription at
least once. The second national survey, the Youth Risk Behavior Survey
(YRBS), is a biennial survey conducted since 1991 by CDC.[Footnote 9]
The YRBS is part of a surveillance system consisting of national,
state, and local surveys of students in grades 9 through 12. These
surveys collect information about a wide variety of risk behaviors,
including sexual activity and alcohol and drug use. The most recent
available national YRBS survey--conducted in 2005--asked one question
related to lifetime steroid use without a prescription, which showed
that 3.3 percent of 12TH graders had used steroids at least once.
Figure 1: Reported Lifetime Anabolic Steroid Abuse among 12TH Graders,
1991-2006:
This figure is a combination line chart showing reported lifetime
anabolic steroid abuse among 12th graders, between 1991 and 2006. The X
axis represents the year, and the Y axis represents the percentage. One
line represents Monitoring the Future (MTF), and the other represents
Youth Risk Behavior Survey (YRBS).
[See PDF for image]
Source: GAO analysis of MTF and YRBS data.
[End of figure]
The MTF and YRBS surveys indicate a low abuse rate for anabolic
steroids among teenagers[Footnote 10] when compared with the abuse
rates for other drugs.[Footnote 11] However, the reported easy
availability of steroids[Footnote 12] and the potential for serious
health effects make anabolic steroid abuse a health concern for
teenagers, particularly among males. In general, the reported rates of
anabolic steroid abuse are higher for males than for females (see fig.
2). Data from the 2006 MTF survey showed that 1.7 percent of teenage
males reported abusing anabolic steroids in the past year, as compared
with 0.6 percent of females. Data from the 2005 YRBS survey showed that
4.8 percent of high school males reported abusing steroids in their
lifetime, as compared with 3.2 percent of females.
Figure 2: Reported Past Year Anabolic Steroid Abuse by Male and Female
Adolescents, 2002-2006:
This figure is a combination line chart showing reported past year
anabolic steroid abuse by male and female adolescents, between 2002 and
2006. The X axis represents the year, and the Y axis represents the
percentage. One line represents females, and the other line represents
males.
[See PDF for image]
Source: GAO analysis of MTF data.
Note: These are combined data for 8TH, 10TH, and 12TH grade students.
[End of figure]
Some Federally Funded Efforts Are Designed to Focus on Preventing
Teenage Steroid Abuse, While Other Efforts Designed to Address
Substance Abuse in General May Include Teenagers:
There are two categories of federally funded efforts that address
teenage abuse of anabolic steroids. Efforts are either designed to
focus on preventing the abuse of anabolic steroids among teenagers or
are broader and designed to prevent substance abuse in general--which
can include abuse of anabolic steroids among teenagers. Two programs
that received federal research funding for their development and
testing, ATLAS and ATHENA, are designed to focus on preventing or
reducing teen abuse of anabolic steroids. In addition, there are
various research efforts and education and outreach activities that
focus on this issue. Two federal grant programs--ONDCP's Drug-Free
Communities Support program and Education's School-Based Student Drug
Testing program--are designed to support state and local efforts to
prevent substance abuse in general and may include anabolic steroid
abuse among teenagers as part of the programs' substance abuse
prevention efforts. See appendix I for a list of the federally funded
efforts discussed below.
Some Federally Funded Programs, Research, and Activities Are Designed
to Focus on Preventing Teenage Anabolic Steroid Abuse:
There are various federally funded efforts--programs, research, and
educational activities--that address teenage abuse of anabolic
steroids. Some of these efforts are designed to focus on preventing or
reducing anabolic steroid abuse among teenagers. As part of our review
we identified two programs, the ATLAS and ATHENA programs, which
received federal research funding during their development and testing
and are designed to focus on preventing the abuse of anabolic steroids
among male and female high school athletes, respectively.
ATLAS is a student-led curriculum designed to prevent male high school
athletes from abusing anabolic steroids and other performance-enhancing
substances. The program's intervention strategy relies on peer pressure
and providing information on healthy alternatives for increasing muscle
strength and size. The ATLAS curriculum is typically delivered during a
sport team's season in a series of 45-minute sessions scheduled at the
coaches' discretion and integrated into the usual team practice
activities. The athletes meet as a team in groups of six or eight
students with one student functioning as the assigned group leader.
Coaches, group leaders, and student athletes all work from manuals and
workbooks, which provide brief, interactive activities that focus on
drugs used in sports, sport supplements, strength training, sport
nutrition, and decision making.
The ATHENA program is designed to prevent the abuse of body-shaping
substances such as diet pills and anabolic steroids, although abuse of
the latter is less common in females than in males. Like ATLAS, the
ATHENA curriculum is integrated into a sport team's usual practice
activities and uses workbooks and student group leaders. The ATHENA
curriculum takes into account that female athletes are less likely than
males to abuse anabolic steroids but are more likely to have problems
with eating disorders and to use drugs such as diet pills and tobacco.
As a result, ATHENA's curriculum gives more attention than ATLAS's to
addressing these behaviors.
The ATLAS and ATHENA curricula were developed and tested with funding
provided by NIDA.[Footnote 13] From fiscal years 1993 through 2001,
NIDA provided more than $3.4 million to fund the research that
developed and tested the effectiveness of the ATLAS curriculum.
Similarly, from fiscal years 1999 through 2003 NIDA provided $4.7
million in research funding to develop and test the effectiveness of
the ATHENA curriculum. While ATLAS and ATHENA were developed and tested
with federal funding, the programs are implemented at the local level.
Schools in at least 25 states have chosen to implement the programs
with local and private funds, and the National Football League and
Sports Illustrated magazine together have supported the programs in
more than 70 schools nationwide.[Footnote 14]
In addition to the ATLAS and ATHENA programs, there are various
federally funded research efforts that focus on preventing or reducing
anabolic steroid abuse among teenagers. NIDA has funded several
research projects examining the factors that influence teenagers to
abuse anabolic steroids and the effectiveness of interventions used to
prevent teenage steroid abuse. From fiscal years 2000 through 2006,
NIDA awarded nearly $10.1 million in grants to support an average of
four research projects each year related to anabolic steroid abuse with
a specific focus on adolescents.[Footnote 15] In fiscal year 2006, for
example, NIDA awarded a total of nearly $638,000 to three research
projects that examined risk factors for anabolic steroid abuse among
teenagers or the effects of steroid abuse in this population. Like
NIDA, the United States Anti-Doping Agency (USADA)--an independent,
nonprofit corporation funded primarily by ONDCP--supports research
related to the abuse of anabolic steroids and other performance-
enhancing drugs by athletes, including teenage athletes.[Footnote 16]
In fiscal year 2006, USADA spent $1.8 million for research, and an
ONDCP official estimated that about one-third of that research funding
was directed to anabolic steroids and another performance-enhancing
drug, human growth hormone.
In addition to research, there are various education and outreach
activities that focus on preventing anabolic steroid abuse among
teenagers. Many of these efforts have been supported by NIDA. Since
2000, NIDA has provided nearly $500,000 in funding for a variety of
education and outreach efforts in support of this goal.[Footnote 17]
For example, in April 2000, in response to an upward trend in steroid
abuse among students, NIDA launched a multimedia educational initiative
intended to prevent anabolic steroid abuse among teenagers. Along with
several national partners, including the National Collegiate Athletic
Association, the American College of Sports Medicine, and the American
Academy of Pediatrics, the initiative produced a Web site, a research
report on steroid abuse, and postcard-sized messages about steroids for
placement in gyms, movie theaters, shopping malls, bookstores, and
restaurants in selected areas. By 2007, NIDA funding for this
particular initiative totaled about $124,000.
In addition to NIDA, other federal agencies and organizations have
supported educational and outreach activities that focus on preventing
anabolic steroid abuse among teenagers, as the following examples
illustrate.
* ONDCP has funded six informational briefings since 2001 to encourage
journalists, entertainment writers, and producers to accurately cover
anabolic steroids and drug abuse among teenage athletes. ONDCP also has
Web sites for teens and parents with information about anabolic
steroids and links to NIDA resources.
* Since 2003, USADA has produced written publications and annual
reports on anabolic steroid abuse and has distributed those
publications through high schools and state high school associations.
In addition, some USADA public service announcements to be aired during
televised sports events and movie trailers have targeted anabolic
steroid abuse.
* In fiscal years 2007 and 2008, SAMHSA expects to spend a total of
$99,000 under a contract to develop and disseminate educational
materials addressing the abuse of anabolic steroids by adolescent
athletes. These materials, which are intended for use by high school
athletic and health science departments, include brochures, a video,
and 10 high school outreach seminars.
Two Federal Grant Programs Designed to Address Substance Abuse May
Address Teenage Anabolic Steroid Abuse:
As part of our review, we identified two federal grant programs that
are designed to support state and local efforts to prevent various
forms of substance abuse and that may include teenagers. Grantees of
these programs may address teenage anabolic steroid abuse as part of
the programs' general substance abuse prevention efforts. The Drug-Free
Communities Support program, funded by ONDCP and administered by SAMHSA
under an interagency agreement, provides grants to community coalitions
to address drug abuse problems identified in their
communities.[Footnote 18] Many community coalitions choose to implement
school-based drug prevention programs with their grant funding and are
allowed to tailor these programs to address the drug prevention needs
of their communities. In 2007, about one-quarter of more than 700
grantees reported that they were addressing steroid abuse as one of
their program's objectives.[Footnote 19] Each community coalition is
eligible for grants of up to $125,000 per year, renewable for up to 4
more years, and requiring dollar-for-dollar community matching
funds.[Footnote 20] In 2007, the Drug-Free Communities Support program
is providing about $80 million in grants to 709 community coalitions
for drug prevention activities based on the needs of the communities.
Another federal grant program that supports substance abuse prevention
efforts for teenagers and that may also include efforts to address
anabolic steroid abuse in this population is the School-Based Student
Drug Testing program in Education's Office of Safe and Drug-Free
Schools.[Footnote 21] Since 2003, this program has provided grants to
school districts and public and private entities to establish school-
based drug-testing efforts. For fiscal years 2003 through 2007, the
Office of Safe and Drug-Free Schools awarded $32.2 million in grants to
87 individual School-Based Student Drug Testing grantees.[Footnote 22]
According to information provided in the grantees' grant applications,
34 of the grantees (representing 180 middle, junior, and high schools
and at least 70,000 students) proposed using their grant-supported drug
testing to test for anabolic steroids in addition to other substances
such as amphetamines, marijuana, and cocaine.[Footnote 23] Education
officials told us that although grantees generally identify the drugs
for which they are testing in their annual performance reports, there
has been no independent verification by Education staff that confirms
that the 34 grantees actually have implemented anabolic steroid testing
or whether additional grantees have included steroid testing in their
efforts.
Research Shows Teenage Anabolic Steroid Abuse Is Linked to Certain Risk
Factors and That Prevention Programs May Have Some Short-term
Effectiveness:
Of the 16 studies we reviewed, nearly half focused on linking certain
risk factors and behaviors to teenagers' abuse of anabolic steroids,
including the use of other drugs, risky sexual behaviors, and
aggressive behaviors.[Footnote 24] Most of the other studies we
reviewed were assessments of the ATLAS and ATHENA prevention programs
and in general suggested that the programs may reduce abuse of anabolic
steroids and other drugs among high school athletes immediately
following participation in the programs. Appendix II is a list of the
articles we reviewed.
Almost half of the studies we reviewed identified certain risk factors
and behaviors linked to the abuse of anabolic steroids among
teenagers.[Footnote 25] Risk factors, such as antisocial behavior,
family violence, and low academic achievement, are linked to youths'
likelihood of engaging in risky behaviors, including drug abuse.
Several studies found that the use of alcohol and other drugs--such as
tobacco, marijuana, and cocaine--is associated with the abuse of
anabolic steroids among teenagers, including teenage athletes and non-
athletes. One 2005 study found that the use of other drugs was more
likely to predict anabolic steroid abuse than participation in athletic
activities. Several studies we reviewed found no difference between
athletes and non-athletes in their abuse of anabolic steroids, and one
2007 study of teenage girls found that female athletes were less likely
than female non-athletes to abuse anabolic steroids. A few studies we
reviewed found a positive correlation between anabolic steroid abuse
and risky sexual behaviors such as early initiation of sexual activity
and an increased number of sexual partners. Some studies found that
aggressive behaviors such as fighting were related to anabolic steroid
abuse by both males and females. Moreover, one 1997 study found that
adolescents (both male and female) who reported abusing anabolic
steroids in the past year were more likely to be perpetrators of sexual
violence. However, the cause-and-effect relationships between anabolic
steroid abuse and other risky behaviors, such as violence, have not
been determined.[Footnote 26]
About half of the studies we reviewed were assessments of the ATLAS and
ATHENA prevention programs, and in general these studies suggested that
these programs may reduce abuse of anabolic steroids and other drugs
among high school athletes immediately following participation in the
programs. Researchers assessing the ATLAS program reported that both
the intention to abuse anabolic steroids and the reported abuse of
steroids were lower among athletes who participated in the ATLAS
program than among athletes who did not participate in the program. The
most recent study found that although the intention to abuse anabolic
steroids remained lower at follow-up 1 year later for athletes who
participated in the ATLAS program, the effectiveness of the program in
reducing reported use diminished with time. Similarly, researchers
assessing the ATHENA program found that girls who participated in the
program reported less ongoing and new abuse of anabolic steroids as
well as a reduction in the abuse of other performance-enhancing and
body-shaping substances. The authors note that these results are short
term, and the long-term effectiveness of the ATHENA program is not
known.
The authors of the one study in our review that looked at student drug-
testing programs found that the abuse of anabolic steroids and other
illicit drugs and performance-enhancing substances was decreased among
athletes at schools that implemented mandatory, random drug-testing
programs. However, this group of athletes also showed an increase in
risk factors that are generally associated with greater abuse of
illicit drugs, including anabolic steroids. For example, athletes at
schools with drug-testing programs were more likely to believe that
peers and authority figures were more tolerant of drug abuse, had less
belief in the negative consequences of drug abuse, and had less belief
in the efficacy of drug testing. Based on these seemingly inconsistent
findings, the study's authors called for caution in interpreting the
findings.
Experts Find There Are Gaps in Research on the Sustained Effectiveness
of Prevention Programs and on the Long-term Health Effects for
Teenagers:
Experts identified gaps in the research that addresses anabolic steroid
abuse among teenagers. Experts identified gaps in the current research
on the outcomes of prevention programs that focus on anabolic steroids.
Experts also identified gaps in the research on the long-term health
effects of initiating the abuse of anabolic steroids as teenagers.
According to experts, available research does not establish the extent
to which the ATLAS and ATHENA programs are effective over time in
preventing anabolic steroid abuse among teenage athletes. Experts
acknowledge that both programs appear promising in their ability to
prevent the abuse of anabolic steroids among teenage athletes
immediately following participants' completion of the programs.
Assessment of the effectiveness of the ATLAS program 1 year later,
however, found that the lower incidence of anabolic steroid use was not
sustained, although participants continued to report reduced intentions
to use anabolic steroids. The long-term effectiveness of the ATHENA
program has not been reported. The effectiveness of these programs has
been assessed only in some schools in Oregon, and therefore experts
report that the effectiveness of the programs may not be generalizable.
In another example, experts identified the need for additional research
to assess the effectiveness of drug-testing programs, such as those
funded under Education's School-Based Student Drug Testing program, in
reducing anabolic steroid abuse among teenagers.[Footnote 27]
According to experts, there are several gaps in research on the health
effects of teenage abuse of anabolic steroids. Experts report that
while there is some research that has examined the health effects of
anabolic steroid abuse among adults--for example, the harmful effects
on the cardiovascular, hormonal, and immune systems--there is a lack of
research on these effects among teenagers. There is also a lack of
research on the long-term health effects of initiating anabolic steroid
abuse during the teenage years. Some health effects of steroid abuse
among adults, such as adverse effects on the hormonal system, have been
shown to be reversible when the adults have stopped abusing anabolic
steroids. Experts point out, however, that it is not known whether this
reversibility holds true for teenagers as well. While some experts
suggest that anabolic steroid abuse may do more lasting harm to
teenagers, due to the complex physical changes unique to adolescence,
according to other experts there is no conclusive evidence of
potentially permanent health effects. Experts also report that the
extent of the psychological effects of anabolic steroid abuse and, in
particular, of withdrawal from steroid abuse, is unclear due to limited
research. Some experts we consulted noted a need to better inform
primary care physicians and pediatricians about anabolic steroid abuse
among teenagers, so these providers would be better able to recognize
steroid abuse in their patients and initiate early intervention and
treatment.
Agency Comments:
We provided a draft of this report to HHS and Education for comment and
received technical comments only, which we incorporated into the report
as appropriate.
As arranged with your offices, unless you publicly announce the
contents of this report earlier, we plan no further distribution of it
until 30 days after its issue date. At that time, we will send copies
of this report to the Secretary of Health and Human Services and to the
Secretary of Education. We will also provide copies to others upon
request. In addition, the report is available at no charge on the GAO
Web site at [hyperlink, http://www.gao.gov].
If you or your staff members have any questions regarding this report,
please contact me at (202) 512-7114 or ekstrandl@gao.gov. Contact
points for our Offices of Congressional Relations and Public Affairs
may be found on the last page of this report. GAO staff members who
made major contributions to this report are listed in appendix III.
Signed by:
Laurie Ekstrand:
Director, Health Care:
[End of section]
Appendix I: Selected Federally Funded Efforts That Address or Can
Address Anabolic Steroid Abuse among Teenagers:
Table 1 lists selected federally funded efforts--including programs,
research, and educational and outreach activities--that are designed to
focus on preventing or reducing the abuse of anabolic steroids by
teenagers (focused efforts), as well as other broader efforts that may
address teenage abuse of anabolic steroids as part of the programs'
general substance abuse prevention efforts. The list includes programs
funded by two departments and the Office of National Drug Control
Policy (ONDCP), in the Executive Office of the President.
Table 1: Selected Federally Funded Efforts That Address or Can Address
Anabolic Steroid Abuse among Teenagers:
Program: Department of Health and Human Services: National Institute
on Drug Abuse (NIDA): Athletes Training and Learning to Avoid Steroids
(ATLAS);
Funding for fiscal year 2006: Department of Health and Human Services:
National Institute on Drug Abuse (NIDA): ---[A];
Program implementers or eligible applicants: Department of Health and
Human Services: National Institute on Drug Abuse (NIDA): School
districts, schools, behavioral health agencies, others;
Targeted beneficiaries: Department of Health and Human Services:
National Institute on Drug Abuse (NIDA): Male high school athletes;
Program description: Department of Health and Human Services: National
Institute on Drug Abuse (NIDA): Focused effort: program to prevent male
high school athletes from abusing anabolic steroids and other
performance-enhancing drugs, and to promote healthy strength training
and nutrition.
Program: Department of Health and Human Services: National Institute on
Drug Abuse (NIDA): Athletes Targeting Healthy Exercise & Nutrition
Alternatives (ATHENA);
Funding for fiscal year 2006: Department of Health and Human Services:
National Institute on Drug Abuse (NIDA): ---[B];
Program implementers or eligible applicants: Department of Health and
Human Services: National Institute on Drug Abuse (NIDA): School
districts, schools, behavioral health agencies, others;
Targeted beneficiaries: Department of Health and Human Services:
National Institute on Drug Abuse (NIDA): Female high school athletes;
Program description: Department of Health and Human Services: National
Institute on Drug Abuse (NIDA): Focused effort: program to prevent
female high school athletes from abusing body- shaping substances such
as diet pills, tobacco, and anabolic steroids, and to promote healthy
training and nutrition.
Program: Department of Health and Human Services: National Institute on
Drug Abuse (NIDA): Research projects;
Funding for fiscal year 2006: Department of Health and Human Services:
National Institute on Drug Abuse (NIDA): $638,000;
Program implementers or eligible applicants: Department of Health and
Human Services: National Institute on Drug Abuse (NIDA): Researchers;
Targeted beneficiaries: Department of Health and Human Services:
National Institute on Drug Abuse (NIDA): Adolescent age group;
Program description: Department of Health and Human Services: National
Institute on Drug Abuse (NIDA): Focused effort: funding for three
steroid-related research projects focused on the adolescent age group
in humans and animals.
Program: Department of Health and Human Services: National Institute on
Drug Abuse (NIDA): Educational and outreach activities;
Funding for fiscal year 2006: Department of Health and Human Services:
National Institute on Drug Abuse (NIDA): $521,000;
Program implementers or eligible applicants: Department of Health and
Human Services: National Institute on Drug Abuse (NIDA): NIDA and its
partners, including National Collegiate Athletic Association, American
Academy of Pediatrics, American College of Sports Medicine, others;
Targeted beneficiaries: Department of Health and Human Services:
National Institute on Drug Abuse (NIDA): Teenage students, teachers,
general public;
Program description: Department of Health and Human Services: National
Institute on Drug Abuse (NIDA): Focused and broad efforts: to
distribute a research report on anabolic steroid abuse to schools;
develop steroid abuse posters for schools;
and support Scholastic Magazines substance abuse information to schools
including anabolic steroids.
Program: Substance Abuse and Mental Health Services Administration
(SAMHSA): Center for Substance Abuse Treatment: What Steroids Can Do to
You - The Drug-The Danger-The Deception;
Funding for fiscal year 2006: Substance Abuse and Mental Health
Services Administration (SAMHSA):--[C];
Program implementers or eligible applicants: Substance Abuse and Mental
Health Services Administration (SAMHSA): SAMHSA contractor;
Targeted beneficiaries: Substance Abuse and Mental Health Services
Administration (SAMHSA): High school teachers, coaches, students;
Program description: Substance Abuse and Mental Health Services
Administration (SAMHSA): Focused effort: program of print materials,
video, and high school assemblies to disseminate accurate information
describing the health effects of anabolic steroids.
Program: Department of Education: School-Based Student Drug Testing
grants program;
Funding for fiscal year 2006: Department of Education: $8.6 million;
Program implementers or eligible applicants: Department of Education:
School districts, public and private entities;
Targeted beneficiaries: Department of Education: Students primarily in
grades 6 through 12;
Program description: Department of Education: Broad effort: as of 2006,
72 grants to support programs that address drug prevention in schools,
including anabolic steroid prevention efforts.
Program: Executive Office of the President: Office of National Drug
Control Policy (ONDCP): Drug-Free Communities Support program;
Funding for fiscal year 2006: Executive Office of the President: Office
of National Drug Control Policy (ONDCP): about $80 million;
Program implementers or eligible applicants: Executive Office of the
President: Office of National Drug Control Policy (ONDCP): Community
coalitions;
Targeted beneficiaries: Executive Office of the President: Office of
National Drug Control Policy (ONDCP): Various beneficiaries, including
school-age youth, depending on community needs assessments;
Program description: Executive Office of the President: Office of
National Drug Control Policy (ONDCP): Broad effort: as of 2006, more
than 700 grants to communities to support coalitions and grassroots
organizations engaged in efforts to prevent use of alcohol, tobacco,
and illicit drugs including anabolic steroids.
Program: Executive Office of the President: Office of National Drug
Control Policy (ONDCP): ONDCP public information and entertainment
industry outreach;
Funding for fiscal year 2006: Executive Office of the President: Office
of National Drug Control Policy (ONDCP): $5,000 for 1 event in January
2006;
Program implementers or eligible applicants: Executive Office of the
President: Office of National Drug Control Policy (ONDCP): Medical
experts, coaches, teen athletes;
Targeted beneficiaries: Executive Office of the President: Office of
National Drug Control Policy (ONDCP): Journalists, entertainment
writers, producers;
Program description: Executive Office of the President: Office of
National Drug Control Policy (ONDCP): Focused and broad efforts: 6
briefings from 2001-2007, including roundtable for a journalists'
conference on teen athletes, briefings for magazine staffs, and media
roundtables on teen athletes and performance- enhancing drugs.
Program: Executive Office of the President: Office of National Drug
Control Policy (ONDCP): United States Anti-Doping Agency (USADA)
research projects[D];
Funding for fiscal year 2006: Executive Office of the President: Office
of National Drug Control Policy (ONDCP): $1.8 million;
Program implementers or eligible applicants: Executive Office of the
President: Office of National Drug Control Policy (ONDCP): Researchers;
Targeted beneficiaries: Executive Office of the President: Office of
National Drug Control Policy (ONDCP): Young athletes including
teenagers;
Program description: Executive Office of the President: Office of
National Drug Control Policy (ONDCP): Focused and broad efforts: grants
for research on current and emerging drug issues;
estimated one-third of research funding addresses anabolic steroids and
human growth hormone.
Program: Executive Office of the President: Office of National Drug
Control Policy (ONDCP): USADA education and outreach activities[D];
Funding for fiscal year 2006: Executive Office of the President: Office
of National Drug Control Policy (ONDCP): $1.5 million;
Program implementers or eligible applicants: Executive Office of the
President: Office of National Drug Control Policy (ONDCP): Public and
private organizations;
Targeted beneficiaries: Executive Office of the President: Office of
National Drug Control Policy (ONDCP): Teenagers, young adult athletes,
parents, coaches;
Program description: Executive Office of the President: Office of
National Drug Control Policy (ONDCP): Focused and broad efforts:
publications about anabolic steroid issues for high schools, public
service announcements, and Web sites.
Sources: Agency documents and program officials.
[A] In 2006, NIDA did not provide any funding for the ATLAS program.
From 1993 through 2001, however, NIDA funded $3.4 million in research
related to developing and testing the ATLAS curriculum.
[B] Similarly, NIDA did not fund research related to the ATHENA program
in 2006, but from 1999 through 2003 the agency provided $4.7 million to
develop and test the program.
[C] SAMHSA officials reported that the agency expects to spend up to
$99,000 on this project. A contract for that amount was awarded on July
6, 2006. As of August 2007, SAMHSA reported that it had made $40,000 in
payments under the contract and expects to pay the remaining $59,000 in
fiscal year 2008.
[D] USADA is not organizationally part of the Executive Office of the
President. However, because it is an independent, nonprofit corporation
funded primarily by ONDCP, for purposes of this report we have grouped
USADA's activities with ONDCP's.
[End of table]
[End of section]
Appendix II: Articles Included in GAO's Review:
Borowsky, I.W., M. Hogan, and M. Ireland. "Adolescent sexual
aggression: risk and protective factors." Pediatrics, vol. 100, no. 6
(1997): e71-e78.
Dukarm, C.P., R.S. Byrd, P. Auinger, and M. Weitzman. "Illicit
substance use, gender, and the risk of violent behavior among
adolescents." Archives of Pediatric & Adolescent Medicine, vol. 150,
no. 8 (1996): 797-801.
DuRant, R.H., L.G. Escobedo, and G.W. Heath, "Anabolic-steroid use,
strength training, and multiple drug use among adolescents in the
United States." Pediatrics, vol. 96, no. 1 (1995): 23-28.
Elliot, D., J. Cheong, E.L. Moe, and L. Goldberg. "Cross-sectional
study of female students reporting anabolic steroid use." Archives of
Pediatric & Adolescent Medicine, vol. 161, no. 6 (2007): 572-577.
Elliot, D., and L. Goldberg. "Intervention and prevention of steroid
use in adolescents." American Journal of Sports Medicine, vol. 24, no.
6 (1996): S46-S47.
Elliot, D.L., L. Goldberg, E.L. Moe, C.A. DeFrancesco, M.B. Durham, and
H. Hix-Small. "Preventing substance use and disordered eating: Initial
outcomes of the ATHENA (Athletes Targeting Healthy Exercise and
Nutrition Alternatives) program." Archives of Pediatric & Adolescent
Medicine, vol. 158, no. 11 (2004): 1043-1049.
Elliot, D.L., E.L. Moe, L. Goldberg, C.A. DeFrancesco, M.B. Durham, and
H. Hix-Small. "Definition and outcome of a curriculum to prevent
disordered eating and body-shaping drug use." The Journal of School
Health, vol. 76, no. 2 (2006): 67-73.
Fritz, M.S., D.P. MacKinnon, J. Williams, L. Goldberg, E.L. Moe, and
D.L. Elliot. "Analysis of baseline by treatment interactions in a drug
prevention and health promotion program for high school male athletes."
Addictive Behaviors, vol. 30, no. 5 (2005): 1001-1005.
Goldberg, L., D. Elliot, G.N. Clarke, D.P. MacKinnon, E. Moe, L. Zoref,
E. Greffrath, D.J. Miller, and A. Lapin. "Effects of a multidimensional
anabolic steroid prevention intervention: the Adolescents Training and
Learning to Avoid Steroids (ATLAS) program." JAMA, vol. 276, no. 19
(1996): 1555-1562.
Goldberg, L., D. Elliot, G.N. Clarke, D.P. MacKinnon, L. Zoref, E. Moe,
C. Green, and S.L. Wolf. "The Adolescent Training and Learning to Avoid
Steroids (ATLAS) prevention program: background and results of a model
intervention." Archives of Pediatric & Adolescent Medicine, vol. 150
(1996): 713-721.
Goldberg, L., D.L. Elliot, D.P. MacKinnon, E. Moe, K.S. Kuehl, L.
Nohre, and C.M. Lockwood. "Drug testing athletes to prevent substance
abuse: Background and pilot study results of the SATURN (Student
Athlete Testing Using Random Notification) study." Journal of
Adolescent Health, vol. 32, no. 1 (2003): 16-25.
Goldberg, L., D.P. MacKinnon, D.L. Elliot, E.L. Moe, G. Clarke, and J.
Cheong. "The Adolescents Training and Learning to Avoid Steroids
Program: Preventing drug use and promoting health behaviors." Archives
of Pediatric & Adolescent Medicine, vol. 154, no. 4 (2000): 332-338.
MacKinnon, D.P., L. Goldberg, G. Clarke, D.L. Elliot, J. Cheong, A.
Lapin, E.L. Moe, and J.L. Krull. "Mediating mechanisms in a program to
reduce intentions to use anabolic steroids and improve exercise self-
efficacy and dietary behavior." Prevention Science, vol. 2, no. 1
(2001): 15-28.
Miller, K.E., J.H. Hoffman, G.M. Barnes, D. Sabo, M.J. Melnick, and
M.P. Farrell. "Adolescent anabolic steroid use, gender, physical
activity, and other problem behaviors." Substance Use & Misuse, vol.
40, no. 11 (2005): 1637-1657.
Naylor, A.H., D. Gardner, and L. Zaichkowsky. "Drug use patterns among
high school athletes and nonathletes." Adolescence, vol. 36, no. 144
(2001): 627-639.
Rich, J.D., C.K. Foisie, C.W. Towe, B.P. Dickinson, M. McKenzie, and
C.M. Salas. "Needle exchange program participation by anabolic steroid
injectors." Drug and Alcohol Dependence, vol. 56, no. 2 (1999): 157-
160.
[End of section]
Appendix III: GAO Contact and Staff Acknowledgments:
GAO Contact:
Laurie Ekstrand, at (202) 512-7114 or ekstrandl@gao.gov.
Staff Acknowledgments:
In addition to the contact named above, key contributors to this report
were Christine Brudevold, Assistant Director; Ellen M. Smith; Julie
Thomas; Rasanjali Wickrema; and Krister Friday.
[End of section]
Footnotes:
[1] We use the term anabolic steroids to refer to anabolic steroids and
their precursors, as defined in the Controlled Substances Act. See 21
U.S.C. § 802 (23), (41).
[2] The Crime Control Act of 1990 amended the Controlled Substances Act
to include anabolic steroids. 21 U.S.C. § 812(c), Schedule III (e).
[3] We searched both the Catalog of Federal Domestic Assistance, a
database of federal grant programs maintained by the General Services
Administration, and the Computer Retrieval of Information on Scientific
Projects, a database of research grants funded by the National
Institutes of Health.
[4] We define federally funded programs as including programs that were
developed, implemented, or tested using federal funding.
[5] The efforts that we discuss in this report may not represent all
federally funded activities that address anabolic steroid abuse among
teenagers but reflect those efforts mentioned by federal officials with
whom we consulted. We were unable to determine the extent of total
federal funding for programs that address teenage anabolic steroid
abuse because, in some instances, funding information covers more than
prevention of teenage anabolic steroid abuse.
[6] We searched using the keywords anabolic steroids, abuse, addiction,
teen, youth, adolescent, prevent, and treat.
[7] ATLAS--the acronym for the prevention program named Athletes
Training and Learning to Avoid Steroids--originally stood for
Adolescents Training and Learning to Avoid Steroids, which was the
title of the NIDA research grants that supported the program's
development. For this reason, some published research describing the
program, as listed in appendix II, for example, refers to ATLAS as
Adolescents Training and Learning to Avoid Steroids.
[8] The MTF survey is administered to nationally representative samples
of public and private secondary school students throughout the United
States. In 2006, sample sizes were about 17,000, 16,600, and 14,800 in
8th, 10th, and 12th grades, respectively. In all, about 48,500 students
in 410 secondary schools participated in the 2006 survey.
[9] The sampling frame for the 2005 national YRBS survey consisted of
all public and private schools with students in at least one of grades
9 through 12 in the 50 states and the District of Columbia. For the
2005 national YRBS survey, 13,953 questionnaires were completed in 159
schools by a nationally representative sample of students in grades 9
through12.
[10] Several researchers conducted an analysis indicating that the
prevalence rates of teenage anabolic steroid abuse reported by MTF and
YRBS are overestimated and that actual prevalence of teenage anabolic
steroid abuse is even lower than these surveys report. See Gen Kanayama
et al., "Anabolic Steroid Abuse Among Teenage Girls: An Illusory
Problem?" Drug and Alcohol Dependence, 88 (2007): 156-162.
[11] For example, according to the 2006 MTF survey, 42.3 percent of
12th graders reported abusing marijuana at least once, and 8.5 percent
reported abusing cocaine at least once.
[12] In our previous work looking at the availability of anabolic
steroids, we found that anabolic steroids were easily obtained without
a prescription through the Internet. See GAO, Anabolic Steroids Are
Easily Purchased Without a Prescription and Present Significant
Challenges to Law Enforcement Officials, GAO-06-243R (Washington, D.C.:
Nov. 3, 2005).
[13] The programs originated in investigator-initiated research into
the risk factors associated with male and female high school athletes'
abuse of anabolic steroids.
[14] According to NIDA officials, the principal investigators who
developed the ATLAS and ATHENA programs signed a contract with the
National Football League to place the programs in schools in the
vicinity of eight National Football League teams in 2007. The contract
was expected to support the training of about 800 coaches and 20,000
athletes.
[15] For fiscal years 2000 through 2006, NIDA officials reported that
they awarded a total of 31 annual grants, many of which were
continuation grants for previously-approved projects, for steroid-
related research focused on the adolescent age group in humans or
animals. Because of the continuity of the projects from year to year,
we are reporting the average numbers of projects that were funded and
active each year.
[16] ONDCP officials told us that from fiscal years 2001 through 2007,
USADA funding from ONDCP totaled nearly $46 million. In 2007, for
example, ONDCP funding was $8.4 million or about 70 percent of USADA's
$12 million budget, with the United States Olympic Committee providing
the remaining 30 percent.
[17] In addition to this funding for education and outreach activities
specifically focused on anabolic steroid abuse among teenagers, NIDA
has contracted with Scholastic Magazines since 2002 to provide
information about drug abuse and addiction to students and teachers
during the school year. This program, under which Scholastic Magazines
receives $500,000 per year for fiscal years 2002 through 2009 for a
total of $4 million, supports broader substance abuse prevention
activities that have at times included anabolic steroid prevention
articles, posters, and other materials.
[18] Project officers in SAMHSA's Center for Substance Abuse Prevention
work with the Drug-Free Communities Support program grantees to provide
technical assistance and help them comply with grant requirements.
[19] An ONDCP official told us that 189 of 702 communities (27 percent)
provided information that they were addressing steroids in their grant
activities along with other drugs.
[20] Follow-on grants are also authorized. 21 U.S.C. § 1532(b)(3).
[21] Education funds no programs specifically targeting steroid
prevention for teens. Except for alcohol prevention efforts, the
department addresses illegal drug abuse in schools with a comprehensive
strategy, not drug by drug.
[22] Total funding for the School-Based Student Drug Testing program
for fiscal years 2003 through 2007 was about $36 million, of which
$32.2 million (89 percent) was awarded to grantees. The remainder of
the funding supported evaluation and peer review activities.
[23] During a discussion of Education's program, an ONDCP official said
that because testing for anabolic steroids is more expensive than for
other drugs--adding $50 to $100 to the cost of a common panel of five
drug tests--some schools add steroids to the tests for only a few of
the students, as a deterrent. The official said that in some cases,
federal funding helps schools afford to add steroids to their usual
test panel. The official estimated that about 1,000 schools and school
districts across the country were doing some sort of student drug
testing and sometimes were including steroids. According to the
official, New Jersey requires steroid testing for some athletic teams
and Florida and Texas were considering similar legislation.
[24] We reviewed 16 studies published from January 1995 through June
2007.
[25] These studies sought to identify a correlation between risk
factors and behaviors and anabolic steroid abuse by teenagers. The
studies did not identify causation.
[26] Because aggressive behavior is one of the potential psychological
effects of anabolic steroid abuse, anabolic steroids could predispose
an individual to aggressive acts, including sexual violence.
[27] Education officials told us that the agency is currently
conducting an evaluation of the effectiveness of the student drug-
testing programs implemented by its grantees.
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