Correspondence
Use of Anabolic Steroids among Adolescents
N Engl J Med 1993; 329:888-889September 16, 1993
- Article
To the Editor:
In their study of the use of multiple drugs among adolescents who use anabolic steroids, DuRant et al. (April 1 issue)1 used a questionnaire to determine that 6.5 percent of high-school boys enrolled in compulsory health-science classes took these drugs. The authors note that their results depend on the validity of the students' reports, but appear reassured because their findings agree with the figure of 5 to 11 percent reported by others using comparable methods to study similar populations. Anabolic-steroid use seems to have been assessed with a single question, “During your life, how many times have you taken steroid pills or shots without a doctor's prescription?” We wonder whether this question distinguishes between anabolic androgenic steroids and glucocorticoids. In addition, our results in older athletes raise questions about the validity of self-reported data on anabolic-steroid use2.
We examined cardiac size and function in 13 men who reported using anabolic steroids and 12 men who reported never using these drugs2. Their reports were validated by urine testing. Anabolic steroids or their metabolites were detected in 12 of the 13 users and 1 of the 12 who denied such use. Only 19 of 29 reported drugs (66 percent) were found in urine samples from athletes who reported the recent use of a specific anabolic steroid; samples from 7 of the 12 drug users with positive urine tests (58 percent) contained an unreported drug.
Our results demonstrate that anabolic-steroid users are often misinformed about the drugs that they use, or that some anabolic-steroid users give unreliable histories.
2 ReferencesPaul D. Thompson, M.D.
Joseph M. Zmuda, M.S.
University of Pittsburgh Heart Institute, Pittsburgh, PA 15213Don H. Catlin, M.D.
University of California, Los Angeles, Los Angeles, CA 900251
DuRant RH ,Rickert VI ,Ashworth CS ,Newman C ,Slavens G . Use of multiple drugs among adolescents who use anabolic steroids. N Engl J Med 1993;328:922-926
Full Text | Web of Science | Medline2
Thompson PD ,Sadaniantz A ,Cullinane EM , et al. Left ventricular function is not impaired in weight-lifters who use anabolic steroids. J Am Coll Cardiol 1992;19:278-282
CrossRef | Web of Science | Medline
Author/Editor Response
The authors reply:
To the Editor: The findings of Thompson et al. may not reflect unreliable reporting. It is possible that their subjects thought they were using the agent that they reported, but because the drugs were obtained from black-market sources, the substance purchased may not have been the one requested. In fact, the data from the study of Thompson et al.1 support this explanation. When we calculated positive and negative predictive values of self-reports of anabolic-steroid use as compared with the results of urine testing for anabolic steroids or their metabolites, we found a positive predictive value of 92.3 percent and a negative predictive value of 91.7 percent. These findings indicate that the weight lifters were accurately reporting whether or not they used anabolic steroids. However, we must be careful about drawing strong conclusions from this finding since the study was based on a small sample with self-selection bias.
Our study used a self-administered questionnaire constructed from two epidemiologic surveillance instruments used extensively by the Centers for Disease Control and Prevention. Participants remained anonymous. Other research conducted in adolescents has also used a single question to distinguish users of steroids from nonusers2. Although self-reported information is subject to scrutiny by those of us who work with adolescents, it appears to be a reliable index. In fact, data suggest that self-reports of drug use may underestimate use as compared with anonymous computer-assisted data collection3. We believe that a single question can distinguish between anabolic-steroid use and glucocorticoid use, on the basis of our previous research, in which adolescents who were to complete an anonymous, confidential survey were first allowed a brief question-and-answer period to eliminate confusion about what was meant by “anabolic steroids”4. At no time during the completion of over 1400 surveys did any question arise that suggested confusion.
In confirmation of our study, we recently reported the results of a follow-up survey completed by 1422 of the original 1744 ninth-grade students four months after the first survey. We found that 4.8 percent of boys and 2.9 percent of girls reported anabolic-steroid use, as compared with 5.4 percent and 1.5 percent, respectively, four months earlier. The relation between anabolic-steroid use and the use of other drugs remained stable over the four-month period. Consequently, we feel confident that our results closely reflect what is occurring in this group of young adolescents.
4 ReferencesRobert H. DuRant, Ph.D.
Medical College of Georgia, Augusta, GA 30912-3771Vaughn I. Rickert, Psy.D.
University of Arkansas for Medical Sciences, Little Rock, AK 72202-3591Carolyn Seymore Ashworth, M.D.
University of Alabama at Birmingham, Birmingham, AL 352331
Thompson PD ,Sadaniantz A ,Cullinane EM , et al. Left ventricular function is not impaired in weight-lifters who use anabolic steroids. J Am Coll Cardiol 1992;19:278-282
CrossRef | Web of Science | Medline2
Komoroski EM ,Rickert VI . Adolescent body image and attitudes to anabolic steroid use. Am J Dis Child 1992;146:823-828
Web of Science | Medline3
Paperny DM ,Aono JY ,Lehman RM ,Hammar SL ,Risser J . Computer-assisted detection and intervention in adolescent high-risk health behaviors. J Pediatr 1990;116:456-462
CrossRef | Web of Science | Medline4
DuRant RH, Ashworth CS, Newman C, Rickert VI. Stability of the relationships between anabolic steroid use and multiple substance use by young adolescents. J Adolesc Health (in press).
