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In 2014, between one and two percent of students in grades eight, ten, and twelve reported they used steroids without a doctor s prescription within the past 12 months. Importance Anabolic-androgenic steroids, commonly associated with athletes and body builders, are synthetically produced forms of the hormone testosterone. While doctors may prescribe steroids, youth may also take these substances illegally to appear more muscular, or to enhance their strength, size, or aggressiveness in order to excel in athletics. Steroid abuse has been associated with health problems and other undesirable outcomes, such as stunted growth, acne, insomnia, nausea/vomiting, hypertension, heart attack, liver damage or cancer, baldness, and increased risk of ligament and tendon injuries. Females may experience a deepened voice, increases in body and facial hair, menstrual irregularities, and an enlarged clitoris. Males may experience testicle shrinkage, infertility, and breast development. In addition, psychological effects, such as increased aggression and hostility, irritability, anxiety, paranoia, mood swings, depression, and suicidal thoughts may also occur with steroid use. 1,2,3 Anabolic steroid users have also been found to exhibit symptoms of dependence and withdrawal similar to those associated with other abused drugs. 4 Adolescent steroid use has been linked with other risky behaviors, such as drinking, use of other drugs, and tobacco smoking. 5,6 One study found steroid users had higher levels of sexually-transmitted diseases, were more likely to drink and drive, and to get into fights than were their non-using peers. In addition, youth often share needles when using steroids, running the risk of contracting HIV or other infectious diseases. 7 The American Academy of Pediatrics recommends that pediatricians ask adolescents about the use of performance-enhancing substances, such as anabolic steroids, when assessing their risky behaviors during physical exams or well-visits. 8 2
Trends For students in grades eight and ten, steroid use increased between 1991 and 2000 (peaking at 1.7 and 2.2 percent, respectively), and then decreased between 2000 and 2014, to less than one percent. For twelfth-graders, use peaked slightly later, between 2001 and 2004, at 2.5 percent, before declining, and was at 1.5 percent in 2014. (Figure 1) Figure 1 10 8 Percentage of Students in Grades 8, 10, and 12 Who Report They Used Steroids without Doctor Instructions in the Past Year: 1989-2014 8th grade 10th grade 12th grade Percent 6 4 2.5 2.2 1.9 2 1.1 1.2 1.5 1.1 1.0 0.8 0.6 0 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Source: Johnston, L. D., O Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2015). Demographic subgroup trends among adolescents in the use of various licit and illicit drugs: 1975-2014 (Monitoring the Future Occasional Paper No. 83). Ann Arbor, MI: Institute for Social Research. Available at: http://monitoringthefuture.org/pubs/occpapers/mtf-occ83.pdf. Tables 134-136 Differences by Gender There were no significant differences by gender in steroid use in 2014. (Appendix 1) 3
Differences by Race and Hispanic Origin 9 There are no significant differences in use of steroids in the past 12 months when comparing whites, blacks, and Hispanics. (Appendix 1) Differences by College Plans In 2014, students in tenth-grade with plans to complete four years of college were less likely to have used steroids in the 12 months prior to the survey than were their counterparts without such plans. Among tenth-grade students who planned to complete four years of college, 0.6 percent used steroids, versus 2.5 percent among students with either no college aspirations or plans to attend for fewer than four years. Differences at other grade levels were not significant. (Figure 2) Figure 2 10 Percentage of Eighth-, Tenth-, and Twelfth-Graders Who Report They Used Steroids in the Past Year, by College Plans: 2014 None or under 4 years Complete four years 8 Percentage 6 4 2.5 2 1.4 1.8 1.3 0.5 0.6 0 8th grade 10th grade 12th grade Source: Johnston, L. D., O Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2015). Demographic subgroup trends among adolescents in the use of various licit and illicit drugs: 1975-2014 (Monitoring the Future Occasional Paper No. 83). Ann Arbor, MI: Institute for Social Research. Available at: http://monitoringthefuture.org/pubs/occpapers/mtf-occ83.pdf. Tables 134-136 4
State and Local Estimates 2013 estimates for lifetime illegal steroid use are available for high school students (grades 9-12) for select states and cities from the Youth Risk Behavior Survey (YRBS) at http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf (See Table 60) NOTE: Estimates of drug use from the Youth Risk Behavior Survey, used to generate these state-level estimates, are generally higher than estimates generated by the Monitoring the Future Survey (MTF). The MTF was the source of the national estimates presented in this indicator, and users should not make direct comparisons of estimates made from the two sources. For information on methodological differences in the surveys that may be causing these differences in estimates, see: Harrison, L.D. (2001). Understanding the differences in youth drug prevalence rates produced by the MTF, NHSDA, and YRBS studies. Journal of Drug Issues, 31(3), pp. 665-694. International Estimates The World Anti-Doping Association publishes statistics on athletes who have been found to have illegal substances in their system. For more information, see the following: http://www.wada-ama.org/en/resources/testing-figures/ National Goals The Anabolic Steroid Abuse website, under the auspices of the National Institute on Drug Abuse, is a resource geared towards young people. Its mission is to educate people and to disseminate information toward the goal of preventing steroid abuse. The website provides information on the risks associated with misuse of steroids, as well as referral information. For more information, see the following: www.drugabuse.gov/drugs-abuse/steroids-anabolic Additionally, since 1988, the Office of National Drug Control Policy has issued a yearly report, the National Drug Control Strategy, which includes long-term goals to achieve the objective of a drug-free America. The 2009 report, Chapter 1, discusses policies that have been implemented and the federal government s support to local communities in fighting drug use in sports. More information is available at: https://www.whitehouse.gov/ondcp/national-drugcontrol-strategy 5
Through its Healthy People 2020 initiative, the federal government has set a national goal to reduce steroid use by 10 percent among adolescents in eighth, tenth, and twelfth grades. More information is available at the following link: http://www.healthypeople.gov/2020/topicsobjectives/topic/substance-abuse/objectives?topicid=40 (Objective SA-18). What Works to Make Progress on This Indicator Bandy, T., & Moore, K. A. (2008). What works for preventing and stopping substance use in adolescents: Lessons from experimental evaluations of programs and interventions [Electronic Version] Washington, DC: Child Trends from www.childtrends.org/wpcontent/uploads/2013/03/child_trends-2008_05_20_fs_whatworkssub.pdf. The National Registry of Evidence-based Programs and Practices, a project of the Substance Abuse and Mental Health Services Administration, is a searchable database of interventions for the prevention and treatment of mental health and substance abuse disorders. It allows users to refine searches by the rigor of the evidence for effectiveness, and by other parameters, such as age group of the target population. See: http://www.nrepp.samhsa.gov/ Related Indicators Participation in School Athletics: www.childtrends.org/?indicators=participation-inschool-athletics Binge Drinking: www.childtrends.org/?indicators=binge-drinking Substance Free Youth: www.childtrends.org/?indicators=substance-free-youth Daily Cigarette Use: www.childtrends.org/?indicators=daily-cigarette-use Illicit Drug Use: www.childtrends.org/?indicators=illicit-drug-use Marijuana Use: www.childtrends.org/?indicators=marijuana-use 6
Definition Steroid use in this report is reported as using steroids one or more times, without being instructed to do so by a doctor, in the past year. Data Sources Data for 1991-2014: Johnston, L. D., O Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2013). Demographic subgroup trends among adolescents for forty-six classes of licit and illicit drugs, 1975 2014 (Monitoring the Future Occasional Paper No. 79). Ann Arbor, MI: Institute for Social Research. Available at: http://www.monitoringthefuture.org/pubs/occpapers/mtf-occ79.pdf Raw Data Source Monitoring the Future Survey: http://www.monitoringthefuture.org/ 7
Appendix 1: Among 8th, 10th, and 12th Grade Students, Percentage Reporting Steroid Use in the Past Twelve Months: Selected Years, 1976-2014 1991 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Eighth Grade Gender Male Female Race/Hispanic Origin 1 White Black Hispanic Parental Education 2 1.0 1.0 1.7 1.6 1.5 1.4 1.1 1.1 0.9 0.8 0.9 0.8 0.5 0.7 0.6 0.6 0.6 1.8 1.3 2.2 2.3 1.8 1.8 1.3 1.2 1.2 1.1 1.2 1.0 0.7 1.0 0.8 0.7 0.6 0.3 0.8 1.0 1.0 1.2 1.1 1.0 0.9 0.6 0.4 0.5 0.5 0.3 0.4 0.3 0.4 0.5-1.1 1.9 1.8 1.7 1.6 1.3 1.0 0.9 0.8 0.8 0.7 0.5 0.5 0.6 0.5 0.5-0.9 0.7 0.8 1.2 1.2 0.9 0.9 0.8 0.8 0.7 0.7 0.7 0.5 0.7 0.8 0.7-1.3 1.8 1.5 1.5 1.7 1.7 1.2 0.9 0.7 0.7 0.9 0.8 0.7 0.4 0.5 0.6 Less than high school 1.8 1.3 2.5 2.0 1.8 1.3 1.5 2.1 1.0 1.7 1.7 2.1 0.7 1.0 0.6 0.6 0.8 Completed high school 1.1 1.3 2.1 1.6 1.7 1.9 1.4 1.0 0.9 0.9 1.0 0.7 0.5 0.9 0.6 0.7 0.5 Some college Completed college Graduate school College Plans 1.0 0.8 1.3 1.9 1.9 1.6 1.0 1.1 1.0 0.8 1.0 0.9 0.5 0.9 0.4 0.6 0.7 0.7 0.8 1.6 1.5 1.0 1.3 1.2 1.1 0.7 0.4 0.7 0.5 0.6 0.5 0.5 0.3 0.5 1.0 1.5 1.6 1.7 1.6 1.0 0.7 0.7 1.1 0.8 0.8 0.6 0.5 0.8 0.9 0.8 0.6 None or under 4 years 2.2 2.2 3.6 3.1 3.6 2.7 3.2 2.4 2.4 2.7 2.3 2.2 1.4 1.4 1.4 1.6 1.4 Complete four years 0.8 0.9 1.5 1.5 1.3 1.3 0.9 0.9 0.7 0.6 0.8 0.7 0.5 0.7 0.5 0.5 0.5 8
1991 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Tenth Grade Gender Male Female Race/Hispanic Origin 1 White Black Hispanic Parental Education 2 1.1 1.2 2.2 2.1 2.2 1.7 1.5 1.3 1.2 1.1 0.9 0.8 1.0 0.9 0.8 0.8 0.8 1.9 2.0 3.6 3.3 3.2 2.3 2.3 1.8 1.9 1.7 1.4 1.2 1.3 1.4 1.3 1.3 1.5 0.3 0.5 0.8 1.0 1.2 1.1 0.9 0.7 0.5 0.4 0.5 0.4 0.5 0.4 0.4 0.5 0.5-1.2 2.1 2.3 2.4 2.3 1.8 1.6 1.3 1.2 1.0 0.8 0.7 0.8 0.8 0.8 0.8-0.7 1.2 1.6 1.2 0.8 0.7 0.9 1.1 0.9 0.8 0.7 1.0 1.3 1.0 0.9 1.0-0.9 1.8 2.1 2.1 1.8 1.6 1.3 1.0 0.7 1.1 1.3 0.8 0.6 0.8 0.9 0.5 Less than high school 0.7 1.2 2.3 1.6 1.6 1.9 1.5 1.8 1.4 1.0 1.5 1.0 1.5 0.5 1.1 1.0 0.6 Completed high school 1.3 1.1 2.2 2.1 2.0 1.9 1.8 1.2 1.5 1.4 1.0 0.9 1.0 0.9 0.9 0.9 0.6 Some college Completed college Graduate school College Plans 1.0 1.6 2.0 2.3 2.8 1.9 1.7 1.0 1.3 1.0 0.9 0.7 0.9 0.8 0.7 1.2 1.0 0.9 1.1 2.4 2.0 2.0 1.6 1.5 1.5 0.9 1.1 0.8 0.7 0.7 1.1 0.9 0.5 0.7 1.2 1.0 2.2 2.1 3.0 1.3 1.2 1.3 1.4 0.9 1.0 0.9 0.2 1.0 0.7 0.7 0.8 None or under 4 years 1.7 2.1 3.6 3.2 3.0 2.7 2.9 1.9 2.3 1.9 2.6 1.6 2.6 2.1 2.3 1.2 2.5 Complete four years 0.9 1.1 1.9 1.9 2.1 1.5 1.4 1.2 1.1 0.9 0.7 0.7 0.8 0.8 0.7 0.8 0.6 9
1991 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Twelfth Grade Gender Male Female Race/Hispanic Origin 1 White Black Hispanic Parental Education 2 1.4 1.5 1.7 2.4 2.5 2.1 2.5 1.5 1.8 1.4 1.5 1.5 1.5 1.2 1.3 1.5 1.5 2.4 2.4 2.5 3.8 3.8 3.2 3.3 2.6 2.7 2.3 2.5 2.5 2.5 1.8 1.7 2.2 2.0 0.2 0.6 0.9 1.1 1.3 1.1 1.7 0.4 0.7 0.6 0.4 0.4 0.3 0.5 0.7 0.7 0.7 1.3 1.4 1.8 2.1 2.5 2.4 2.4 2.1 1.6 1.5 1.5 1.5 1.5 1.3 1.2 1.3 1.1 1.2 1.2 1.0 1.2 1.0 1.1 1.3 1.6 1.7 1.6 1.4 1.5 1.7 1.8 1.6 1.4 2.7 3.3 1.3 2.4 2.1 2.2 1.8 2.4 2.0 2.3 2.3 1.3 1.0 1.3 1.4 0.4 1.1 1.4 Less than high school 2.0 1.1 1.3 2.1 3.6 2.9 4.9 2.1 2.8 3.0 2.1 1.7 1.6 2.2 1.5 3.3 1.9 Completed high school 0.6 1.3 1.6 3.2 3.0 1.3 2.9 1.3 1.8 1.6 1.6 1.8 2.2 1.3 1.0 1.5 1.4 Some college Completed college Graduate school College Plans 1.6 1.1 1.9 1.9 2.8 2.7 2.5 1.7 1.7 1.1 1.3 1.6 1.6 1.5 1.1 0.8 1.1 1.6 2.0 1.4 1.9 2.3 2.3 1.8 1.3 1.3 1.1 1.4 1.3 0.7 0.6 1.0 1.7 1.2 0.5 1.4 2.4 2.2 1.0 1.4 2.4 1.2 1.5 1.5 1.5 0.9 1.4 0.8 1.8 0.5 1.4 None or under 4 years 2.1 2.0 2.0 4.6 4.1 2.6 2.8 2.1 2.7 2.1 3.1 2.9 3.3 1.6 1.4 2.7 1.8 Complete four years 1.2 1.2 1.6 1.8 2.0 2.0 2.4 1.2 1.5 1.3 1.1 1.2 1.1 1.1 1.1 1.1 1.3 1 Race estimates are based on two year averages of the year specified and the previous year in order to increase sample size and provide more stable estimates. 2 Parental education is calculated by the Institute of Social Research as the average of the mother's and father's education. Child Trends has relabeled these results to reflect the education level of the most educated parent. In those circumstances where the gap between mothers' and fathers' education is more than one level, this results in an underestimate of the most educated parent's education level. Source: Johnston, L. D., O Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2015). Demographic subgroup trends among adolescents for forty-six classes of licit and illicit drugs, 1975 2014 (Monitoring the Future Occasional Paper No. 79). Ann Arbor, MI: Institute for Social Research. Available at: http://www.monitoringthefuture.org/pubs/occpapers/mtf-occ79.pdf 10
Endnotes 1 American Osteopathic College of Dermatology. (2013). Steroids (oral). Retrieved February 26, 2013, from http://www.aocd.org/skin/dermatologic_diseases/steroids_oral.html 2 American Academy of Pediatrics. (2005). Use of performance-enhancing substances. Policy Statement [Electronic Version]. Pediatrics, 115, 1103-1106. Available at http://pediatrics.aappublications.org/cgi/content/full/115/4/1103#rfn1. 3 New South Wales Department of Health. (2002). Anabolic steroids. Retrieved February 26, 2013, from http://www.health.nsw.gov.au/factsheets/drugandalcohol/anabolic_steroids.html 4 Gonzalez, A., McLachlan, S., & Keaney, F. (2001). Anabolic steroid misuse: How much should we know? International Journal of Psychiatry in Clinical Practice, 5, 159-167. 5 Rufant, R. H., Escobedo, L. G., & Heath, G. W. (1995). Anabolic-steroid use, strength training, and multiple drug use among adolescents in the United States. Pediatrics, 96(1), 23-28. 6 Miller, K. E., Barnes, G. M., Sabo, D., Melnick, M. J., & Farrell, M. P. (2002). A comparison of health risk behavior in adolescent users of anabolic-androgenic steroids, by gender and athlete status. Sociology of Sport Journal, 19, 385-402. 7 Trenhaile, J., Choi, H.-S., Proctor, T. B., & Work, P. B. (1998). The effect of anabolic steroid education in knowledge and attitudes of at-risk preadolescents. Journal of Alcohol and Drug Education, 43(2), 20-35. 8 American Academy of Pediatrics. (2005). Op cit. 9 Hispanics may be of any race. Estimates of blacks and whites in this report do not include Hispanics. 11