A Dual Pathway Model of Steroid Use among Adolescent Boys: Results from a Nationally Representative Sample

Nonconforming gender expression and adolescent anabolic-androgenic steroids misuse

BACKGROUND

Gender nonconformity (GNC) is an under-researched area of adolescent health that is of increasing interest to researchers and general public. However, little is known about whether it is associated with anabolic-androgenic steroids (AAS) misuse. We aimed to investigate the association among high school students using a cross-sectional design.

METHODS

We pooled the 6 school districts data from the Youth Risk Behavior Survey in 2017 and 2019. We compared the prevalence of AAS misuse among gender nonconforming and conforming students. AAS misuse was determined on the reported experience of lifetime non-prescription steroid use. GNC was derived from perceived gender expression and sex. We estimated the sex-stratified adjusted odds ratios (AORs) for the association of GNC with AAS misuse after adjusting for race/ethnicity, grade, and sexual orientation.

RESULTS

The study population consisted of 17,754 US high school students including 9143 (49.67%) female students. Among female students, GNC was significantly associated with moderate (AOR, 3.69; 95% CI 1.28-10.62; P = 0.016) and severe (AOR, 5.00; 95% CI 1.05-23.76; P = 0.043) AAS misuse, but not with any AAS misuse (AOR, 0.85; 95% CI 0.34-2.14; P = 0.734). Among male students, GNC was significantly associated with any (AOR, 4.75; 95% CI 2.93-7.69; P < 0.001), moderate (AOR, 4.86; 95% CI 2.66-8.89; P < 0.001) and severe (AOR, 4.13; 95% CI 1.43-11.95; P = 0.009) AAS misuse. We did not observe a dose-response relationship between GNC and any AAS misuse in female and male students.

CONCLUSIONS

This study suggests that AAS misuse is associated with GNC among female and male adolescents.

Anabolic-Androgenic Steroid Use in Sports, Health, and Society

This consensus statement is an update of the 1987 American College of Sports Medicine (ACSM) position stand on the use of anabolic-androgenic steroids (AAS). Substantial data have been collected since the previous position stand, and AAS use patterns have changed significantly. The ACSM acknowledges that lawful and ethical therapeutic use of AAS is now an accepted mainstream treatment for several clinical disorders; however, there is increased recognition that AAS are commonly used illicitly to enhance performance and appearance in several segments of the population, including competitive athletes. The illicit use of AAS by competitive athletes is contrary to the rules and ethics of many sport governing bodies. Thus, the ACSM deplores the illicit use of AAS for athletic and recreational purposes. This consensus statement provides a brief history of AAS use, an update on the science of how we now understand AAS to be working metabolically/biochemically, potential side effects, the prevalence of use among athletes, and the use of AAS in clinical scenarios.

The Association Between Substance Use and Violence: Results from a Nationally Representative Sample of High School Students in the United States

With over 52% of high school students reporting that they have tried alcohol or illicit drugs, 16% carrying a weapon, and 23% engaging in a physical fight, substance use and youth violence remain critical public health challenges in the United States. Using data from the 2017 Youth Risk Behavior Survey, study results revealed that youth who reported heavy use of either alcohol, marijuana, or illicit drugs were three to ten times more likely to report carrying a weapon or engaging in a physical fight. Similarly, youth with heavy substance use were one and half times to 14 times more likely to be a victim of violence or sexual or dating violence. The SEM analysis indicated that substance use had a significant effect on all aspects of violence. School-based behavioral health specialists and community-based pediatricians may need to develop targeted messages to address the potential for violence among youth who use alcohol and/or illicit drugs.

Sexual orientation, bullying for being labeled gay or bisexual, and steroid use among US adolescent boys

Use of anabolic-androgenic steroids is a public health concern for adolescent boys. This study examined bullying based on being labeled gay/bisexual and steroid use among US adolescent boys, including sexual orientation disparities. Data from 2660 boys from the 2015 Youth Behavior Risk Survey were used. Among heterosexual boys, steroid use was higher among those who reported being bullied due to being labeled gay or bisexual. No such relationship existed among non-heterosexual boys. The results speak to the need to address issues of masculinity in clinical work with boys and young men.

Victimization as a mediator of alcohol use disparities between sexual minority subgroups and sexual majority youth using the 2015 National Youth Risk Behavior Survey

BACKGROUND

Alcohol use among underage youth is a significant public health concern. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol is the "drug of choice" among adolescents, meaning more youth use and abuse alcohol than any other substance. Prevalence of alcohol use is disproportionately higher among sexual minority youth (SMY) than among their heterosexual peers. We examined sexual identity and sexual behavior disparities in alcohol use, and the mediational role of bullying in a sample of high school students.

METHODS

Data from the 2015 National Youth Risk Behavior Survey were used to assess the association between sexual minority status (identity and behavior) and alcohol use with weighted logistic regression. Due to well-documented differences between males and females, we stratified models by gender. Physical and cyberbullying were examined as mediators of the relationship between sexual minority status and alcohol use.

RESULTS

We detected associations between certain subgroups of sexual minority youth and alcohol use across all four drinking variables (ever drank alcohol, age at first drink, current alcohol use, and binge drinking). Most of these associations were found among bisexual-identified youth and students with both male and female sexual partners; these individuals had up to twice the odds of engaging in alcohol use behaviors when compared with sexual majority students. Associations were strongest among females. Bullying mediated sexual minority status and alcohol use only among bisexual females.

CONCLUSIONS

As disparities in alcohol use differ by gender, sexual identity, and sexual behavior, interventions should be targeted accordingly.

A model of disturbed eating behavior in men: The role of body dissatisfaction, emotion dysregulation and cognitive distortions

Comprehensive models, targeting the development of eating disorders (EDs) in males, often employ a sociocultural perspective and empathize the importance of body dissatisfaction (BD). To further illuminate psychological factors contributing to the development of ED pathology, we propose a mediator model of disturbed eating and compensatory behavior (DECB) for men. This model suggests that emotion dysregulation and the susceptibility to body-related cognitive distortions (thought-shape fusion, TSF) mediate the relationship between BD and DECB. Based on data from a cross-sectional online-survey we tested our model in a non-clinical community sample of young men (N=123, 18-37 years). We found a significant positive association between BD and DECB, accounting for participant's body mass index (BMI), age and depressive symptoms. While TSF partially mediated the relationship between BD and DECB, we did not detect a corresponding effect for emotion dysregulation. Based on our findings, we concluded that TSF, which describes specific distorted cognitions with respect to one's own body triggered by fattening/ forbidden food, contributes to the pathological eating- and body-related behavior in men who are dissatisfied with their body. We suggest that TSF should be included in etiological models as a relevant aspect of cognitive information processing with emotional and behavioral consequences.

Self-Perceived Weight and Anabolic Steroid Misuse Among US Adolescent Boys

PURPOSE

Anabolic steroid misuse is a growing concern among adolescent boys, and chronic misuse is associated with multisystemic health consequences. However, little is known about weight related predictors of anabolic steroid misuse. We examined the prediction of lifetime anabolic steroid misuse as a function of self-perceived weight status among US adolescent boys.

METHODS

Analysis was undertaken using the 2013 Youth Risk Behavior Survey, a nationally representative data set sampling public and private high school students throughout the United States. Data from a total of 6,000 US adolescent boys were used in the present study.

RESULTS

The prevalence of ever misusing anabolic androgenic steroids was 12.6% among boys who viewed themselves as very underweight, 11.9% for boys who viewed themselves as very overweight, compared with 3.8% for boys who viewed themselves as about the right weight. Compared to boys who viewed themselves as about the right weight, boys who self-perceived themselves as very underweight (adjusted odds ratio = 6.9, 95% confidence interval: 2.7-17.7, p < .001) and very overweight (adjusted odds ratio = 3.8, 95% confidence interval: 1.8-7.7, p < .001) were significantly associated with increased risk of anabolic androgenic steroid misuse.

CONCLUSIONS

Large effect size estimates were revealed, suggesting that anabolic androgenic steroid misuse is not solely a function of boys desiring increased mass; boys who desire leanness are also likely to misuse anabolic androgenic steroids. Future prevention efforts should target not only boys who view themselves as underweight but also those who perceive themselves as overweight.

Sexual orientation and anabolic-androgenic steroids in U.S. adolescent boys

OBJECTIVES

We compared the lifetime prevalence of anabolic-androgenic steroid (AAS) misuse among sexual minority versus heterosexual U.S. adolescent boys, and secondarily, sought to explore possible intermediate variables that may explain prevalence differences.

METHODS

Participants were 17,250 adolescent boys taken from a pooled data set of the 14 jurisdictions from the 2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. Data were analyzed for overall prevalence of AAS misuse and possible intermediary risk factors.

RESULTS

Sexual minority adolescent boys were at an increased odds of 5.8 (95% confidence interval 4.1-8.2) to report a lifetime prevalence of AAS (21% vs. 4%) compared with their heterosexual counterparts, P < .001. Exploratory analyses suggested that increased depressive symptoms/suicidality, victimization, and substance use contributed to this disparity.

CONCLUSIONS

This is the first known study to test and find substantial health disparities in the prevalence of AAS misuse as a function of sexual orientation. Prevention and intervention efforts are needed for sexual minority adolescent boys.