Developing and evaluating a peer-based mental health literacy intervention with adolescent athletes

Widespread adolescent involvement in organized sport means that sport contexts are well-suited to 'actively' integrate prevention programs that may promote population-level change. This mixed methods study aimed to evaluate the feasibility and acceptability of a peer-based mental health literacy intervention. The intervention (i.e., Team Talk) was presented to eleven adolescent sport teams in the United States, with a total of 174 participants. Athlete participants completed surveys immediately before and after the intervention-including measures of workshop acceptability, social identity, and help-seeking behaviors. Semi-structured interviews were also conducted with a subset of five athletes, nine parents, and two coaches. With respect to recruitment as an indicator of feasibility, club-level adoption of the intervention was low, with difficulty recruiting clubs for intervention delivery. This signals that feasibility of the intervention-as it is currently designed and implemented by the research team-is low when considering similar competitive adolescent sport clubs and delivered as team-level workshops. Meanwhile, participants reported high acceptability of the intervention, and acceptability levels across participants was predicted by contextual factors related to implementation such as session duration. Regarding limited efficacy testing with measures completed before and after the intervention session: (a) social identity scores increased following the intervention, and (b) significant differences were not identified regarding efficacy to recognize symptoms of mental disorders. Athlete, coach, and parent interview responses also described potential adaptations to mental health programs. This research demonstrates the potential utility of peer-based mental health literacy interventions, while also revealing that further implementation research is necessary to adapt mental health literacy interventions to suit diverse adolescent sport contexts.

A Moral Intervention Reduces Doping Likelihood in British and Greek Athletes: Evidence From a Cluster Randomized Control Trial

OBJECTIVES

The authors aimed to develop a moral intervention and to determine whether it was more effective in preventing doping than an educational (i.e., knowledge-based) intervention; their primary outcome was doping likelihood, and the secondary outcomes were moral identity, moral disengagement, moral atmosphere, and anticipated guilt.

METHODS

Eligible athletes (N = 303) in the United Kingdom and Greece took part in the study. The authors randomly assigned 33 clubs to either the moral or the educational intervention. They measured outcomes pre- and postintervention and at 3- and 6-month follow-up.

RESULTS

Athletes in both interventions in both countries reported lower doping likelihood and moral disengagement and higher guilt from pre- to postintervention. These effects were maintained at the 3- and 6-month follow-ups. There were no effects on moral identity or moral atmosphere.

CONCLUSIONS

In addition to disseminating information about doping, doping prevention programs should include content that focuses on moral variables.

Exploring pathways to substance use: A longitudinal examination of adolescent sport involvement, aggression, and peer substance use

The relationship between adolescent sport involvement and later substance use (SU) has been unclear. Understanding the pathways through which sport involvement influences SU may help identify targets for prevention. Using a sample of 535 adolescents from the Michigan Longitudinal Study (MLS; 67.29% male, 78.13% European American), this study prospectively examined whether aggression during late adolescence mediated the association between sport involvement during early adolescence and alcohol, marijuana, and cigarette use during early adulthood. In addition, perceived peer SU during early adolescence was tested as a potential moderator in the association between sport involvement on SU. High sport involvement was associated with more alcohol use. In contrast, the indirect effect of sport involvement on SU via aggression was significant for cigarette use, and marginally significant for marijuana use. Lastly, peer SU was a significant moderator in the cigarette model, indicating low peer SU was somewhat protective among high sport-involved adolescents. Prevention targeting alcohol use and associated consequences, as well as aggressive behaviors may help address future substance use.

Muscle building supplement use in Australian adolescent boys: relationships with body image, weight lifting, and sports engagement

Background

The extent and implications of muscle building protein supplement use among adolescents is relatively unknown. This study aimed to describe the prevalence of protein powder, creatine, and anabolic steroid use in a sample of 14–16 year-old boys in Australia, and the predictors of actual use, and intentions to use protein powder.

Methods

Data were obtained from questionnaires with Australian adolescent boys aged 14–16 years from one independent boy’s school in Melbourne (N = 237). Hierarchical linear and logistic regressions were used to determine the predictors of intentions, and actual use of protein powder.

Results

49.8% of boys reported current use of, and 62% intended to use protein powder; 8.4% used creatine, and 4.2% used anabolic steroids. Higher levels of drive for muscularity, participation in weight training, and playing a greater number of sports were significant predictors of higher current use and intentions to use protein powder, but age, BMI, body esteem, and ethnicity were not.

Conclusions

Prevalence of muscle building supplement use was relatively high among this adolescent population. This research has implications for intervention and prevention programs to educate young boys about muscle building supplements to reduce negative physical and psychological health effects of their use.

An Italian Campaign to Promote Anti-doping Culture in High-School Students

Doping poses a threat to sport worldwide. Studies have revealed that, in addition to elite athletes, amateur and recreational sportsmen and sportswomen are making increasing use of performance-enhancing drugs. Worryingly this trend has been documented among young people. Anti-doping efforts seeking to deter elite athletes from doping through detection of the use of prohibited substances are costly and have not been completely effective either at the top-level or the amateur/recreational level. A thoughtful education program, inspired by honesty and respect, might be more effective in shaping attitudes toward doping in young people and protecting their health. For these reasons, the Italian “Lotta al Doping” (Fight Against Doping) project sought to cause a cultural shift in young people by taking anti-doping seminars to high schools. In the 2017–2018 school year we reached more than 20,800 students from 157 high schools through 202 seminars. Before and after the seminars, we administrated anonymous, voluntarily completed surveys with a set of questions (items = 15), taken from the WADA-Play-True-Quiz. Upon completion of the 2-h seminar, the majority of the answers given by the students resulted correct (13 out of 15 items, p < 0.000001, McNemar) confirming the value of the initiative. This project stands out as promising in the doping prevention process at the youth and amateur levels.

Perception of the Current Anti-doping Regime - A Quantitative Study Among German Top-Level Cyclists and Track and Field Athletes

In recent years anti-doping organizations have implemented various measures to deter elite athletes from using performance-enhancing drugs. One of the main challenges in the fight against doping is that the effectiveness of these anti-doping measures is still unknown. Since the effectiveness of the measures depends primarily on the athletes’ perception, this study focuses on the following four objectives: (1) How effective do top-level athletes perceive individual anti-doping measures to be? (2) Are the results stable across different sports and (3) genders? (4) How can the anti-doping measures be structured into appropriate categories? To address these issues the perceived effectiveness of 14 anti-doping measures was surveyed among 146 top athletes from Germany (Cycling: N = 42; Athletics: N = 104) who are members of at least the National Testing Pool. Results reveal significant differences in the perceived effectiveness of the anti-doping measures. Improved diagnostics were considered to be the most effective remedy for doping, followed by increased bans and the implementation of an anti-doping law. In contrast, fines and a leniency program were considered significantly less effective. Second, with the exception of indirect detection methods and increased use of an Anti-Doping Administration and Management System, results were consistent across cyclists and track and field athletes. Third, no significant gender difference was observed. Finally, an exploratory factor analysis showed that all anti-doping measures can be classified into the three categories risk of detection (e.g., control frequency and efficiency), punishment (e.g., fines and bans) and communication (e.g., education program). The results of this study provide a guideline for future research and for anti-doping and sport organizations when developing strategies against doping and allocating their anti-doping budget.

Children's First Experience of Taking Anabolic-Androgenic Steroids can Occur before Their 10th Birthday: A Systematic Review Identifying 9 Factors That Predicted Doping among Young People

Taking performance-enhancing drugs (PEDs) can cause serious and irreversible health consequences, which can ultimately lead to premature death. Some young people may take PEDs without fully understanding the ramifications of their actions or based on the advice from others. The purpose of this systematic review was to identify the main factors that predicted doping among young people. The literature was systematically reviewed using search engines, manually searching specialist journals, and pearl growing. Fifty-two studies, which included 187,288 young people aged between 10 and 21 years of age, 883 parents of adolescent athletes, and 11 adult coaches, who were interviewed regarding young athletes, were included in this review. Nine factors predicted doping among young people: gender; age; sports participation; sport type; psychological variables; entourage; ethnicity; nutritional supplements; and health harming behaviors. In regards to psychological variables, 22 different constructs were associated with doping among young people. Some psychological constructs were negatively associated with doping (e.g., self-esteem, resisting social pressure, and perfectionist strivings), whereas other were positively associated with doping (e.g., suicide risk, anticipated regret, and aggression). Policy makers and National Anti-Doping Organizations could use these findings to help identify athletes who are more at risk of doping and then expose these individuals to anti-doping education. Based on the current findings, it also appears that education programs should commence at the onset of adolescence or even late childhood, due to the young age in which some individuals start doping.

The Effectiveness of a New School-Based Media Literacy Intervention on Adolescents' Doping Attitudes and Supplements Use

The aim of the study was to evaluate the effectiveness of a media literacy intervention targeting, for the first time, the specific topic of Performance and Appearance Enhancing Substances (PAESs) use in high-school students. Overall, 389 students (52% male) aged between 13 and 19 years (mean = 16.56 year; SD = 1.26) participated to a media literacy intervention (i.e., “intervention group”) while 103 students aged between 14 and 19 year (mean = 16.10 year; SD = 1.38) were considered as the control group (i.e., “control group”). In two separate occasions over the course of six consecutive months, students in both groups filled out a set of questionnaires which included measures of social-cognitive beliefs (i.e., attitudes, subjective norms, intentions) and a self-reported measure of retrospective use of doping (Yes/No) and supplements (Yes/No). Compared to students in the control group (Mean_(time1) = 1.96; SD_(time1) = 0.85; and Mean_(time2) = 2.09; SD_(time2) = 0.94), intervention students on average expressed relatively stronger attitudes against doping use over time (Mean_(time1) = 2.2; SD_(time1) = 0.85; and Mean_(time2) = 2.05; SD_(time2) = 0.82). Students in the latter group also showed a statistically significant decrease in self-reported supplement use (Use_(time1) = 6.7%; Use_(time2) = 3.8%; p = 0.05, McNemar Test). Interestingly, albeit marginally significant, students in the control group showed a relative increment in the self-reported use of supplements over time (Use_(time1) = 4.9%; Use_(time2) = 8.7%; p = 0.22, McNemar Test). Overall, the media literacy intervention investigated in the present study was effective in decreasing adolescent student’s positive attitudes toward doping use and in reducing the use of legal PAES. These findings supported the generalizability and the usefulness of a media literacy approach in the specific field of PAES.

Personal and psychosocial predictors of doping use in physical activity settings: a meta-analysis

BACKGROUND

There is a growing body of empirical evidence on demographic and psychosocial predictors of doping intentions and behaviors utilizing a variety of variables and conceptual models. However, to date there has been no attempt to quantitatively synthesize the available evidence and identify the strongest predictors of doping.

OBJECTIVES

Using meta-analysis, we aimed to (i) determine effect sizes of psychological (e.g. attitudes) and social-contextual factors (e.g. social norms), and demographic (e.g. sex and age) variables on doping intentions and use; (ii) examine variables that moderate such effect sizes; and (iii) test a path analysis model, using the meta-analyzed effect sizes, based on variables from the theory of planned behavior (TPB).

DATA SOURCES

Articles were identified from online databases, by contacting experts in the field, and searching the World Anti-Doping Agency website.

STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS

Studies that measured doping behaviors and/or doping intentions, and at least one other demographic, psychological, or social-contextual variable were included. We identified 63 independent datasets.

STUDY APPRAISAL AND SYNTHESIS METHOD

Study information was extracted by using predefined data fields and taking into account study quality indicators. A random effects meta-analysis was carried out, correcting for sampling and measurement error, and identifying moderator variables. Path analysis was conducted on a subset of studies that utilized the TPB.

RESULTS

Use of legal supplements, perceived social norms, and positive attitudes towards doping were the strongest positive correlates of doping intentions and behaviors. In contrast, morality and self-efficacy to refrain from doping had the strongest negative association with doping intentions and behaviors. Furthermore, path analysis suggested that attitudes, perceived norms, and self-efficacy to refrain from doping predicted intentions to dope and, indirectly, doping behaviors.

LIMITATIONS

Various meta-analyzed effect sizes were based on a small number of studies, which were correlational in nature. This is a limitation of the extant literature.

CONCLUSIONS

This review identifies a number of important correlates of doping intention and behavior, many of which were measured via self-reports and were drawn from an extended TPB framework. Future research might benefit from embracing other conceptual models of doping behavior and adopting experimental methodologies that will test some of the identified correlates in an effort to develop targeted anti-doping policies and programs.

Using response-time latencies to measure athletes' doping attitudes: the brief implicit attitude test identifies substance abuse in bodybuilders

Background

Knowing and, if necessary, altering competitive athletes’ real attitudes towards the use of banned performance-enhancing substances is an important goal of worldwide doping prevention efforts. However athletes will not always be willing to reporting their real opinions. Reaction time-based attitude tests help conceal the ultimate goal of measurement from the participant and impede strategic answering. This study investigated how well a reaction time-based attitude test discriminated between athletes who were doping and those who were not. We investigated whether athletes whose urine samples were positive for at least one banned substance (dopers) evaluated doping more favorably than clean athletes (non-dopers).

Methods

We approached a group of 61 male competitive bodybuilders and collected urine samples for biochemical testing. The pictorial doping Brief Implicit Association Test (BIAT) was used for attitude measurement. This test quantifies the difference in response latencies (in milliseconds) to stimuli representing related concepts (i.e. doping–dislike/like–[health food]).

Results

Prohibited substances were found in 43% of all tested urine samples. Dopers had more lenient attitudes to doping than non-dopers (Hedges’s g = -0.76). D-scores greater than -0.57 (CI95 = -0.72 to -0.46) might be indicative of a rather lenient attitude to doping. In urine samples evidence of administration of combinations of substances, complementary administration of substances to treat side effects and use of stimulants to promote loss of body fat was common.

Conclusion

This study demonstrates that athletes’ attitudes to doping can be assessed indirectly with a reaction time-based test, and that their attitudes are related to their behavior. Although bodybuilders may be more willing to reveal their attitude to doping than other athletes, these results still provide evidence that the pictorial doping BIAT may be useful in athletes from other sports, perhaps as a complementary measure in evaluations of the effectiveness of doping prevention interventions.

„Ich wünschte, ich wäre muskulöser”: Eine teststatistische Überprüfung der deutschsprachigen Fassung der Drive for Muscularity Scale (DMS)

Die Drive for Muscularity Scale (DMS) ist der am häufigsten verwendete Fragebogen zur Erfassung des Muskulositätsstrebens. Ziel der Studie war die psychometrische Überprüfung der deutschsprachigen Version der DMS. 601 Männer aus muskel- und kraftorientierten Sportarten wurden am Computer oder mit der Papierversion der DMS und mit weiteren Skalen befragt. Interne Konsistenz und Retest-Reliabilität der DMS liegen im sehr guten Bereich (>.88), ebenso die Korrelation mit einem Alternativtest (Male Body Attitudes Scale: .81). Muskulositäts- und Schlankheitsstreben lassen sich eindeutig differenzieren (Eating Disorder Inventory-2-DT: .11). Die durchgeführten Faktorenanalysen stützen die Einteilung in eine kognitive und eine korrelierte behaviorale Subskala. Es zeigten sich Zusammenhänge mit körperbezogenem Selbstwert und körperdysmorphen Sorgen. Die deutschsprachige DMS ist ein reliables und valides Instrument zur Erfassung des Muskulositätsstrebens in Forschung und klinischer Einzelfallanwendung.

Media exposure, mediated social comparison to idealized images of muscularity, and anabolic steroid use

This study examined the association between anabolic-androgenic steroid (AAS) use and dominant sociocultural factors, specifically media exposure to idealized images of male muscularity, and mediated social comparison trends among a sample of young Arab adults. The study found evidence that participants more exposed to content that promotes muscularity and those who idealize images of muscularity and perceive them as motivators for achieving muscularity are more likely to be AAS users. It also found that a significant percentage of participants used at least one kind of dietary supplement and that the level of AAS use among health club participants indicates it is a significant public health problem in Lebanon. The study suggests that dealing with this problem requires a unique approach, beyond the typical awareness of risks strategy, since some users were well aware of the risks yet continue to use AAS, and their motivations pertain more to body image and sexuality. A stronger approach that utilizes critical media literacy teaching that ingrains these issues into school and university curricula will have a more lasting impact.

Incongruence in doping related attitudes, beliefs and opinions in the context of discordant behavioural data: in which measure do we trust?

Background

Social psychology research on doping and outcome based evaluation of primary anti-doping prevention and intervention programmes have been dominated by self-reports. Having confidence in the validity and reliability of such data is vital.

Methodology/Principal Findings

The sample of 82 athletes from 30 sports (52.4% female, mean age: 21.48±2.86 years) was split into quasi-experimental groups based on i) self-admitted previous experience with prohibited performance enhancing drugs (PED) and ii) the presence of at least one prohibited PED in hair covering up to 6 months prior to data collection. Participants responded to questionnaires assessing a range of social cognitive determinants of doping via self-reports; and completed a modified version of the Brief Implicit Association Test (BIAT) assessing implicit attitudes to doping relative to the acceptable nutritional supplements (NS). Social projection regarding NS was used as control.

PEDs were detected in hair samples from 10 athletes (12% prevalence), none of whom admitted doping use. This group of ‘deniers’ was characterised by a dissociation between explicit (verbal declarations) and implicit (BIAT) responding, while convergence was observed in the ‘clean’ athlete group. This dissociation, if replicated, may act as a cognitive marker of the denier group, with promising applications of the combined explicit-implicit cognitive protocol as a proxy in lieu of biochemical detection methods in social science research. Overall, discrepancies in the relationship between declared doping-related opinion and implicit doping attitudes were observed between the groups, with control measures remaining unaffected. Questionnaire responses showed a pattern consistent with self-reported doping use.

Conclusions/Significance

Following our preliminary work, this study provides further evidence that both self-reports on behaviour and social cognitive measures could be affected by some form of response bias. This can question the validity of self-reports, with reliability remaining unaffected. Triangulation of various assessment methods is recommended.

Methodological considerations regarding response bias effect in substance use research: is correlation between the measured variables sufficient?

Efforts for drug free sport include developing a better understanding of the behavioural determinants that underline doping with an increased interest in developing anti-doping prevention and intervention programmes. Empirical testing of both is dominated by self-report questionnaires, which is the most widely used method in psychological assessments and sociology polls. Disturbingly, the potential distorting effect of socially desirable responding (SD) is seldom considered in doping research, or dismissed based on weak correlation between some SD measure and the variables of interest. The aim of this report is to draw attention to i) the potential distorting effect of SD and ii) the limitation of using correlation analysis between a SD measure and the individual measures. Models of doping opinion as a potentially contentious issue was tested using structural equation modeling technique (SEM) with and without the SD variable, on a dataset of 278 athletes, assessing the SD effect both at the i) indicator and ii) construct levels, as well as iii) testing SD as an independent variable affecting expressed doping opinion. Participants were categorised by their SD score into high- and low SD groups. Based on low correlation coefficients (<|0.22|) observed in the overall sample, SD effect on the indicator variables could be disregarded. Regression weights between predictors and the outcome variable varied between groups with high and low SD but despite the practically non-existing relationship between SD and predictors (<|0.11|) in the low SD group, both groups showed improved model fit with SD, independently. The results of this study clearly demonstrate the presence of SD effect and the inadequacy of the commonly used pairwise correlation to assess social desirability at model level. In the absence of direct observation of the target behaviour (i.e. doping use), evaluation of the effectiveness of future anti-doping campaign, along with empirical testing of refined doping behavioural models, will likely to continue to rely on self-reported information. Over and above controlling the effect of socially desirable responding in research that makes inferences based on self-reported information on social cognitive and behavioural measures, it is recommended that SD effect is appropriately assessed during data analysis.

Sports celebrities and public health: Diego Maradona's influence on drug use prevention

Exposure to a sports celebrity through media and sporting events can have important influences on a public health issue associated with that celebrity. The battle against drug use by Argentinean soccer icon Diego Maradona has provoked concerns about drug abuse and prevention in Argentina, particularly among young people. The present study analyzes how two forms of involvement with Maradona affected the public's concern and perceptions of drug use after Maradona's drug-related health crisis in 2004. Results indicate that those who had a greater degree of parasocial interaction with Maradona were more likely to have an increased awareness of drug abuse, a greater personal concern about drug abuse, abstained from drug use, and more strongly support drug abuse prevention programs. In contrast, identification with Maradona had a mitigating effect on drug use prevention. Implications of these findings regarding the influence of sports celebrities on substance abuse are discussed.