Steroid Abuse Found Among Preadolescents, By: Crystal Phend

June 22, 2007

Steroids and other performance-enhancing agents appear to be creeping into use by ever-younger populations -- even junior high students, researchers found.

In a longitudinal study of students in eastern France, 1.2% of 11-year-olds and 3.0% of 15-year-olds reported using steroids, albuterol, or other agents to improve athletic prowess during the prior six months, according to a report in the British Journal of Sports Medicine.

Although most studies have focused on older teens and college students, "this result shows that doping does exist among very young athletes, whatever their level of sports participation, including leisure," wrote Patrick Laure, M.D., Ph.D. and Caroline Binsinger, Ph.D., both of Direction regionale de la Jeunesse et des Sports de Lorraine here.

The findings would likely be similar in the United States, commented Timothy E. Hewett, Ph.D., of the University of Cincinnati and director of the Sports Medicine Biodynamics Center at Cincinnati Children's Hospital Medical Center.

"Be aware that kids at younger ages, particularly those in junior high, are using doping agents at the level that high school students were a decade ago," he cautioned.

Because drug testing programs for student athletes typically begin at the high school level, "picking up steroid use in students that young is going to be up to the pediatrician or the family physician," he said. "They should be prepared to look for the same signs that you might look for in the college or high school athlete."

The prospective "Cohorte Myrtilles" study enrolled all 3,564 students entering their first year of secondary school in the Lorraine region of France in 2001 and followed them for four years.

The children completed anonymous questionnaires during class. They reported extracurricular sports participation, rated self-esteem and trait anxiety, and non-medical use of drugs included on the World Anti-Doping Agency "prohibited list."

Among them, 10.7% reported practicing with a sports group outside of school (average 3.5 to 5.2 hours a week, 69.5% team sports), 86.6% reported occasional extracurricular sports activity (2.5 to 3.2 hours a week, 32.9% team sports), and just 2.5% reported no sports practice outside of school.

Doping increased significantly over time in the cohort (P<0.001) from 1.2% at the beginning of sixth grade to 3.0% at the end of ninth grade.

The rise was not surprising, commented David A. Baron, M.S.Ed., D.O., of Temple University in Philadelphia. "As they get older, the stakes get higher."

Notably, though, doping was more common among occasional athletes than those reporting regular practice with a sports group in sixth grade (1.4% versus 0.4%). By ninth grade, 2.9% of those reporting intermittent practice and even 1.0% of those reporting no sports practice were using performance-enhancing agents.

This finding fits with a "disturbing" trend seen recently toward an increase in steroid use among nonathletes, particularly adolescents and preadolescents, for cosmetic purposes, Dr. Baron said.

Furthermore, the frequency of use increased during the four-year study. Comparing baseline and the final survey, just as many students used doping agents daily (23% versus 24%), and twice as many did so at least once a week (15% versus 38%).

The asthma drug albuterol was the most commonly abused agent (45.5%) followed by anabolic steroids, stimulants and the rest of the "other" category (38.0%), corticosteroids (10.2%), and marijuana (6.3%).

"Taking into account the nature of the main substances used, even though the amounts taken are not known from this study, we can assume that the probability of an adverse effect increases too," the researchers wrote.

However, few students reported adverse effects related to doping (4%). One became violent with a stimulant, one developed a "raucous" voice with albuterol, and two reported fainting with albuterol. None of them reported discussing the problem with anyone.

The reason for such a low adverse effect rate may have been, in part, the limitations of self-reporting, the authors acknowledge, with students failing to make a connection between the events and doping, or minimizing or denying the effects.

Even the medical literature has been unclear on side effects in this age group, though, Dr. Baron said.

"A lot of things we see in the adults or adolescents we may not see in the preadolescents because their physiology is different," he noted.

Altering the hormonal profile with anabolic steroids during puberty could have serious long-term side effects, such as stunting growth or causing sterility, Dr. Hewett said.

Factors that increased the likelihood of doping in the study included:

• Intention to use a doping drug (global odds ratio 6.9, 95% confidence interval 4.7 to 10.2).

• Use of other drugs including tobacco, alcohol, and recreational marijuana (OR 5.9, 7.3 and 10.9, respectively).

• Low self-esteem (average scores were significantly lower at most time points for users, P<0.05).

• High global trait anxiety scores (averages were significantly higher at most time points for users, P<0.05).

• Depressive feelings (significantly more users reported feeling unhappy than happy at most time points, P<0.01).

Boys were significantly more likely than girls to use performance-enhancing substances at each timepoint (1.7% versus 0.6% at age 11, 3.7% versus 2.3% at age 15, P<0.05 for all comparisons).

"Adults responsible for young people should be alerted by these signs, even though the results are from an epidemiological study and therefore must be applied to individual people with care," the researchers said.

Dr. Baron particularly warned against relying on the point estimates because the study used only self-reported data, which is notoriously difficult to collect accurately on illicit substances.

Nonetheless, all agreed that the reach of performance-enhancing drugs is expanding.

"This type of abuse is creeping down to a younger and younger age," commented Vito Perriello, M.D., of the Pediatric Association of Charlottesville, Virginia, and the National Federation of State High School Associations.

"We need to be aware of this and educate our patients at younger and younger ages," he said.

However, stopping the trend "will probably not be easy," the researchers noted, because 44% of users attributed winning at least one sporting event to doping agents.

Ironically, "except for steroids, none of the supplements used have been convincingly shown to improve performance that much," Dr. Perriello said. "A lot of these things are being used with a false sense of benefit."