Key Determinants

My problem definition for my paper was as follows: Increasing Circulatory Risks Associated with Pre-workout Supplements in the United States among Athletes age 18-30 from 2005 to 2013. However, due to the fact that it is a topic of recent emergence, not much research has been done on this problem and there are not many sources of statistical data available for reference. As a result, I am modifying my problem definition around the use of performance enhancing drugs – specifically anabolic steroids. My new problem definition is Increasing Hormonal complications Associated with Anabolic Steroid use in the United States among adolescents from 2000 to 2013.

In the United States, an estimated 1 to 3 million people have used anabolic steroids. An estimated 4% to 12% of US high school boys and up to 3.3% of high school girls have used anabolic steroids, confirmed by  2003 Centers for Disease Control report. In a recent study of substance abuse by the National Collegiate Athletic Association (NCAA), an overall usage rate of 1.1% was found across all 3 of its divisions (Cheatham, 2008). These numbers have all been found through surveys given to the respective athletes, but anecdotal infomation suggests more widepread abuse. The purpose of anabolic steroids is to increase their muscle mass and strength; the main anabolic steroid hormone produced by the body is testosterone. For athletes actively taking 6 to 12 week cycles of anabolic steroids, their bodies reacted with negative hormonal effects to their bodies (Cheatham, 2008). In one study of male bodybuilders, more than half had testicular atrophy, which is the shrinking of the testicles, and/or gynecomastia, the development of breasts.  In the female body, anabolic steroids cause masculinization. Breast size and body fat decrease, the skin becomes coarse, the clitoris enlarges, and the voice deepens. Women may experience excessive growth of body hair but lose scalp hair. With continued administration of steroids, some of these effects become irreversible  (Mayo Clinic Staff, 2012).

The choice of using anabolic steroids is a choice, but there are several factors. The most pertinent to the use of anabolic steroids within adolescents are biological, behavioral, environmental, economic, and political.

In biological key determinants, pre-existing health issues pose as a post-event problem. There have been studies indicating if an individual has a family history of cancer, taking anabolic steroids increases the risk of contracting cancer, particularly liver tumors and cancer and specifically prostate cancer in males. Gender roles also play a large role in biological key determinants. For both male and female users, they may use steroids to improve performance and to improve recovery (The Hormone Health Network, 2009). However, for males it may be more to gain muscle mass, while for females they may try to lose weight, since these are one of the effects of the steroid. Generally, the relative risk for anabolic steroid use is 2 to 3 times higher in men (American Academy of Pediatrics , 1997).

Behavioral key determinants are likely the largest reason for anabolic steroid use. One reason for steroid abuse found is due to sexual trauma. In one series of interviews with male weightlifters, 25 percent who abused steroids reported memories of childhood physical or sexual abuse. Similarly, female weightlifters who had been raped were found to be twice as likely to report use of anabolic steroids compared with those who had not been raped. Moreover, almost all of those who had been raped reported that they markedly increased their bodybuilding activities after the attack. They believed that being bigger and stronger would discourage further attacks because men would find them either intimidating or unattractive ( National Institute on Drug Abuse, 2001). Additionally, some adolescents abuse steroids as part of a pattern of high-risk behaviors. According to a 2005 "Monitoring the Future Survey", the annual prevalence of steroid use among males gradually increased, from a 1.5% use in 8th grade to 2.5% use in 10th grade to about a 3.3% use in 12th grade ( National Institute on Drug Abuse, 2001).

There is also an economic key determinant, which is more prevalent in older adolescent elite athletes in which they take anabolic steroids in order to receive financial gain through securing a spot on a particular team or receiving sponsorship. Also, physically demanding jobs may push an individual to take anabolic steroids. According to the Department of Defense, 3.8% of active duty personnel reported ever using steroids, while 1.9% reported using this within the past year and 1.1% within the past month. The US census has recorded that there are currently 1,468,364 active duty personnel in the United States military (Pearson Education, Inc, 2007).

 Moreover, there are political factors that have tried to control the use of steroids: the Anabolic Steroid Control Act of 2004. While this is not a solid for why someone may want to use anabolic steroids, the implication of the law creates a reason to use it. This policy  amends the Controlled Substances Act to redefine anabolic steroid to mean any drug or hormonal substance, chemically and pharmacologically related to testosterone, as well as directs the Secretary to take action in creating incentives for athletes to not use steroids (108th congress, 2004). Despite this, there are large sales within the black market of illegal anabolic steroids; therefore their is loose policy implementation acquiring these steroids are not an issue for anyone that wants to take them.

The last key determinant has to do with environmental factors. Within sports, there is a very popular culture of competitiveness, and athletes have to go the extra mile in order to secure the position that they desire. In such an environment, the use of performance-enhancing drugs has become increasingly common (Morente-Sánchez, 2013). As athletic competition continues to intensify, athletes strive to higher levels of performance to achieve success. There are surrounding pressures from not only the athlete and the team, but also from their coaches and parents.  However, no longer is this just a problem of the elite athlete; today, the perception that anabolic steroids correlate with athletic success can be found among collegiate and scholastic athletes as well. Also, it is important to keep in mind that 30% to 40% of anabolic steroid users do not participate in a school-sponsored sport. More likely, these users participate in bodybuilding or weightlifting.

In conclusion, with such determinants such as the ease of access to anabolic steroids and the strong desire for enhanced performances by athletes, the most rational solution for this complex issue would be to send out a campaign targeted to adolescents educating them on the harms of steroids, provide some sort of incentives to athletes that do not use anabolic steroids, and possibly regulate the distribution of these drugs better.

References 

American Academy of Pediatrics . (1997). Adolescents and anabolic steroids: A subject review. Committee on Sports Medicine and Fitness, 99(6), 904 -908. doi: 10.1542/peds.99.6.904

Cheatham, S. A. (2008). Performance-enhancing drugs and today’s athlete: A growing concern. Orthopedics,31(10), Retrieved from http://www.healio.com/orthopedics/sports-medicine/journals/ortho/{93d32e5b-a2c8-4c5c-8e0c-d600a3fee2b3}/performance-enhancing-drugs-and-todays-athlete-a-growing-concern

The Hormone Health Network. (2009). Hormone abuse overview. Abuse , Retrieved from http://www.hormone.org/Abuse/overview.cfm

Mayo Clinic Staff. (2012). Performance-enhancing drugs: Know the risks. Healthy Lifestyle: Fitness, doi: Mayo Clinic

Morente-Sánchez, Z. M. (2013, March 27). Doping in sport: A review of elite athletes' attitudes, beliefs, and knowledge.. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23532595

National Institute on Drug Abuse. (2001). Anabolic steroid abuse . National Insititute on Drug Abuse Research Report series, NIH Pub Number: 06-3721, Retrieved from http://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse

Pearson Education, Inc. (2007). Active duty military personnel, 1940–20111. Military Affairs , Retrieved from http://www.infoplease.com/ipa/A0004598.html

S. 2195--108th Congress: Anabolic Steroid Control Act of 2004. (2004). In www.GovTrack.us. Retrieved April 6, 2013, from http://www.govtrack.us/congress/bills/108/s2195