Sport Science Review, vol.Sport
XXII,Science
no. 1-2,
2013,vol.
109XXII,
- 128 No. 1-2, April 2013
Review,
DOI: 10.2478/ssr-2013-0006
Attitudes Toward Anabolic-Androgenic
Steroids Among Non-competing Athletes
in Various Types of Sports
- A Cross-sectional Study John SINGHAMMER1
A
ims: This study investigated the association between attitudes and
intentions to use of anabolic – androgenic – steroids (AAS) between
participants in various sports and within sports. Methods: Data were derived
through a cross - sectional population based survey on 5,010 men and women
aged 15 to 60 years. Response – rate was 34%. A combination of postal and
web-based questionnaire was used. Data for the present study was restricted
to 1,045 males. Results: Prevalence of AAS use was 23 (1.8 %), and 104 (5.3
%) of the respondents had considered AAS – use. On average, respondents
that had considered using AAS held more positive attitudes toward AAS - use,
compared to respondents without experienced within all types of sports. The
biggest difference between considered and non – experienced was observed
for Aerobics (1.09 CI, 0.76 - 1.41, R2 = 0.23, p = 0.000). No difference in
attitudes to AAS – use between types of sports were observed. Conclusions:
Attitudes toward AAS did not vary between types of sports and the level of
acceptance was consistently higher among non – competing athletes with
intentions to use AAS, regardless of the type of sport. The implication of the
observations suggests that preventive actions against AAS use should revolve
around individuals suggesting interest in AAS regardless of type of sport.
Keywords: anabolic-androgenic steroids, cross-sectional study
1 Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense.
ISSN: (print) 2066-8732/(online) 2069-7244
© 2013 • National Institute for Sport Research • Bucharest, Romania
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Attitudes Toward Anabolic - Androgenic - Steroids
Introduction
Social science research in anabolic - androgenic steroids (AAS) has mostly
revolved around the distribution of AAS use among adolescents participating
in sports competitions or elite athletes. However, AAS use is also observed
among non – competing athletes (Goulet, Valois, Buist, & Cote, 2010; Laure,
Lecerf, Friser, & Binsinger, 2004; Lucidi, Grano, Leone, Lombardo, & Pesce,
2004; Nilsson, Baigi, Marklund, & Fridlund 2001; Simon, Striegel, Aust, Dietz,
& Ulrich, 2006; Wichström & Pedersen, 2001), including individuals that do
not appear in sport clubs and gyms. Similarly, AAS use is not only confined to
adolescents but is also observed among adults (Yesalis, Kennedy, Kopstein, &
Bahrke, 1993), though mostly among men. In Denmark, participation in sport
is increasing - especially in fitness centers and gyms, and is currently engaging
approximately 15% of the adult population between 15 to 60 years (Kirkegaard,
2009). Thus, the number of individuals potentially being exposed to AAS is
substantial making AAS-use a public health issue affecting the population
similarly to other illegal and health compromising drugs.
Much social research in AAS use focuses on social – cognitive models
to investigate the influence on actual and intentional doping-use by attitudes,
beliefs and subjective norms (Dodge & Jaccard, 2008; Donovan, Egger,
Kapernick, & Mendoza, 2002; Goulet et al., 2010; Petroczi, 2007; SasNowosielski & Swiatkowska, 2008; Zelli, Mallia, & Lucidi, 2010), and it is
suggested that preventive measures should target individuals that consider using
AAS, while preventive effort targeting individual that actually uses AAS should
be downgraded (Backhouse, McKenna, Robinson, & Atkin, 2007). Knowledge
about the proportion of competing and non-competing athletes in various
sports that considers using AAS is an important premise for a successful change
of the current anti-doping prevention policy. Studies about the distribution of
athletes that considers using AAS are rare although some information do exist.
For example, Wickström (Wichström & Pedersen, 2001) reported that 5% of
Norwegian adolescent aged 12 to 20 years intended to use AAS. In a study of
preadolescent pupils Laure (Laure et al., 2004) observed a prevalence rate of
intention to use AAS between 0% and 21.8% and Krowchuck (Krowchuk et
al., 1989) found that 14% male high school student had intention to use AAS.
Perhaps not surprisingly, the reported prevalence rate of individuals who have
considered using AAS are higher than rates of actual use of AAS (Goulet et al.,
2010; Papadopoulos, Skalkidis, Parkkari, & Petridou, 2006; Pedersen, Wichstrom,
& Blekesaune, 2001; Wichström & Pedersen, 2001), and suggests a significant
potential for preventive actions.
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It is a commonly held assumption that use of AAS is most prevalent
in sports characterised by strength and speed (Bahrke, Yesalis, Kopstein, &
Stephens, 2000). However, AAS use has been observed in other sports such as
soccer (Ama, Betnga, Ama Moor, & Kamga, 2003), and table tennis (Kondric,
Sekulic, & Mandic, 2010), which are characterised by endurance. Although
these findings represents exceptions, they nevertheless points to some common
individual characteristic such as indulgence in polydrug use and personality trait
(Bahrke et al., 2000; Harmer, 2010), and to cultural factors specific to the type
of sport athletes are engaged in (Petroczi, 2007). Thus, individual and cultural
factors may vary between types of sports and affect the prevalence of AAS use.
Similarly, attitudes to AAS may vary between types of sports. This study extends
the existing research on AAS attitude to non – competing male individuals aged
15 to 60 years and investigate the level of AAS – attitudes across various types
of sports and the attitude – intention relationship within sports.
Specifically, the aims of this study are to; 1. investigate the proportion of
participants with life time intentions to use AAS in a cross – sectional sample of
randomly selected non – competing males aged 15 to 60 years and; 2. investigate
the level of anabolic – androgenic – steroids (AAS) – attitudes between sports
and; 3. investigate the relation between attitudes and intention to use AAS within
sports.
Methods
Ethics
The Danish Data Inspectorate approved the study. The study is conducted
in accordance with the World Medical Association Declaration of Helsinki.
Participants
Data are derived from a cross-sectional survey on attitudes toward
performance enhancing drugs and methods in Denmark, conducted in 2009.
The sample frame of the survey was the population of Denmark, as it registered
in the Central Person Register (CPR), of whom two samples consisting of
4006 men aged 15 to 25 years and 6,004 men and women age 15 to 60 years
were randomly selected using the unique identification number, assigned to
every individual living in Denmark. Individuals with concealed id numbers
were excluded (n = 1,609). From the remaining sub-samples, 2,006 young men
and 3,004 men and women were selected at random. Thus, the eligible sample
consisted of 5,010 individuals. The present paper is part of a larger study on
attitudes to performance enhancing drugs and methods in the general population
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Attitudes Toward Anabolic - Androgenic - Steroids
in Denmark. To increase sample size for investigation of AAS use, an extra
sample of young men (n=4,006) was selected. As the present paper investigates
the relation between intentions to use AAS and sports activities among men
information for all men aged 15 to 60 years was included.
Data collection
Each individual received a letter with information on the survey and an
invitation to participate, 3 weeks prior to data collection. The letter emphasised
participants’ anonymity and right to refrain from participating. Data were
collected by postal and web-based questionnaire by a private company (UNI-C,
2011). Participant’s that did not respond received two telephone calls and were
re-invited to participate. The overall response rate was 34%. Details of the
sampling procedure and participation rate are provided in figure 1. Information
was available for gender, age and marital status for the total population and the
sample . A significantly higher proportion of married women aged 36 - 45 years
(76.5%) and 46 - 60 years old (77.5 %) participated in the survey, compared to
the distribution in the general population (63.1% and 66.6%, respectively). The
proportional distribution among men by marital status and age was similar to
the general population. The present investigation was restricted to men aged 15
to 60 years and the disproportionate composition of women does not affect the
results of the analysis.
Measures
In 1999, a population based cross-sectional survey on use of and attitudes
to performance enhancing drugs and methods - including AAS were conducted
in Denmark (Ibsen et al., 1999). Several questions from the 1999 survey were
repeated in the present survey including questions about sport and leisure
time physical activity pattern, motivation for exercising, self-perceived health,
self-perceived physical fitness, and attitudes and knowledge and use of AAS.
Questions on age, gender and level of education were also included. For the
present paper, information on attitudes toward and use of AAS was included, as
were information on leisure time physical activity, type of sport activity, age and
level of education.
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Figure 1. Data collection procedure and attrition of the sample.
* CPR refers to the Central Personal Registry of all individuals living in
Denmark. A unique identification number is assigned to each person by birth.
“M” and “W” refers to men and women, respectively.
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Outcome variables
Participant’s experience with AAS was measured by the question:
“Have you used or do you consider using muscle enhancing drugs?”
followed by the response options:
1) “Yes, I am currently using it”, 2) “Yes, I have been using it but not
currently”, 3) “Yes, but I have never used it” and, 4) “No, I have never
considered it”.
A new variable named ”Experiences” was constructed including response from
category 1 and 2 that was collapsed into one category (“experienced”), and
response 3 and 4 (“considered” and “non - experience”, respectively).
Attitudes toward AAS were assessed by types of sport, and compared by
categories of participants experience with AAS. In designing the present survey,
a team of researchers from University of Southern Denmark and practitioners
from the Anti Doping Denmark considered several options for measuring
attitudes toward AAS in the general population and decided to include the
items used in the 1999 survey, as valid measures of attitudes toward AAS with
good psychometric properties are currently lacking (Backhouse et al., 2007).
Thus, measures of attitudes do at least have face validity. For the present study,
attitudes were measured through participant’s agreement or disagreement of
seven statements that were all preceded by the notion:
“What is your attitude to use of the muscle enhancing drugs” followed by the statements: “it’s acceptable to use muscle enhancing drugs
if you don’t compete”, “…if the drugs is not a threat to your health”, “..if
others in the competition are also using the drugs”, “...as long as others
don’t know”,”...if use is controlled by a general practitioner”, and “Use of
muscle enhancing drugs is a personal matter”, “Use of muscle enhancing
drugs is always wrong”? For all questions, response options were “Totally
agree” = 2, “Agree” = 1, “Neither” = 0, “Disagree” = -1, and “Totally
disagree” = -2.
All responses were coded in the same direction and a composite score across all
variables was calculated and divided by the number of questions. The scale of the
composite scores resembles that of the original responses. Internal consistency
was acceptable (a = 0.82). The composite score was named “AAS - attitudes”.
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Predictor variables
Information on types of sports was derived through response to the
question:
“Have you regularly been active within the following sports during the
past 12 months?” Response options where: “Athletics”, “Ball (soccer,
football, basketball, etc)”, “Rackets (tennis, golfing, squash, etc)”,
“Aerobics (workout, dance, etc)”, “Canoeing”, “Martial arts”, “Spinning”,
“Weight training”, “Swimming”, “Jogging (walking, bicycling, etc)”, and
“Miscellaneous (go-cart, motor-cross, climbing, yoga, etc)”.
Participants could report several types of sports. Participant’s age, and
weekly hours physically active (WHPA) were also obtained and included as
categorical measures. Level of education was coded “No education” = 1, “Nonmanual” = 2, “Manual” = 3, “Semi-skilled” = 4, “Skilled” = 5, and “Professional”
= 6.
The questionnaire was pre-tested among a group of nineteen master
students of Exercise and Sport at the University of Southern Denmark to
detect sources of misconceptions. No major problems with understanding the
questions were identified.
Statistical analysis
Proportional differences in age, level of education and WHPA was evaluated
by cross-tabulations and calculation of adjusted Wald statistic. Multiple regression
and subsequent calculation of point estimates, 95% confidence intervals (CI) and
associated p – values was used to investigate for differences in level of attitude to
AAS within types of sports. First, crude estimates were calculated. Estimates of
attitudes to AAS adjusted for known predictors of AAS use (level of education,
WHPA, and age) were subsequently calculated. Logistic regression was used to
investigate for differences in AAS – attitudes between participants who reported
having no experience with AAS (“non-experienced”) and participants reporting
having considered using AAS (“considered”), separately by types of sport. Results
for participants reporting having some experience with AAS (“experienced”)
were calculated and included as descriptive information, but results were not
further interpreted, as the number of participants in this subsample was too
small. The statistical significance threshold used was 0.05. Data were analysed
using the STATA software package version 12.0 (StataCorp, 2012).
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Men are the primary target group for anti-doping initiatives in Denmark.
As effect size of results from other studies on the attitude – intention association
are modest (Petroczi, 2007), analyses are restricted to men and to subsample of
more than ten subjects.
Role of the funding source
The study sponsors had no role in the study design, the collection, analysis,
or interpretation of the data, writing of the report, or the decision to submit the
paper for publication. The corresponding author had full access to all the data
in the study and had final responsibility to submit for publication.
Results
23 (1.8%) of the participants reported having experience with AAS.
104 (5.3%) reported having considered using AAS, and 900 (93%) had never
considered using AAS. The majority of participants were engaged in several
sports simultaneously with jogging as the most frequently reported single activity
(n=169, 18.9 %). Overall mean and standard deviation of AAS – attitudes was
-1.16 + 0.89. A graded level of AAS-attitudes across participants experience
with AAS was observed. Mean and standard deviation AAS-attitudes for
experienced users were 0.42 + 1.0, -0.22 + 0.85 for considered, and -1.04 + 0.74
for non-experienced, respectively. Compared to non-experienced, the difference
between considered (mean difference = -0.82, t = 10.52, S X = 0.08, p = 0.00),
was statistical significant.
Participant having considered using AAS were more frequently engaged in
five of eleven sports in comparison to non-experienced (Table 1). The biggest
difference was observed in Weight training were 22.6% of non – experienced
were engaged compared to 59.3% among the considered (proportional difference
was 36.6% (CI, 29.9 – 43.2, p = 0.000).
The level of education was lower among participants having considered
AAS. For example, the proportional difference in participant with no education
among considered, compared to non – experienced, was 19.3% (CI, 6.12 - 32.39,
p = 0.001). In general, the considered were younger than non – experienced. For
example, there were 9.8% (CI, 3.13 - 16.47, p = 0.000) more participants in the
age group 15 - 18 year olds, compared to non – experienced. No differences in
WHPA among participants experience with AAS was observed.
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Table 1
Percent participants in sports, level of education, hours physically active per week, and age, by
level of experience with AAS (n = 893)
Variable
Sports
Athletic
Ball
Rackets
Aerobics
Canoeing
Martial arts
Spinning
Weight training
Swimming
Jogging
Miscellaneous
Level of education
No education
Non-manual
Manual
Semi-skilled
Skilled
Professional
Weekly hours physical
active
< 1.5 hours
2 – 3.5 hours
4 – 7 hours
7.5 – 12 hours
> 13 hours
Age
< 19 years
19 – 24 years
25 – 43 years
44 – 60 years
a
Non-experienced
Percent
n
Considered
Percent
n
Experienced
Percent
n
3.3
20.9
25.5
7.7
3.9
3.1
17.0
23.9
18.2
59.5
10.2
53
331
263
109
50
62
169
331
175
526
103
11.5*
48.5***
21.3
20.0**
6.5
12.5***
28.6
60.9***
28.3
57.5
7.6
11
61
32
23
5
20
29
77
30
57
8
12.5
20.7
24.8
2.6
7.3
34.8
88.6***
35.1
53.9
9.9
3
7
5
2
0
3
9
20
8
13
1
17.8
3.6
29.4
11.8
19.4
15.3
350
37
189
70
119
99
37.1**
10.7*
21.1
5.3
7.2
13.4
56
7
19
4
8
6
25.0
6.8
36.9
21.4
7.6
8
3
6
0
3
2
9.4
28.9
30.1
14.7
4.5
72
224
269
175
73
4.9
20.7
35.0
22.5
8.0
3
16
31
34
14
7.5
42.6
33.5
2.6
0
3
8
8
2
6.6
8.3
27.8
57.3
232
226
201
241
16.5***
28.7***
38.2*
16.6***
35
44
21
4
3.9
20.1
65.4*
10.6
3
9
10
1
) Statistically significantly different from non-experienced * p < 0.05, ** p < 0.01, *** p < 0.001.
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Level of attitudes between sports
Overall, participants in all types of sports disfavored use of AAS (Table
2). Adjusting for level of education, age and WHPA attenuated the variation
in level of AAS – attitudes between the various types of sport. The difference
between the highest (Miscellaneous) and lowest (Aerobics) mean level of AAS
– attitudes was -0.27 (CI, -0.62 - 0.09, R2 = 0.14, p = 0.147), for a male at age
twenty years with non-manual level of education and being physical active five
hours per week.
Table 2
Crude and adjusted mean attitude and 95% Confidence Interval to Androgenic-AnabolicSteriods, by types of sports
Variable
Athletic
Ball
Rackets
Aerobics
Canoeing
Martial arts
Spinning
Weight training
Swimming
Jogging
Miscellaneous
Crude
Mean
-0.88
-0.93
-1.35
-1.20
-1.18
-0.95
-1.12
-0.94
-1.03
-1.22
-1.16
CI
(-1.22 - -0.53)
(-1.03 - -0.81)***
(-1.45 - -1.24)*
(-1.36 - -1.04)
(-1.39 - -0.96)
(-1.02 - -0.77)*
(-1.26 - -0.99)
(-1.05 - -0.82)***
(-1.17 - -0.88)*
(-1.29 - -1.15)*
(-1.22 - -1.10)
Adjustedb
Mean
-0.74
-0.73
-0.88
-0.88
-0.86
-0.68
-0.81
-0.73
-0.70
-0.84
-0.61
CI
(-1.06 - -0.42)
(-0.87 - -0.60)
(-1.04 - -0.73)*
(-1.10 - -0.65)
(-1.14 - -0.68)
(-0.97 - -0.38)
(-0.99 - -0.64)
(-0.87 - -0.58)
(-0.89 - -0.52)
(-0.98 - -0.71)
(-0.91 - -0.31)
a
) Statistically significantly different from participants not active in the particular sport
*p < 0.05, ** p < 0.01, *** p < 0.001. b) estimates are adjusted for age, level of education and selfreported weekly hours of physical activity. Thus, estimates are calculated for a hypothetical male
at age 20 years with non-manual level of education and being physical active 5 hours per week
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Level of attitudes within sports
Mean level of AAS – attitudes was evaluated by respondents experience
with AAS within types of sports, after adjusting for level of education, age and
WHPA. The mean level of AAS – attitude were statistically significantly higher
among considered, compared to non – experienced, within all sports (Table 3).
The biggest difference between considered and non – experienced was observed
for Aerobics (1.09 CI, 0.76 - 1.41, R2 = 0.23, p = 0.000).
Table 3
Adjusted mean level of attitude to AAS (95 % Confidence interval), by level of experience
with doping and by types of sports
Non-experiencedb
Consideredb
Experiencedb
Variable
Mean
CI
Mean
CI
Mean
CI
Athletic
-0.97
- 0.03
-
-0.85
-
-
Rackets
-1.00
-
-
Aerobics
-1.10
-0.01
(-0.68 *–
0.74)
(-0.59*0.04)
(-0.48 ***
-0.03)
(-0.31***0.29)
-
Ball
-
-
Canoeing
-1.01
-
-
-
-
Martial arts
-0.85
-0.14
-
-0.93
-
-
Weight
training
-0.90
0.44
(-0.46** 1.3)
Swimming
-0.86
-
-
Jogging
-0.97
-0.38
(-0.61*0.34)
(-0.83*0.00)
(-0.65***0.09)
(-0.53**0.35)
(-0.69 -0.06)***
-
Spinning
0.38
(-0.53***–
1.30)
Miscellaneous
-0.82
(-1.23 -0.70)
(-0.99 -0.71)
(-1.16 -0.85)
(-1.28 -0.91)
(-1.25 -0.78)
(-1.13 -0.56)
(-1.11 -0.75)
(-1.04 -0.76)
(-1.05 -0.67)
(-1.11 -0.84)
(-1.06 -0.57)
-
-
-0.27
-0.23
-0.41
-0.37
-0.09
) Statistically significantly different from Non-experienced. * p < 0.05, ** p < 0.01, *** p < 0.001.
) adjusted estimates are calculated for a hypothetical male at age 20 years with non-manual level
of education and being physical active 5 hours per week. Missing estimates are omitted because
of low sample size
a
b
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In all analysis of the level of AAS – attitudes between types of sports and
by participants level of experience with AAS, age was the only covariate included
that significantly accounted for variance of AAS – attitude. Thus, a decreasing
level of AAS – attitude was observed with participants’ increasing age.
Discussion
A small proportion of the participants reported experience with AAS.
The observed prevalence approximate those observed in other studies (Goulet
et al., 2010; Papadopoulos et al., 2006; Pedersen et al., 2001; Wichström &
Pedersen, 2001). Similarly, the proportion of participants having considered
using AAS was somewhat lower than that reported by other scholars (Laure
et al., 2004; Wichström & Pedersen, 2001). With regard to the study by Laure
(Laure et al., 2004), results were based on information from non - competing
preadolescents aged 11 years on average. In contrast, the study sample of the
present investigation included men only, aged 15 - 60 years. Thus, differences
in age across the study samples may account for the difference in reported
prevalence of intention to use AAS. The observed proportion was however
considerably lower than that reported by Krowchuk (Krowchuk et al., 1989).
However, results of the present analysis were based on data from the general
population, while those of Krowchuck (Krowchuk et al., 1989) were based on a
sample of generally non – competing high school students. As reporting of the
prevalence of intentions to use AAS is rare, comparison of the rate observed in
the present study is limited.
No statistical significant difference in attitudes to AAS was observed
between types of sports. The majority of the participants were opposed to
AAS use and the proportion of participants with a lenient attitude to AAS did
not influence the difference between types of sports. Similar observation was
reported in a Norwegian study including a sample of the general population,
where a substantial proportion reported opponent attitudes to AAS (Breivik,
Hanstad, & Loland, 2009). The inconsistent relation between attitudes to AAS
and types of sport resembles those of Krowchuck surveying a sample of high
school students (Krowchuk et al., 1989). However, the present results suggested
that participants were least opposed to AAS use in sports characterized by
strength and speed and more opposed to use in sports characterized by endurance.
Expectantly, participants who have considered using AAS reported more liberal
attitudes toward use in comparison with participants who have never considered
using AAS, regardless of type of sports. Although this result was anticipated it
was surprising that individuals with relative liberal attitudes to AAS-use were in
each type of sport included in the present study.
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The level of AAS – attitudes among non - experienced participants were
remarkably homogeneous across types of sport suggesting some common
characteristics for this group including but not limited to: high self-esteem,
moral engagement and satisfaction with own body image. These and other
characteristic may be highly prevalent among athletes that disapprove of AAS
as such substances are not part of their options for pursuing desired goals.
(Kindlundh, Hagekull, Isacson, & Nyberg, 2001; Komoroski & Rickert, 1992).
Thus, social and personality aspects may distinguish users from non-users across
types of sports.
Age was the only covariate associated with types of sport and AAS –
attitude in all analysis conducted for the present investigation. Weekly number
of physical activity was not associated to participants experience with AAS. This
is contrasting the findings of Laure (Laure et al., 2004) who observed that – in
addition to age - higher number of hours of practice per week was a significant
predictor of doping use. However, Laure (Laure et al., 2004) measure of doping
use included a combined measure of tobacco, alcohol, cannabis and prohibited
doping substances, and as these behaviors are more common than use of AAS,
an association of experience with AAS and WHPA would perhaps also have
been apparent in the present study, had such substances been included.
Limitations
A substantial proportion of the eligible subjects did not participate in this
study. If the loss is not random, the results of the present study are susceptible
to a number of errors. Most importantly, it is likely that the proportion of
individuals with intentions to use AAS differ in terms of preferred type of
sports, which distort the differences in mean AAS – attitudes across participants
experience with AAS by sports type. It was anticipated that participants were not
exclusively active in a single type of sport and they were allowed to report several
sports activities if preferred. Many participants obviously combine types of
sports characterized by strength with sports characterized by endurance and this
variation may explain that a relatively high level of AAS acceptance was found
in some sports characterized by endurance (e.g. Swimming and Ball). Potentially,
participants’ mixture of sports may lead to misclassification bias of the sport –
AAS attitude relation. However, mixing various sports is a common feature among
participants and the influence of this bias is trivial. Subjects engaged in illegal
behaviours such as AAS use or intention to use AAS may refuse to participate by
fear of disclosure (Petroczi et al., 2010). Thus, selection bias is present if both type
of sports preference and experience with AAS characterises non – participants.
Auxiliary information on sport preferences and experience with AAS was not
available, thereby precluding further characterisation of non – participants.
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Social desirability is another potential source of bias that may characterise
the individuals that chose to participate in the study. Social desirability was
not measured explicitly, but the remarkable homogeneous response pattern in
AAS – attitudes across types of sports among individuals with no experience of
AAS use suggests a tendency to respond to controversial issues in a way that is
assumed socially acceptable (Goldstein, 1960). Other scholars have noted the
influence of social desirability on the attitude – AAS – experience association
(Petroczi et al., 2010) and social desirability must be assumed a common source
of bias in surveys on AAS use – including the present study. The combination
of a low response - rate and associated risk of selection bias and some degree
of social desirability in response pattern affect the interpretation of this study.
Conclusion
Doping prevention in Denmark is primarily organised and managed by
the Danish Doping Agency through the Act of Promotion of Doping-Free Sports
(Kulturministeriet, 2005) and includes random testing of athletes – including non
- competing athletes - in gyms and at sports events that attracts a large number of
participants. The primary objective is to detect and deter engagement in doping
through proactive initiatives aimed at increasing athletes’ knowledge of the
consequences of doping and facilitating opponent attitudes toward doping. The
results of the present study aids in qualifying the current knowledge by showing
that attitudes toward AAS did not vary between types of sports and that the
level of acceptance was consistently higher among non – competing athletes
with intentions to use AAS, regardless of the type of sport. The implication
of the observations suggests that preventive actions against AAS use should
revolve around individuals suggesting interest in AAS regardless of type of
sport and not be restricted to “high risk” sports such as athletics, martial arts
and weight training.
Competing interest. None
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Table 4 (supplementary)
Correlation matrix of variables included in the study
Sport Science Review, vol. XXII, No. 1-2, April 2013
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John SINGHAMMER, PhD is currently an associate professor of Exercise Epidemiology
at University of Southern Denmark where he has been for the past four years. He
earned his PhD in health promotion at the University of Bergen, Norway. His research
includes health and health behaviour among immigrants and ethnic minorities and use
of performance-enhancing drugs. Currently, his research if focused on investigation of
the influence of psychosocial factors on children’s physical activity and sedentariness.
Corresponding address:
John Singhammer,
Institute of Sport and Biomechanic,
University of Sourthern Denmark,
Campusvej 55,
DK5230 Odense M,
Denmark.
Telephone +45 21 35 60 11.
Email: [email protected]
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