Elsevier

Biological Psychiatry

Volume 71, Issue 3, 1 February 2012, Pages 254-261
Biological Psychiatry

Archival Report
Risk Factors for Illicit Anabolic-Androgenic Steroid Use in Male Weightlifters: A Cross-Sectional Cohort Study

https://doi.org/10.1016/j.biopsych.2011.06.024Get rights and content

Background

Illicit anabolic-androgenic steroid (AAS) abuse, though an important public health problem, remains inadequately studied. Almost all AAS abusers are male and lift weights, but the risk factors for AAS use among male weightlifters remain poorly understood.

Methods

We recruited 233 experienced male weightlifters, of whom 102 (44%) reported lifetime AAS use, and assessed their childhood and adolescent attributes retrospectively, using structured clinical interviews and computerized questionnaires. This cross-sectional cohort approach—a design that we have formally presented in the recent methodological literature—utilizes a study cohort, not selected for outcomes of interest, and assesses exposures and outcomes retrospectively. We hypothesized that conduct disorder and body-image concerns would be major risk factors for subsequent AAS use among male weightlifters.

Results

Within our study population, many attributes showed little association with AAS use, but conduct disorder and body-image concerns showed strong associations. For individuals with prior conduct disorder versus those without, the hazard ratio (95% confidence interval) for subsequent AAS use was 2.2 (1.5, 3.4). For individuals in the middle versus lowest tertile of scores on a retrospective adolescent muscle-dysmorphia scale, the hazard ratio was 1.5 (.84, 2.6); for the highest versus lowest tertile, the hazard ratio was 3.3 (2.0, 5.3); and for the linear trend of hazard ratios, p < .001.

Conclusions

Conduct disorder and body-image concerns represent important risk factors for AAS use among male weightlifters. Thus, assessment of these attributes may help to identify individuals most likely to require interventions to discourage this form of substance abuse.

Section snippets

Participants

Because most illicit AAS users are male and lift weights (1, 20, 21), we chose this known high-risk population for study (see further discussion of this rationale below). Using methods developed in prior studies (18), we advertised in gymnasiums for men aged 18 to 40 who could “bench-press 275 pounds for at least one repetition, now or in the past, for a psychological and medical evaluation.” As previously explained (18, 22), the bench-press requirement was simply a device to generate an

Participants

We recruited 250 men at the three study sites, of whom 17 were excluded from analysis as described above, leaving 233 evaluable participants (Table 1). Of these, 102 (44%) reported lifetime AAS use (42 in Florida, 39 in Massachusetts, and 21 in California); their age at first AAS use ranged from 15 to 37 years, with a mean (SD) of 22.8 (5.1) years. Only 6 (6%) users reported onset of use before age 17. Users reported a mean of 110 (174) lifetime weeks of AAS use (range 1–900 weeks) at a mean

Discussion

We explored risk factors for AAS use among 233 community-recruited male weightlifters, aged 18 to 40, from Massachusetts, Florida, and California. The study used a cross-sectional cohort design (19), wherein the study population was recruited without selecting for the outcome variable (AAS use) and where the outcome and exposure variables were assessed retrospectively. As discussed above, this design entails no threats to validity not already present in an equivalent case-control design and

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