Nonmedical Anabolic-Androgenic Steroid Use: Prevalence, Attitudes, and Social Perception

Abstract

It is important that trends in the prevalence of illicit anabolic-androgenic steroid (AAS) use are monitored and understood globally in order to avert this public health problem. This necessitates the extension of research into AAS use to currently under-represented regions or contexts such as Africa. Additionally, although some studies have investigated the social perceptions of the personality of AAS users and nonusers through experimental designs, there is a dearth of experimental investigations of the social perceptions of the personality traits (Five-Factor Model) associated with AAS-using individuals and nonusers as well as users of ergogenic aids such as erythropoietin (EPO) and protein powder. Three investigations were conducted to elucidate the gaps in the literature noted above. The first aim was to estimate the global lifetime prevalence rate of AAS use and investigate moderators of the prevalence rate. The second aim was to explore the attitudes of Ghanaian high school students towards AAS use. The third aim was to investigate observer perceptions of the personality of AAS users in comparison with an EPO user, a protein powder user, and a nonuser of these performance-enhancing methods. A meta-analysis and a meta-regression analysis were performed to achieve the first aim. Included were 187 studies that provided original data on 271 lifetime prevalence rates. Studies were gathered from searches in PsycINFO, PubMed, ISI Web of Science, and Google Scholar among others. Heterogeneity was assessed by the I2 index and the Q-statistic. Random effect-size modeling was used. The global lifetime prevalence rate obtained was 3.3%. The prevalence rate for males, 6.4%, was significantly higher than the rate for females, 1.6%. Results of the meta-regression analysis indicated that athletes were associated with higher prevalence compared to high school students. Additionally, interview only studies had higher prevalence whereas studies combining interviews and questionnaires had lower prevalence (compared to questionnaire only studies). Sampling method (nonrandom) had a significant positive association with AAS use prevalence. Moreover, male sample percentage (lower than 75%) was associated with lower prevalence compared to studies with percentage of males not provided. The second study involved a cross-sectional survey of 2,597 (1,146 male and 1,412 female) high school students in Ghana. The response rate was 96.8%. Participants’ ages ranged between 11 to 35 years (M = 17.2, SD = 1.4). In addition to questions about nonmedical AAS use, participants answered questions about demography and sports participation. Standard descriptive statistics and multinomial logistic regression were used to analyze the data. The lifetime prevalence of AAS use was 3.8% (4.9% for males and 3.1% for females). Moreover, 18.5% admitted that they had an acquaintance that had used or did use AAS while 6.0% of the sample disclosed that they had been offered AAS previously. However, no valid AAS name was provided by users. Use and contemplation to use AAS was also significantly higher among males, teenagers, athletes (versus recreational sportspeople and nonathletes), and ball game players (versus other sports). Participation in martial arts, and swimming had significant negative association with AAS use attitudes. Conversely, female gender, living alone, religiosity, and participation in jogging had significant positive association with AAS use attitudes. Study 3 was an experimental investigation of ratings of the perceived personality (Five-Factor Model) of an AAS-using protagonist, an EPO-using protagonist, a protein powder-using protagonist and a nonuser of any of these ergogenic aids. The sample included 328 (236 females) non-substance use students drawn from three institutions of higher education in Norway. Participants were aged between 18 and 52 years (M = 21.88, SD = 4.13) and were randomly allocated into four separate experimental conditions: food (n = 82), protein powder (n = 83), erythropoietin (n = 83), and AAS (n = 80). In all four conditions, participants were similar in number, age, and gender distribution. They rated their protagonist on the NEO Five-Factor Inventory (NEO FFI). Multivariate analysis of variance was used to analyze the data. In line with our prediction, results showed that the food protagonist was perceived as least neurotic whereas the AAS and EPO protagonists were rated as similar on neuroticism. The food and protein powder protagonists were perceived as similar on openness although higher than the EPO protagonist. Protagonists of the ergogenic aids were perceived as less agreeable than the food protagonist. Although subject to some limitations, the results indicate that nonmedical AAS use is a serious widespread public health problem. The results also suggest a high prevalence of use and intent to use AAS among high school students in Ghana. Furthermore, the results indicate that a perception of AAS use has a negative effect on perception of the personality or social image of the user. Findings from these studies add to the existing knowledge on nonmedical AAS use. They may also be useful for public health interventions and clinical work involving AAS users.