Human growth hormone: a new substance of abuse among adolescents?

It has been estimated that as many as 250,000 adolescents are using anabolic steroids (AS). Recently, anecdotal reports suggest that athletes may also be using human growth hormone (HGH). The purpose of the present study was to determine the following: 1) if adolescents in two suburban midwestern high schools (83% white, 14% Asian, and 3% black) were using HGH; 2) knowledge of its effects; 3) reasons for use; and 4) concurrent AS use. After we obtained informed written consent, 224 male and 208 female 10th-grade students were surveyed using a 15-item questionnaire. Of male students surveyed, 5% (n = 11) reported past or present use of HGH, and one female student reported use. Our data suggest that among male adolescents surveyed, a majority had heard of this substance, and 31% of males reported knowing someone who was using HGH. Chi-square analysis found a significant association between AS and HGH use where seven AS users reported past or present use of HGH. Most HGH users were unaware of its side effects and reported first use between 14 and 15 years of age. No differences in sports activity, ethnicity, or age were found between users and nonusers of HGH.     

The use of anabolic steroids in high school students

The use of anabolic steroids by athletes has been a frequent topic in many recent reports. While much has been written in the lay literature, there is little in the scientific literature documenting the actual use of steroids, particularly in adolescents. We describe the results of a survey of 2113 high school students. The survey was designed to elicit information about students' general knowledge about anabolic steroids, awareness of the risks and side effects, and the incidence of use of anabolic steroids. Ninety-four (4.4%) of 2113 students admitted using anabolic steroids. Broken down by sex, 67 (6.5%) of 1028 males and 27 (2.5%) of 1085 females were users of steroids. Athletes had a higher use of steroids (79 [5.5%] of 1436 subjects) than nonathletes (15 [2.4%] of 636 subjects). These data suggest that we have another serious, as yet unappreciated drug problem in our adolescents.     

Use of dietary supplements and hormones in adolescents: A cautionary tale

Ergogenic aids, such as nutritional supplements, anabolic steroids and human growth hormone, are increasingly being used to enhance sports performance or body image. While few rigorous scientific studies have derived significant conclusions, the marketing and promotion of most supplements is intense and far exceeds the data supporting their use. Particular concern has arisen regarding safety in the use of these substances among adolescents, who may be at particular risk when using caffeine-ephedra and anabolic steroid combinations. Indeed, long-term effects and fatalities have been reported. As a consequence, the American Academy of Pediatrics has condemned the use of anabolic steroid use for bodybuilding or performance enhancement in adolescents. Health care professionals need to educate themselves about ergogenic use and ask informed questions of their adolescent patients. An honest discussion of the limitations of most supplements, and acknowledgement that some supplements may work some of the time, may allow the physician to be more credible and useful in providing medical care and guidance to the adolescent seeking to improve body image or athletic performance.     

Use of a statewide system to improve health and safety in child care facilities.

BACKGROUND: The Early Childhood Education Linkage System (ECELS) in Pennsylvania (PA) models ideals of the national Healthy Child Care America (HCCA) Campaign. Little is known about how child care providers use these newly developed statewide systems and about how users compare with nonusers of such a system. OBJECTIVES: Our objectives were 1) to assess knowledge and use of ECELS among child care providers in PA, 2) to compare users and nonusers of ECELS with regard to health concerns, advice-seeking preferences, and infant sleep positioning, and 3) to assess satisfaction among users of ECELS. METHODS: Cross-sectional telephone survey of directors of 400 licensed child care centers (CCCs) and providers of 400 registered family child care homes (FCCHs) in PA. RESULTS: The proportion of children with certain special health care needs mirrored the prevalence in the national child population. Of the facilities surveyed, 88% of CCCs and 71% of FCCHs had heard of ECELS. Among these, 85% had used ECELS's services in the previous 12 months. Significantly more nonusers than users consulted doctors, whereas more users consulted health professionals from government agencies and used printed materials. Of those who enrolled infants, 46% of users and 41% of nonusers reported placing infants on their backs only to sleep. Users who placed infants on their backs were more likely than nonusers to have a written policy about the correct practice (55% and 26%, respectively; P =.02). Overall, 46% of users and 28% of nonusers reported having a sleep position policy (P =.02). Users were at least 95% satisfied with ECELS's services. CONCLUSION: This statewide system reached most child care providers surveyed: more outreach is needed to providers in FCCHs. The health concerns, safety practices, and advice-seeking preferences of child care providers described in this article can inform others who are developing similar collaborative services in each state. Further research on the impact of HCCA programs on health and safety practices (such as correct infant sleep positioning) is warranted.     

Cross-sectional study of female students reporting anabolic steroid use

OBJECTIVE: To determine the characteristics of female US high school students reporting anabolic steroid use. DESIGN: Cross-sectional assessment using the 2003 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey database. SETTING: Nationally representative sample of US high schools. PARTICIPANTS: Female students in grades 9 through 12 (n = 7544). MAIN OUTCOME MEASURES: Participants' self-reported anabolic steroid use was compared with other health-related behaviors and with sports participation. RESULTS: Prior or ongoing anabolic steroid use was reported by 5.3% of female high school students. Those adolescent girls had a marked increase in other health-compromising behaviors, including past 30-day use of alcohol (odds ratio [OR], 8.83; 95% confidence interval [CI], 5.49-14.20]), cigarettes (OR, 5.14; 95% CI, 3.14-8.42), marijuana (OR, 7.91; 95% CI, 5.20-12.04), cocaine (OR, 10.78; 95% CI, 6.18-18.81), and diet pills (OR, 4.86; 95% CI, 2.98-7.93). They were more likely to carry a weapon (OR, 7.54; 95% CI, 4.83-11.76), have had sexual intercourse before age 13 years (OR, 2.90; 95% CI, 1.58-5.33), and have had feelings of sadness or hopelessness almost every day for at least 2 consecutive weeks (OR, 4.13; 95% CI, 2.57-7.22). They were less likely to play school-sponsored team sports (OR, 0.52; 95% CI 0.34-0.80). Steroid users participating in sports shared the same problem behaviors as steroid users not participating in team athletics. CONCLUSION: Self-reported anabolic steroid use is not confined to adolescent girls in competitive athletics and is an indicator of adolescent girls with a marked increase in a cluster of other health-harming behaviors.     

Anabolic steroid use by male adolescents

Anabolic steroids have recently been used by professional and college athletes to improve athletic ability by increasing muscle size and strength. A study was done to determine the extent of steroid use and knowledge about these drugs in a population of high school male adolescents in a southern state. A self-report questionnaire, which allowed multiple answers for each question, was administered to 853 male students in six high schools. Results indicated that an average of 11% had used or were using anabolic steroids. The following were assessed: the reasons for steroid use, the sources from which the students received information about steroids, their familiarity with the physiologic effects and complications of steroid use, and the extent of their involvement in sports. The results suggest that a segment of male adolescents are using anabolic steroids without fully understanding the risks of such behavior. Health care providers need to become knowledgeable about steroids so that they may better educate adolescents about the potential deleterious effects of these agents.     

Traumatic stress and gender differences in relationship to substance abuse,mental health,physical health,and HIV risk behavior in a sample of adolescents enrolled in drug treatment

Research on traumatic stress (TS) among adolescent substance users is limited, with research indicating that not all adolescents who experience trauma are substance users and not all adolescent substance users report symptoms of TS. In the general adolescent population, research on TS symptoms indicates gender differences, with more females reporting traumatic life events and more symptoms associated with traumatic stress. A gap in research exists, however, with regard to gender differences among adolescent substance users who report low versus acute levels of TS symptoms. This study included 274 male and 104 female adolescents enrolled in four drug treatment programs in Arizona. Comparisons between males and females and those with low versus acute levels of TS symptoms were examined with regard to substance use, mental health, physical health, and HIV risk-taking behavior. Results indicate significant differences between males and females and between those reporting low versus acute TS. In general, females and those with acute levels of TS symptoms had higher levels of substance use, mental health, and physical health problems as well as greater HIV risk behaviors when compared to males and those with low levels of TS symptoms. Results of this study indicate the need to assess adolescents for TS, including victimization and maltreatment histories, when entering substance abuse treatment and the need to simultaneously address issues of substance use, TS, and related mental health, physical health, and HIV sex risk behavior while in treatment.     

Complementary and alternative medicine use in children and adolescents with type 1 diabetes

BACKGROUND:

The use of complementary and alternative medicine (CAM) in paediatric patients varies between 11% and 68%. There are limited reports of its use in children with type 1 diabetes mellitus (T1DM).

OBJECTIVE:

To describe the use of CAM in children with T1DM, and the perceptions of both users and nonusers regarding the effect of CAM on diabetes management.

DESIGN/METHODS:

A cross-sectional, anonymous questionnaire survey was mailed to a randomly selected subgroup of patients with T1DM. Each patient’s main caregiver was asked to complete the questionnaire.

RESULTS:

Of 403 questionnaires mailed, 195 (48%) were completed. The mean (± SD) age of the children was 12.2±4.0 years (56% boys). Use of CAM was reported in 110 children (56%) (vitamins/minerals [n=99], herbal medicine [n=22], dietary supplement [n=13]). When excluding the use of vitamins/minerals, the CAM number dropped to 47 children (24%). Only the current age of the child was significantly different between users and nonusers of CAM. In users, reasons cited for using CAM were to minimize symptoms, improve control, prevent complications and add benefits to insulin. Only 30% of CAM users stated that CAM improved diabetes control. Nonusers cited satisfaction with current diabetes treatment and lack of knowledge as reasons for not using CAM.

CONCLUSIONS:

CAM use in children with T1DM was frequent, and appeared to be an attempt to improve control or prevent diabetes complications. However, improved control was not reported as a benefit. Diabetes care teams should assess the use of CAM in children with T1DM, and monitor for any potential positive or negative effects.     

Risk-compensation behavior in children: myth or reality?

OBJECTIVE: To assess risk compensation and risk homeostasis theory in children. DESIGN: We used a case-control study design in children aged 8 to 18 years who had an injury while participating in an activity that did or could entail the use of protective equipment (PE). SETTING: Montreal Children's Hospital emergency department from December 1, 2001, to November 30, 2002. PARTICIPANTS: We interviewed consenting children and compared the reports of risk-taking behaviors in those who did and those who did not report using PE. MAIN OUTCOME MEASURES: Indicators of risk-taking behavior and injury severity. RESULTS: A total of 674 children presented with injuries during the study, and 394 were interviewed (235 PE users and 159 nonusers). There was no evidence of an association between indicators of risk-taking behavior and PE use after adjusting for age, sex, personality, and type of activity and no relationship between injury severity and PE use. CONCLUSIONS: Results of this study provide no support for hypotheses about risk homeostasis theory among children using PE. The validity of the theory appears highly doubtful for children in this age range.     

Anabolic steroid use in adolescent athletes

Anabolic steroids are being used by adolescents largely to improve athletic performance but also to improve their appearance and to obtain peer approval. With the appropriate knowledge about the effects and side effects of anabolic steroids, primary care physicians can adequately educate teenagers, parents, teachers, and coaches about them and can screen for steroid use, if necessary.     

Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception

BACKGROUND: Several studies report an association between depot medroxyprogesterone acetate (DMPA) injectable contraception and decreased bone mineral density. Adolescents, who are still gaining bone, may be particularly affected, but there has been little study of the association in adolescent users and none following discontinuation. OBJECTIVE: To evaluate bone mineral density changes in adolescents using and discontinuing use of DMPA contraception. DESIGN: A population-based prospective cohort study. PARTICIPANTS: One hundred seventy adolescent women, aged 14 to 18 years; 80 baseline DMPA users and 90 age-similar, unexposed comparison women. Sixty-one participants discontinued DMPA use during follow-up. MAIN OUTCOME MEASURE: Bone mineral density, measured every 6 months for 24 to 36 months at the hip, spine, and whole body, comparing mean bone mineral density changes in DMPA users and discontinuers with nonusers. RESULTS: Among DMPA users, bone mineral density declined significantly relative to nonusers at the hip and spine but not the whole body. Annualized mean percentage changes, adjusted for covariates, were hip, -1.81% vs -0.19%; P<.001; spine, -0.97% vs 1.32%; P<.001, and whole body, 0.73% vs 0.88%; P = .78 for DMPA users vs nonusers, respectively. New users lost bone mineral density more rapidly than prevalent users. Discontinuers experienced significantly increased bone mineral density relative to nonusers at all anatomical sites; annualized mean percentage changes were hip, 1.34% vs -0.19%; P = .004; spine, 2.86% vs 1.32%; P = .004; and whole body, 3.56% vs 0.88%; P<.001. CONCLUSIONS: Use of DMPA contraception in adolescents was associated with significant continuous losses of bone mineral density at the hip and spine. However, significant gains postdiscontinuation provide evidence that the loss of bone mass is apparently reversed.     

Baby powder use in infant skin care. Parental knowledge and determinants of powder usage

One hundred parents of infants aged 2 weeks to 6 months were surveyed at the time of routine well-child visits to assess parental knowledge about baby powder and to determine whether hospital policy of providing a free powder sample to newly delivered mothers was unwittingly promoting powder usage. Most parents (69%) reported regular baby powder use as part of routine infant skin care. Powder-users were significantly more likely than nonusers to attribute to baby powder the ability to kill bacteria and yeast and to prevent diaper rash (p less than 0.01). Even among nonusers, fewer than half were aware that aspiration/ingestion of baby powder was a potential health hazard. Almost all parents reported receiving a free sample of baby powder while in the hospital as part of a complimentary gift pack provided by the manufacturers. Most powder-users were currently using a brand they had received as a sample, and eight parents cited the receipt of a sample as the major determinant for selecting a particular brand of powder. The short- and long-term effects of distributing sample packs to newly delivered parents deserve further study.     

Anabolic steroid education and adolescents: do scare tactics work?

The opinions (level of agreement) of high school varsity football players with regard to reported effects of anabolic steroids were assessed before and after two different education interventions. Lectures and handouts of a balanced education program (potential risks and benefits) were compared with a risks-only (negative or "scare tactics") presentation, in a controlled manner. Those receiving the balanced review significantly increased their agreement with 5 of 10 targeted adverse effects, while no change occurred for any risks among those taught by the negative intervention. A teaching model that only emphasizes the untoward consequences of anabolic steroids is ineffective, even in the short-term. A balanced education approach can improve understanding of the potential adverse effects of these drugs. Additional strategies may be required to change young athletes' attitudes toward anabolic androgenic steroid use.     

New addictions in the third millennium: anabolic steroids as a substance of abuse

AIM: The abuse of anabolic steroids is emerging as a psychosocially significant issue. In the last few years the use of the substances has shifted from professional sports to amateur sports and certain occupations (bouncers, models, etc.).In the literature, steroid users are portrayed as multidrug users who engage in dangerous and aggressive behavior towards themselves and others. This study looks into the habits, lifestyles and psychological profiles of a group of subjects who make regular use of sports centres in the city of Palermo, Italy, with the aim of establishing how the abuse of anabolic substances is associated with a specific lifestyle and particular psychosocial behaviour. METHODS: A revision of the American Massachusetts Youth Risk Survey questionnaire (1993), adapted for the Italian context, and a personality assessment scale, The Adjective Check List (1980), were administered to a group of 71 subjects. RESULTS: Fifteen of these subjects admitted taking steroids with differing frequencies. Using Spearman's rho rank correlation, repeated use of anabolic steroids was found to be correlated with abuse of other types of drugs, risk behavior and a distinct personality pattern. Steroid abuse was found to be significantly correlated (r = 0.35, 0.31, 0.30, 0.28, P < 0.01) with illegal drug use (LSD, cocaine and heroin). CONCLUSIONS: It is therefore imperative to develop studies and analyses to investigate more thoroughly the phenomenon and its related psychological and social context in order to lay the foundations for a targeted prevention programme, especially in countries such as Italy where this type of drug abuse is still largely unrecognised and risks degenerating into a new, full-blown social disease.     

Marijuana use in adolescence

The prevalence of marijuana use by adolescents has fluctuated in recent decades, but, overall, has increased significantly. In a study of adolescent health status and risk behaviours among students in grades 7 to 12 in British Columbia, it was found that the patterns of marijuana use had changed, especially among early adolescents. An earlier age of onset of use and an increased frequency of use were noted. The present paper examines the clinical and psychosocial implications of early age of onset of marijuana use, and reports important differences in risky behaviours between users and nonusers. The prevailing attitude that marijuana is a ‘safe, recreational’ drug is challenged.     

Perceived health status in a Turkish adolescent sample: risk and protective factors

The objective of this study was to investigate health status of Turkish adolescents and to determine the factors affecting their self perceptions of health. The subjects of the study were 4,153 grade 9–11 students from 26 randomly selected high schools in Istanbul. In total, 78% (n=3231) and 62% (n=2537) of the students reported that they were feeling healthy and happy, respectively. Prevalence of headache, abdominal pain and backache; feeling low, irritable, nervous and dizzy; medication use for headache, abdominal pain and nervousness were higher in females than in males (P<0.05 for each comparison). Prevalence of difficulty in getting to sleep and medication use for it were quite similar in both genders. Perceived higher socio-economic status, feeling happy and exercising longer than 2–3 h a week were found as protective factors related to feeling healthy for both genders. In females, ease of talking to mother and perceived adequate parental support on school matters and in males, ease of talking to father and satisfaction with body size were protective factors related to feeling healthy, respectively. Cigarette smoking and having headaches put feeling healthy at risk in both genders. In females, feeling left out of things, having backache and dizziness and medication use for nervousness and in males, feeling pressured by school work, abdominal pain and difficulty in getting to sleep were risk factors related to feeling healthy, respectively. Conclusion: the findings of this study suggest that a significant number of Turkish adolescents perceive themselves as not very healthy and experience psychosomatic symptoms. Perception of health differed to some extent according to gender. Programmes promoting health-related activities and coping strategies with parental participation need to be developed for improving health in high school students.     

Popular ergogenic drugs and supplements in young athletes

Ergogenic drugs are substances that are used to enhance athletic performance. These drugs include illicit substances as well as compounds that are marketed as nutritional supplements. Many such drugs have been used widely by professional and elite athletes for several decades. However, in recent years, research indicates that younger athletes are increasingly experimenting with these drugs to improve both appearance and athletic abilities. Ergogenic drugs that are commonly used by youths today include anabolic-androgenic steroids, steroid precursors (androstenedione and dehydroepiandrosterone), growth hormone, creatine, and ephedra alkaloids. Reviewing the literature to date, it is clear that children are exposed to these substances at younger ages than in years past, with use starting as early as middle school. Anabolic steroids and creatine do offer potential gains in body mass and strength but risk adverse effects to multiple organ systems. Steroid precursors, growth hormone, and ephedra alkaloids have not been proven to enhance any athletic measures, whereas they do impart many risks to their users. To combat this drug abuse, there have been recent changes in the legal status of several substances, changes in the rules of youth athletics including drug testing of high school students, and educational initiatives designed for the young athlete. This article summarizes the current literature regarding these ergogenic substances and details their use, effects, risks, and legal standing.     

Cerebral palsy: what do medical students know and believe?

OBJECTIVES: Negative attitudes toward people with disabilities, including cerebral palsy, may be related to misunderstandings or lack of knowledge about the disability. If held by medical practitioners, they can have detrimental implications for the care of people with disabilities. The purposes of this study were to examine the knowledge and attitudes of medical students regarding cerebral palsy and to examine the effects of the videotape 'Understanding Cerebral Palsy' on these two areas. METHODS: The attitudes and knowledge regarding cerebral palsy of 54 medical students in their penultimate year were measured before and after watching a video produced to educate health professionals about cerebral palsy. They were assessed using a self-administered questionnaire constructed specifically for the study, adapted from previously validated questionnaires. RESULTS: These medical students generally had limited knowledge about cerebral palsy and displayed negative attitudes toward people with cerebral palsy. It was also found that males had less positive attitudes than females (P = 0.014) and that students educated mainly in Asia had less positive attitudes than students educated mainly in Australia (P = 0.012). The videotape was shown to be effective in improving the students' knowledge about cerebral palsy. A small but significant improvement in attitudes was also shown (P = 0.014), with the attitudes of some students improving dramatically. However, negative attitudes remained in many. CONCLUSIONS: Based on the findings, structured teaching about cerebral palsy is necessary within the medical curriculum at the University of Melbourne. Greater promotion of positive attitudes toward people with cerebral palsy and other disabilities is required.