Research

Attitudes of Health Club Patrons Toward the Use of Non-medical Anabolic-androgenic Steroids by Competitive Athletes Versus Recreational Weightlifters

J. Jay Dawes, PhD, CSCS, *D, NSCA-CPT, *D, FNSCA

 

Richard L. Dukes, PhD

 

Craig Elder, PhD

 

Don Melrose, PhD, CSCS*D

 

Liette B. Ocker, PhD

 

author email    corresponding author email   

Topics in Integrative Health Care 2013, Vol. 4(2)   ID: 4.2004



Published on
June 28, 2013
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Abstract

This study investigated societal attitudes toward non-medical anabolic-androgenic steroid (AAS) use. One hundred and seventy-eight (n=178) health club patrons were presented two vignettes featuring an athlete or recreational weightlifter taking AAS to improve either performance or looks. After reading the vignette participants responded to 3 open-ended questions and a 10-item questionnaire about the use of AAS. A cross-tabulation analysis using Cramer’s V and Multivariate Analysis of Variance were used to examine the extent to which the independent variable of “scenario” had an effect on each of the dependent variables. Analysis revealed more harsh feelings toward the athlete using AAS for performance versus the non-athlete using AAS for looks. Significant differences were found between the vignette scenarios regarding the two different types of AAS users. Based on the results of this research it appears that individuals that take AAS for the purpose of improving their appearance are viewed less harshly than athletes taking AAS to improve sports performance. Professionals in the field need to recognize that societal pressure may not be a good deterrent against AAS use and should instead encourage scientifically based nutrition, dietary supplement and strength training programs to help their clients or patients achieve their goals.

Introduction

In recent years the use of anabolic–androgenic steroids (AAS) for improving athletic performance has received a great deal of media attention. Several high-profile news stories, such as the Bay Area Laboratory Cooperative (BALCO) Scandal, the 2007 Mitchell Report on Steroid Use in Baseball, and the admission of steroid use by Olympic gold medalist Marion Jones have captured the headlines and tainted the image of competitive sports for many.1 While the use of AAS by athletes continues to be highly publicized, these individuals likely represent only a small fraction of the estimated 3 million Americans who may have used AAS for non-medical purposes.2 In fact, a majority of AAS users are not athletes at all, but rather individuals seeking to improve their overall muscularity and physical appearance or other non-medical purposes, such as increasing lean muscle mass, enhancing strength and power potential, decreasing body fat, and hastening recovery from training and competition.1,3-5 In a survey of 1,955 males using illicit AAS, the majority of respondents were not athletes, and were motivated primarily by improving muscle size, strength, and physical attractiveness.6
 
The prevalence of steroid use in athletics has received a great deal of attention from the media, public and even the US government.1 While the use of AAS by high-profile athletes seems to grab the majority of the headlines, the use of illicit AAS by the general population receives little attention. Cohen, Collins, Darkes and Gwartny6 surveyed 1,955 males using illicit AAS. In this study the authors discovered that the majority of respondents were not motivated by athletics, were not active in organized sports, and were motivated to use AAS in an attempt to accrue greater amounts of muscle mass, improve strength, and enhance physical attractiveness. Furthermore, it was found that the average respondent was actually a highly-educated, gainfully employed professional, approximately 30 years of age, earning an above-average income. Parkinson and Evans7 obtained similar results. In their survey of 500 anabolic steroid users, 78.4% (392/500) were non-competitive bodybuilders and non-athletes. This suggests these individuals are likely using AAS as a means of improving aesthetics.
 
At this time it is unclear what perceptions are of those who take AAS for non-medical purposes. It is also unclear as to whether athletes are judged more harshly than those individuals who take AAS to improve their looks.

Methods

To investigate attitudes toward non-medical anabolic-androgenic steroid (AAS) use by competitive athletes and recreational weightlifters, a convenience sample of 113 male and 64 female health club patrons between the ages of 18- 77 ( µ = 38.3 ± 13.35 yrs.) was selected and randomly assigned to read one of two prepared vignettes created by the investigators. The authors chose health club members because they felt they were the most likely group of individuals to have opinions on the recreational and performance enhancing use of AAS. Approximately 87% of the respondents reported that the ethnicity that best classified them was Caucasian and 65% of respondents reported being married.
 
The first vignette depicted a professional male competitive athlete who took AAS to improve his performance (n=92) and the second vignette was a recreational male weightlifter who took AAS to improve his looks (n=86). After reading the vignette participants responded to 3-open ended questions regarding the vignette (Table 1a and Table 1b) and three items with structured responses about the vignette and the use of AAS (Table 2). A cross-tabulation analysis using Cramer’s V was used to examine the extent to which the independent variable of “scenario” had an effect on each of the three dependent variables that were coded from the open-ended questions. Multivariate Analysis of Variance (MANOVA) was subsequently conducted on the three closed-ended items within the questionnaire.


Table 1a: Professional athlete vignette
 
Joe is a professional athlete taking anabolic-androgenic steroids to improve his performance.
  1. What do you think is Joe’s “real” motivation is for using steroids?
  2. If Joe tested positive for using AAS, what should he do?
  3. What should happen to Joe?



Table 1b: Recreational weightlifter vignette
 
Joe is a recreational weightlifter taking anabolic-androgenic steroids to improve his looks
  1. What do you think is Joe’s “real” motivation is for using steroids?
  2. If Joe tested positive for using AAS, what should he do?
  3. What should happen to Joe?
 



Table 2: Analysis of closed-ended items by “item” and “scenario”.


AAS for Performance 
AAS for Looks
 
 
 
n
Mean
SD
n
Mean
SD
F
p
Joe is obsessive.
 
 
90
4.07
0.98
 
81
3.70
0.99
5.77
< 0.01
Joe should be ashamed.
 
 
90
3.79
1.08
 
80
3.40
1.05
5.66
< 0.05
Joe believes he has no other choice.
 
88
3.13
1.21
 
81
2.65
1.17
9.34
< 0.05

Note: Response categories for all three items were as follows: Strongly disagree (1), Disagree (2), Neutral (3), Agree (4) and Strongly agree (5)


Results

The relation between “scenario” and “the athlete’s presumed real motivation for using steroids” is presented in Table 2. The association was substantial and statistically significant (V = 0.52, p < 0.001, n=176). The relation between “scenario” and “the recommended action that the athlete should take in response to a positive test for steroids” is presented in Table 3. The association was strong and statistically significant (V = 0.52, p < 0.001, n=173). The relation between “scenario” and “the recommended action that should be taken against the athlete” is presented in Table 5. The association was strong and statistically significant (V = 0.72, p < 0.001, n=171). The numbers of cases in the three analyses above vary due to missing data.

Table 3. Crosstabulation of Joe’s real reason for using steroids by scenario.

 
What do you think is Joe’s “real” motivation is for using steroids?
 
AAS for
Performance:
Percent
AAS for
Looks:
Percent
 
Total
Percent
Improvement in performance
43.5
9.5
27.3
Improvement in body composition
20.7
32.1
26.1
Faster results
6.5
21.4
13.6
Greater recognition and monetary reward
16.3
2.4
9.7
Greater sexual attractiveness
1.1
6.0
3.4
Compensation for poor self-esteem
10.9
19.0
14.8
Other
1.1
9.5
5.1
Total
100.0
100.0
100.0
 



Table 4. Crosstabulation of what Joe should do by scenario

 
If Joe tested positive for using steroids, what should he do?
AAS for
Performance:
Percent
AAS for
Looks:
Percent
 
Total
Percent
Confess to using AAS
40.7
31.7
36.4
Deny using AAS
3.3
1.2
2.3
Stop using AAS
26.4
25.6
26.0
Get professional help
6.6
14.6
10.4
Nothing
0.0
8.5
4.0
Accept the consequences of using AAS
13.2
1.2
7.5
Other
9.9
17.1
13.3
Total
100.0
100.0
100.0

 


Table 5. Crosstabulation of what should happen to Joe by scenario

 
What should happen to Joe?
AAS for
Performance:
Percent
AAS for
Looks:
Percent
 
Total
Percent
Punishment by sport
58.2
2.5
32.2
Punishment by law
2.2
20.0
10.5
Other punishment
13.2
2.5
8.2
Professional help & education
2.2
23.8
12.3
Nothing
13.2
42.5
26.9
Other
11.0
8.8
9.9
Total
100.0
100.0
100.0
 


 
A multivariate analysis of variance (MANOVA) was computed for the answers to the three closed-ended items (i.e. “Joe is obsessive,” “Joe should be ashamed” and “Joe believes he had no choice”) to examine the difference between the AAS for performance group and the AAS for looks group when the dependent variables are considered together. Means and standard deviations for these items are presented in Table 5. When they are considered together, Pillai’s Trace was .09. The effect size using Eta was .30, and it was statistically significant beyond the .01 level. When the MANOVA is statistically significant there is no need to analyze the dependent variables separately; however, all of the p-values for the univariate Fs are statistically significant beyond the .05 level. They are presented in the last column of Table 5.
 
Respondents who read the vignette that depicted the competitive athlete regarded him as more obsessive, as having better choices, and as someone who should be more ashamed of his AAS use than did participants who read the vignette that depicted the recreational weightlifter (all 3 Fs (1,169)  > 5.66, all 3 ps < .05). In addition, 75% of respondents who read the vignette on the competitive athlete judged that he should be punished legally or by his sport (with 20% stating he should be banned from his sport for life). On the other hand, only 25% of participants who read the vignette on the recreational weightlifter judged that he should be punished. In addition, only 2% of the participants who read the scenario on the competitive weightlifter thought he needed professional help, including drug education. Twenty-four percent of the participants who read the vignette on the recreational weightlifter thought that he needed this type of help. Finally, 13% of participants thought nothing should happen to the competitive athlete, but 42% thought that nothing should happen to the recreational weightlifter (Cramer’s V (df = 3) = .54, p < 0.001). In fact, many participants judged that for the recreational AAS user, any negative health complications were punishment enough. When we analyzed separately the 87 responses that recommended punishment, 90% of participants who read the vignette on the competitive athlete, and who advised punishment, recommended that he be punished by his sport, but 80% of participants who read the vignette on the recreational athlete, and who advised punishment, recommended that he be punished by the criminal justice system (V = .66, p < 0.001).

Discussion

The purpose of this study was to investigate the attitudes of health club users toward the use of AAS for non-medical purposes and their attitudes toward those that use them. One-hundred seventy-eight respondents were asked to answer 4-open ended questions and a 10-item questionnaire regarding their opinions toward two different types of non-medical steroid users based on one of two vignettes, as well as a demographic questionnaire.

When respondents were asked “What is Joe’s real reason for using AAS?” , the majority of respondents answering the athlete scenario believed it was to improve his physical ability, while for the non-athlete scenario respondents believed Joe took AAS to get better/faster results. Ironically, for both scenarios, poor self-image/esteem were both cited as possible reasons for use. While this explanation would be expected in the non-athlete scenario, it is curious as to why individuals would perceive this as being the main reason for using AAS by an athlete concerned with performance. One explanation for this may be that many athletes rely on endorsements and those perceived as being more attractive, or sex symbols may have an opportunity to increase their financial earnings. Another potential reason for this explanation may relate to the respondent’s own level of self-image/esteem. Feather9 showed that the generalized beliefs people hold about their own self-worth will affect their attitudes toward others. Thus, respondents who believed Joe was taking steroids due to a poor self-image or a lack of self-esteem may be projecting their feelings toward themselves to the character discussed in the vignette.

When asked, “If Joe were accused of using AAS, what should he do?” most respondents agreed he should confess. However, in the athlete scenario a few interesting themes emerged regarding the specific terms of Joe’s confession. Several respondents said Joe should only confess if accused by a coach, and he would not be punished by the authorities in his sport. A few respondents even suggested that Joe request a drug test in order to stall his accusers and attempt to “clean his system” prior to being tested. While the reasons for these responses are unclear, it is likely that the respondents may be projecting their own values and the manner in which they would respond in this situation.
 
Most respondents also agreed that Joe should confess his use if he tested positive for AAS use. Interestingly, athletes who have admitted to using AAS, apologized, and proclaimed they are no longer using AAS seem to receive far less public scrutiny than players who emphatically deny using AAS.8 
 
At this time, it is unclear as to whether these athletes did in fact use AAS to improve their performance. However it appears they are persecuted to a greater extent than those players who have admitted to using AAS and discontinued their use. In fact, because many of these players have set world records or accrued statistics worthy of lifetime achievement recognitions, such as Hall of Fame induction, many believe they should either not be inducted, or their records and statistics should be asterisked to denote that they did not attain their accomplishments “naturally.” However, in this study many respondents appear willing to forgive those athletes who admit to AAS use, and wrong-doing, as long as those individuals display a sincere intent to prove themselves naturally from that point forward. When asked, “What should happen to Joe?”, approximately 65% of all respondents believed the athlete should be punished for his actions, whereas only 14% of respondents believed the non-athlete should be punished. Furthermore, 40% of all respondents believed that the non-athlete should not suffer any consequences. In fact, many stated that the damage he has done to his body is punishment enough. Thus, based on this question it appears that athletes may be judged more harshly for using AAS than their non-athletic counterparts. This rationale is supported by a study conducted by Feather8,9 regarding the use of steroids by gold-medalist Ben Johnson. In this study, negative attitudes toward this athlete were found to be directly related to his negatively-valued and controllable behavior, more specifically his use of AAS to improve performance. This may be due to the fact that the athlete using AAS is perceived to have an unfair advantage over their competition. This explanation is supported by Paccagnella and Grove9 who state “outcomes are more likely to be judged undeserved if the person is not seen to be responsible for their high status” (p.311). Therefore, athletes using AAS may not be viewed as solely responsible for their accomplishments due to their use of AAS as an ergogenic aid. As a result, they are more scrutinized by the public. However, this does not explain why athletes who have admitted and discontinued use of AAS are judged less harshly. In fact, former baseball Commissioner Fay Vincent was quoted by Jenkins4 as saying, “any big-time player who has used steroids should come clean immediately and ask for forgiveness” (p.5). In the same article, Vincent added, "I would expect that a very big percentage of fans are going to say, 'We don't care what they took.' "(p. 5).
 
After ANOVA was conducted on the 10-item questionnaire, a strong relationship was found between the variable of scenario and three independent variables. Basic descriptive statistics revealed that on the statements “Joe is obsessive”, and “Joe should be ashamed” the majority of respondents agreed with these statements. Conversely, most respondents disagreed with the statement that “Joe believes he has no other choice”. Based on these findings, it appears that regardless of vignette, respondents viewed Joe’s use of AAS as both negative and controllable, which may significantly impact attitudes toward those using AAS for non-medical reasons.
 
While the majority of respondents viewed the use of AAS to improve both performance and aesthetics as negative, athletes were judged more harshly than those taking AAS to improve their looks. Many of our respondents perceive the use of these substances by athletes as cheating and feel that these individuals should receive punishment ranging from censure to banishment in their respective sports. Others feel that use of AAS is so prevalent in sport that they should receive no punishment, as they perceive it is required for an individual to compete at a high level. Conversely, for individuals seeking aesthetic benefits many stated that they felt any negative health consequences experienced by the user would be sufficient punishment for their actions.
 
Anabolic-androgenic steroids are not legal for use in the United States without medical prescription. Therefore, individuals in the United States must illegally purchase these substances from individuals, via the Internet, or on the black-market. This brings into question the purity of these substances, and subsequently their safety. Thus, even if an individual were willing to accept the risk of using AAS they may not be willing to accept the risk of other substances that may be found in these products. Furthermore, since these products would be obtained through criminal activities there is little recourse for products found to be impure. Educational programs aimed at sharing this information with potential AAS users, in addition to providing scientifically based nutrition, dietary supplement and strength training material to help individuals to safely achieve their goals. 
 
To gain greater insight into societal attitudes toward non-medical AAS users, future research should use larger sample sizes and investigate differences in response by the respondent’s political and religious views, as these factors may have an impact on perceptions and attitudes toward AAS users. In addition, this study did not investigate the potential impact of projection, personality factors or self-esteem on the respondent’s attitudes and perceptions toward the vignettes. Additional research in these areas may provide a greater understanding of the reasons for societal views toward individuals using AAS for non-medical purposes. With regards to self-esteem, an interesting theoretical consideration is what has been referred to by Feather 8 as the “tall poppy syndrome”. According to this syndrome, individuals with higher self-esteem who are high-achievers, and classify themselves as tall poppies, identify better with other tall poppies and have a tendency to want see them rewarded.9-11 However, those with low self-esteem are typically less likely to identify with tall poppies. Though they may admire and respect them for their achievements, they may have more negative attitudes toward tall poppies than people with high self-esteem.11 

Conclusions

This study sought to determine how society views individuals engaged in the use of AAS for non-medical purposes. Based on these findings it appears that, in our sample, societal pressure did not appear to be a significant deterrent for individuals contemplating using AAS for non-medical purposes. However, since the sample population for this study was only health club users it may not be representative of the entire U.S. demographic. Consequently, further research using larger and more diverse populations may be of value.
 
In conclusion, this study revealed that, in this sample of health club members, athletes using AAS to improve performance were judged more harshly than those using AAS for aesthetic purposes. Reasons for this may relate to the respondents’ individual personality factors and level of self-esteem. However, future research is needed in this area to gain a greater understanding of how these factors may impact attitudes toward non-medical AAS-users.
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