Anabolic Steroid Abuse: Federal Efforts to Prevent and Reduce	 
Anabolic Steroid Abuse among Teenagers (31-OCT-07, GAO-08-15).	 
                                                                 
The abuse of anabolic steroids by teenagers--that is, their use  
without a prescription--is a health concern. Anabolic steroids	 
are synthetic forms of the hormone testosterone that can be taken
orally, injected, or rubbed on the skin. Although a 2006 survey  
funded by the National Institute on Drug Abuse (NIDA) found that 
less than 3 percent of 12th graders had abused anabolic steroids,
it also found that about 40 percent of 12th graders described	 
anabolic steroids as "fairly easy" or "very easy" to get. The	 
abuse of anabolic steroids can cause serious health effects and  
behavioral changes in teenagers. GAO was asked to examine	 
federally funded efforts to address the abuse of anabolic	 
steroids among teenagers and to review available research on this
issue. This report describes (1) federally funded efforts that	 
address teenage abuse of anabolic steroids, (2) available	 
research on teenage abuse of anabolic steroids, and (3) gaps or  
areas in need of improvement that federal officials and other	 
experts identify in research that addresses teenage anabolic	 
steroid abuse. To do this work, GAO reviewed federal agency	 
materials and published studies identified through a literature  
review and interviewed federal officials and other experts.	 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-15						        
    ACCNO:   A77798						        
  TITLE:     Anabolic Steroid Abuse: Federal Efforts to Prevent and   
Reduce Anabolic Steroid Abuse among Teenagers			 
     DATE:   10/31/2007 
  SUBJECT:   Adolescent health					 
	     Drug abuse 					 
	     Drug abuse prevention				 
	     Drugs						 
	     Federal aid programs				 
	     Health hazards					 
	     Program evaluation 				 
	     Public health research				 
	     Schools						 
	     Secondary school students				 
	     Steroids						 
	     Students						 
	     Surveys						 
	     Teenagers						 
	     Athletes Targeting Healthy Exercise &		 
	     Nutrition Alternatives				 
                                                                 
	     Athletes Training and Learning to Avoid		 
	     Steroids						 
                                                                 
	     Drug-Free Communities Support program		 
	     School-Based Student Drug Testing			 
	     program						 
                                                                 

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GAO-08-15

   

     * [1]Results in Brief
     * [2]Background
     * [3]Some Federally Funded Efforts Are Designed to Focus on Preve

          * [4]Some Federally Funded Programs, Research, and Activities Are
          * [5]Two Federal Grant Programs Designed to Address Substance Abu

     * [6]Research Shows Teenage Anabolic Steroid Abuse Is Linked to C
     * [7]Experts Find There Are Gaps in Research on the Sustained Eff
     * [8]Agency Comments
     * [9]Appendix I: Selected Federally Funded Efforts That Address o
     * [10]Appendix II: Articles Included in GAO's Review
     * [11]Appendix III: GAO Contact and Staff Acknowledgments

          * [12]GAO Contact
          * [13]Staff Acknowledgments

               * [14]Order by Mail or Phone

Report to the Committee on Oversight and Government Reform, House of
Representatives

United States Government Accountability Office

GAO

October 2007

ANABOLIC STEROID ABUSE

Federal Efforts to Prevent and Reduce Anabolic Steroid Abuse among
Teenagers

GAO-08-15

Contents

Letter 1

Results in Brief 3
Background 4
Some Federally Funded Efforts Are Designed to Focus on Preventing Teenage
Steroid Abuse, While Other Efforts Designed to Address Substance Abuse in
General May Include Teenagers 9
Research Shows Teenage Anabolic Steroid Abuse Is Linked to Certain Risk
Factors and That Prevention Programs May Have Some Short-term
Effectiveness 14
Experts Find There Are Gaps in Research on the Sustained Effectiveness of
Prevention Programs and on the Long-term Health Effects for Teenagers 16
Agency Comments 17
Appendix I Selected Federally Funded Efforts That Address or Can Address
Anabolic Steroid Abuse among Teenagers 18
Appendix II Articles Included in GAO's Review 21
Appendix III GAO Contact and Staff Acknowledgments 23

Table

Table 1: Selected Federally Funded Efforts That Address or Can Address
Anabolic Steroid Abuse among Teenagers 18

Figures

Figure 1: Reported Lifetime Anabolic Steroid Abuse among 12^th Graders,
1991-2006 7
Figure 2: Reported Past Year Anabolic Steroid Abuse by Male and Female
Adolescents, 2002-2006 8

Abbreviations

ATHENA: Athletes Targeting Healthy Exercise & Nutrition Alternatives: 
ATLAS: Athletes Training and Learning to Avoid Steroids: 
CDC: Centers for Disease Control and Prevention: 
HHS: Department of Health and Human Services: 
MTF: Monitoring the Future: 
NIDA: National Institute on Drug Abuse: 
NIH: National Institutes of Health: 
ONDCP: Office of National Drug Control Policy: 
SAMHSA: Substance Abuse and Mental Health Services Administration: 
USADA: United States Anti-Doping Agency: 
YRBS: Youth Risk Behavior Survey: 

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separately.

United States Government Accountability Office
Washington, DC 20548

October 31, 2007

The Honorable Henry A. Waxman: 
Chairman: 
The Honorable Tom Davis: 
Ranking Member: 
Committee on Oversight and Government Reform: 
House of Representatives: 

The abuse of anabolic steroids^1 by teenagers--that is, their use without
a prescription--is a health concern. Anabolic steroids are synthetic forms
of the hormone testosterone that can be taken orally, injected, or rubbed
on the skin. Although a 2006 survey funded by the National Institute on
Drug Abuse (NIDA) showed that less than 3 percent of 12^th graders had
abused anabolic steroids, the survey also showed that about 40 percent of
12^th graders described anabolic steroids as "fairly easy" or "very easy"
to get. The abuse of anabolic steroids can cause serious health effects
and behavioral changes in teenagers. Under U.S. law, anabolic steroids are
controlled substances whose manufacture, possession, and use are regulated
by the federal government;^2 they also cannot be sold legally without a
prescription.

You asked us to examine federally funded efforts to address the abuse of
anabolic steroids among teenagers and to review available research on this
issue. In this report, we

           1. describe major, federally funded efforts that address teenage
           abuse of anabolic steroids,
           2. describe the available research on teenage abuse of anabolic
           steroids, and
           3. describe gaps or areas in need of improvement that federal
           officials and other experts identify in research that addresses
           anabolic steroid abuse among teenagers.

^1We use the term anabolic steroids to refer to anabolic steroids and
their precursors, as defined in the Controlled Substances Act. See 21
U.S.C. S 802 (23), (41).

^2The Crime Control Act of 1990 amended the Controlled Substances Act to
include anabolic steroids. 21 U.S.C. S 812(c), Schedule III (e).

We focused our review on the abuse of anabolic steroids by teenagers in
grades 8 through 12. To describe federally funded efforts to address
anabolic steroid abuse among teenagers, we reviewed databases of federal
grant programs.^3 We also obtained and reviewed pertinent reports and
information from the Web sites of agencies within the Department of Health
and Human Services (HHS)--the Centers for Disease Control and Prevention
(CDC), the National Institutes of Health (NIH), and the Substance Abuse
and Mental Health Services Administration (SAMHSA)--as well as the Web
sites of the Department of Education (Education) and the Office of
National Drug Control Policy (ONDCP). We used these resources to identify
federally funded programs,^4 research, and education and outreach
activities that address--through efforts to either prevent or
reduce--anabolic steroid abuse among teenagers. After identifying these
efforts, we interviewed and collected information from federal officials
to confirm that these efforts are intended to prevent or reduce anabolic
steroid abuse among teenagers. Where available, we requested funding
information on the federal efforts that we identified.^5

To describe the available research on teenage abuse of anabolic steroids,
we conducted a systematic review of the published literature on this
topic. We identified 16 articles that related to teenage abuse of anabolic
steroids and were published from January 1995 through June 2007. To select
the articles, we conducted a keyword search using the Dialog Database
System,^6 a system that searches numerous database files, and reviewed the
resulting article titles and abstracts to identify whether the articles
focused on teenage abuse of anabolic steroids. We did not select articles
that were international works, based on reviews of other articles or
research, position papers, policy statements, or federal agency program
documents. The references we make to articles refer strictly to those that
we reviewed.

^3We searched both the Catalog of Federal Domestic Assistance, a database
of federal grant programs maintained by the General Services
Administration, and the Computer Retrieval of Information on Scientific
Projects, a database of research grants funded by the National Institutes
of Health.

^4We define federally funded programs as including programs that were
developed, implemented, or tested using federal funding.

^5The efforts that we discuss in this report may not represent all
federally funded activities that address anabolic steroid abuse among
teenagers but reflect those efforts mentioned by federal officials with
whom we consulted. We were unable to determine the extent of total federal
funding for programs that address teenage anabolic steroid abuse because,
in some instances, funding information covers more than prevention of
teenage anabolic steroid abuse.

^6We searched using the keywords anabolic steroids, abuse, addiction,
teen, youth, adolescent, prevent, and treat.

To describe the gaps or areas in need of improvement in research that
addresses teenage abuse of anabolic steroids as identified by experts, we
interviewed experts in anabolic steroid abuse and reviewed relevant
literature. We interviewed federal officials from CDC, NIDA, SAMHSA, and
Education, as well as other experts from universities and professional
associations. We reviewed research articles identifying gaps or areas in
need of improvement as part of our systematic review of the literature. We
conducted the work for our review from January 2007 through September 2007
in accordance with generally accepted government auditing standards.

Results in Brief

There are two categories of federally funded efforts that address teenage
abuse of anabolic steroids. Efforts are either designed to focus on
preventing the abuse of anabolic steroids among teenagers or are broader
and designed to prevent substance abuse in general--which can include
abuse of anabolic steroids among teenagers. Two programs that received
federal funding during their development and testing, Athletes Training
and Learning to Avoid Steroids (ATLAS)^7 and Athletes Targeting Healthy
Exercise & Nutrition Alternatives (ATHENA), are designed to focus on
preventing or reducing teen abuse of anabolic steroids. In addition, there
are various research efforts and education and outreach activities that
focus on this issue. For example, in addition to steroid-related research,
since 2000 NIDA has provided nearly $500,000 in funding for a variety of
education and outreach activities including a multimedia educational
initiative intended to prevent anabolic steroid abuse among teenagers. Two
federal grant programs--ONDCP's Drug-Free Communities Support program and
Education's School-Based Student Drug Testing program--are designed to
support state and local efforts to prevent substance abuse in general and
may include anabolic steroid abuse among teenagers as part of the
programs' substance abuse prevention efforts. In 2007, about one-quarter
of more than 700 Drug-Free Communities Support program grantees reported
that they were addressing steroid abuse as one of their program's
objectives.

^7ATLAS--the acronym for the prevention program named Athletes Training
and Learning to Avoid Steroids--originally stood for Adolescents Training
and Learning to Avoid Steroids, which was the title of the NIDA research
grants that supported the program's development. For this reason, some
published research describing the program, as listed in appendix II, for
example, refers to ATLAS as Adolescents Training and Learning to Avoid
Steroids.

Almost half of the 16 studies we reviewed identified certain risk factors
and behaviors linked to the abuse of anabolic steroids among teenagers.
Several of these studies found connections between anabolic steroid abuse
and risk factors such as use of other drugs, risky sexual behaviors, and
aggressive behaviors. Most of the other studies we reviewed were
assessments of the ATLAS and ATHENA prevention programs. In general, these
studies suggested that the programs may reduce abuse of anabolic steroids
and other drugs among high school athletes immediately following
participation in the programs.

Experts identified gaps in the research that addresses anabolic steroid
abuse among teenagers. Experts identified a lack of conclusive evidence of
sustained effectiveness over time of available prevention programs, for
example at 1 year following participants' completion of the programs.
Experts also identified gaps in the research on the long-term heath
effects of initiating anabolic steroid abuse as a teenager--including
research on effects that may be particularly harmful in teenagers--and in
the research on psychological effects.

HHS and Education provided technical comments only, which we incorporated
into the report as appropriate.

Background

The abuse of anabolic steroids differs from the abuse of other illicit
substances. When users initially begin to abuse anabolic steroids, they
typically are not driven by a desire to achieve an immediate euphoria like
that which accompanies most abused drugs such as cocaine, heroin, and
marijuana. The abuse of anabolic steroids is typically driven by the
desire of users to improve their athletic performance and
appearance--characteristics that are important to many teenagers. Anabolic
steroids can increase strength and boost confidence, leading users to
overlook the potential serious and long-term damage to their health that
these substances can cause. In addition, the methods and patterns of use
for anabolic steroids differ from those of other drugs. Anabolic steroids
are most often taken orally or injected, typically in cycles of weeks or
months (referred to as "cycling"), rather than continuously. Cycling
involves taking multiple doses of anabolic steroids over a specific period
of time, stopping for a period, and starting again. In addition, users
often combine several different types of anabolic steroids to maximize
their effectiveness (referred to as "stacking").

While anabolic steroids can enhance certain types of performance or
appearance, when used inappropriately they can cause a host of severe,
long-term, and in some cases, irreversible health consequences. The abuse
of anabolic steroids can lead to heart attacks, strokes, liver tumors, and
kidney failure. In addition, because anabolic steroids are often injected,
users who share needles or use nonsterile injection techniques are at risk
for contracting dangerous infections, such as HIV/AIDS and hepatitis B and
C. There are also numerous side effects that are gender-specific,
including reduced sperm count, infertility, baldness, and development of
breasts among men; and growth of facial hair, male-pattern baldness,
changes in or cessation of the menstrual cycle, and deepened voice among
women. There is also concern that teenagers who abuse anabolic steroids
may face the additional risk of halted growth resulting from premature
skeletal maturation and accelerated puberty changes.

The abuse of anabolic steroids may also lead to aggressive behavior and
other psychological side effects. Many users report feeling good about
themselves while on anabolic steroids, but for some users extreme mood
swings also can occur, including manic-like symptoms leading to violence.
Some users also may experience depression when the drugs are stopped,
which may contribute to dependence on anabolic steroids. Users may also
suffer from paranoia, jealousy, extreme irritability, delusions, and
impaired judgment stemming from feelings of invincibility.

Two national surveys showed increasing prevalence in teenage abuse of
steroids throughout the 1990s until about 2002 and a decline since then
(see fig. 1). One of these two national surveys, the Monitoring the Future
(MTF) survey, is an annual survey conducted by the University of Michigan
and supported by NIDA funding.^8 The MTF survey measures drug use and
attitudes among students in grades 8, 10, and 12, and asks several
questions about the use of and attitudes towards anabolic steroids, such
as perceived risk, disapproval, and availability of anabolic steroids. The
survey's questions are designed to assess respondents' use of steroids in
the last 30 days, the past year, and over the course of the respondent's
lifetime. Questions about steroid use were added to the study beginning in
1989. The most recent results from this survey showed that in 2006, 2.7
percent of 12^th graders said they had used anabolic steroids without a
prescription at least once. The second national survey, the Youth Risk
Behavior Survey (YRBS), is a biennial survey conducted since 1991 by
CDC.^9 The YRBS is part of a surveillance system consisting of national,
state, and local surveys of students in grades 9 through 12. These surveys
collect information about a wide variety of risk behaviors, including
sexual activity and alcohol and drug use. The most recent available
national YRBS survey--conducted in 2005--asked one question related to
lifetime steroid use without a prescription, which showed that 3.3 percent
of 12^th graders had used steroids at least once.

^8The MTF survey is administered to nationally representative samples of
public and private secondary school students throughout the United States.
In 2006, sample sizes were about 17,000, 16,600, and 14,800 in 8th, 10th,
and 12th grades, respectively. In all, about 48,500 students in 410
secondary schools participated in the 2006 survey.

^9The sampling frame for the 2005 national YRBS survey consisted of all
public and private schools with students in at least one of grades 9
through 12 in the 50 states and the District of Columbia. For the 2005
national YRBS survey, 13,953 questionnaires were completed in 159 schools
by a nationally representative sample of students in grades 9 through12.

Figure 1: Reported Lifetime Anabolic Steroid Abuse among 12^th Graders,
1991-2006

The MTF and YRBS surveys indicate a low abuse rate for anabolic steroids
among teenagers^10 when compared with the abuse rates for other drugs.^11
However, the reported easy availability of steroids^12 and the potential
for serious health effects make anabolic steroid abuse a health concern
for teenagers, particularly among males. In general, the reported rates of
anabolic steroid abuse are higher for males than for females (see fig. 2).
Data from the 2006 MTF survey showed that 1.7 percent of teenage males
reported abusing anabolic steroids in the past year, as compared with 0.6
percent of females. Data from the 2005 YRBS survey showed that 4.8 percent
of high school males reported abusing steroids in their lifetime, as
compared with 3.2 percent of females.

^10Several researchers conducted an analysis indicating that the
prevalence rates of teenage anabolic steroid abuse reported by MTF and
YRBS are overestimated and that actual prevalence of teenage anabolic
steroid abuse is even lower than these surveys report. See Gen Kanayama et
al., "Anabolic Steroid Abuse Among Teenage Girls: An Illusory Problem?"
Drug and Alcohol Dependence, 88 (2007): 156-162.

^11For example, according to the 2006 MTF survey, 42.3 percent of 12th
graders reported abusing marijuana at least once, and 8.5 percent reported
abusing cocaine at least once.

^12In our previous work looking at the availability of anabolic steroids,
we found that anabolic steroids were easily obtained without a
prescription through the Internet. See GAO, Anabolic Steroids Are Easily
Purchased Without a Prescription and Present Significant Challenges to Law
Enforcement Officials, [15]GAO-06-243R (Washington, D.C.: Nov. 3, 2005).

Figure 2: Reported Past Year Anabolic Steroid Abuse by Male and Female
Adolescents, 2002-2006

Note: These are combined data for 8^th, 10^th, and 12^th grade students.

Some Federally Funded Efforts Are Designed to Focus on Preventing Teenage
Steroid Abuse, While Other Efforts Designed to Address Substance Abuse in
General May Include Teenagers

There are two categories of federally funded efforts that address teenage
abuse of anabolic steroids. Efforts are either designed to focus on
preventing the abuse of anabolic steroids among teenagers or are broader
and designed to prevent substance abuse in general--which can include
abuse of anabolic steroids among teenagers. Two programs that received
federal research funding for their development and testing, ATLAS and
ATHENA, are designed to focus on preventing or reducing teen abuse of
anabolic steroids. In addition, there are various research efforts and
education and outreach activities that focus on this issue. Two federal
grant programs--ONDCP's Drug-Free Communities Support program and
Education's School-Based Student Drug Testing program--are designed to
support state and local efforts to prevent substance abuse in general and
may include anabolic steroid abuse among teenagers as part of the
programs' substance abuse prevention efforts. See appendix I for a list of
the federally funded efforts discussed below.

Some Federally Funded Programs, Research, and Activities Are Designed to Focus
on Preventing Teenage Anabolic Steroid Abuse

There are various federally funded efforts--programs, research, and
educational activities--that address teenage abuse of anabolic steroids.
Some of these efforts are designed to focus on preventing or reducing
anabolic steroid abuse among teenagers. As part of our review we
identified two programs, the ATLAS and ATHENA programs, which received
federal research funding during their development and testing and are
designed to focus on preventing the abuse of anabolic steroids among male
and female high school athletes, respectively.

ATLAS is a student-led curriculum designed to prevent male high school
athletes from abusing anabolic steroids and other performance-enhancing
substances. The program's intervention strategy relies on peer pressure
and providing information on healthy alternatives for increasing muscle
strength and size. The ATLAS curriculum is typically delivered during a
sport team's season in a series of 45-minute sessions scheduled at the
coaches' discretion and integrated into the usual team practice
activities. The athletes meet as a team in groups of six or eight students
with one student functioning as the assigned group leader. Coaches, group
leaders, and student athletes all work from manuals and workbooks, which
provide brief, interactive activities that focus on drugs used in sports,
sport supplements, strength training, sport nutrition, and decision
making.

The ATHENA program is designed to prevent the abuse of body-shaping
substances such as diet pills and anabolic steroids, although abuse of the
latter is less common in females than in males. Like ATLAS, the ATHENA
curriculum is integrated into a sport team's usual practice activities and
uses workbooks and student group leaders. The ATHENA curriculum takes into
account that female athletes are less likely than males to abuse anabolic
steroids but are more likely to have problems with eating disorders and to
use drugs such as diet pills and tobacco. As a result, ATHENA's curriculum
gives more attention than ATLAS's to addressing these behaviors.

The ATLAS and ATHENA curricula were developed and tested with funding
provided by NIDA.^13 From fiscal years 1993 through 2001, NIDA provided
more than $3.4 million to fund the research that developed and tested the
effectiveness of the ATLAS curriculum. Similarly, from fiscal years 1999
through 2003 NIDA provided $4.7 million in research funding to develop and
test the effectiveness of the ATHENA curriculum. While ATLAS and ATHENA
were developed and tested with federal funding, the programs are
implemented at the local level. Schools in at least 25 states have chosen
to implement the programs with local and private funds, and the National
Football League and Sports Illustrated magazine together have supported
the programs in more than 70 schools nationwide.^14

In addition to the ATLAS and ATHENA programs, there are various federally
funded research efforts that focus on preventing or reducing anabolic
steroid abuse among teenagers. NIDA has funded several research projects
examining the factors that influence teenagers to abuse anabolic steroids
and the effectiveness of interventions used to prevent teenage steroid
abuse. From fiscal years 2000 through 2006, NIDA awarded nearly $10.1
million in grants to support an average of four research projects each
year related to anabolic steroid abuse with a specific focus on
adolescents.^15 In fiscal year 2006, for example, NIDA awarded a total of
nearly $638,000 to three research projects that examined risk factors for
anabolic steroid abuse among teenagers or the effects of steroid abuse in
this population. Like NIDA, the United States Anti-Doping Agency
(USADA)--an independent, nonprofit corporation funded primarily by
ONDCP--supports research related to the abuse of anabolic steroids and
other performance-enhancing drugs by athletes, including teenage
athletes.^16 In fiscal year 2006, USADA spent $1.8 million for research,
and an ONDCP official estimated that about one-third of that research
funding was directed to anabolic steroids and another
performance-enhancing drug, human growth hormone.

^13The programs originated in investigator-initiated research into the
risk factors associated with male and female high school athletes' abuse
of anabolic steroids.

^14According to NIDA officials, the principal investigators who developed
the ATLAS and ATHENA programs signed a contract with the National Football
League to place the programs in schools in the vicinity of eight National
Football League teams in 2007. The contract was expected to support the
training of about 800 coaches and 20,000 athletes.

^15For fiscal years 2000 through 2006, NIDA officials reported that they
awarded a total of 31 annual grants, many of which were continuation
grants for previously-approved projects, for steroid-related research
focused on the adolescent age group in humans or animals. Because of the
continuity of the projects from year to year, we are reporting the average
numbers of projects that were funded and active each year.

In addition to research, there are various education and outreach
activities that focus on preventing anabolic steroid abuse among
teenagers. Many of these efforts have been supported by NIDA. Since 2000,
NIDA has provided nearly $500,000 in funding for a variety of education
and outreach efforts in support of this goal.^17 For example, in April
2000, in response to an upward trend in steroid abuse among students, NIDA
launched a multimedia educational initiative intended to prevent anabolic
steroid abuse among teenagers. Along with several national partners,
including the National Collegiate Athletic Association, the American
College of Sports Medicine, and the American Academy of Pediatrics, the
initiative produced a Web site, a research report on steroid abuse, and
postcard-sized messages about steroids for placement in gyms, movie
theaters, shopping malls, bookstores, and restaurants in selected areas.
By 2007, NIDA funding for this particular initiative totaled about
$124,000.

In addition to NIDA, other federal agencies and organizations have
supported educational and outreach activities that focus on preventing
anabolic steroid abuse among teenagers, as the following examples
illustrate.

           o ONDCP has funded six informational briefings since 2001 to
           encourage journalists, entertainment writers, and producers to
           accurately cover anabolic steroids and drug abuse among teenage
           athletes. ONDCP also has Web sites for teens and parents with
           information about anabolic steroids and links to NIDA resources.

           o Since 2003, USADA has produced written publications and annual
           reports on anabolic steroid abuse and has distributed those
           publications through high schools and state high school
           associations. In addition, some USADA public service announcements
           to be aired during televised sports events and movie trailers have
           targeted anabolic steroid abuse.

           o In fiscal years 2007 and 2008, SAMHSA expects to spend a total
           of $99,000 under a contract to develop and disseminate educational
           materials addressing the abuse of anabolic steroids by adolescent
           athletes. These materials, which are intended for use by high
           school athletic and health science departments, include brochures,
           a video, and 10 high school outreach seminars.
			  
^16ONDCP officials told us that from fiscal years 2001 through 2007, USADA
funding from ONDCP totaled nearly $46 million. In 2007, for example, ONDCP
funding was $8.4 million or about 70 percent of USADA's $12 million
budget, with the United States Olympic Committee providing the remaining
30 percent.

^17In addition to this funding for education and outreach activities
specifically focused on anabolic steroid abuse among teenagers, NIDA has
contracted with Scholastic Magazines since 2002 to provide information
about drug abuse and addiction to students and teachers during the school
year. This program, under which Scholastic Magazines receives $500,000 per
year for fiscal years 2002 through 2009 for a total of $4 million,
supports broader substance abuse prevention activities that have at times
included anabolic steroid prevention articles, posters, and other
materials.
           
           Two Federal Grant Programs Designed to Address Substance Abuse May
			  Address Teenage Anabolic Steroid Abuse

           As part of our review, we identified two federal grant programs
           that are designed to support state and local efforts to prevent
           various forms of substance abuse and that may include teenagers.
           Grantees of these programs may address teenage anabolic steroid
           abuse as part of the programs' general substance abuse prevention
           efforts. The Drug-Free Communities Support program, funded by
           ONDCP and administered by SAMHSA under an interagency agreement,
           provides grants to community coalitions to address drug abuse
           problems identified in their communities.^18 Many community
           coalitions choose to implement school-based drug prevention
           programs with their grant funding and are allowed to tailor these
           programs to address the drug prevention needs of their
           communities. In 2007, about one-quarter of more than 700 grantees
           reported that they were addressing steroid abuse as one of their
           program's objectives.^19 Each community coalition is eligible for
           grants of up to $125,000 per year, renewable for up to 4 more
           years, and requiring dollar-for-dollar community matching
           funds.^20 In 2007, the Drug-Free Communities Support program is
           providing about $80 million in grants to 709 community coalitions
           for drug prevention activities based on the needs of the
           communities.

^18Project officers in SAMHSA's Center for Substance Abuse Prevention work
with the Drug-Free Communities Support program grantees to provide
technical assistance and help them comply with grant requirements.

^19An ONDCP official told us that 189 of 702 communities (27 percent)
provided information that they were addressing steroids in their grant
activities along with other drugs.

^20Follow-on grants are also authorized. 21 U.S.C. S 1532(b)(3).

           Another federal grant program that supports substance abuse
           prevention efforts for teenagers and that may also include efforts
           to address anabolic steroid abuse in this population is the
           School-Based Student Drug Testing program in Education's Office of
           Safe and Drug-Free Schools.^21 Since 2003, this program has
           provided grants to school districts and public and private
           entities to establish school-based drug-testing efforts. For
           fiscal years 2003 through 2007, the Office of Safe and Drug-Free
           Schools awarded $32.2 million in grants to 87 individual
           School-Based Student Drug Testing grantees.^22 According to
           information provided in the grantees' grant applications, 34 of
           the grantees (representing 180 middle, junior, and high schools
           and at least 70,000 students) proposed using their grant-supported
           drug testing to test for anabolic steroids in addition to other
           substances such as amphetamines, marijuana, and cocaine.^23
           Education officials told us that although grantees generally
           identify the drugs for which they are testing in their annual
           performance reports, there has been no independent verification by
           Education staff that confirms that the 34 grantees actually have
           implemented anabolic steroid testing or whether additional
           grantees have included steroid testing in their efforts.

^21Education funds no programs specifically targeting steroid prevention
for teens. Except for alcohol prevention efforts, the department addresses
illegal drug abuse in schools with a comprehensive strategy, not drug by
drug.

^22Total funding for the School-Based Student Drug Testing program for
fiscal years 2003 through 2007 was about $36 million, of which $32.2
million (89 percent) was awarded to grantees. The remainder of the funding
supported evaluation and peer review activities.

^23During a discussion of Education's program, an ONDCP official said that
because testing for anabolic steroids is more expensive than for other
drugs--adding $50 to $100 to the cost of a common panel of five drug
tests--some schools add steroids to the tests for only a few of the
students, as a deterrent. The official said that in some cases, federal
funding helps schools afford to add steroids to their usual test panel.
The official estimated that about 1,000 schools and school districts
across the country were doing some sort of student drug testing and
sometimes were including steroids. According to the official, New Jersey
requires steroid testing for some athletic teams and Florida and Texas
^21Education funds no programs specifically targeting steroid prevention
for teens. Except for alcohol prevention efforts, the department addresses
illegal drug abuse in schools with a comprehensive strategy, not drug by
drug.

^22Total funding for the School-Based Student Drug Testing program for
fiscal years 2003 through 2007 was about $36 million, of which $32.2
million (89 percent) was awarded to grantees. The remainder of the funding
supported evaluation and peer review activities.

^23During a discussion of Education's program, an ONDCP official said that
because testing for anabolic steroids is more expensive than for other
drugs--adding $50 to $100 to the cost of a common panel of five drug
tests--some schools add steroids to the tests for only a few of the
students, as a deterrent. The official said that in some cases, federal
funding helps schools afford to add steroids to their usual test panel.
The official estimated that about 1,000 schools and school districts
across the country were doing some sort of student drug testing and
sometimes were including steroids. According to the official, New Jersey
requires steroid testing for some athletic teams and Florida and Texas
^21Education funds no programs specifically targeting steroid prevention
for teens. Except for alcohol prevention efforts, the department addresses
illegal drug abuse in schools with a comprehensive strategy, not drug by
drug.

^22Total funding for the School-Based Student Drug Testing program for
fiscal years 2003 through 2007 was about $36 million, of which $32.2
million (89 percent) was awarded to grantees. The remainder of the funding
supported evaluation and peer review activities.

^23During a discussion of Education's program, an ONDCP official said that
because testing for anabolic steroids is more expensive than for other
drugs--adding $50 to $100 to the cost of a common panel of five drug
tests--some schools add steroids to the tests for only a few of the
students, as a deterrent. The official said that in some cases, federal
funding helps schools afford to add steroids to their usual test panel.
The official estimated that about 1,000 schools and school districts
across the country were doing some sort of student drug testing and
sometimes were including steroids. According to the official, New Jersey
requires steroid testing for some athletic teams and Florida and Texas
were considering similar legislation.

           Research Shows Teenage Anabolic Steroid Abuse Is Linked to Certain
			  Risk Factors and That Prevention Programs May Have Some Short-term
			  Effectiveness

           Of the 16 studies we reviewed, nearly half focused on linking
           certain risk factors and behaviors to teenagers' abuse of anabolic
           steroids, including the use of other drugs, risky sexual
           behaviors, and aggressive behaviors.^24 Most of the other studies
           we reviewed were assessments of the ATLAS and ATHENA prevention
           programs and in general suggested that the programs may reduce
           abuse of anabolic steroids and other drugs among high school
           athletes immediately following participation in the programs.
           Appendix II is a list of the articles we reviewed.

           Almost half of the studies we reviewed identified certain risk
           factors and behaviors linked to the abuse of anabolic steroids
           among teenagers.^25 Risk factors, such as antisocial behavior,
           family violence, and low academic achievement, are linked to
           youths' likelihood of engaging in risky behaviors, including drug
           abuse. Several studies found that the use of alcohol and other
           drugs--such as tobacco, marijuana, and cocaine--is associated with
           the abuse of anabolic steroids among teenagers, including teenage
           athletes and non-athletes. One 2005 study found that the use of
           other drugs was more likely to predict anabolic steroid abuse than
           participation in athletic activities. Several studies we reviewed
           found no difference between athletes and non-athletes in their
           abuse of anabolic steroids, and one 2007 study of teenage girls
           found that female athletes were less likely than female
           non-athletes to abuse anabolic steroids. A few studies we reviewed
           found a positive correlation between anabolic steroid abuse and
           risky sexual behaviors such as early initiation of sexual activity
           and an increased number of sexual partners. Some studies found
           that aggressive behaviors such as fighting were related to
           anabolic steroid abuse by both males and females. Moreover, one
           1997 study found that adolescents (both male and female) who
           reported abusing anabolic steroids in the past year were more
           likely to be perpetrators of sexual violence. However, the
           cause-and-effect relationships between anabolic steroid abuse and
           other risky behaviors, such as violence, have not been
           determined.^26

^24We reviewed 16 studies published from January 1995 through June 2007.

^25These studies sought to identify a correlation between risk factors and
behaviors and anabolic steroid abuse by teenagers. The studies did not
identify causation.

^26Because aggressive behavior is one of the potential psychological
effects of anabolic steroid abuse, anabolic steroids could predispose an
individual to aggressive acts, including sexual violence.

           About half of the studies we reviewed were assessments of the
           ATLAS and ATHENA prevention programs, and in general these studies
           suggested that these programs may reduce abuse of anabolic
           steroids and other drugs among high school athletes immediately
           following participation in the programs. Researchers assessing the
           ATLAS program reported that both the intention to abuse anabolic
           steroids and the reported abuse of steroids were lower among
           athletes who participated in the ATLAS program than among athletes
           who did not participate in the program. The most recent study
           found that although the intention to abuse anabolic steroids
           remained lower at follow-up 1 year later for athletes who
           participated in the ATLAS program, the effectiveness of the
           program in reducing reported use diminished with time. Similarly,
           researchers assessing the ATHENA program found that girls who
           participated in the program reported less ongoing and new abuse of
           anabolic steroids as well as a reduction in the abuse of other
           performance-enhancing and body-shaping substances. The authors
           note that these results are short term, and the long-term
           effectiveness of the ATHENA program is not known.

           The authors of the one study in our review that looked at student
           drug-testing programs found that the abuse of anabolic steroids
           and other illicit drugs and performance-enhancing substances was
           decreased among athletes at schools that implemented mandatory,
           random drug-testing programs. However, this group of athletes also
           showed an increase in risk factors that are generally associated
           with greater abuse of illicit drugs, including anabolic steroids.
           For example, athletes at schools with drug-testing programs were
           more likely to believe that peers and authority figures were more
           tolerant of drug abuse, had less belief in the negative
           consequences of drug abuse, and had less belief in the efficacy of
           drug testing. Based on these seemingly inconsistent findings, the
           study's authors called for caution in interpreting the findings.
			  
			  Experts Find There Are Gaps in Research on the Sustained Effectiveness
			  of Prevention Programs and on the Long-term Health Effects for Teenagers

           Experts identified gaps in the research that addresses anabolic
           steroid abuse among teenagers. Experts identified gaps in the
           current research on the outcomes of prevention programs that focus
           on anabolic steroids. Experts also identified gaps in the research
           on the long-term health effects of initiating the abuse of
           anabolic steroids as teenagers.

           According to experts, available research does not establish the
           extent to which the ATLAS and ATHENA programs are effective over
           time in preventing anabolic steroid abuse among teenage athletes.
           Experts acknowledge that both programs appear promising in their
           ability to prevent the abuse of anabolic steroids among teenage
           athletes immediately following participants' completion of the
           programs. Assessment of the effectiveness of the ATLAS program 1
           year later, however, found that the lower incidence of anabolic
           steroid use was not sustained, although participants continued to
           report reduced intentions to use anabolic steroids. The long-term
           effectiveness of the ATHENA program has not been reported. The
           effectiveness of these programs has been assessed only in some
           schools in Oregon, and therefore experts report that the
           effectiveness of the programs may not be generalizable. In another
           example, experts identified the need for additional research to
           assess the effectiveness of drug-testing programs, such as those
           funded under Education's School-Based Student Drug Testing
           program, in reducing anabolic steroid abuse among teenagers.^27

           According to experts, there are several gaps in research on the
           health effects of teenage abuse of anabolic steroids. Experts
           report that while there is some research that has examined the
           health effects of anabolic steroid abuse among adults--for
           example, the harmful effects on the cardiovascular, hormonal, and
           immune systems--there is a lack of research on these effects among
           teenagers. There is also a lack of research on the long-term
           health effects of initiating anabolic steroid abuse during the
           teenage years. Some health effects of steroid abuse among adults,
           such as adverse effects on the hormonal system, have been shown to
           be reversible when the adults have stopped abusing anabolic
           steroids. Experts point out, however, that it is not known whether
           this reversibility holds true for teenagers as well. While some
           experts suggest that anabolic steroid abuse may do more lasting
           harm to teenagers, due to the complex physical changes unique to
           adolescence, according to other experts there is no conclusive
           evidence of potentially permanent health effects. Experts also
           report that the extent of the psychological effects of anabolic
           steroid abuse and, in particular, of withdrawal from steroid
           abuse, is unclear due to limited research. Some experts we
           consulted noted a need to better inform primary care physicians
           and pediatricians about anabolic steroid abuse among teenagers, so
           these providers would be better able to recognize steroid abuse in
           their patients and initiate early intervention and treatment.
			  
^27Education officials told us that the agency is currently conducting an
evaluation of the effectiveness of the student drug-testing programs
implemented by its grantees.

           Agency Comments

           We provided a draft of this report to HHS and Education for
           comment and received technical comments only, which we
           incorporated into the report as appropriate.

           As arranged with your offices, unless you publicly announce the
           contents of this report earlier, we plan no further distribution
           of it until 30 days after its issue date. At that time, we will
           send copies of this report to the Secretary of Health and Human
           Services and to the Secretary of Education. We will also provide
           copies to others upon request. In addition, the report is
           available at no charge on the GAO Web site at
           [16]http://www.gao.gov .

           If you or your staff members have any questions regarding this
           report, please contact me at (202) 512-7114 or [email protected].
           Contact points for our Offices of Congressional Relations and
           Public Affairs may be found on the last page of this report. GAO
           staff members who made major contributions to this report are
           listed in appendix III.

           Laurie Ekstrand
			  Director, Health Care
			  
			  Appendix I: Selected Federally Funded Efforts That Address or Can
			  Address Anabolic Steroid Abuse among Teenagers 

           Table 1 lists selected federally funded efforts--including
           programs, research, and educational and outreach activities--that
           are designed to focus on preventing or reducing the abuse of
           anabolic steroids by teenagers (focused efforts), as well as other
           broader efforts that may address teenage abuse of anabolic
           steroids as part of the programs' general substance abuse
           prevention efforts. The list includes programs funded by two
           departments and the Office of National Drug Control Policy
           (ONDCP), in the Executive Office of the President.

Table 1: Selected Federally Funded Efforts That Address or Can Address
Anabolic Steroid Abuse among Teenagers

                  Funding                                                     
                  for      Program                                            
                  fiscal   implementers                                       
                  year     or eligible   Targeted                             
Program        2006     applicants    beneficiaries  Program description   
Department of Health and Human                                             
Services                                                                   
National Institute on Drug Abuse                                           
(NIDA)                                                                     
Athletes       ---^a    School        Male high      Focused effort:       
Training and            districts,    school         program to prevent    
Learning to             schools,      athletes       male high school      
Avoid Steroids          behavioral                   athletes from abusing 
(ATLAS)                 health                       anabolic steroids and 
                           agencies,                    other                 
                           others                       performance-enhancing 
                                                        drugs, and to promote 
                                                        healthy strength      
                                                        training and          
                                                        nutrition             
Athletes       ---^b    School        Female high    Focused effort:       
Targeting               districts,    school         program to prevent    
Healthy                 schools,      athletes       female high school    
Exercise &              behavioral                   athletes from abusing 
Nutrition               health                       body-shaping          
Alternatives            agencies,                    substances such as    
(ATHENA)                others                       diet pills, tobacco,  
                                                        and anabolic          
                                                        steroids, and to      
                                                        promote healthy       
                                                        training and          
                                                        nutrition             
Research       $638,000 Researchers   Adolescent age Focused effort:       
projects                              group          funding for three     
                                                        steroid-related       
                                                        research projects     
                                                        focused on the        
                                                        adolescent age group  
                                                        in humans and animals 
Educational    $521,000 NIDA and its  Teenage        Focused and broad     
and outreach            partners,     students,      efforts: to           
activities              including     teachers,      distribute a research 
                           National      general public report on anabolic    
                           Collegiate                   steroid abuse to      
                           Athletic                     schools; develop      
                           Association,                 steroid abuse posters 
                           American                     for schools; and      
                           Academy of                   support Scholastic    
                           Pediatrics,                  Magazines substance   
                           American                     abuse information to  
                           College of                   schools including     
                           Sports                       anabolic steroids     
                           Medicine,                                          
                           others                                             
Substance Abuse and Mental Health                                          
Services Administration (SAMHSA)                                           
Center for     ---^c    SAMHSA        High school    Focused effort:       
Substance               contractor    teachers,      program of print      
Abuse                                 coaches,       materials, video, and 
Treatment:                            students       high school           
What Steroids                                        assemblies to         
Can Do to You                                        disseminate accurate  
- The Drug-The                                       information           
Danger-The                                           describing the health 
Deception                                            effects of anabolic   
                                                        steroids              
Department of Education                                                    
School-Based   $8.6     School        Students       Broad effort: as of   
Student Drug   million  districts,    primarily in   2006, 72 grants to    
Testing grants          public and    grades 6       support programs that 
program                 private       through 12     address drug          
                           entities                     prevention in         
                                                        schools, including    
                                                        anabolic steroid      
                                                        prevention efforts    
Executive Office of the                                                    
President                                                                  
Office of National Drug Control                                            
Policy (ONDCP)                                                             
Drug-Free      about    Community     Various        Broad effort: as of   
Communities    $80      coalitions    beneficiaries, 2006, more than 700   
Support        million                including      grants to communities 
program                               school-age     to support coalitions 
                                         youth,         and grassroots        
                                         depending on   organizations engaged 
                                         community      in efforts to prevent 
                                         needs          use of alcohol,       
                                         assessments    tobacco, and illicit  
                                                        drugs including       
                                                        anabolic steroids     
ONDCP public   $5,000   Medical       Journalists,   Focused and broad     
information    for 1    experts,      entertainment  efforts: 6 briefings  
and            event in coaches, teen writers,       from 2001-2007,       
entertainment  January  athletes      producers      including roundtable  
industry       2006                                  for a journalists'    
outreach                                             conference on teen    
                                                        athletes, briefings   
                                                        for magazine staffs,  
                                                        and media roundtables 
                                                        on teen athletes and  
                                                        performance-enhancing 
                                                        drugs                 
United States  $1.8     Researchers   Young athletes Focused and broad     
Anti-Doping    million                including      efforts: grants for   
Agency (USADA)                        teenagers      research on current   
research                                             and emerging drug     
projects^d                                           issues; estimated     
                                                        one-third of research 
                                                        funding addresses     
                                                        anabolic steroids and 
                                                        human growth hormone  
USADA          $1.5     Public and    Teenagers,     Focused and broad     
education and  million  private       young adult    efforts: publications 
outreach                organizations athletes,      about anabolic        
activities^d                          parents,       steroid issues for    
                                         coaches        high schools, public  
                                                        service               
                                                        announcements, and    
                                                        Web sites             

Sources: Agency documents and program officials.

aIn 2006, NIDA did not provide any funding for the ATLAS program. From
1993 through 2001, however, NIDA funded $3.4 million in research related
to developing and testing the ATLAS curriculum.

bSimilarly, NIDA did not fund research related to the ATHENA program in
2006, but from 1999 through 2003 the agency provided $4.7 million to
develop and test the program.

cSAMHSA officials reported that the agency expects to spend up to $99,000
on this project. A contract for that amount was awarded on July 6, 2006.
As of August 2007, SAMHSA reported that it had made $40,000 in payments
under the contract and expects to pay the remaining $59,000 in fiscal year
2008.

dUSADA is not organizationally part of the Executive Office of the
President. However, because it is an independent, nonprofit corporation
funded primarily by ONDCP, for purposes of this report we have grouped
USADA's activities with ONDCP's.

Appendix II: Articles Included in GAO's Review

Borowsky, I.W., M. Hogan, and M. Ireland. "Adolescent sexual aggression:
risk and protective factors." Pediatrics, vol. 100, no. 6 (1997): e71-e78.

Dukarm, C.P., R.S. Byrd, P. Auinger, and M. Weitzman. "Illicit substance
use, gender, and the risk of violent behavior among adolescents." Archives
of Pediatric & Adolescent Medicine, vol. 150, no. 8 (1996): 797-801.

DuRant, R.H., L.G. Escobedo, and G.W. Heath, "Anabolic-steroid use,
strength training, and multiple drug use among adolescents in the United
States." Pediatrics, vol. 96, no. 1 (1995): 23-28.

Elliot, D., J. Cheong, E.L. Moe, and L. Goldberg. "Cross-sectional study
of female students reporting anabolic steroid use." Archives of Pediatric
& Adolescent Medicine, vol. 161, no. 6 (2007): 572-577.

Elliot, D., and L. Goldberg. "Intervention and prevention of steroid use
in adolescents." American Journal of Sports Medicine, vol. 24, no. 6
(1996): S46-S47.

Elliot, D.L., L. Goldberg, E.L. Moe, C.A. DeFrancesco, M.B. Durham, and H.
Hix-Small. "Preventing substance use and disordered eating: Initial
outcomes of the ATHENA (Athletes Targeting Healthy Exercise and Nutrition
Alternatives) program." Archives of Pediatric & Adolescent Medicine, vol.
158, no. 11 (2004): 1043-1049.

Elliot, D.L., E.L. Moe, L. Goldberg, C.A. DeFrancesco, M.B. Durham, and H.
Hix-Small. "Definition and outcome of a curriculum to prevent disordered
eating and body-shaping drug use." The Journal of School Health, vol. 76,
no. 2 (2006): 67-73.

Fritz, M.S., D.P. MacKinnon, J. Williams, L. Goldberg, E.L. Moe, and D.L.
Elliot. "Analysis of baseline by treatment interactions in a drug
prevention and health promotion program for high school male athletes."
Addictive Behaviors, vol. 30, no. 5 (2005): 1001-1005.

Goldberg, L., D. Elliot, G.N. Clarke, D.P. MacKinnon, E. Moe, L. Zoref, E.
Greffrath, D.J. Miller, and A. Lapin. "Effects of a multidimensional
anabolic steroid prevention intervention: the Adolescents Training and
Learning to Avoid Steroids (ATLAS) program." JAMA, vol. 276, no. 19
(1996): 1555-1562.

Goldberg, L., D. Elliot, G.N. Clarke, D.P. MacKinnon, L. Zoref, E. Moe, C.
Green, and S.L. Wolf. "The Adolescent Training and Learning to Avoid
Steroids (ATLAS) prevention program: background and results of a model
intervention." Archives of Pediatric & Adolescent Medicine, vol. 150
(1996): 713-721.

Goldberg, L., D.L. Elliot, D.P. MacKinnon, E. Moe, K.S. Kuehl, L. Nohre,
and C.M. Lockwood. "Drug testing athletes to prevent substance abuse:
Background and pilot study results of the SATURN (Student Athlete Testing
Using Random Notification) study." Journal of Adolescent Health, vol. 32,
no. 1 (2003): 16-25.

Goldberg, L., D.P. MacKinnon, D.L. Elliot, E.L. Moe, G. Clarke, and J.
Cheong. "The Adolescents Training and Learning to Avoid Steroids Program:
Preventing drug use and promoting health behaviors." Archives of Pediatric
& Adolescent Medicine, vol. 154, no. 4 (2000): 332-338.

MacKinnon, D.P., L. Goldberg, G. Clarke, D.L. Elliot, J. Cheong, A. Lapin,
E.L. Moe, and J.L. Krull. "Mediating mechanisms in a program to reduce
intentions to use anabolic steroids and improve exercise self-efficacy and
dietary behavior." Prevention Science, vol. 2, no. 1 (2001): 15-28.

Miller, K.E., J.H. Hoffman, G.M. Barnes, D. Sabo, M.J. Melnick, and M.P.
Farrell. "Adolescent anabolic steroid use, gender, physical activity, and
other problem behaviors." Substance Use & Misuse, vol. 40, no. 11 (2005):
1637-1657.

Naylor, A.H., D. Gardner, and L. Zaichkowsky. "Drug use patterns among
high school athletes and nonathletes." Adolescence, vol. 36, no. 144
(2001): 627-639.

Rich, J.D., C.K. Foisie, C.W. Towe, B.P. Dickinson, M. McKenzie, and C.M.
Salas. "Needle exchange program participation by anabolic steroid
injectors." Drug and Alcohol Dependence, vol. 56, no. 2 (1999): 157-160.

Appendix III: GAO Contact and Staff Acknowledgments

GAO Contact

Laurie Ekstrand, at (202) 512-7114 or [email protected].

Staff Acknowledgments

In addition to the contact named above, key contributors to this report
were Christine Brudevold, Assistant Director; Ellen M. Smith; Julie
Thomas; Rasanjali Wickrema; and Krister Friday.

(290594)

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Highlights of [22]GAO-08-15 , a report to the Committee on Oversight and
Government Reform, House of Representatives

October 2007

ANABOLIC STEROID ABUSE

Federal Efforts to Prevent and Reduce Anabolic Steroid Abuse among
Teenagers

The abuse of anabolic steroids by teenagers--that is, their use without a
prescription--is a health concern. Anabolic steroids are synthetic forms
of the hormone testosterone that can be taken orally, injected, or rubbed
on the skin. Although a 2006 survey funded by the National Institute on
Drug Abuse (NIDA) found that less than 3 percent of 12^th graders had
abused anabolic steroids, it also found that about 40 percent of 12^th
graders described anabolic steroids as "fairly easy" or "very easy" to
get. The abuse of anabolic steroids can cause serious health effects and
behavioral changes in teenagers.

GAO was asked to examine federally funded efforts to address the abuse of
anabolic steroids among teenagers and to review available research on this
issue. This report describes (1) federally funded efforts that address
teenage abuse of anabolic steroids,

(2) available research on teenage abuse of anabolic steroids, and

(3) gaps or areas in need of improvement that federal officials and other
experts identify in research that addresses teenage anabolic steroid
abuse. To do this work, GAO reviewed federal agency materials and
published studies identified through a literature review and interviewed
federal officials and other experts.

There are two categories of federally funded efforts that address teenage
abuse of anabolic steroids. Efforts are either designed to focus on
preventing the abuse of anabolic steroids among teenagers or are broader
and designed to prevent substance abuse in general--which can include
abuse of anabolic steroids among teenagers. Two programs that received
federal funding during their development and testing, Athletes Training
and Learning to Avoid Steroids (ATLAS) and Athletes Targeting Healthy
Exercise & Nutrition Alternatives (ATHENA), are designed to focus on
preventing or reducing teen abuse of anabolic steroids through use of
gender-specific student-led curricula. In addition, there are various
research efforts and education and outreach activities that focus on this
issue. Two federal grant programs--the Office of National Drug Control
Policy's Drug-Free Communities Support program and the Department of
Education's School-Based Student Drug Testing program--are designed to
support state and local efforts to prevent substance abuse in general and
may include anabolic steroid abuse among teenagers as part of the
programs' substance abuse prevention efforts. In 2007, about one-quarter
of more than 700 Drug-Free Communities Support program grantees reported
that they were addressing steroid abuse as one of their program's
objectives.

Almost half of the 16 studies GAO reviewed identified certain risk factors
and behaviors linked to the abuse of anabolic steroids among teenagers.
Several of these studies found connections between anabolic steroid abuse
and risk factors such as use of other drugs, risky sexual behaviors, and
aggressive behaviors. Most of the other studies were assessments of the
ATLAS and ATHENA prevention programs and in general suggested that the
programs may reduce abuse of anabolic steroids and other drugs among high
school athletes immediately following participation in the programs.

Experts identified gaps in the research addressing teenage abuse of
anabolic steroids. Experts identified a lack of conclusive evidence of the
sustained effectiveness over time of available prevention programs, for
example at

1 year following participants' completion of the programs. Experts also
identified gaps in the research on the long-term health effects of
initiating anabolic steroid abuse as a teenager--including research on
effects that may be particularly harmful in teens--and in research on
psychological effects of anabolic steroid abuse.

References

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  17. http://www.gao.gov/
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  19. http://www.gao.gov/fraudnet/fraudnet.htm
  20. mailto:[email protected]
  21. http://www.gao.gov/cgi-bin/getrpt?GAO-08-15
  22. http://www.gao.gov/cgi-bin/getrpt?GAO-08-15
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