Doping Prevalence in Competitive Sport: Evidence Synthesis with "Best Practice" Recommendations and Reporting Guidelines from the WADA Working Group on Doping Prevalence

Applying a systems thinking lens to anti-doping: A systematic review identifying the contributory factors to doping in sport

The use of performance enhancing substances and methods (known as "doping") in sport is an intractable issue, with current anti-doping strategies predominantly focused on the personal responsibility and strict liability of individual athletes. This is despite an emerging understanding that athletes exist as part of a broader complex sports system that includes governance, policymakers, media, sponsors, clubs, team members, and athlete support staff, to name a few. As such, there is a need to examine the broader systemic factors that influence doping in sport. The aim of this systematic review was to identify and synthesise the factors contributing to doping and doping behaviours, attitudes, and beliefs and the extent to which this knowledge extends beyond the athlete to consider broader sports systems. The review followed PRISMA guidelines with risk of bias and study quality assessed by the Mixed Methods Appraisal Tool, and identified contributory factors synthesised and mapped onto a systems thinking-based framework. Overall, the included studies were determined to be of high quality. Support personnel, the coach, and the coach-athlete relationship represent key influences on the athletes' decisions to dope. From the evidence presented, doping is an emergent property of sport systems and represents a complex systemic problem that will require whole-of-system interventions. The implications for this and the focus of future research are discussed.

Relationships between achievement goals and doping in cycling: Exploring the mediating role of athlete burnout

Doping remains a pressing issue in competitive sport. This study investigated the relationships between achievement goals and doping by examining the mediating role of athlete burnout. French competitive cyclists (N = 251, Mage = 24.95, SD = 9.85) completed a survey measuring 2 × 2 achievement goals, burnout (i.e. physical exhaustion, reduced accomplishment, negative feelings towards sport, cognitive weariness), doping attitudes and likelihood. Structural equation modelling revealed that performance-approach goals were negatively related to each dimension of burnout and to doping likelihood with a total effect (β = -.10; p < .05). A significant total effect (β = .23; p < .05), as well as direct (β = .17; p < .05) and indirect through the mediating role of cognitive weariness (β = .06, 95% CI = [0.025, 0.601]) were observed between performance-avoidance goals and doping attitudes. The model explained 11.9% of the doping likelihood variance. Burnout may play a key role in understanding the relationships between achievement goals and doping. Considering both athletes' achievement goals and burnout thus appear as crucial for anti-doping efforts. Therefore, developing mental health interventions should be prioritized. Further experimental and longitudinal research is necessary to establish the temporal and causal effects of these relationships.

Use of Sport Supplements and Doping Substances by Athletes: Prevalence and Relationships

Background: The use of sport supplements may represent a risk factor for the use of doping in sports. To explore this putative risk, the current study examined the frequency of sport supplement use and associations between the use of sport supplements and the use of doping substances and methods in athletes. Methods: The participants (n = 345; 56% male, 22 ± 5 years, 18-43 years) completed measures of sport supplement use, sport supplement beliefs, doping likelihood, and doping use. Based on the Australian Institute of Sport's "Sports Supplement Framework", the participants were asked whether they used 23 sport supplements from four categories (sport foods, medical supplements, performance supplements, other). They were also asked whether they used six classes of doping substances and methods (alphabodies, stimulants, steroids, erythropoietin, growth hormone, blood doping). Results: Sport supplements were used by 96% of the athletes, whereas doping substances were used by 4% of the athletes. Moreover, athletes who used more sport supplements also used more doping substances. The use of sport supplements was related to the use of doping substances both directly and indirectly via sport supplement beliefs and doping likelihood. Conclusions: Consumption of sport supplements is common, whereas doping is rare, and, moreover, the belief that sport supplements help optimize performance in competitive sport confers an increased risk for doping.

How often do you cheat? Dispositional influences and intrapersonal stability of dishonest behavior

Dishonesty, including lying, cheating, deception, and deviating from societal norms, has far-reaching implications across various aspects of modern society. From minor consequences like social discontent to severe outcomes such as economic damage through tax evasion, dishonest behavior affects us in multiple ways. This study investigates whether gender and psychological traits contribute to dishonest behavior, and whether unethical conduct is stable across diverse tasks. We examined 63 participants using a "Difference Spotting Task" (DST) and two motor tasks (1. coordinative throwing; 2. isometric strength). Dishonesty was measured by comparing self-reported performance with actual performance, allowing for a comprehensive analysis of both occurrence and extent of dishonesty. Our findings indicate that gender does not significantly influence the occurrence or extent of dishonest behavior. Moreover, we discovered that "Social Desirability" positively influences the extent of dishonesty, while "Task Orientation" increases the likelihood of engaging in dishonest acts. The study also reveals that the level of dishonesty remains relatively stable across all three tasks at an intrapersonal level.

Profile of gym-goers who do not use performance-enhancement substances

Introduction

Currently the use of prohibited performance-enhancing substances (PES) in fitness and gym settings is a public health concern as adverse health consequences are emerging. Understanding the characteristics of gym-goers who do not use these substances could lead to an important complement to the ongoing research about risk factors for PES use. The aim of this study was to identify the profile of PES non-use in gym-goers.

Methods

In total, 453 gym-goers (mean age = 35.64 years; SD = 13.08 - measure of central tendency location and measure of absolute dispersion, respectively) completed an online survey assessing sociodemographic factors, exercise characteristics, gym modalities, peers, social influence, attitudes, subjective norms, beliefs, intentions, and self-reported use of PES.

Results

Decision Trees showed that being a woman, training less frequently, not practicing bodybuilding and having a negative intention to consume PES were identified as characteristics of non-users of PES.

Discussion

These results may support evidence-based anti-doping interventions to prevent abusive use of PES in the fitness context.

Exploring the scope and applications of anti-doping measures in ultramarathon: an analysis of the positions of ultramarathon race organizers

Introduction

With ultramarathon attracting burgeoning interest, evidence has emerged about doping behaviors. However, currently, research into the anti-doping policy landscape and the adoption of testing and athlete surveillance is limited, including the applicability of rubric from the World Anti-Doping Agency (WADA) and National Anti-Doping Organizations (NADOs). Consequently, it remains unclear if anti-doping provisions have been developed and enforced in ultramarathon, which is a timely consideration given growth in the sport.

Methods

This study gathered perspectives on anti-doping and testing procedures from ultramarathon race organizers (UMROs). To that end, a sample of n = 35 prominent competitions was compiled using web materials and community engagement, encompassing elite and amateur entrants, diverse course designs, and prize money opportunities. Data-gathering was conducted across two phases between November and December 2023, with an initial review of UMRO web resources. Subsequently, UMROs were contacted via email to validate or ascertain their anti-doping and testing policies. Insights from UMRO respondents were reviewed and coded. UMROs who did not reply were excluded from the analysis.

Results

Based on this methodology, the positions of n = 17 UMROs were captured, covering 159 ultramarathon races and approximately 96,500 annual participants. Of these, n = 8 UMROs did not have a self-developed policy and their rubric was pursuant to external authorities like WADA and NADOs. n = 4 had created a specific proprietary policy, which often incorporated WADO or NADO materials. The remaining n = 5 UMROs reported no anti-doping controls were in place at the time of the study. There was also notable heterogeneity in testing and surveillance, ranging from rigorous procedures to an absence of protocols. Interestingly, none of the included UMROs explicitly reported that they had enacted anti-doping measures against athletes.

Discussion

Various determinants could inform these regulatory inconsistencies across UMROs, such as financial constraints, infrastructural and logistical barriers, cultural factors, and the lack of a unifying international federation in ultramarathon. Given the disparate approaches identified in our results, greater cooperation and education may be necessary to enhance understanding about the implications of doping and advance cohesive frameworks. This should involve collaborations with WADA and NADOs to promote best-practices and evidence-based exchanges within the community.

Doping Prevalence among U.S. Elite Athletes Subject to Drug Testing under the World Anti-Doping Code

BACKGROUND

Determining the prevalence of doping within an elite athlete population is challenging due to the extreme sensitivity of the topic; however, understanding true doping prevalence is important when designing anti-doping programs and measuring their effectiveness. The objective of this study was to estimate the prevalence of doping among Olympic, Paralympic, World, and National-level competitive athletes in the United States subject to the World Anti-Doping Code. All athletes who were subject to the U.S. Anti-Doping Agency's Protocol for Olympic and Paralympic Movement Testing, a World Anti-Doping Code ("Code")-compliant anti-doping program, were invited to complete a web-delivered survey. Using a direct questioning approach, the survey items asked athletes whether they had used each specific category of banned substance / method on the World Anti-Doping Agency's Prohibited List. Multiple strategies to encourage honest reporting (e.g., protecting anonymity by collecting minimal demographic information; using an outside organization to administer the survey) and to detect inconsistent responses were used.

RESULTS

Depending on the method of calculation, 6.5-9.2% of the 1,398 respondents reported using one or more prohibited substances or methods in the 12 months prior to survey administration. Specific doping prevalence rates for each individual substance / method categories ranged from 0.1% (for both diuretics / masking agents and stem cell / gene editing) to 4.2% for in-competition use of cannabinoids.

CONCLUSION

Determining the prevalence of doping within different athlete populations is critical so that sport governing bodies can evaluate their anti-doping efforts and better tailor their programming. By measuring doping prevalence of specific categories of substances and methods, rather than just the overall prevalence of doping, this study also highlights where sport governing bodies should focus their future educational and detection efforts.

The purpose and effectiveness of doping testing in sport

Maintaining an effective testing program is critical to the success and credibility of the anti-doping movement. However, a low detection ratio compared to the assumed real prevalence of sport doping has led some to question and criticize the effectiveness of the current testing system. In this perspective article, we review the results of the global testing program, discuss the purpose of testing, and compare benefits and limitations of performance indicators commonly used to evaluate testing efforts. We suggest that an effective testing program should distinguish between preventive testing and testing aimed at detecting the use of prohibited substances and prohibited methods. In case of preventive testing, the volume of the test program in terms of number of samples, tests and analyses is likely to be positively related to the extent of the deterrent effect achieved. However, there is a lack of literature on how the deterrent effect works in the practical context of doping testing. If the primary goal is to detect doping, the testing must be risk- and intelligence-based, and quality in test planning is more important than quantity in sample collection. The detection ratio can be a useful tool for evaluating the effectiveness of doping testing, but for the calculation one should take into account the number of athletes tested and not just the number of collected samples, as the former would provide a more precise measure of the tests' ability to detect doping among athletes.

Qualitative analysis of the factors associated with whistleblowing intentions among athletes from six European countries

Although whistleblowing is thought to represent an effective mechanism for detecting and uncovering doping in sport, it has yet to become a widely adopted practice. Understanding the factors that encourage or discourage whistleblowing is of vital importance for the promotion of this practice and the development of pedagogical material to enhance the likelihood of whistleblowing. The current study employed a qualitative methodology to explore the personal and organisational factors that underpin intentions to blow the whistle or that may lead to engagement in whistleblowing behaviours in sport. Thirty-three competitive athletes across a range of sports took part in a semi-structured interview which sought to explore what they would do should they encounter a doping scenario. Content analysis revealed that whistleblowing is a dynamic process characterised by the interaction of a range of personal and organisational factors in determining the intention to report PED use. These factors included moral reasoning, a desire to keep the matter "in-house", perceived personal costs, institutional attitudes to doping, and social support. Analysis revealed a number of "intervening events", including a perceived lack of organisational protection (e.g., ethical leadership) within some sporting sub-cultures, which present an important obstacle to whistleblowing. The intention to report doping was underpinned by a "fairness-loyalty trade-off" which involved athletes choosing to adhere to either fairness norms (which relate to a sense that all people and groups are treated equally) or loyalty norms (which reflect preferential treatment towards an in-group) when deciding whether they would blow the whistle. The promotion of fairness norms that emphasise a group's collective interests might encourage athletes to view whistleblowing as a means of increasing group cohesiveness and effectiveness and thereby increase the likelihood of this practice.

Perceived Coach-Created Empowering and Disempowering Climate Effects on Athletes' Intentions to Use Doping: The Mediational Role of Self-Regulatory Efficacy and Attitudes towards Doping

BACKGROUND

The purpose of this study was to examine the relationship between perceived coach-created empowering and disempowering motivational climate and doping likelihood among athletes and whether the attitudes towards doping and doping self-regulatory efficacy mediates these relationships.

METHODS

Athletes (N = 948; 50% male; mean age, 20.32, SD = 2.45) recruited from a variety of sports completed questionnaires assessing their perceptions of coach-created motivational climate, attitudes towards doping, doping self-regulatory efficacy, and doping likelihood.

RESULTS

The study's results showed significant negative direct effects of a perceived empowering climate on doping likelihood (β = -0.50) and attitudes towards doping (β = -0.48), and a positive effect on self-regulatory efficacy (β = 0.48). On the contrary, a disempowering climate had positive direct effects on doping likelihood (β = 0.53) and attitudes towards doping (β = 0.45), and a negative effect on self-regulatory efficacy (β = -0.49). Significant indirect effects on doping likelihood via attitudes and self-regulatory efficacy were found.

CONCLUSIONS

Our findings suggest that athletes who perceive a more empowering climate created by the coach are less likely to use banned substances due to their more negative attitudes towards doping and stronger belief in their ability to resist the temptation to use doping.

Fighting fair: community perspectives on the fairness of performance enhancement in esports

Aims

This study aims to explore community perspectives on enhancer usage in competitive gaming and esports, focusing on the perception of fairness and concerns about various potential performance enhancers.

Methods

We conducted both qualitative and quantitative surveys to understand the competitive gaming community's opinions on different types of performance enhancers and their potential impact on esports. A thematic analysis was performed to identify key themes in how players rationalize their opinions.

Conclusions

The gaming community differentiates between potential performance enhancers based on how problematic they are for the esports scene, with the most concern surrounding hard drugs, pharmaceuticals, and brain stimulation interventions. Participants who are more invested in competitive gaming tend to be more sceptical of enhancers and express greater concerns. Four themes were identified in the thematic analysis: (1) risk, (2) morality, (3) enhancer effects, and (4) regulation. To increase acceptance and perceived legitimacy in decision-making, it is recommended that regulators engage a variety of stakeholders in transparent decision-making processes when forming tournament rules and regulations. This will help address the fragmented regulatory landscape and prevent potential differences in the perception of tournament winners based on the governing body supervising the competition.

The impact of image and performance enhancing drugs on atrial structure and function in resistance trained individuals

BACKGROUND

Image and performance enhancing drugs (IPEDs) are commonly used in resistance trained (RT) individuals and negatively impact left ventricular (LV) structure and function. Few studies have investigated the impact of IPEDs on atrial structure and function with no previous studies investigating bi-atrial strain. Additionally, the impact of current use vs. past use of IPEDs is unclear.

METHODS

Utilising a cross-sectional design, male (n = 81) and female (n = 15) RT individuals were grouped based on IPED user status: current (n = 57), past (n = 19) and non-users (n = 20). Participants completed IPED questionnaires, anthropometrical measurements, electrocardiography, and transthoracic echocardiography with strain imaging. Structural cardiac data was allometrically scaled to body surface area (BSA) according to laws of geometric similarity.

RESULTS

Body mass and BSA were greater in current users than past and non-users of IPEDs (p < 0.01). Absolute left atrial (LA) volume (60 ± 17 vs 46 ± 12, p = 0.001) and right atrial (RA) area (19 ± 4 vs 15 ± 3, p < 0.001) were greater in current users than non-users but this difference was lost following scaling (p > 0.05). Left atrial reservoir (p = 0.008, p < 0.001) and conduit (p < 0.001, p < 0.001) strain were lower in current users than past and non-users (conduit: current = 22 ± 6, past = 29 ± 9 and non-users = 31 ± 7 and reservoir: current = 33 ± 8, past = 39 ± 8, non-users = 42 ± 8). Right atrial reservoir (p = 0.015) and conduit (p = 0.007) strain were lower in current than non-users (conduit: current = 25 ± 8, non-users = 33 ± 10 and reservoir: current = 36 ± 10, non-users = 44 ± 13). Current users showed reduced LV diastolic function (A wave: p = 0.022, p = 0.049 and E/A ratio: p = 0.039, p < 0.001) and higher LA stiffness (p = 0.001, p < 0.001) than past and non-users (A wave: current = 0.54 ± 0.1, past = 0.46 ± 0.1, non-users = 0.47 ± 0.09 and E/A ratio: current = 1.5 ± 0.5, past = 1.8 ± 0.4, non-users = 1.9 ± 0.4, LA stiffness: current = 0.21 ± 0.7, past = 0.15 ± 0.04, non-users = 0.15 ± 0.07).

CONCLUSION

Resistance trained individuals using IPEDs have bi-atrial enlargement that normalises with allometric scaling, suggesting that increased size is, in part, associated with increased body size. The lower LA and RA reservoir and conduit strain and greater absolute bi-atrial structural parameters in current than non-users of IPEDs suggests pathological adaptation with IPED use, although the similarity in these parameters between past and non-users suggests reversibility of pathological changes with withdrawal.

Is the use of performance and image enhancing drugs (PIEDs) in women an issue of concern? The findings from a stakeholder consultation

OBJECTIVES

There is limited research into the use of performance and image enhancing drugs among women who participate in sport, despite evidence that women do use these substances and experience related harms. The aim of this project is to capture stakeholder perspectives on the current research, policy, and practice landscape in Australia regarding women's performance and image enhancing drug use in regulated and unregulated sport settings.

DESIGN

Qualitative interviews.

METHODS

Thirty-two semi-structured interviews were conducted online with stakeholders from Australia between September and December 2021. Interviews ranged between 15 and 90 min in duration. Data were imported into the NVivo (Version 12) platform and analysed using thematic analysis.

RESULTS

Thirty-two participants (20 females and 12 males) who held a variety of roles (e.g., coach/strength coaches, gym owners, anti-doping agents, athletes) were interviewed. Fourteen participants reported performance and image enhancing drug use. There were four overarching themes generated from the data: 'participation in untested sports'; 'environmental factors driving use'; 'individual rationalisation'; and, 'the dark side of performance and image enhancing drug use'.

CONCLUSIONS

Performance and image enhancing drug use was identified as an issue of concern for women competing in non-elite strength and power-based sports. Of particular concern is the influence of unqualified advice from third parties (i.e., coaches and partners) regarding performance and image enhancing drug use. The environments in which performance and image enhancing drug use occurs can impact individual decisions of women and eventuate in significant and long-lasting physical and psychological harms.

Doping in Paralympic sport: perceptions, responsibility and anti-doping education experiences from the perspective of Paralympic athletes and parasport coaches

Introduction

Limited effort has been invested in understanding doping in Paralympic sport. The limited evidence that exists suggests that factors influencing doping in parasport are similar to Olympic sport. However, based on the design and nature of the previous studies, where methods have been mostly limited to qualitative data and prevalence numbers, further research is warranted to extend previous findings.

Methods

Informed by current evidence from Paralympic and Olympic sport, we aimed to investigate (1) para-athletes' perceptions of Anti-Doping Rule Violations (ADRVs) and responsibility for them, (2) descriptive norms for doping in parasport (3) perceptions of anti-doping education and legitimacy of anti-doping authorities, and (4) coach engagement in doping prevention and levels of doping confrontation efficacy using a quantitative survey approach.

Results

In total, valid survey responses from 126 Paralympic athletes and 35 coaches from four countries (Germany, Austria, Switzerland, UK) were analysed for experience with anti-doping, descriptive norms, anti-doping education, perceived legitimacy, knowledge, and doping confrontation efficacy (coaches only). Across both athletes and coaches, the level of education was generally good and doping willingness was low. Classification cheating was considered a form of doping and seems to be an important issue for athletes and coaches, especially within the UK sample. For 33.3% of the athletes, doping control was their first experience with anti-doping. Coaches' engagement with doping prevention activities and their perceived efficacy to confront doping-related matters appears to be higher compared to Olympic coaches' samples.

Discussion

Sport organisations/NADOs in Paralympic sport could use synergies with those organisations in Olympic sport, adopting similar approaches to anti-doping education, also focusing on a balanced communication of doping prevalence numbers and testing figures. Efforts to ensure athletes are educated about anti-doping before they are tested should be upheld. It seems that in para sport, different compared to able-bodied coaches, anti-doping organizations do not have to convince the coaches about their roles (i.e., being responsible for anti-doping education) anymore but can directly build on these resources. Overall, it seems that there are few differences between parasport and able-bodied sports and thus responsible organisations could use the existing programmes in Olympic sport and only adapt special content (e.g., boosting) which is unique to Paralympic athletes.

Are dietary supplement users more likely to dope than non-users?: A systematic review and meta-analysis

In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help international and national sport organisations understand the degree to which dietary supplement use is related to doping, the objectives of this systematic review and meta-analysis were to 1) compare the prevalence of doping between dietary supplement users and non-users and 2) identify whether supplement use is related to doping social cognitive factors. We searched for studies sampling athletes and that measured both dietary supplement use and doping in EMBASE, MEDLINE, PsychINFO, CINAHL and SPORTDiscus from database creation to May 2022. Risk of bias was assessed using JBI Critical Appraisal Checklist for cross-sectional studies and the STROBE checklist. Twenty-six cross-sectional studies, involving 13,296 athletes were included. Random-effect models revealed that doping was 2.74 (95% CI=2.10 to 3.57) times more prevalent in dietary supplement users (pooled prevalence = 14.7%) than non-users (6.7%), and that users reported stronger doping intentions (r=0.26, 0.18 to 0.34) and attitudes (r=0.21, 0.13 to 0.28) compared to non-users. Preliminary evidence also suggests that dietary supplement users were less likely to dope if they were more task oriented and had a stronger sense of morality. Results of the review are limited by the cross-sectional design used in all studies and lack of consistency in measurement of dietary supplement use and doping. Data indicate that athletes using dietary supplements are more likely to self-report doping Anti-doping policy should, therefore, target dietary supplement use in anti-doping education programmes by providing alternative strategies for performance enhancement or highlighting the safest ways they can be consumed. Similarly, as a large proportion of athletes use dietary supplements without doping, further research is needed to understand the factors that protect a dietary supplement user from doping. No funding was received for the review. A study protocol can be found here: https://osf.io/xvcaq.

Perfectionism and doping willingness in athletes: The mediating role of moral disengagement

Although trait perfectionism has been related to doping attitudes in athletes, research investigating variables that could account for relationships between perfectionism and doping outcomes has received scant attention. Consequently, the aim of the present study was to investigate whether perfectionism was related to doping willingness directly, and indirectly via moral disengagement. We recruited a sample of 204 student athletes (M age = 19.12 years, SD = 1.17, n = 81 females - 39.70%) who completed measures of perfectionistic strivings, perfectionistic concerns, doping moral disengagement, and doping willingness. Multiple regression analyses revealed a significant positive relationship between perfectionistic concerns and doping willingness (β = .13, p < .05) and a nonsignificant relationship between perfectionistic strivings and doping willingness (β = -.01, p > .05). Moreover, bias-corrected bootstrapped indirect effects revealed that doping moral disengagement mediated the relationship between perfectionistic concerns and doping willingness (ab = .12; 95% CI = 0.02 to 0.21). The findings suggest that the relationship between perfectionistic concerns and doping extends beyond attitudes - to doping willingness - and the propensity to morally disengage explains why this is the case.

Changes in Health-related Parameters Associated with Sports Performance Enhancement Drugs

The purpose of this study was to evaluate changes in health-related parameters caused by the administration of anabolic-androgenic steroids and "fat-burning drugs" during a 6-month competition preparation period. The physiological, biochemical, and anthropometric parameters studied included serum cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, aspartate aminotransferase, alanine transaminase, bilirubin, body mass, and percentage of total body fat. Changes in the parameters studied were analyzed at monthly intervals during six months of preparation for competition. The study revealed a continuous increase in body mass, accompanied by a decrease in body fat percentage to the physiologically essential level. Total cholesterol levels remined in the desirable concentration range. The mean levels of triglycerides fluctuated between borderline high and high. Mean high-density lipoprotein cholesterol levels remained within the low range, while low-density lipoprotein cholesterol fluctuated between near-optimal / above-optimal, borderline high, and high levels. Serum levels of aspartate aminotransferase and alanine transaminase remained within the high concentration. The bilirubin concentration remained in the desirable range. The blood nitrogen urea concentration fluctuated between normal and elevated levels. Sports-enhancing drugs analyzed in this study do not have an immediate detrimental impact on the selected biochemical, physiological, and anthropometric parameters that define health.

Recreational Athletes' Use of Performance-Enhancing Substances: Results from the First European Randomized Response Technique Survey

BACKGROUND AND AIM

Measuring the prevalence of doping in recreational sport is difficult. However, to fit their initiatives, National Anti-Doping Organizations are interested in knowing the numbers, so their scarce resources are not wasted. The present study aimed to estimate the prevalence of doping and over-the-counter medicine use for performance enhancement among recreational athletes in eight European countries.

DESIGN

A survey covering + 200 sports aimed at recreational athletes 15 years and older was distributed via social media to sports clubs and individuals in eight European countries. To overcome social desirability bias, we applied indirect questioning by using the Randomized Response Technique and asked for the use of over-the-counter medicine and doping for the year 2019.

RESULTS

The prevalence of the use of over-the-counter medications for performance enhancement was estimated at 10.4%. We differentiated between the concept of "doping" as the behavior to enhance performance in a certain sport and the concept of "a doper" as a property of a person. The prevalence of dopers in recreational sport was found to be 0.4%, with 3.1% male and 0% female dopers. Responses were separated into four categories: "Artistic sports," "Combat sports," "Games," and "CGS sports" (i.e., sports measured in centimeters, grams, and seconds). The overall prevalence of doping in recreational sports was found to be 1.6%, and the results from Artistic and CGS sports did not differ significantly from this. However, in Games we found an estimated doping prevalence of 6.9%.

DISCUSSION

The estimates for the prevalence of dopers and doping in this study do not equal Anti-Doping Rule Violations as stipulated by the World Anti-Doping Agency. Still, while doping is not absent in recreational sport in Europe, it appears to be a low frequent phenomenon. Also, the differences in doping prevalence between the sports categories might reflect structural and competition-related differences, rather than differences in the logic of the sporting competition or discipline-related subcultures.

CONCLUSION

While few recreational athletes appear to use illegal drugs to enhance performance, those who do use them are more often men than women. Yet, 1 in 10 recreational athletes uses over-the-counter medication for performance enhancement and more than 4 out of 10 use medication for other reasons than performance enhancement when doing sports. The highest doping prevalence was found in the sub-category of Games, which can likely be attributed to competition-related differences between the categories. Therefore, research on doping in recreational sports needs tailored approaches to come to a better understanding of the phenomenon.

Refinement of the extended crosswise model with a number sequence randomizer: Evidence from three different studies in the UK

The Extended Crosswise Model (ECWM) is a randomized response model with neutral response categories, relatively simple instructions, and the availability of a goodness-of-fit test. This paper refines this model with a number sequence randomizer that virtually precludes the possibility to give evasive responses. The motivation for developing this model stems from a strategic priority of WADA (World Anti-Doping Agency) to monitor the prevalence of doping use by elite athletes. For this model we derived a maximum likelihood estimator that allows for binary logistic regression analysis. Three studies were conducted on online platforms with a total of over 6, 000 respondents; two on controlled substance use and one on compliance with COVID-19 regulations in the UK during the first lockdown. The results of these studies are promising. The goodness-of-fit tests showed little to no evidence for response biases, and the ECWM yielded higher prevalence estimates than direct questions for sensitive questions, and similar ones for non-sensitive questions. Furthermore, the randomizer with the shortest number sequences yielded the smallest response error rates on a control question with known prevalence.

Hidden figures: Revisiting doping prevalence estimates previously reported for two major international sport events in the context of further empirical evidence and the extant literature

Background

High levels of admitted doping use (43.6% and 57.1%) were reported for two international sport events in 2011. Because these are frequently referenced in evaluating aspects of anti-doping, having high level of confidence in these estimates is paramount.

Objectives

In this study, we present new prevalence estimates from a concurrently administered method, the Single Sample Count (SSC), and critically review the two sets of estimates in the context of other doping prevalence estimates.

Methods

The survey featuring the SSC model was completed by 1,203 athletes at the 2011 World Championships in Athletics (WCA) (65.3% of all participating athletes) and 954 athletes at the 2011 Pan-Arab Games (PAG) (28.2% of all participating athletes). At WCA, athletes completed both UQM and SSC surveys in randomised order. At PAG, athletes were randomly allocated to one of the two surveys. Doping was defined as "having knowingly violated anti-doping regulations by using a prohibited substance or method."

Results

Estimates with the SSC model for 12-month doping prevalence were 21.2% (95% CI: 9.69-32.7) at WCA and 10.6% (95% CI: 1.76-19.4) at PAG. Estimated herbal, mineral, and/or vitamin supplements use was 8.57% (95% CI: 1.3-16.11) at PAG. Reliability of the estimates were confirmed with re-sampling method (n = 1,000, 80% of the sample). Survey non-compliance (31.90%, 95%CI: 26.28-37.52; p < 0.0001) was detected in the WCA data but occurred to a lesser degree at PAG (9.85%, 95% CI: 4.01-15.69, p = 0.0144 and 11.43%, 95% CI: 5.31-11.55, p = 0.0196, for doping and nutritional supplement use, respectively). A large discrepancy between those previously reported from the UQM and the prevalence rate estimated by the SSC model for the same population is evident.

Conclusion

Caution in interpreting these estimates as bona fide prevalence rates is warranted. Critical appraisal of the obtained prevalence rates and triangulation with other sources are recommended over "the higher rate must be closer to the truth" heuristics. Non-compliance appears to be the Achilles heel of the indirect estimation models thus it should be routinely tested for and minimised. Further research into cognitive and behaviour aspects, including motivation for honesty, is needed to improve the ecological validity of the estimated prevalence rates.

Associations Between Esports Participation and Health: A Scoping Review

Esports are a contemporary phenomenon, with millions of people involved. Still, scientific literature on the topic is scarce. Anecdotal reports, mostly based on what is known from videogames practice, have associated esports with unhealthy lifestyles and health-related problems. The present scoping review aimed to provide an overview of findings from studies regarding the health and well-being in adult esports players, while identifying the most studied topics in the field and those still lacking scientific research.The search was conducted in MEDLINE, Scopus, Web of Science, B-on, and ESCBO databases. Studies regarding health consequences of esports practice conducted with adult esports players were included. No exclusion criteria concerning age, sex, esports modality, or esports level were applied, but articles related to other forms of video gaming or gambling were excluded. The search was limited to peer-reviewed articles. Opinion and review articles were excluded.There were 1416 articles retrieved from which 33 met the inclusion criteria. Lifestyle habits, sleep, exercise and physical health (including musculoskeletal health), physiological demands, and mental health were the main topics of investigation. Several gaps in the literature were identified, namely studies on cardiovascular, respiratory, or metabolic health, or consuming-related risks. Also, the lack of homogeneous methodologies and definitions used in esports-related studies was identified.Esports practice has been associated with different health-related symptoms, but more studies using more robust methodologies and appropriate research design are needed. Topics such as cardiovascular health or the use of performance-enhancing drugs are lacking.

The athletic characteristics of Olympic sports to assist anti-doping strategies

The determinants of success in Olympic Games competition are specific to the athletic demands of the sporting event. A global evaluation to quantify the athletic demands across the spectrum of the Olympic Games sport events has not previously been conducted. Thus far, the interpretation and the comparison of sport physiological characteristics within anti-doping organisations (ADOs) risk assessments remains subjective without a standardised framework. Despite its subjective assessment, this information is a key component of any anti-doping programme. Sport characteristics inevitably influence the type of substances and/or methods used for doping purpose and should be captured through a comprehensive analysis. Seven applied sport scientists independently conducted an assessment to quantify the athletic demands across six preselected athletic variables. A Principal Component Analysis was performed on the results of the panel's quantitative assessment for 160 Olympic Sport events. Sport events were clustered using the Hierarchical Density Based Spatial Clustering of Applications with Noise (HDBSCAN) algorithm. The HDBSCAN identified 19 independent cluster groups, 36 sport events remained statistically unassigned to a cluster group representing unique and eventspecific athletic demands. This investigation provides guidance to the anti-doping community to assist in the development of the sport specific physiology component of the risk assessment for Olympic Games disciplines. The dominant athletic characteristics to excel in each of these individual events will highlight areas of how athletes may strive to gain a competitive advantage through doping strategies, and inform the development of an effective and proportionate allocation of testing resources.

Every Young Athlete Counts: Are Tailored Doping Prevention Programs Necessary in Young Elite Sports?

Conclusions from doping prevention literature recommend tailored anti-doping education for athletes' specific needs. Newer approaches like the International Standard for Education of the World Anti-Doping Agency recommend a needs assessment before implementing measures. The International Standard for Education refers to the type of sports and its associated risk for doping. Following this idea, elite athletes from different types of sports should differ in their prerequisites for doping prevention. Consequently, the guiding research question focused on exploring the doping-prevention-related background of young athletes as a particular group for prevention efforts. Sixty young elite athletes (58.3% male) took part in a cross-sectional online survey, which was quantitatively analyzed. Participants included 26 athletes from a sport with low doping prevalence (sailing) and 34 athletes from a sport associated with high doping prevalence (wrestling). Sailors and wrestlers differed concerning the perceived resistance against doping temptations (p = 0.031, r = 0.31) and the estimated actual doping prevalence regarding sports in general (national frame: p &lt; 0.001, r = 0.60; international frame: p = 0.013, r = 0.43). No differences between the two types of sports occurred, referring to doping attitudes, tendency to disengage morally, or topics athletes wish to learn about during doping prevention measures. All results indicated a good baseline for doping prevention with young elite athletes at the beginning of their careers. There is no sport-specific needs profile that could be used as a base for tailored measures. However, the data suggest that a differentiated consideration of gender could be helpful in the planning of doping prevention measures.

Use, Perceptions and Attitudes of Cognitive and Sports Performance Enhancing Substances Among University Students

The use of prohibited performance enhancing substances (PESs) is well-documented among athletes, and includes student athletes in institutions of higher learning. In addition to using PESs to enhance sporting performance, they may be used for cognitive and academic achievement, specifically through the use of neuroactive substances. The latter in particular is under-researched and poses public health risks. Understanding the extent and reasons for using or not using PESs by university students will assist in addressing further research, and means to deter their use. This study aimed to explore the prevalence, attitude, and perceptions of the use of both sport and academic performance-enhancing substances by students at two universities in Johannesburg, South Africa. The study utilized a cross-sectional, descriptive survey design using a self-administered online questionnaire. All registered students were invited to participate via email using the university communications modes, with a link to a Google Forms questionnaire. Ethical approval was granted for the study and data were collected anonymously. The sample size of responses with completed data was 548, comprising predominantly female and undergraduate students, with 32 (6%) indicating current or past use of PESs. Among the prohibited substances used, neuroactive drugs were mostly used, with cannabis the highest followed by stimulants. The most popular reasons reported were for academic and cognitive performance. Most responded with what would be deemed ethically appropriate answers on the perception of PES use and 72% of the participants believe that a drug-testing program will prevent their use in the university, and further, that educational programs will help improve students' knowledge of PES. Although relatively low usage, university students use performance enhancing substances, mostly for cognitive enhancement using neuroactive stimulants. Most believe that the use of all forms of PESs is high among their peers; and favor education and testing programs, suggesting that intervention programs may be effective. Better defined research should be conducted to unpack the broad findings in this study.

Moral Disengagement, Social Norms, and Motivational Profiles Influence Attitudes Toward Doping Among Spanish Athletics Coaches

Coaches strongly influence athletes' attitudes toward doping and can shape athlete's beliefs, behaviors, and decisions to be for or against doping. Coached-centered studies examining multiple factors affecting coaches' doping attitudes and behavior are scarce. The aim of this study was to analyze for the first-time attitudes toward doping in athletics coaches using the Sport Drug Control Model (SDCM) as a theoretical framework. A secondary aim was to determine the factors in the model predicting attitude and susceptibility toward doping. A cross-sectional study was carried out using a sample consisting of 201 Spanish athletics competitive level coaches from whom 11.4% were female. Participants completed a cross-sectional online survey. Structural equation modeling showed a good fitness of the SDCM. Positive attitudes toward doping predicted high susceptibility to doping (β = 0.39, p < 0.001). Moral disengagement (β = 0.58, p < 0.001), descriptive norms (β = 0.42, p = 0.001), ego-oriented goals (β = 0.34, p < 0.05), and self-efficacy to refrain from doping (β = 0.26, p < 0.05) displayed a significant influence on attitudes toward doping. Self-reported doping prevalence in coaches was 4.5%. These variables should be considered when designing anti-doping research projects and educational programs aiming at modifying coaches' attitudes toward doping. It is recommended to focus more efforts on coaches, without putting aside the athletes, and therefore turn coaches into reliable doping prevention factors. To this end, it is necessary to enhance scientific research and then develop, implement, and promote more educational programs targeting coaches, on a mandatory basis while covering the specific needs of coaches so that they can perform their role as anti-doping educators in an effective, committed, and proactive manner.

A Supplementary Approach for Effective Anti-Doping Education: A Pilot Study Applying Refutation Texts to Modify Misperception of the Whereabouts System

Background: Over the past twenty years, a multifaceted anti-doping system was established to detect, deter, and prevent doping among athletes. However, perception of the whereabouts system has been a controversial issue. This pilot study aimed to evaluate the effects of refutation text intervention on the perception of the whereabouts system. Methods: In two studies, we tested whether (1) detailed refutation texts are perceived as more effective than simply refuting with a true or false claim among 132 athletes (47.73% female, mean age = 20.99 ± 2.11), and if (2) refutation text intervention can alter the perception of the whereabouts system among 177 athletes (53.11% female, mean age = 21.17 ± 2.27). Descriptive statistics were calculated, followed by a one-sample T-test, independent T-test, chi-square test, and a repeated-measures analysis of variance. Results: The results demonstrate that five true/false statements were developed as refutation texts, and the mean accuracy of the true/false test is less than the probability of guess (p < 0.05, d = −0.18). In addition, detailed refutation texts evoked significantly greater perceived effectiveness than the simple refutation texts (p < 0.01, d = 0.66). Furthermore, the refutation text intervention enhanced the positive perception of the whereabouts system (p < 0.01, η² = 0.15). Conclusions: Our findings support the efficacy of refutation texts to improve the misperception of anti-doping regimes among athletes and have implications for future education prevention initiatives.

Cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids in relation to sports: a position statement of the sport cardiology and exercise nucleus of the European Association of Preventive Cardiology

The use of substances and medications with potential cardiovascular effects among those practicing sports and physical activity has progressively increased in recent years. This is also connected to the promotion of physical activity and exercise as core aspects of a healthy lifestyle, which has led also to an increase in sport participation across all ages. In this context, three main users' categories can be identified, (i) professional and amateur athletes using substances to enhance their performance, (ii) people with chronic conditions, which include physical activity and sport in their therapeutic plan, in association with prescribed medications, and (iii) athletes and young individuals using supplements or ergogenic aids to integrate their diet or obtaining a cognitive enhancement effect. All the substances used for these purposes have been reported to have side effects, among whom the cardiovascular consequences are the most dangerous and could lead to cardiac events. The cardiovascular effect depends on the type of substance, the amount, the duration of use, and the individual response to the substances, considering the great variability in responses. This Position Paper reviews the recent literature and represents an update to the previously published Position Paper published in 2006. The objective is to inform physicians, athletes, coaches, and those participating in sport for a health enhancement purpose, about the adverse cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids, when associated with sport and exercise.

Efficient Ways to Combat Doping in a Sports Education Context!? A Systematic Review on Doping Prevention Measures Focusing on Young Age Groups

Youth is characterized by testing and crossing natural boundaries, sometimes with the help of performance-enhancing substances. In this context, doping prevention measures play a crucial role to protect individuals both within and outside the context of elite sport. Based on the PRISMA guidelines, a systematic literature search was conducted in the databases ProQuest (ERIC), Scopus, PSYNDEX/PsychInfo, PubMed, and Web of Science Core Collection to provide an overview of the impact of doping prevention measures, with particular attention to the underlying understanding of learning. As a result of the screening process, 30 of the initial 5,591 articles met the previously defined and recorded eligibility criteria. The analysis led to heterogeneous results regarding content, implementation, target group, or outcome variables considered relevant. Two-thirds of the studies related to the competitive sports context. Nevertheless, there has been a growing interest in studying doping prevention and its effects on non-elite athlete target groups in recent years. In terms of effectiveness, many measures did not achieve long-term changes or did not collect any follow-up data. This contrasts with understanding learning as sustained change and reduces the intended long-term protection of prevention measures, especially for adolescent target groups. Even young age groups from 10 years upwards benefited from doping prevention measures, and almost all doping prevention measures enabled their participants to increase their physical and health literacy. No conclusion can be drawn as to whether doping prevention measures based on constructivist ideas are superior to cognitivist approaches or a combination of both. Nevertheless, programs that actively engage their participants appear superior to lecture-based knowledge transfer. Most of the prevention measures offered a benefit-orientation so that participants can achieve added value, besides trying to initiate health-promoting change through rejection. Because of the lack of sustained changes, a further modification in doping prevention seems necessary. The review results support the value of primary prevention. Doping prevention measures should enable tailored learning and development options in the sense of more meaningful differentiation to individual needs. The implementation in a school context or an online setting is promising and sees doping as a problem for society. The review highlights the importance of accompanying evaluation measures to identify efficient prevention components that promote health and protect young people.

Annual banned-substance review: Analytical approaches in human sports drug testing 2020/2021

Most core areas of anti-doping research exploit and rely on analytical chemistry, applied to studies aiming at further improving the test methods' analytical sensitivity, the assays' comprehensiveness, the interpretation of metabolic profiles and patterns, but also at facilitating the differentiation of natural/endogenous substances from structurally identical but synthetically derived compounds and comprehending the athlete's exposome. Further, a continuously growing number of advantages of complementary matrices such as dried blood spots have been identified and transferred from research to sports drug testing routine applications, with an overall gain of valuable additions to the anti-doping field. In this edition of the annual banned-substance review, literature on recent developments in anti-doping published between October 2020 and September 2021 is summarized and discussed, particularly focusing on human doping controls and potential applications of new testing strategies to substances and methods of doping specified in the World Anti-Doping Agency's 2021 Prohibited List.