The Development and Efficacy of a High School Athlete Education Program for Safe Nutritional Supplement Use

High school athletes' practical knowledge on where to find and order third-party tested nutritional supplements increases after education when compared to a control group

To promote safe supplement use, athletes are advised to choose third-party tested (TPT) supplements to minimise doping risk. This study evaluated changes in knowledge on supplements in US high school athletes from a 2-week online supplement education programme. One group of sophomores (ED, n = 48) completed a Canvas course on safe supplement use, based on the Theory of Planned Behaviour, while the other group of freshmen (NOED, n = 38) did not. Participants completed questionnaires pre- and post-intervention to assess practical knowledge of finding and ordering TPT supplements, familiarity with World Anti-Doping Agency (WADA) banned substances and decision-making in supplement purchasing. Chi-Square and McNemar tests were applied with significance set at p ≤ 0.05. Pre-intervention no differences were found between groups (ages 14-17 years, 39.5% female) for any knowledge questions (p = 0.18). Post-intervention, ED participants were more likely to know where to find (58.3% vs. 39.5%, p = 0.041), and order (62.5% vs. 28.9%, p = 0.001) TPT supplements, and more athletes in ED (72.9%) than NOED (40.0%) reported deciding to purchase supplements themselves (p = 0.015). Parents were less influential in ED (75.0% vs. 92.1%, p = 0.019). Importantly, positive changes over time were larger for ED versus NOED in knowing where to find (28% vs. 13%, p = 0.04) and order (28% vs. 7%, p < 0.001) TPT supplements and WADA familiarity (19% vs. 5%, p = 0.01). Within-group changes showed ED improved on all practical knowledge questions (p = <0.001-0.008), whereas NOED only increased in knowing where to find TPT supplements (p = 0.003). These findings suggest an online educational programme may enhance practical knowledge of safe supplement use among high school athletes.

Equalizing the Playing Field and Improving School Food Literacy Programs Through the Eyes of Teens: A Grounded Theory Analysis Using a Gender and Sport Participation Lens

Background: School food literacy programs (e.g., home economics) are an opportunity to improve the dietary habits of teens. However, the literature suggests that girls and athletes have better food literacy, and it is not clear how school programs contribute to this inequality. To address this, we explored how gender and sport influenced teens' perspectives of their school food literacy experiences and how they can be improved. Methods: Using semi-structured interviews and a Grounded Theory analysis, we generated a theoretical understanding of how to improve school food literacy programs for athletes and non-athletes of diverse genders. Thirty-three teens were recruited to balance sport participation (n = 18 athletes) and gender (n = 15 boys; n = 14 girls; n = 4 non-binary) based on data saturation. Results: Teens expressed four categories to improve school programs that aligned with principles of the Capability, Opportunity, Motivation and Behaviours (COM-B) Model of behaviour change. Programs should Provide a challenge (e.g., more advanced recipes), Make it fun (e.g., explore new cuisines in interactive ways) and Establish importance (e.g., health impacts). Practice is key for teens' self-confidence and development of food skills (e.g., meal planning) as well. Boys emphasized Make it fun whereas girls and non-binary teens emphasized Establishing importance. Athletes valued Practice is key more than non-athletes. Conclusions: School programs should relay the importance of food literacy in fun and tailored ways to teens (e.g., meal planning among athletes). It may be especially salient for programs to tailor their activities and messaging, where possible, to appeal to diverse teens who play sports and those who do not.

Cross-validation of the safe supplement screener (S3) predicting consistent third-party-tested nutritional supplement use in NCAA Division I athletes

Introduction

This cross-sectional study aimed to cross-validate an earlier developed algorithm-based screener and explore additional potential predictors for whether athletes will use third-party-tested (TPT) supplements.

Methods

To justify the initial model behind the supplement safety screener (S3) algorithm which predicts whether athletes will use TPT supplements, a cross-validation was performed using this independent dataset based on responses of a large group of collegiate NCAA DI athletes. Additionally, explorative modeling using stepwise logistic regression was used to identify new predictors for TPT supplement use to create and evaluate a new model for future use.

Results

The S3 algorithm was applied to the responses from n = 662 athletes using supplements (age: 20 ± 1.5 years, 50% female, from >24 sports) confirming that the algorithm identifies consistent and inconsistent TPT users (χ2 (1) = 15.95, p < 0.001), with a moderate area under the curve (AUC, 0.67) and a moderate specificity (68%), but low sensitivity (51%). Explorative modeling identified two new variables: TPT logo recognition, and having at least one name, image, likeness (NIL) deal that may help to predict TPT supplement use.

Discussion

Strong relationships between risk groupings and product use outcomes toward TPT supplement use were identified for the athletes screened. The S3 screener showed high sensitivity for identifying student-athletes inconsistently using TPT supplements, but a low specificity, lacking the ability to place less risky athletes into low-risk quadrants. The exploratory modeling, identifying TPT logo recognition and having a NIL deal, further strengthens our knowledge on predictors for consistent TPT supplement use.

Predictors of Third-Party Tested Nutritional Supplementation Use Among DI and DIII Student-Athletes at A Northeast University

Nutritional supplements (NS) are linked to adverse events and unintentional doping among college-athletes. The use of third-party tested (TPT) NS can increase safety and reduce the risk of inadvertent consumption of banned substances. The purpose of this study was to examine self-reported use of TPT supplements between the National Collegiate Athletic Association (NCAA) Division I (DI) and Division III (DIII) college-athletes and explore the potential predictors of TPT use. This cross-sectional study used data from a web-based, 50-question survey on supplement use, behaviors, and knowledge. A total of 271 individuals completed the survey, 118 athletes (66.9% DI, 33.1% DIII) were included in the analysis due to completion of TPT NS questions. Among this sample, 80.5% of student-athletes reported use of TPT NS, however, only 17.8% of students reported consistent use of TPT NS. In the multivariable model adjusted for athletic division, sex, and sport-type, student-athletes who preferred information from a strength and conditioning coach or athletic trainer were 69% less likely to report consistent use of TPT NS across all categories when compared to those who preferred going to a registered dietitian nutritionist (RDN). Student-athletes with limited access to an RD/RDN were more likely to use an athletic trainer or strength and conditioning coach for supplement information. Having dedicated RDNs within athletic departments may benefit athletes when it comes to safe NS use. Programs should also consider additional supplement education to athletic trainers and strength and conditioning coaches to help ensure safe and effective use of NS.

Development of a screener to assess athlete risk behavior of not using third-party tested nutritional supplements

Introduction

The aim of this cross-sectional study was to develop an algorithm to predict athletes use of third-party tested (TPT) supplements. Therefore, a nutritional supplement questionnaire was used with a section about self-reported TPT supplement use.

Methods

Outcomes were randomly assigned to a training dataset to identify predictors using logistic regression models, or a cross-validation dataset. Training data were used to develop an algorithm with a score from 0 to 100 predicting use or non-use of TPT nutritional supplements.

Results

A total of n = 410 NCAA Division I student-athletes (age: 21.4 ± 1.6 years, 53% female, from >20 sports) were included. Then n = 320 were randomly selected, of which 34% (n = 109) of users consistently reported that all supplements they used were TPT. Analyses resulted in a 10-item algorithm associated with use or non-use of TPT. Risk quadrants provided the best fit for classifying low vs. high risk toward inconsistent TPT-use resulting in a cut-off ≥60% (χ2(4) = 61.26, P < 0.001), with reasonable AUC 0.78. There was a significant association for TPT use (yes/no) and risk behavior (low vs. high) defined from the algorithm (χ2(1)=58.6, P < 0.001). The algorithm had a high sensitivity, classifying 89% of non-TPT users correctly, while having a low specificity, classifying 49% of TPT-users correctly. This was confirmed by cross-validation (n = 34), reporting a high sensitivity (83%), despite a lower AUC (0.61).

Discussion

The algorithm classifies high-risk inconsistent TPT-users with reasonable accuracy, but lacks the specificity to classify consistent users at low risk. This approach should be useful in identifying athletes that would benefit from additional counseling.

The Development and Efficacy of a High School Athlete Education Program for Safe Nutritional Supplement Use

Many high school athletes report using nutritional supplements. Due to a lack of education at the high school level, the use of safe for sports third-party tested nutritional supplements may be limited. To determine the impact of a short online nutritional supplement education program on safe dietary supplement behavior a cross-sectional repeated measures design was used. Therefore, a convenience sample of 106 high school athletes (14-19 years old) was recruited to measure pre-post education difference for nutritional supplement use and third-party tested (TPT) supplements. Additionally, it was analyzed if nutritional supplement related Theory of Planned Behavior (TPB) constructs were associated with athlete choices. The most popular supplements included protein powder (65%), caffeine from beverages (45%), and different types of vitamins (ranging from 38-44%). Consistent use of (safe) third-party tested individual supplements was low, ranging from 35-77% for the most frequently reported supplements. The combined TPB determinants explained 26% of the variance of the intention to use safe supplements (F3, 102 = 13.03, p < 0.001, Adj R2 = 0.26). The self-reported intention to use third-party tested supplements increased significantly (+7%-36% per individual supplement) after following the education program (Z = -3.288, p = 0.001) resulting in an intentional use of 54-94% TPT supplements. In conclusion, education resulted in more high school athletes reporting future third-party tested supplements use, and TPB construct scores did not change over time but could explain a substantial part of the variance of safe supplement use intentions.