An Italian Campaign to Promote Anti-doping Culture in High-School Students

The association between subjective anti-doping knowledge and objective knowledge among Japanese university athletes: a cross-sectional study

Introduction

This study aimed to assess the association between subjective anti-doping knowledge (subjective ADK) and objective anti-doping knowledge (objective ADK) among Japanese university athletes, framed within the context of the Theory of Planned Behavior (TPB).

Methods

Eligible participants were 486 university athletes [320 men (65.8%), 166 women; mean age of 18.9 ± 1.0 years]. The participants categorized themselves in terms of the quality of their anti-doping knowledge. This assessment resulted in an independent variable coded as "(1) substantial lack of adequate knowledge," "(2) some lack of adequate knowledge," "(3) fair amount of knowledge" or "(4) good amount of knowledge." Objective ADK was assessed using the Athlete Learning Program about Health and Anti-Doping (ALPHA) test, a set of questions derived from the ALPHA-a former World Anti-Doping Agency e-learning program. The test comprises 12 questions (four choices each; passing index: ≧10 points or 80% correct answer rate). ANCOVA was conducted using subjective ADK as an independent variable and ALPHA scores as a dependent variable, adjusting for confounding factors (anti-doping experience).

Results

The ALPHA corrected answer rate across subjective ADK levels for the group were 73.10% for "(1) substantial lack of adequate knowledge," 71.97% for "(2) some lack of adequate knowledge," 75.18% for "(3) fair amount of knowledge" and 72.86% for "(4) good amount of knowledge." Comparison between different levels of subjective ADK revealed no significant differences in ALPHA score considering the main effects or any of their interactions.

Discussion

The present results revealed that Japanese university athletes' subjective ADK did not match their objective ADK. In the context of the TPB, there may be limitations in the perceived behavioral control in anti-doping knowledge. Even if athletes view doping as a wrongful act and have formed attitudes and subjective norms to comply with the rules, the results suggest that errors may occur in the composition of behavioral intentions due to a lack of knowledge. This could lead to the possibility of facing the risk of unintentional anti-doping rule violations. It highlights the need for targeted educational interventions to align subjective ADK of athletes with their objective ADK.

"I RUN CLEAN Project"-An Innovative and Self-Sustainable Approach to Develop Clean Sport Behaviours in Grassroots Athletes

The phenomenon of doping is a public health issue that poses threats to sport and society. In recent decades, the emphasis on efforts to address the issue and reduce the incidence of doping by young people in sport has shifted from deterrence through testing and punishment to the promotion of clean sport behaviours through values-based education. The "I Run Clean project" sought to develop new and effective tools targeting grassroots athletes and those around them (coaches, medical support personnel, sport leaders, parents). These included sport-specific e-learning and in-person peer-to-peer workshops led by trained volunteer ambassadors. The aim of all "I Run Clean" measures is to go beyond the warnings and provision of factual information about early anti-doping campaigns to a more holistic educational approach that focuses participants on their personal and sport-related values in order to encourage good decision-making and resistance to doping-related behaviours. This study evaluates the efficacy of the peer-to-peer workshops and their impact on selected psycho-social variables. The collaboration of the volunteer ambassadors is shown to effectively transmit the desired reasoning, reduce doping risk factors and enhance protective factors.

Knowledge and experience of Kazakhstan athletes in anti-doping and the impact of past educational intervention

Background

Although Kazakhstan National Anti-Doping Organization (KazNADO) exists since 2013, but little is yet known about anti-doping (AD) knowledge of Kazakhstan athletes. The aim of this study was to assess the AD education knowledge level and experience among Kazakhstan athletes, as well as the impact of any past AD educational program on them.

Methods

Altogether, 590 athletes (the median was age 17 years (interquartile range 8)), representing various sports, participated in the web-based study and completed the questionnaire, which consisted of socio-demographic part and ALPHA test. We assessed the association of any past AD education and experience with anti-doping knowledge using adjusted regression models.

Results

A total of 54.6% participants underwent doping control and 82,7% of athletes received AD education at least once. More than 300 participants (50.8%) provided correct answers for 10 questions. Age and years in sports (competition duration) were significantly associated with the ALPHA scores of athletes. Athletes who received AD education more than once in the past had significantly higher ALPHA scores than non-AD educated athletes in most questions.

Conclusion

AD education was associated with AD knowledge. Further research is needed to identify the adherence to anti-doping knowledge.

Effectiveness of the world anti-doping agency's e-learning programme for anti-doping education on knowledge of, explicit and implicit attitudes towards, and likelihood of doping among Chinese college athletes and non-athletes

Background

This study aimed to evaluate the effects of the World Anti-Doping Agency's e-learning programme for anti-doping education on knowledge of, explicit and implicit attitudes towards, and likelihood of doping among Chinese college athletes and non-athletes.

Method

Thirty-two young adults (including 16 college athletes) were recruited to receive the Athlete Learning Program about Health and Anti-Doping (ALPHA) intervention (Zh-hans version). Another 32 young adults were recruited for no-treatment control purposes. Before and immediately after the intervention, the ALPHA test, performance enhancement attitude scale, doping likelihood scale, and brief implicit association test (BIAT) were performed. Cortical activity during the BIAT test was monitored using a functional near-infrared spectroscopy instrument.

Results

Significant intervention effects were observed for knowledge (p < 0.01, η² = 0.21) and explicit attitude (p < 0.05, η² = 0.12) but not for doping likelihood (p > 0.05; benefit situation: η² = 0.04; cost situation: η² = 0.02). Compared with the non-athletes, the college athletes reported lower doping likelihood scores in benefit situations (e.g., financial gain, p < 0.05, η² = 0.10). Regarding the BIAT task, the experimental effect was successfully induced by different semantic associations between the concepts and the attitude (doping + like vs. doping + dislike). The mean reaction times (p < 0.01, η² = 0.36) and error rate (p < 0.01, η² = 0.34) in the doping-like block were higher than those in the doping-dislike block. Moreover, oxygenated haemoglobin (oxy-Hb) in response to BIAT interference in the temporoparietal junction-related channels was increased during the post-intervention test (p < 0.05, η² varied from 0.09 to 0.16).

Conclusions

The findings suggest that the online anti-doping education programme is partially effective among Chinese college athletes and non-athletes. Furthermore, our findings reflect enhanced cognitive control after the education intervention to suppress a prepotent implicit attitude towards doping.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-022-00459-1.

Anti-Doping Knowledge of Students Undertaking Bachelor's Degrees in Sports Sciences in Spain

In Spain, students pursuing a career in athletic training, physical education, or scientific evaluation of sports enroll in a bachelor’s degree in sports sciences. This degree provides knowledge and skills in a broad array of sports settings and promotes research-based interdisciplinary knowledge. However, the student’s syllabus rarely includes specific academic training on anti-doping regulations or doping prevention. The purpose of this study was to assess the anti-doping knowledge of the students undertaking a bachelor’s degree in sports sciences in Spanish universities. One thousand two hundred and thirty-three bachelor students in sport science (907 males, 322 females, and 4 participants with non-binary sex) from 26 Spanish universities completed a validated questionnaire about general anti-doping knowledge. The questionnaire is an adapted version of the Play True Quiz of the World Anti-Doping Agency and contains 37 multiple-choice questions. The score obtained in the questionnaire was transformed into a 0−100-point scale. The questionnaire was distributed among students within each university by a faculty member and it was filled out online. Students obtained a score of 65.8 ± 10.10 points (range = 32−92 points). There was an effect of the course in the score obtained (p < 0.001). Students of the first course (63.6 ± 9.5 points) had lower scores than the remaining courses (p < 0.037) while the students of the fourth course obtained the highest scores (68.7 ± 9.5 points; p < 0.019). The students with an itinerary on sports performance were the respondents with the highest anti-doping knowledge (67.2 ± 10.2) points, followed by the students with an itinerary on health (66.7 ± 9.5 points). The knowledge of basic anti-doping rules and doping prevention strategies of the bachelor students in sports sciences in Spain was suboptimal. Increasing doping prevention information in the syllabus of the bachelor’s degree in sports sciences is essential as these future professionals will directly work with populations at risk of doping.

Answering the call for values-based anti-doping education—An evidence-informed intervention for elite adolescent athletes in Germany and Austria

Doping has serious negative consequences for athletes and the integrity of sports, implying the need for effective prevention programs. Since educating young athletes about doping-related knowledge is deemed to be not sufficiently effective to minimize doping, a focus on values, emotions and morality is seen as a promising approach and previous research indicates which variables exactly could be addressed in anti-doping efforts. These variables are anticipated guilt, empathy, moral disengagement, and collective moral norms, since these constructs have been strongly and consistently linked to doping intention, likelihood, or behavior. Therefore, the purpose of this study was to develop a values-based anti-doping intervention, which targets the aforementioned variables, and to evaluate its effectiveness in producing changes in outcomes in comparison to an information-based intervention and a waiting control group. To evaluate their effectiveness, both interventions, which each consist of six 45-min sessions (one session per week) were implemented in a sample of 321 young elite athletes, aged 13–19 years, from a broad range of team and individual sports. Thirty different teams, training groups or classes were randomly assigned to either the values-based intervention, the information-based intervention, or to a waiting control group. Doping intention, doping susceptibility as well as the above mentioned variables were assessed at pre- and posttest and, for participants of the values- and information-based conditions also at a 3 to 4-month follow up. Within a multilevel modeling framework general linear mixed regression analyses revealed that the values-based intervention, compared to the control group, was able to decrease athletes' moral disengagement and increase their anticipated guilt immediately after the intervention (at posttest), whereas no effects for the information-based intervention emerged. Looking at how the outcomes developed over time (i.e., at the follow up measurement), it could be demonstrated that the reduction in moral disengagement sustained. The increase in anticipated guilt, however, was not sustainable and, surprisingly, decreased from post to follow up. Furthermore, athletes in the values-based intervention reported higher empathy from post to follow up, which could possibly indicate a “delayed” effect. This study provides support that a values-based approach can produce changes in some, yet, not all addressed variables and specific elements from this intervention could potentially be a useful addition to traditional anti-doping education (i.e., information provision).

Relationship between the level of willingness to learn about anti-doping and objective knowledge among Japanese university athletes: A cross-sectional study

Previous studies have indicated that athletes' anti-doping knowledge is inadequate. Athletes' willingness to learn about anti-doping (willingness to learn) may influence their anti-doping knowledge, but the actual situation is unclear. This study aimed to determine the relationship between athletes' willingness to learn about anti-doping and their objective measurement knowledge and explore directions for educational interventions. The eligible participants were 971 male and 802 female university athletes. We used the ALPHA test (12 questions/four choices; passing index: ≥10 points/80% correct answer rate) to assess objective anti-doping knowledge. The willingness to learn question was, “Would you like to learn more about anti-doping?” Responses were given on a 4-point scale ranging from 1: strongly disagree to 4: strongly agree. An ANCOVA was conducted with four levels of willingness to learn as the independent variable and ALPHA correct answer rate as the dependent variable, adjusting for confounding factors (years of athletic experience and anti-doping education experience). The percentage of athletes (%) and each ALPHA correct answer rate (%) by the level of willingness to learn was 1: strongly disagree, n = 1.64%, 61.78%; 2: somewhat disagree, n = 13.14%, 62.38%; 3: somewhat agree, n = 62.94%, 64.08%; 4: strongly agree, n = 22.28%, 67.11%. The ALPHA correct answer rates showed significant differences in the main effect by the level of willingness to learn [F_{(3, 1767)} = 2.873, p < 0.05, η² = 0.01], although the effect size was small, and multiple comparisons showed no significant differences between the levels. The results indicated that the ALPHA correct answer rate did not reach 80% even for the “strongly agree” level of willingness to learn, suggesting that information on anti-doping may be inadequate. The need to provide sufficient educational content to improve knowledge was evident.

Appearance and Performance Enhancing Drugs and Substances: The Role of the School Nurse

The purpose of this article is to provide the school nurse with the ability to recognize performance and appearance enhancing substance use and understand treatment and prevention strategies to reduce associated health risks. The use of appearance and performance enhancing drugs and substances, also known as "doping," has been an ethical and health issue in sports for many years. It is vital that school nurses learn to recognize performance and appearance enhancing substance use to ensure student athletes and exercisers receive the care and education they need. Commonly used performance and appearance enhancing substances include anabolic-androgenic steroids, stimulants, diuretics, growth hormone, and supplements. Signs and symptoms that may look similar to other health concerns include palpitations, stunted growth, acne, severe headaches, muscle cramps, dizziness, and dehydration, but some long-term severe complications occur as well. Doping can lead to severe and sometimes permanent organ damage, including liver, kidney, and heart disease. The school nurse can play a key role by working with parents, coaches, school counselors, and educators to foster an anti-doping culture.

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.

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.

Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review

The misuse of dietary supplements and doping substances is commonly associated with toxicity, nutritional imbalances, and health and psychological consequences. This is alarming especially in light of the increasing prevalence of the use of dietary supplements and doping, particularly among young adults including athletes. There is evidence that education interventions can lead to improved knowledge, intentions, and practices. However, no review has summarized and evaluated the effectiveness of such interventions. The aim of this article is to review the characteristics, contents and effects of education interventions that were designed and implemented to improve knowledge, attitudes, beliefs and intentions with respect to the use of dietary supplements and doping agents in different populations. PubMed, Scopus, CINAHL, PsycInfo and Google Scholar were searched for English-language education interventions targeting dietary supplements and doping substances. A total of 20 articles were identified and have generally provided consistent findings. Most interventions reported a significant improvement in knowledge on dietary supplements and doping agents. Unfortunately, the heavy reliance on self-reported assessment tools limits the validity of these interventions, with almost all articles targeting athletes and adolescents.

Doping Attitudes, Beliefs, and Practices among Young, Amateur Croatian Athletes

Recent studies revealed that amateur athletes, especially young ones, have an increasing tendency of performance-enhancing drugs (PEDs) usage. The aim of this study was to explore PEDs attitudes, beliefs, and practices among young, amateur Croatian athletes. This cross-sectional study using a specially designed questionnaire as a research tool was done during the August 2019 to January 2020 period among a convenient sample of 400 amateur athletes of median age 18 (interquartile range 15 to 21) years. The prevalence of current PEDs usage was 1.3%, while past PEDs usage prevalence was 3.3%. Current PEDs usage was more frequent among young adults (p = 0.048) and athletes playing individual sports (p = 0.001). Athletes who were engaged in sports from one to five years had more permissive attitudes toward PEDs (p < 0.001) as measured by the Performance Enhancement Attitude Scale. Female athletes had more positive beliefs about PEDs usage (p = 0.008). The study did not establish any correlation between current or past PEDs usage and attitudes toward PEDs as well as beliefs about PEDs usage. However, there was a weak positive correlation between attitudes toward PEDs and athletes’ beliefs about PEDs usage (r_s = 0.465, p < 0.001). PEDs usage is present among young Croatian amateur athletes. There is a need for interventions directed toward the prevention of PEDs usage in an observed subgroup of athletes.