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

Effective Intervention Features of a Doping Prevention Program for Athletes: A Systematic Review with Meta-Analysis

This study systematically reviewed the effectiveness of cognitive, affective, and combined approaches in doping prevention, considering the impact of athletes' active versus passive participation. Following the PRISMA 2020 guidelines and the PICOS framework, a literature search identified ten studies involving 3581 athletes (1094 women, 2487 men). Ten studies were included as a sample in the meta-analysis and meta-regression, which were used in the effect size calculation. This meta-analysis shows that anti-doping education programs effectively improve short-term doping intentions (ES = 0.29, p < 0.001) and anti-doping behaviors (ES = -0.27, p < 0.001), although there is a decline in the long-term effects (ES = -0.13, p = 0.009). Moral behaviors were unaffected (ES = 0.01, p < 0.001), suggesting that changing deeper values requires alternative approaches like mentorship. Passive participation negatively impacted doping intentions (ES = -0.40, p = 0.004) and behaviors (ES = -0.40, p = 0.022), highlighting the need for active engagement. Pre-experimental designs showed a negative effect on behaviors (ES = -0.74, p = 0.023), emphasizing the importance of rigorous methodologies. While anti-doping education programs effectively influence short-term attitudes and intentions, sustaining behavioral change requires continuous reinforcement and active engagement. The decline in the long-term effects suggests that standalone interventions are insufficient to instill lasting anti-doping behaviors in athletes.

Safety Implications of Off-Label Medication Use in Athletes: A Narrative Review

In recent years, the off-label use of medications in sports has increased significantly, primarily driven by psychological and social factors. Athletes frequently misuse drugs without adequate medical supervision, relying on unreliable sources of information, which leads to improper usage and serious health risks. This narrative review analyzes literature from PubMed® (Medline), Scopus®, and Web of Science® databases, focusing on studies up to December 2023, to examine the safety concerns related to off-label drug use in sports. The review presents an overview of the off-label use of pharmacological substances by athletes, focusing on both hormonal and non-hormonal drugs. Hormonal substances such as anabolic steroids and growth hormones, and non-hormonal agents like diuretics and β2-agonists, are frequently abused. These practices are associated with severe side effects, including infections, cardiovascular complications, hormonal imbalances, psychological disorders, dependence, and even cases of death. The study emphasizes the need for stronger regulation, public awareness initiatives, and preventive strategies to mitigate the health risks associated with this growing trend.

Performance-Enhancing Drugs in Healthy Athletes: An Umbrella Review of Systematic Reviews and Meta-analyses

CONTEXT

Many clinicians, trainers, and athletes do not have a true understanding of the effects of commonly used performance-enhancing drugs (PEDs) on performance and health.

OBJECTIVE

To provide an evidence-based review of 7 commonly used pharmacological interventions for performance enhancement in athletes.

DATA SOURCES

PubMed and Scopus databases were searched on April 8, 2022.

STUDY SELECTION

Systematic reviews (SRs) and meta-analyses (MAs) assessing the performance-enhancing effects of the following interventions were included: androgenic anabolic steroids (AAS), growth hormone (GH), selective androgen receptor modulators (SARMs), creatine, angiotensin-converting enzyme (ACE)-inhibitors, recombinant human erythropoietin (rHuEPO), and cannabis.

STUDY DESIGN

Umbrella review of SRs and MAs.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Primary outcomes collected were (1) body mass, (2) muscle strength, (3) performance, and (4) recovery. Adverse effects were also noted.

RESULTS

A total of 27 papers evaluating 5 pharmacological interventions met inclusion criteria. No studies evaluating SARMs or ACE-inhibitors were included. AAS lead to a 5% to 52% increase in strength and a 0.62 standard mean difference in lean body mass with subsequent lipid derangements. GH alters body composition, without providing a strength or performance benefit, but potential risks include soft tissue edema, fatigue, arthralgias, and carpel tunnel syndrome. Creatine use during resistance training can safely increase total and lean body mass, strength, and performance in high-intensity, short-duration, repetitive tasks. Limited evidence supports rHuEPO benefit on performance despite increases in both VO2max and maximal power output, and severe cardiovascular risks are documented. Cannabis provides no performance benefit and may even impair athletic performance.

CONCLUSION

In young healthy persons and athletes, creatine can safely provide a performance-enhancing benefit when taken in controlled doses. AAS, GH, and rHuEPO are associated with severe adverse events and do not support a performance benefit, despite showing the ability to change bodily composition, strength, and/or physiologic measures. Cannabis may have an ergolytic, instead of ergogenic, effect.

Relationship between Doping Prevalence and Socioeconomic Parameters: An Analysis by Sport Categories and World Areas

Socioeconomic differences between countries, including corruption and doping scandals, have increased in the last few decades. The aims of the current investigation were to examine doping prevalence according to world areas and sport groups and its association with socioeconomic factors worldwide. The Anti-Doping Rule Violations (ADRVs) of 160 countries competing at 2016 Olympics were analyzed between 2013 and 2018. In addition, the relationship between doping prevalence and socioeconomic characteristics, including Human Development Index (HDI), Per Capita Income (PCI) and Corruption Index (CI), was investigated. Africa, Asia, and America were revealed to have a significantly lower doping prevalence than Europe and Oceania when observing the sum and the mean ADRV/10,000 inhabitants (p < 0.01). Strong to moderate correlations were identified between Corruption Index and ADRVs and HDI and ADRVs (p < 0.01). However, the number of Olympic athletes was positively associated with the ADRVs and the HDI (r = 0.663 and 0.424, respectively). In the comparison by sport groups, the Independent Recognized Sports (AIMS) showed significantly higher Adverse Analytical Findings (AAF) and ADRVs (p < 0.01) than Olympic and Recognized International Sports (ARISF). In conclusion, the results of the current study reveal doping prevalence differences between world areas and sport categories, identifying associations with socioeconomic characteristics of each country.