title: Anabolic steroid use among adolescents in a rural state.
abstract: BACKGROUND
  Anabolic-androgenic steroid use is an increasing problem among high school students. Previous reports have been mainly from metropolitan areas.
  
  
  METHODS
  We report the first study of anabolic-androgenic steroid use to concentrate on rural communities. The study was conducted using an anonymous survey of a random sample of male high school students (N = 3900) in grades 10 through 12 encompassing 31 high schools in a predominantly rural state.
  
  
  RESULTS
  Two-hundred five (5.3%) students reported using steroids. The prevalence of illicit drug use was significantly higher (P < .05) in steroid users (74%) than in nonusers (31%) (P < .001). The association was between anabolic-androgenic steroid use and illicit drug use rather than between sports participation of any type and illicit drug use (P > .2). Comparison of the prevalence of illicit drug use among athletic (63.2%) and nonathletic (36.8%) steroid users found no significant difference. Findings were similar with cigarette use. There was no difference in the rate of steroid use by school enrollment (69 to 1495) or by city population size (< 200 to 64,000). The predominant reason for steroid use was to improve appearance (43%).
  
  
  CONCLUSIONS
  This study found the prevalence of steroid use throughout a predominantly rural state to be similar to that found by previous studies conducted in metropolitan areas; prevalence was not affected by city or school size. Steroid use was closely associated with illicit drug and cigarette use, a new finding that deserves further examination.
authors.affiliation: Department of Family Medicine, School of Medicine, Ohio State University, Columbus 43210-1228.
authors.forename: R
authors.initials: R
authors.lastname: Whitehead
authors.forename: S
authors.initials: S
authors.lastname: Chillag
authors.forename: D
authors.initials: D
authors.lastname: Elliott
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D045930:Anabolic Agents; D004300:Doping in Sports; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D015995:Prevalence; D000297:Psychology, Adolescent; D012424:Rural Population; D012574:Schools; D012907:Smoking / Q000453:epidemiology; D013177:Sports; D013334:Students; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014903:West Virginia / Q000453:epidemiology
chemical_list: D045930:Anabolic Agents; D013287:Illicit Drugs