title: Daily exercise and anabolic steroids use in adolescents: a cross-national European study.
abstract: OBJECTIVE
  The aim of this paper is to investigate the association between anabolic steroid (AS) use and intensive physical exercise among adolescents.
  
  
  METHODS
  The 1999 cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD). Data collection by standardized methodology using anonymous self-administered questionnaires completed in the classroom.
  
  
  METHODS
  National probability samples of a total of 18,430 16-year-old high school students from six European countries (Bulgaria, Croatia, Cyprus, Greece, the Slovak Republic, and the U.K.)
  
  
  METHODS
  Besides AS use and physical exercise, questionnaire items selected for this study included tobacco, alcohol, and illicit drug use, indicators of other deviant behavior (self-harming thoughts and behavior, truancy, aggressive behavior), friends' use of AS, and perceived availability. Backward elimination with likelihood ratio tests was used to select the variables to be retained in a mutlifactorial model. Interactions of other independent variables with country were checked.
  
  
  RESULTS
  Logistic regression analysis of lifetime AS users compared to nonusers showed that the odds of lifetime AS use are 1.4 times higher for students who exercise almost daily and 1.8 times higher for boys compared to girls. Significant associations of AS use were also found with current frequent alcohol use, lifetime use of tranquilizers/sedatives and cannabis, and with the perceptions of friends' use of AS and of easy availability of the substance.
  
  
  CONCLUSIONS
  Findings indicate that daily exercising appears to increase the risk of anabolic steroid use in adolescents. However, a more general pattern of closely interlinked deviant types of behavior, such as other drug use and aggressive behavior, is prominent. Preventive interventions are needed targeted towards adolescents involved in intensive exercise and sport. These should take into account both the idiosyncrasy and setting of the sporting culture and the special characteristics of this group.
authors.affiliation: Department of Psychiatry, Medical School, University of Athens, Athens, Greece. akokkevi@med.uoa.gr
authors.forename: Anna
authors.initials: A
authors.lastname: Kokkevi
authors.forename: Anastasios
authors.initials: A
authors.lastname: Fotiou
authors.forename: Anina
authors.initials: A
authors.lastname: Chileva
authors.forename: Alojz
authors.initials: A
authors.lastname: Nociar
authors.forename: Patrick
authors.initials: P
authors.lastname: Miller