title: A mediation analysis of the ATHENA intervention for female athletes: prevention of athletic-enhancing substance use and unhealthy weight loss behaviors.
abstract: OBJECTIVE
  To explain, through mediation analyses, the mechanisms by which ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives), a primary prevention and health promotion intervention designed to deter unhealthy body shaping behaviors among female high school athletes, produced immediate changes in intentions for unhealthy weight loss and steroid/creatine use, and to examine the link to long-term follow-up intentions and behaviors.
  
  
  METHODS
  In a randomized trial of 1668 athletes, intervention participants completed coach-led peer-facilitated sessions during their sport season. Participants provided pre-test, immediate post-test, and 9-month follow-up assessments.
  
  
  RESULTS
  ATHENA decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors at post-test. These effects were most strongly mediated by social norms and self-efficacy for healthy eating. Low post-test intentions were maintained 9 months later and predicted subsequent behavior.
  
  
  CONCLUSIONS
  ATHENA successfully modified mediators that in turn related to athletic-enhancing substance use and unhealthy weight loss practices. Mediation analyses aid in the understanding of health promotion interventions and inform program development.
authors.affiliation: Arizona State University, Tempe, AZ 85287-1104, USA.
authors.forename: Krista W
authors.initials: KW
authors.lastname: Ranby
authors.forename: Leona S
authors.initials: LS
authors.lastname: Aiken
authors.forename: David P
authors.initials: DP
authors.lastname: Mackinnon
authors.forename: Diane L
authors.initials: DL
authors.lastname: Elliot
authors.forename: Esther L
authors.initials: EL
authors.lastname: Moe
authors.forename: Wendy
authors.initials: W
authors.lastname: McGinnis
authors.forename: Linn
authors.initials: L
authors.lastname: Goldberg
mesh_terms: D000293:Adolescent; D054874:Athletic Performance; D001490:Basketball / Q000523:psychology; D001828:Body Image; D003401:Creatine; D004300:Doping in Sports / Q000517:prevention & control*; D001068:Feeding and Eating Disorders / Q000517:prevention & control*; D005260:Female; D006266:Health Education; D006801:Humans; D008137:Longitudinal Studies; D008960:Models, Psychological; D010043:Outcome and Process Assessment, Health Care; D010379:Peer Group; D020377:Self Efficacy; D012916:Soccer / Q000523:psychology; D012945:Social Values; D013177:Sports / Q000523:psychology*; D013256:Steroids; D054798:Volleyball / Q000523:psychology; D015431:Weight Loss
chemical_list: D013256:Steroids; D003401:Creatine