title: Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: a cross-sectional cohort study.
abstract: BACKGROUND
  Illicit anabolic-androgenic steroid (AAS) abuse, though an important public health problem, remains inadequately studied. Almost all AAS abusers are male and lift weights, but the risk factors for AAS use among male weightlifters remain poorly understood.
  
  
  METHODS
  We recruited 233 experienced male weightlifters, of whom 102 (44%) reported lifetime AAS use, and assessed their childhood and adolescent attributes retrospectively, using structured clinical interviews and computerized questionnaires. This cross-sectional cohort approach-a design that we have formally presented in the recent methodological literature-utilizes a study cohort, not selected for outcomes of interest, and assesses exposures and outcomes retrospectively. We hypothesized that conduct disorder and body-image concerns would be major risk factors for subsequent AAS use among male weightlifters.
  
  
  RESULTS
  Within our study population, many attributes showed little association with AAS use, but conduct disorder and body-image concerns showed strong associations. For individuals with prior conduct disorder versus those without, the hazard ratio (95% confidence interval) for subsequent AAS use was 2.2 (1.5, 3.4). For individuals in the middle versus lowest tertile of scores on a retrospective adolescent muscle-dysmorphia scale, the hazard ratio was 1.5 (.84, 2.6); for the highest versus lowest tertile, the hazard ratio was 3.3 (2.0, 5.3); and for the linear trend of hazard ratios, p < .001.
  
  
  CONCLUSIONS
  Conduct disorder and body-image concerns represent important risk factors for AAS use among male weightlifters. Thus, assessment of these attributes may help to identify individuals most likely to require interventions to discourage this form of substance abuse.
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02478, USA. hpope@mclean.harvard.edu
authors.forename: Harrison G
authors.initials: HG
authors.lastname: Pope
authors.forename: Gen
authors.initials: G
authors.lastname: Kanayama
authors.forename: James I
authors.initials: JI
authors.lastname: Hudson
mesh_terms: D000293:Adolescent; D000328:Adult; D045930:Anabolic Agents / Q000008:administration & dosage*; D000728:Androgens / Q000008:administration & dosage*; D001828:Body Image; D015331:Cohort Studies; D019955:Conduct Disorder / Q000150:complications / Q000523:psychology; D003430:Cross-Sectional Studies; D004300:Doping in Sports / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012307:Risk Factors; D012651:Self Medication / Q000523:psychology* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014891:Weight Lifting / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D045930:Anabolic Agents; D000728:Androgens