Column - "The New P.E. & Sports Dimension" - April 2003

• "Orioles pitcher Belcher dies; Ephedra implicated."
• "Canseco says 80% of Major League Baseball on steroids."
• "Dietary supplement companies donate more than $10 million to political campaigns since '95."
• "Continental Basketball Association inks deal to promote nutritional supplements."
• "SI Poll: 100% of NHL coaches say no steroids in Hockey."
   

Legal and easily obtainable, sport dietary supplements fall under the guidelines established by the 1994 US Congress when they passed the Dietary Supplement Health and Education Act (DSHEA). The DSHEA effectively states that dietary supplement products cannot be removed from the marketplace unless they are proven to be a health hazard. Furthermore, no pre-market clearance to test the product is required by law before a product can be placed on the shelves of local stores. According to Dr. Gary Wadler, a physician and author of the book Drugs and the Athlete, "The law still requires that if you want to know if dietary supplements are safe or not, you as the consumer have to analyze it - not the government, and not the supplement companies." (NY Daily News, Sunday, July 15, 2001.).

Recent national surveys tell us that young athletes are a primary market for these unregulated sports dietary supplements (Blue Cross/Blue Shield National Performance-enhancing Drug Study, NCAA Study of Substance Use Habits of College Student-Athletes).
With almost 7 million young athletes participating in some form of supervised sport (National Federation of State High Schools Association) and many more continuing actively in college, increased diligence in awareness and education in this arena is certainly warranted.

One traditional scholarly approach to the issue of sport dietary supplement use among young athletes has been administering surveys to the athletes requesting information on usage rates, reasons for use, and products used. There are certainly some good reasons for doing this type of study - it gives researchers a baseline to extract prevalence and incidence data, allows for trend watching, and helps determine demographic profiles. In many researchers opinions however, this is a cart before the horse approach.

By waiting to survey about current practices, the following important behavioral nuances are overlooked: The young athlete, to get to the point of actually taking a supplement (thereby learning drug taking behavior), has had to go through a series of decision-making processes. How will they afford them? How will they take them? Why will they take them? Will my parents, coach, friends, etc., be happy or sad that I am taking them? Will they have to hide their use of them from some people, their doctor or parents for example?

Another important point to consider; well-meaning and well-intended sport personnel often take it upon themselves to design the surveys - unfortunately though, these surveys ultimately result in having almost no reliability and validity to use as intervention tools or to administer to different demographic groups, i.e., different teams. Ultimately, surveys, the traditional norm for research on these products, and the standard from which educational programs spring from, have failed in one area and it's a crucial area - the failure to provide the rich behavioral data needed to initiate outcome-based interventions.

As early as 1992, researchers in the field were calling for social-science theory to be applied to sport dietary supplement research to better understand the complexities of use, and decisions to use/not use (Sobal & Marguart). What are the benefits of theory-based surveys? Theory-based surveys act as a guideline for measuring those behaviors that get us from point A to point B - that is, the young athlete going from a non-supplement user to a user.

Theory-based work gives researchers/sport educators the ability to design effective educational materials that are valid and reliable AND that have measurable outcomes; when the incidence and or prevalence rate changes, researchers will be able to point to the intervention and determine its impact.

These surveys also allow for individual demographics to be targeted; instead of administering a one-size-fits-all survey, you can have surveys designed specifically for female volleyball players, male track athletes, etc. After all, the supplement companies are targeting niche markets of athletes. What's the down side? These types of surveys take a very long time to develop. Data analysis can also be complex and may provide knowledge that is contrary to what the coach/sport educator needs right then.

It's a question of now or later

The truth is most sport educators don't have the resources to design theory-based surveys; they are to busy trying to win games, teach multiple classes, and keep the AD, parents and young athletes happy.

This very week Sports Illustrated ran a feature story (April 7, 2003) on the death of a perfectly healthy young high school football player who was taking sports supplements. While articles like this one appear all the time, they basically are all the same - tell the story of some young player who died, pro's and con's of supplements and the supplement industry, and then usually end with some directive aimed at coaches and parents, and the athletes themselves.

As a result coaches talk to their players about these products but unfortunately they are not equipped with the necessary educational materials to really change the mindset of these athletes. Scare tactics don't work, and every health educator knows that knowledge does not equal behavior change.

Bottom line: Are we better off continuing to survey each new supplement that comes down the pike or do we take the time necessary to develop sound theory-based surveys that get to the heart of why they are taking something in the first place?
 

References

Sobal, J., & Marquart, L. F. (1994). Vitamin/mineral supplement use among
athletes: A review of Literature. Journal of Sports Nutrition, 4, 320-334.

Blue Cross/Blue Shield National Performance-enhancing Drug Study (2002). www.healthycompetition.org/.

NCAA Study of Substance Use Habits of College Student-Athletes (June 2001). NCAA, P.O. Box 6222, Indianapolis, Indiana 46206. www.ncaa.org/library/research/substance_use_habits/2001/substance_use_habits.pdf

Wertheim, L. J. (2003). Jolt of Reality. Sports Illustrated, April 7, 2003, pg. 69-79.

1. Do we take the time to design theory-based surveys or do we continue to get much quicker info from surveys we already have?

2. What type of data; quick demographic or slower behavioral, is more important?

3. What type of data is most important to coaches? Athletes? Others?

4. Who should be the responsible party to initiate any research?

Please send your reaction/questions/comments to Guy Van Damme: guy.vandamme@skynet.be

Guy will collect your replies and then forward it to the author.

The author will read your comments/reactions/feedback and when appropriate will provide additional remarks.

That's all folks - your comments/reactions/feedback will be then added to the discussion list.

May 2003 - Dr. Debby Mitchell will start with a new article.

Have a good discussion, 

co-ordinator 

Guy Van Damme