Introduction
The World Anti-Doping Agency (WADA) is the leader in the fight
against doping in sport. This agency publishes a list of prohibited
substances, which is updated on an annual basis.1 The South Afri-
can Institute for Drug-Free Sport (SAIDS) is one of the many signato-
ries that complies with WADA’s prohibited list, and also publishes an
annual prohibited list based on South African brand names.2 Doping
is regarded as a form of cheating where athletes use substances
that are on these prohibited lists, predominantly for gaining an edge
over their competitors.3 An alternative to doping can be nutritional
substance use, which helps to improve the health and performance
of active adolescent athletes. Despite strong efforts in attempting
to eliminate doping in sport, the use of drugs and prohibited sub-
stances to boost performance is common among athletes.3 South
African adolescent sport seems to have changed dramatically, as it
appears that there are greater pressures placed on adolescent ath-
letes to excel in sport and some are using performance-enhancing
substances (PES) to cope with the demands placed on them.4-6 The
problem is that some of the PES are listed as prohibited, and adoles-
cent athletes might be tempted to use these because the pressures
and stresses facing them may be too immense to resist.1
Just as the competitive nature of professional sports has led to
athletes doing whatever they can to give themselves an edge in
competition, and sometimes placing their well-being at risk, it seems
to have also trickled down into youth sports. Furthermore, many of
the adolescent athletes who do not believe they are successful at a
competitive level may choose to take prohibited PES.7 Additionally,
in spite of the view that the use of doping remains ‘fundamentally
contrary to the spirit of sport’,8 athletes are using prohibited PES
in sport. Some athletes are advocating that these substances
be legitimately used for the enhancement of performance best in
competition.9,10 These banned products may enable them to improve
their athletic performance, help with recovery from hard physical
training and improve self-image in the short term; however, in the
long run there may be negative costs to their well-being and general
health.7 Therefore, the purpose of this study was to investigate the
attitudes and perceptions of male adolescent competitive athletes
from Johannesburg boys high schools towards PES use in sport.
orIgInal research arTIcle
attitudes and perceptions towards performance-
enhancing substance use in Johannesburg boys high
school sport
abstract
Introduction. The environment of youth sport in South Africa has
transformed considerably, where adolescent athletes are faced
with more pressure from coaches, peers and parents to perform
well. Some of the athletes are using nutritional supplements or
prohibited means such as doping to cope with these pressures
and gain an edge in competition.
objectives. In view of the lack of literature investigating the use
of doping in South African adolescents, the objective of the study
was to determine the attitudes and perceptions of male adoles-
cent athletes regarding performance-enhancing substance (PES)
use.
Methods. The design of the study was cross-sectional and used
a self-administered questionnaire. A sample of participants was
obtained from male adolescent high school athletes involved in
1st and 2nd high school sports teams in Johannesburg boys high
schools. Participants were invited to volunteer to participate in
the study. Questionnaires were completed under conditions that
were similar to an examination situation. Demographic data were
analysed using descriptive statistics.
results. The majority (91%) of the athletes indicated a belief that
the number of athletes using PES in sport is increasing. Eighty-
four per cent of them felt that there was pressure placed on them
to use PES to win. Only 55% of respondents believed that dop-
ing tests would prohibit the use of banned substances and 91%
did not believe that the sale of prohibited substances should be
banned. The majority (88%) believed there is a need for further
education.
corresPonDence:
Philippe Gradidge
Centre for Exercise Science and Sports Medicine
University of the Witwatersrand
PO Box 85484
2029 Emmarentia
Tel: +27 11 717 3372
Fax: +27 86 609 2017
E-mail: philippe.gradidge@wits.ac.za
Philippe gradidge (Bspsc (hons) Biokinetics)
Yoga coopoo (DPhil, FacsM)
Demitri constantinou (MB Bch, Bsc Med hons, FFIMs)
Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
32 saJsM vol 22 no. 2 2010
conclusion. Although there is enormous pressure on high school
boys to use PES, their knowledge is lacking, especially with re-
gard to doping in sport.
saJsM vol 22 no. 2 2010 33
Methods
The study used a cross-sectional method design with a self-admin-
istered questionnaire, which had been adapted from a study that in-
vestigated doping in elite South African athletes.11 The reliability and
validity of the adapted questionnaire was tested in a pilot study, and
was found to be 83% reliable. Further validation of the questionnaire
was provided by professionals practising in the fields of biokinetics,
exercise science and sports medicine. The questionnaire was formu-
lated to elicit responses on PES and nutritional supplements used in
order to improve performance. The participants’ attitudes and per-
ceptions regarding PES use were solicited, such as beliefs about
PES use in sport and whether education on doping was needed.
A sample of participants was attained from male adolescent high
school athletes, aged between 15 and 18 years, involved in 1st and
2nd team high school sports from public and private Johannesburg
boys high schools. The Provincial Department of Education granted
permission to conduct the study and ethical clearance (M060953)
was obtained from the University of the Witwatersrand Human Re-
search Ethics Committee.
Arrangements were made to conduct the study on a date and
time that was convenient for the high schools that gave consent to
participate. Those participants who volunteered to participate provided
minor assent and parental informed consent. They completed the
questionnaire under conditions where participants were not allowed
to communicate with each other. The participants were also given
the opportunity to ask questions pertaining to the content and
completion of the questionnaire. Questionnaires were handed in
to the researcher immediately after completion. The collected data
were then group-analysed using the Epi Info (TM) 3.5.1 statistical
software package. Data were descriptive and involved summary
statistics displaying frequencies and percentages.
results
The responses of the participants were coded and missing values
were not included in the analysis because it was not possible to de-
termine what the participants would have answered in these cases.
Some of the participants did not answer all questions and in most
cases multiple responses were given to certain questions where
more than one option could have been chosen. These multiple re-
sponses were taken into account when analysing the data.
Figure 2: Main high school sport participation and establishing whether PES use is believed to be on
the increase
5
1 1 1 1
37
5 5
3
14
5
6
4
5
1
3
1
2
0
5
10
15
20
25
30
35
40
Do think that PES use in sport is increasing?
No (%) Yes (%)
Fig. 1. Main high school sport participation and establishing
whether PES use is believed to be on the increase (n=100)
TaBle I. Prevalence of substances used and reasons
for using Pes (N=100)
Prevalence of Pes use %
Yes 30
No 64
Non-response 6
common prohibited substances used
Anabolic androgenic steroids (N=100) 4
Growth hormone (N=100) 5
Adrenaline /ephedrine (N=100) 4
Insulin (N=100) 2
common non-prohibited supplements used
Caffeine supplementation (N=28) 57
Creatine supplementation (N=84) 32
Carbohydrates supplementation (N=90) 54
Protein supplementation (N=88) 61
Vitamin supplementation (N=88) 61
reasons for using Pes
Assists me in coping with the stresses of sport (N=24) 29
Helps to improve the way I perform in sport (N=25) 68
Helps to reduce food craving in order to
decrease my body weight (N=25) 32
I feel afraid of being dropped from the team (N=24) 21
I will have a better chance of making the team (N=25) 28
Figure 1: General attitudes and perceptions towards PES use in sport (n=100)
9
16
45
28
47
62
84
91
81
91
84
55
72
53
48
16
9
19
Do you feel that the use of PES in sport is
rising? (n=100)
Do you believe there is pressure placed on
high school athletes to use substances in
sport? (n=97)
Do you feel that doping tests will prevent
the use of substances in sport? (n=95)
Are you aware of any substances that are
prohibited by the World Anti-Doping
Agency? (n=96)
Are you aware of the punishment for using
prohibited substances in sport? (n=97)
Do you believe that more doping tests to
be carried out? (n=94)
Do you feel that stricter punishments
should be placed on athletes caught for
doping? (n=94)
Should the sale of prohibited substances be
banned? (n=94)
Do you think that more education on
doping should be provided? (n=94)
0 20 40 60 80 100
Yes (%) No (%)
Fig. 2. General attitudes and perceptions towards PES use in
sport (n=100).
Demographic data
Of the 100 (81% response rate) competitive male adolescent ath-
letes investigated, most were 17 - 18 years old (78%), while a minor-
ity were 15 - 16 years old (22%). They were from grades 10 (11%),
11 (67%) and 12 (22%). The majority of these participants (42%)
played rugby (Fig. 1).
Prevalence of substance use
A number of the participants (30%) indicated using PES for enhance-
ment of performance (Table I). Table I displays the prevalence of
substances utilised for performance enhancement and the rationale
participants had for using them. The majority of these athletes (68%)
indicated that they used PES to have a better performance output
in sport.
general attitudes and perceptions towards Pes use
The responses on the participants’ general attitudes and perceptions
towards doping are shown in Fig. 2.
Most of the participants (91%) felt that PES usage in sport was on
the increase. Only 55% of them believed that testing for substance
abuse would serve as a deterrent. Over half of the participants
(53%) were aware of the punishment that would be meted out for
substance abuse, and 72% of them acknowledged that they knew of
substances that were prohibited by WADA.
More specific attitudes towards PES use
The adolescent athletes were asked to respond to twelve statements
regarding their attitudes and perceptions towards the use of PES
in sport. Fig. 3 illustrates specific attitudes and perceptions towards
doping in sport. Participants’ answers to this section were analysed
and calculated according to the total amount of responses per state-
ment.
Thirty-five per cent of the participants agreed that prohibited
substances were being used in their sports, and 30% agreed that
there were several athletes making use of substances to increase
their performance. Sixty one per cent of the participants agreed that
PES use in sport is unethical.
sources of information for performance-enhancing sub-
stance use
Fig. 4 displays where the athletes obtained their information on PES
usage. Multiple responses were given in this section, thus the data
were calculated by taking into account the number of individual re-
sponses per question.
The highest ranking source of information on PES usage was the
Internet (74%), followed by magazines (72%), from a friend (66%),
the coaching staff (66%), and parents (40%). Some of the other
mentioned sources of information on PES use in sport were from
personal trainers (33%), information brochures (31%), newspapers
(31%), the pharmacist (24%), and 23% indicated that they attained
information from the television and their school.
Discussion
The Olympic Charter’s goal of ‘friendship, solidarity and fair play’12
in sport still needs to become a reality, and should become a core
pillar in the fight against doping in sport. Using prohibited substances
in sport is unethical and unfortunately the adolescent athletes using
them may be doing so at the cost of their well-being and physiologi-
cal development. Even though most participants agreed that doping
was cheating, they also reported immense pressure to perform and
would perhaps turn to PES as a coping mechanism or performance
advantage. It is for this reason that the anti-doping struggle in ado-
lescent sport should not be taken without due consideration.
Adolescent athletes who have the potential to be successful in
sport appear to be required to give maximum effort throughout the
whole high school sporting season and this may be too stressful
for them. Parents, coaching staff and friends may sometimes place
unrealistic demands on individuals and this could indirectly tempt or
even encourage the use of prohibited PES in sport in some adolescent
athletes.3,13 It may be beneficial for all those involved in high school
sport, such as parents/guardians, coaching staff, teachers and
the athletes, to be taught that losing or coming second or third is
acceptable. In reality, even the elite and professional athletes have
times when they do not win or days when performance is not at a
peak level. Hence, this approach could enable adolescent athletes to
learn that fair game play and honest interaction with opponents are
more essential than winning all the time.14
The results indicate that 4% of the participants are using anabolic
androgenic steroids. These athletes may have used this banned
substance in spite of the well-known harmful side-effects.15-17 If this
pattern continues, adolescent sport can evolve into a win-at-all-costs
phenomenon, where doing whatever it takes to excel in competition
may become routine practice in some athletes. With the evolution
of new PES products being engineered and sold on the black
market, the adolescent athletes using them on a regular basis could
be bearing the burden of utilising unknown substances which may
have harmful and irreversible side-effects. Some of these potential
negative effects could include addictive and antisocial behaviour, as
well as increased risk of heart disease.3,13 These side-effects may
34 saJsM vol 22 no. 2 2010
Figure 3. Specific attitudes and perceptions of high school learners towards doping in sport
(n=100)
23
46
27
31
47
27
13
23.7
10
23
12
32
35
42
30
38
37
15
37
37.6
12
16
25
29
28
5
30
19
8
45
18
30.1
22
42
31
21
14
7
13
12
7
14
32
8.6
56
19
32
18
There is a problem of prohibited substance
use in my sport/s. (n=96)
Sport organizations should offer
educational programmes for athletes on the
use of substances in sport. (n=96)
There are too many athletes using
substances in my sport to enhance their
athletic performance. (n=96)
The prohibited use of substances by
athletes has not been reported on enough in
the media. (n=94)
The use of PES and supplements has risen
in the last five years. (n=95)
I would never consider using PES. (n=94)
I am sometimes tempted to use PES.
(n=93)
Many of my friends think it is acceptable
to use PES. (n=93)
If I don’t take PES, I will not be able to
succeed because everyone else does.
(n=94)
I think it is always wrong to use PES.
(n=93)
I think athletes who want to succeed have
to use PES sometimes. (n=94)
I don’t think it is fair to use PES. (n=94)
0 20 40 60 80 100 120
Strongly Agree (%) Agree (%) Disagree (%) Strongly Disagree (%)
Fig. 3. Specific attitudes and perceptions of high school learn-
ers towards doping in sport (n=100).
saJsM vol 22 no. 2 2010 35
result in poor health and poor performance in the long term. Although
most of the athletes reported using PES for helping achieve optimal
performance, most disagreed that taking PES was necessary to
succeed (Fig. 3).
It is certainly acceptable that banned substances may induce a
performance that is unattainable with ‘normal’ physiology or ethical
means. Nevertheless, it is also true that peak performance can be
enhanced via ethical means without incurring the health risks and
moral compromises of drug use. For instance, adolescent athletes
can be taught how to improve performance through legitimate means,
such as periodisation in training and sound nutrition.18 Periodisation
is a means of planning a training programme to ensure adequate
recovery for the body, thus allowing the athlete to peak at the right
times.18 Nutritional supplement use is another way of helping active
adolescents attain a healthy lifestyle and optimal performance in
sport. These favourable and safe methods can give adolescent
athletes a more ethical means of achieving their best in sport.
Moreover, the inclusion of psychology can act as a tool to improve
adolescent athletes’ self-image and mastery in sport. In addition,
more focus should be placed on educating adolescent athletes
as well as others involved with them on the use of doping in sport
and its adverse effects. The results show that the Internet was the
main source of information (74%) on PES use in sport. This result is
possibly because the high schools involved in the study have access
to this resource and its use as a means of finding out information
is generally encouraged by teachers. The Internet can sometimes
be a good and reliable source of information, but the ability of the
athletes to critically discern this is questionable. Perhaps the skills of
critically analysing information resources could be taught as part of
the normal high school curriculum, thus equipping the athletes with
the ability to make mature and ethical decisions regarding PES use.
Education is perhaps one of the key vehicles that can aid in
discouraging the use of doping and prohibited PES in adolescent
sport. Even though a large number of participants in this study (72%)
knew of some substances that were on WADA’s list of prohibited
substances, the findings of this study show that 46% strongly agreed
and 42% agreed that education would provide a means of improving
the awareness of prohibited PES, their adverse effects, and the rules
regarding PES use in sport. These results confirm that the majority
(88%) of the participants have a desire to know more about doping
and feel that sporting bodies and other organisations should be
providing this. Doping may essentially tear down what is decent,
ethical and good regarding adolescent sport. It may even corrode
societal confidence and endanger the athletic adolescent population.
Educational drives should go beyond the elite, professional athlete
and target those involved in recreational sports, where drug testing
is not commonly seen.19 It is important to ensure that developing
adolescent athletes are taught the fundamentals of fair play and
good character while in the developmental stages of sports play. It
would also be useful to include coaching staff, dieticians and other
medical professionals who are involved with anti-doping strategies to
aid and inform adolescent athletes on the use and abuse of drugs in
sport, what factors lead to doping, and how to deal with these.20 It
seems that a holistic approach to combating the problem of doping
could provide a way of restoring the ethical values in sport.
conclusion
The knowledge regarding the use of doping in adolescent sport
seems to be deficient, and the majority of the participants (88%)
indicated that there was a need for more education on prohibited
and non-prohibited PES use. There is great pressure placed on the
athletes to succeed in high school sport, and some of these par-
ticipants use PES to cope with the pressures. It appears that most
adolescent athletes in this sample are not taking prohibited PES,
as the non-prohibited substances were more commonly used. How-
ever, the need for educational intervention is still important to ad-
dress the problem of doping in adolescent sport. It is recommend-
ed that these educational strategies be applicable and relevant to
adolescent athletes, and perhaps be introduced at an early age to
increase anti-doping attitude and develop a character of socially ac-
ceptable sporting behaviour.
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Figure 4. Sources of information for PES use (n=100)
26
28
34
40
67
67
69
71
76
77
81
84
84
90
91
74
72
66
60
33
33
31
29
24
23
19
16
16
10
9
The internet (n=93)
Magazines (n=88)
Friend (n=96)
Coach (n=94)
Parent (n=89)
Personal trainer (n=89)
Information Brochures (n=80)
Newspapers (n=82)
Pharmacist (n=89)
Television and School (n=65)
Sibling (n=85)
Biokineticist (n=87)
Books (n=83)
Physician (n=87)
Journals (n=80)
0 20 40 60 80 100
Yes (%) No (%)
Fig. 4. Sources of information for PES use (n=100).
36 saJsM vol 22 no. 2 2010
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