A Mediation Analysis of the ATHENA Intervention for Female Athletes: Prevention of Athletic-Enhancing Substance Use and Unhealthy Weight Loss Behaviors

Ranby, Krista W.; Aiken, Leona S.; MacKinnon, David P.; Elliot, Diane L.; Moe, Esther; McGinnis, Wendy; Goldberg, Linn

doi:10.1093/jpepsy/jsp025

Cited by 59 publications

(62 citation statements)

References 28 publications

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“…Short-term evaluation of ATHENA (Elliot et al, 2004) indicated fewer new users of 'body shaping drugs' amongst girls who received the intervention. However, this measure included supplements as well as AS, and there was no effect of the intervention on the similar long-term outcome of 'steroid and creatine use' (Ranby et al, 2009). Use of AS increased slightly following the ATLAS intervention, but at a lower rate than amongst controls (Goldberg et al, 1996b).…”

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confidence: 99%

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids

et al. 2017

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A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids.http://researchonline.ljmu.ac.uk/7477/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. Astract:This review aimed to examine strategies applied in interventions to prevent image and performance enhancing drug use in the context of intervention effectiveness. Comprehensive searches identified 14 interventions that met review inclusion criteria. Interventions were predominantly educational and delivered within school sport settings, but targeted a wide range of mediating factors. Identification of effective components was limited across studies by brief or imprecise descriptions of intervention content, lack of behavioural outcome measures and short-term follow up times; however studies with components in addition to information provision may be more promising. Interventions are required outside of sport settings to reflect the transition of this form of substance use to the general population. 2 Introduction Anabolic steroidsAnabolic steroids (AS) are the most prominent of a range of substances used to modify appearance and performance known as image and performance enhancing drugs (IPEDs).Globally the lifetime prevalence of AS has been estimated at 3.3%, with higher prevalence amongst males (6.4%) (Sagoe et al., 2014b), and it is suggested that nearly one third of AS users will develop a form of dependence (Pope et al., 2014a). Although AS can be used without adverse consequences, such as when used therapeutically, risk of harm increases with the far greater doses observed when AS are used outside of clinical settings (Harmer, 2010).Additionally, the quality of illicitly produced AS cannot be controlled and those using them frequently do so as part of complex IPED regimens. This misuse of AS is associated with a range of acute and chronic adverse consequences (Pope et al., 2014b) that range greatly from cosmetic (e.g. acne) to critical (e.g. cardiovascular disease, liver function) with evidence of potential psychological harms (e.g. increased aggression, mania) (ACMD, 2010b). Harms appear to increase with long-term use, which may be characterised by polypharmacy, long or continuous cycles of use, body image disturbance and obsession with training and diet (Kanayama et al., 2009).The majority of th...

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confidence: 99%

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids

et al. 2017

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“…For female athletes, because sports from all three seasons were represented, the longer-term assessment varied from 9 to 12 months. For each program, specifics of the assessment constructs and their reliabilities are available in the original publications [5,6,8,[11][12][13].…”

Section: Methodsmentioning

confidence: 99%

“…Our group has studied a series of behavior change interventions that use a shared format and theoretical structure. All had documented efficacy in randomized controlled trials [5][6][7][8][9][10], and for each, specific program components were related to behavioral endpoints [11][12][13]. Comparing their observed patterns of findings presents a means to assess theories of behavior change and validate an effective intervention format.…”

Section: Introductionmentioning

confidence: 99%

Empiric validation of a process for behavior change

Elliot

Goldberg

MacKinnon

et al. 2015

Behav. Med. Pract. Policy Res.

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Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs' that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre-and post-intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change. KeywordsBehavior change, Mediation, Peer-led INTRODUCTION Knowledge about how healthy lifestyles can prevent illness has outpaced effective means to assist people in living health lives [1]. That limitation is not due to lack of research, and contributions have come from diverse disciplines, such as health promotion, behavioral economics, psychology, decision analysis, and sociology. However, progress may have been constrained due to a focus on outcomes rather than deconstructing how change occurred [2][3][4]. Our group has studied a series of behavior change interventions that use a shared format and theoretical structure. All had documented efficacy in randomized controlled trials [5][6][7][8][9][10], and for each, specific program components were related to behavioral endpoints [11][12][13]. Comparing their observed patterns of findings presents a means to assess theories of behavior change and validate an effective intervention format.

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“…However, studies show that 40%-60% of the athletes still use these methods 7,14 . A lack of adequate and accurate information by wrestlers, coaches, and parents could be one of the causes for these situations 11,15 . Prevention and education is considered a key aspect in reducing or avoiding the risk of these situations.…”

Section: Introductionmentioning

confidence: 99%

“…However, educational programs must have the support or involvement of coaches and families to be effective 5,[15][16][17][18][19] . In fact, available information has shown that they are effective in increasing athletes' knowledge and self-efficacy 16,18 , reducing the intentions to use inadequate methods 15,21 , improving the quality of the athletes' intake 5,22 , and that athletes support their use 16,19 . In the current literature, no studies were found concerning formative programs that combine nutrition and weight control in combat sports.…”

Section: Introductionmentioning

confidence: 99%

Effect of educational training on nutrition and weight control in under-18 Spanish wrestlers

Visiedo

Palao

2017

Motriz: rev. educ. fis.

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-The aim of this study was to investigate the effect of a formative program concerning nutrition, weight control, and its risks wrestlers under the age of 18 (under-18) at the Spanish national level. The sample comprised 36 under-18 wrestlers that were pre-selected for the Spanish national team. A quasi-experimental design with a pre-test and post-test was used. The dependent variables were the knowledge of nutrition and weight control and its risks. The independent variable was the educational program. The program had three 30-minute sessions that combined talks, videos, and tasks to complete. Descriptive and inferential analyses were done (t-test, Wilcoxon test). Results indicate that the educational program was effective at increasing under-18 wrestlers' knowledge about weight control and its risks,but was ineffective with regard to nutrition knowledge. The paper concludes with a discussion regarding the effect of the intervention program, the difficulties with including this type of knowledge and skill in the preparation of combat sport athletes, and the need for further research in this area.

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A Mediation Analysis of the ATHENA Intervention for Female Athletes: Prevention of Athletic-Enhancing Substance Use and Unhealthy Weight Loss Behaviors

Abstract: 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.

Cited by 59 publications

References 28 publications

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids

Empiric validation of a process for behavior change

Effect of educational training on nutrition and weight control in under-18 Spanish wrestlers

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