Abstract:The use of legal performanceenhancing substances (PESs) is common among adolescents, particularly boys. 1 Approximately onethird of all youth use creatine, protein powders, or dietary supplements, 2-4 and an even greater proportion of athletes and college students do so. 5,6 Although previous studies have correlated legal PES use with future use of illegal PESs, 7,8 in a study in this issue of Pediatrics, Ganson et al 9 explore a broader role for PESs as a gateway to alcohol and other substance use.
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